Mental health support services face major challenges

Before the pandemic, Healthwatch England asked people about their experiences of getting mental health support. Three years on, they looked at what has changed and the questions the NHS needs to answer.
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Before the pandemic

In 2019, NHS England published the Long Term Plan, which laid out its ambitions for health and care for the next ten years. The views of over 34,000 people, who told Healthwatch England that they wanted mental health support to improve, helped informed the plan.

The experiences people told Healthwatch England about mental health were largely negative. Concerns included:

  • Long waiting times for diagnosis, assessments, referrals and treatment;
  • Lack of available support while waiting;
  • GP teams being ill-equipped to provide support;
  • Not being able to access the right treatment; and
  • Support not lasting as long as people needed.

To help fix these issues, the NHS made mental health a significant part of their long-term plan and pledged to give services a bigger budget. The need for this was clear: at the end of February 2019, 1.5 million people were using NHS mental health services.

The COVID-19 pandemic has since had an enormous impact on people's mental health, so Healthwatch England have looked again at what their data now tells them about services.

Before the pandemic, a greater proportion of the public's stories about mental health care were negative compared to other NHS services. A review of our evidence indicates that this trend has continued. In 2021-22, 58% of mental health feedback was negative, compared to an average of 49% across other care areas.

What are people reporting now?

An analysis of the experiences of 4,054 people highlights several issues regarding getting mental health support. People told Healthwatch England that:

  • GP teams can vary in how well-equipped they are to deal with mental health issues, and people can struggle to get their GP to refer them for specialist mental health support;
  • Waiting times for services are long at all stages of the mental health system;
  • Crisis services are over-subscribed and therefore often inaccessible;
  • Mental health assessments can feel hasty and often do not lead to the outcome people want;
  • Inpatient treatment is an unpleasant experience, whilst community treatment is patchy and at times unhelpful;
  • Services communicate poorly both with patients and with other services;
  • Treatment often ends too early, before people feel they are ready, and without adequate follow-up support; and
  • Those who need to restart treatment because of relapse often have to start the whole process of getting help again.

Are some communities faring worse?

Healthwatch England also looked at the stories that specific groups of people shared to see if some face greater inequalities when accessing care.

Services are not well designed for autistic people and those with learning disabilities

People with learning disabilities and autism can be more likely to experience poor mental health. We received feedback that mental health services are not well designed for autistic people and people with learning disabilities and that support was often inaccessible. For example, services that are only contactable via phone exclude people who cannot, or do not want to use the phone, which often includes those with learning disabilities and autistic people.

Lack of specialist support for the LGBTQ+ community

LGBTQ+ people said they do not feel well supported by the mental health system. People's stories show a lack of knowledge and specialist support for LGBTQ+ people. Several reports by local Healthwatch show that the lack of appropriate and accessible mental health treatment and care for transgender people is a consistent issue across the country.

What I would like is just representation. What would be really lovely, would be to go into the GP’s clinic and just see one poster or a leaflet or just something that says LGBT stuff or something to show that just maybe these people understand what you’re talking about. (Experience shared with Healthwatch North Yorskshire)

Communication barriers

People with a sensory impairment or who do not speak English as a first language said they find it hard to use mental health services when they don't get communications support. For example:

  • Across England, only three specialist clinicians are skilled in working with Deaf people with mental health issues. As a result, patients often have to travel long distances to get proper support.
  • For people with language needs, interpreters can be challenging to access, making it harder for people to express themselves. For people to be supported appropriately, it's important treatment is delivered in someone's preferred language.
Her son is 35 years old. He was born deaf and developed numerous other serious health conditions over the years…He only has access to a BSL interpreter for two hours per day which is not enough for the psychological and physical therapies he needs. (Experience shared with Healthwatch Torbay)

Services don't reflect the different needs of race and ethnicity

Our research suggests mental health services do not meet the needs of people from ethnic minority backgrounds. Experiences of mental health issues differ across different communities, and so do people's support needs, but services fail to reflect this.

Even when services attempt to cater to more people, the NHS can do it insensitively by assuming people of different backgrounds have the same needs.

My mother is originally from Bangladesh and although she has been under this service for some time now, they came with an assessment which would be suitable for people with Indian origins. I informed the nurse that this was inappropriate. (Experience shared with Healthwatch Sunderland)

Services struggle to deal with complex needs

People whose mental health is intertwined with other issues, such as substance misuse or homelessness, told Healthwatch England that services were unequipped to support more complicated situations. For example:

  • People with substance misuse problems often get trapped between traditional mental health support and substance abuse services. With neither service able to support both issues, individuals can be left unable to get any care.
  • Similarly, for people experiencing homelessness, it is hard to get support without a fixed address or proof of identification. These people also said they encounter stigma and judgement from NHS staff.

Time to improve care

The pandemic has significantly impacted access to all health and social care services. Delays and missed opportunities for providing care can lead to people’s problems getting worse and make it more difficult for services to work together to provide the effective support people need.

Given that so many people have negative experiences of mental health support, and the need for different types of support continues to be so high, Healthwatch England want to see real ambition from health and social care leaders to understand people's experiences and improve services.

At a national and local level, together with other partners they can help decision makers think through the big questions they must tackle.

Key questions

  • Given the delayed, missing, or potentially increased demand for support, are we giving mental health recovery the right amount of focus? The long-term plan pledged more money to mental health services, but has that led to improvements?
  • How can GP and Improving Access to Psychological Therapies Teams work together to improve access to services for people with common or long-term mental health conditions?
  • How can Integrated Care Systems, local commissioners and local authorities work together to improve interim and aftercare support?
  • Given issues with capacity and demand, how can long waiting times for services be reduced while supporting the well-being of staff?
  • Are the public aware of the different teams who can support them with their mental health? Are they aware of emergency support when facing a mental health crisis? How can we improve communication with people needing help?
  • What more can we do to help people facing mental health inequalities and barriers to care?
  • Do services and mental health treatment pathways currently work for everyone?

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