The Care Quality Commission (CQC) is highlighting the ongoing impact of historic and current system pressures on mental health services, their staff and the people using them.
Its Monitoring the Mental Health Act (MHA) report 2021/22, published last week (December 1, 2022), raises concerns which have continued to escalate from previous years. Mental health services and staff are struggling to recover following pressures placed on them during the pandemic and the resulting fallout, and in many cases the ward environment is in urgent need of update and repair. Not only does this have an impact on patients and staff, but many are facing additional waits due to backlogs in repairs as a result of the pandemic.
The report points out that the Royal College of Psychiatrists, responding to the 2021 autumn spending review, stated that the mental health estate is some of the oldest and least suitable in the whole NHS. Backlog maintenance is posing a high risk of catastrophic failure, major disruption to clinical services, or deficiencies in safety liable to cause serious injury and/or prosecution.
What CQC is concerned about:
• Inadequate WiFi access and coverage, limiting people’s ability to contact friends, family and advocates
• Lack of space for patients to eat together
• Insufficient lockable spaces for people to keep their belongings
• Older wards can lack space and ventilation and be unsuitable for people with physical disabilities
• Use of dormitories should be completely removed from inpatient mental health wards
• Noise, echoes and harsh lighting limit the therapeutic experience and can be distressing for some patients, for example, those with autism
• Many wards inspected by CQC were in urgent need of update and repair, with problems including broken windows, holes in walls, dirty wards and broken fixtures and fittings
• The condition of wards has been made worse by additional wear and tear created during lockdowns
• Outdoor spaces that are barren, visually impoverished environments dominated by security fencing can have a detrimental impact on patient recovery and staff morale
• Temporary repairs can be unsightly and a visual reminder of past incidents on wards, leading to patients feeling unsafe
• Patients continue to be cared for in environments that are not suitable for their needs.
Where wards have been refurbished, CQC notes a positive effect on patients and staff; better physical environments improve patient experience and staff morale.
The report also raises major concerns over staff and workforce shortages, as well as the need to resolve longstanding inequalities. Children and young people’s mental health services (CYPMH) are also struggling to meet rising demand. This increases the risk of children ending up in inappropriate environments too.
However, good care was observed. Services were better at involving people in their care and the running of the service and using advance planning to support people’s decisions about their care. Some services actively identified a lead for promoting equality and diversity across wards, taking responsibility for ensuring the service was inclusive of people’s needs. In some services the lack of beds and gaps in community and social care has led to the development of ‘sub-acute’ wards to accommodate people whose discharge from inpatient care is delayed. Refurbished wards reflected positive effects, improving everyone’s experiences, and despite the pressures, some services were taking steps to apply the principle of least restriction to minimise incidents of restraining people.
