A key government target for caring for people with severe mental health conditions in England is being missed due to underfunding, research suggests.
People experiencing a first episode of psychosis should be seen within two weeks and get a quality care package.
But Liberal Democrat research indicates that while more people are being seen on time, few get the right treatment.
NHS England said “the analysis inevitably gives only a partial and dated picture of progress”.
New care and treatment standards for psychosis were introduced by the Department of Health in April 2016.
The rules state at least 50% of people experiencing their first episode of psychosis should start a package of care recommended by the National Institute for Health and Care Excellence (NICE) within a fortnight of being referred.
Norman Lamb, the former Mare Minister who established the care standards, said responses to Freedom of Information requests he had made suggested “the treatment programme is not being properly delivered” in most parts of England.
While official figures show 72% of patients started their treatment within the two-week target in November 2017, Mr Lamb’s figures indicate that fewer than a third of mental health trusts in England were able to offer patients the full NICE package of care.
Of the 45 mental health trusts that responded:
- 12 said they were able to provide the full NICE approved treatment
- 24 said they were not
- five said they were making progress
- Four didn’t provide the information
The typical treatment involves a combination of anti-psychotic medication, psychological therapies such as cognitive behaviour therapy (CBT) and family or social support.
“Could we ever imagine a situation where a cancer patient doesn’t get the full treatment that the evidence says they need?” asks Mr Lamb rhetorically.
“The impact on peoples’ lives of not making this investment is profound.
“You are left with – potentially – a miserable life, a life on benefits, a life with difficult relationships. And yet if we make that investment, we can transform lives.”
‘I thought I was the next Messiah’
Ali Mousa’s first episode of psychosis lasted a fortnight.
“I thought musicians were trying to induct me into some sort of secret society,” he says.
“I thought I was the next Messiah. It felt bizarre, but very real.”
His behaviour, including walking down the middle of busy road, led to him being arrested and spending six months in a psychiatric hospital.
The 28-year-old praises the hospital, but says what made the real difference to his recovery was the support of his local early intervention in psychosis (EIP) team.
“If it wasn’t for them, I wouldn’t have been able to stand up on my own two feet again,” he says.
“I didn’t think I’d get support, to get housing, to get me a job, for someone to help build relations with my mum.”
Ali says he is now fully recovered, and has been in a job, proof, he says, of the value of good care.
Pressure on budgets
NHS England has calculated that a proper care package will cost about £8,250 per patient.
But of the 17 trusts that answered Mr Lamb’s question on funding, all but two (Rotherham, Doncaster and South Humber, and Oxleas) said they were spending less than that amount.
The pressure on budgets indicated by the responses is reflected in a report looking at the performance of EIP teams in the south of England.
The draft report says that of the 16 trusts providing EIP services in the region, not one is receiving the recommended level of investment.
If the expected investment in the service had been realised, says the document, an extra £15m would have been spent in 2017-18; the real increase has been £3.5m.
“There continues to be a gap between the rhetoric and investment reaching the front line,” says the report.
The increasing demand for EIP services and the pressures it’s putting on staff “is demoralising and driving many away from joining and staying within the clinical workforce”, it says.
A member of Dorset Healthcare NHS Trust’s Early Intervention Team was recently assaulted, the BBC has learned, after assessing a new patient alone.
The standard is for two staff members to initially meet new people, in part to protect them.
Evidence seen by BBC News indicates the trust is struggling to provide EIP services – with staff carrying higher caseloads than other nearby trusts and, in a number of areas, delivering fewer types of treatment such as CBT sessions.
Mike Kelly, Dorset Healthcare’s head of mental health services, said: “We know there is work to do and we are recruiting staff to fill the vacant posts to enable the team to provide more support to people who use the service.
“Additional funding will also be required going forward to keep pace with demand.”
An NHS England official said: “10,000 people each year are now receiving treatment through the early intervention in psychosis programme, with over three-quarters of patients getting treatment within two weeks.
“The analysis inevitably gives only a partial and dated picture of progress in these services.”