NHS mental health “early intervention” running on HALF staffing – costing lives and money

distress

There is good evidence that Early Intervention (EI) services in mental health care save lives and money. EI services contribute towards reducing suicide rates from 15% to 1% when compared to generic Community Mental Health services (CMHT).

As tens to hundreds of thousands of people use community mental health services, this percentage reduction in suicides represents a huge number of people.

The government has introduced an array of targets and Jeremy Hunt has boasted on social media about the government’s performance on mental health – before his boast was utterly dismantled by actor Ralf Little.

Targets first tabled under the coalition government and introduced in April 2016 gave staff within Early Intervention services a total of two weeks – within which time each person presenting with a mental health episode must be assessed and started on ‘NICE’-approved interventions.

The measures also extended the age range for those eligible from the then-current 14-35 up to 65 years, hugely increasing the demand on EI services.

Mental health professionals have told the SKWAWKBOX that, while the two-week target is generally met, the Tory government has not invested in the services needed after the intervention starts.

The ideal maximum ratio of EI support workers to ‘service users’ is one staff member to twelve users – or at a stretch, fifteen. But services are so overstretched that most professionals are now trying to help at least thirty people. EI professionals say that this is results in EI turning back into generic services.

One such professional, who tweets as “@greynomatter”, told the SKWAWKBOX:

The government’s disinterest and lack of support is killing vulnerable people. Add that to the DWP-related deaths and it’s a desperately sad picture.

They have not released any figures about the increased rates of death or ‘serious incidents’ but staff are being told that the level of serious incidents have risen dramatically.

These are serious incidents either involving people currently under EI services or amongst those who have relatively recently moved on from EI services – and subsequently killed themselves.

This lack of resourcing has turned the ‘two-week target’ and widening of the age bracket into a crippling weight on EI staff, pushing up demand by up to 300%.

The government waxes lyrical about ‘parity of esteem’ between physical and mental health services, but all references to problems within mental health services are replaced with smooth-talking ‘political speak’ about some modest and inadequate investment.

Front line staff have been told that the Department of Health and NHS England have gathered evidence of poor performance and a significant increase in the number of deaths and serious incidents related to service users either currently or recently involved with Early Intervention services. But they’re not reporting it.

Staff were hopeful that analysis of the relevant figures and looking beyond the superficial headlines would allow politicians as well as ourselves an opportunity to learn from and invest in improving our capacity to deliver the high-quality service that we know works very well when appropriately resourced. Unfortunately these figures did not materialise nor did the public or political interest or scrutiny that was hoped for.

Jeremy Hunt could and probably will at some point quote figures about how many more people are accessing NICE approved packages of care in Early Intervention services, but such claims are disingenuous. Early Intervention services are morphing into generic community mental health teams with high staff to service user ratios and worse outcomes in terms of recovery, quality of life – and life itself.

It feels like no one is interested in mental health aside from those of us directly involved in providing or using such services. But as well as the human suffering caused by Tory disinterest, what’s happening in our Early Intervention services is a perfect example of the subtle dismantling or disintegration of NHS services in the lead up to eventual privatisation.

Early Intervention in psychosis services work with some of the most vulnerable and disadvantaged members of our society. When such services are supported to function as intended, research shows that they contribute reducing suicide rates in this high risk group of distressed individuals from 15% to 1% when compared to generic community mental health services.

As well as saving lives there is abundant evidence that such Early Intervention services, properly resourced and funded, help people to recover quickly and improve their quality of life, employment prospects and wellbeing.

If the alleviation of human suffering and the reduction of mortality rates isn’t enough for those charged with deciding policy and making these life and death decisions, Early Intervention services have a proven track record of saving the NHS and taxpayers a huge amount of money:

For every one pound spent on Early Intervention services, the NHS saves fifteen.

A significant portion of these savings come from the fact that properly-funded EI services help people with mental health problems avoid the need for expensive hospital admissions – reducing the workload on A&E services that are in a record crisis.

Yet the government is, according to mental health professionals, failing either to invest adequately in a system proven to save the NHS and tax-payers money – or to report on the effects of their policies.

Comment:

With most Early Intervention Care Coordinators now supporting caseloads of thirty service users instead of the recommended fifteen, such services are losing their specialist function – and the outcomes that come with it.

According to professionals the SKWAWKBOX has talked to, Early Intervention services are now at the point where they exist in name and in theory but not in practice.

If, as staff have been told, the NHS and Department of Health and Social Care have gathered statistics on the effect of the underfunding of these services, but those statistics are not being released – then the government is covering up a huge toll in lives and misery – while Jeremy Hunt goes on Twitter to boast about his ‘achievements’ in mental health.

In addition to saving lives and alleviating human suffering, investment in Early Intervention is the ultimate ‘efficiency saving’.

So why are such services collapsing under the weight of increased need and reduced proportional investment? Why wouldn’t the Government want to invest more money early in order to save money and lives further down the line?

Deaths among people detained under the Mental Health Act – a phenomenon intimately linked to the availability of properly-resource EI – have already tripled under Tory government.

Unless saving lives, improving quality of life – and even saving money – are not what the government’s real aims are in the way the Tories are treating our NHS.

Few who observe what’s happening in our NHS, whether in mental or physical health services, would doubt that to be the case. As “@greynomatter” observed, this appears to about driving services into collapse as a prelude to even wider privatisation – and some ruse for introducing charges.

Especially when Theresa May refuses to say, when asked, that the latest government-imposed re-organisation of the NHS is about introducing charges for services and an insurance-based NHS.

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Further references:

https://www.oxfordhealth.nhs.uk/news/study-finds-that-early-intervention-services-can-save-nhs-millions/

15% to 1% reduction in suicides: Melle, I., Johannesen, J.O., Friis, S. et al, 2006. Early detection of the first episode of schizophrenia and suicidal behaviour, American Journal of Psychiatry, 163, 800–804.

http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/MHN%20key%20facts%20and%20trends%20factsheet_Fs1356_3_WEB.pdf (“In March 2015, research by Community Care and BBC News found that the funding for NHS trusts to provide mental health services had fallen by 8.25 per cent, £600 million, in real terms over the course of the last parliament (from 2010/11 to 2014/15).3 The data, based on 43 Freedom of Information (FOI) requests to 56 mental health trusts in England, showed that total funding for the trusts’ mental health services fell in cash terms from £6.7 billion in 2010/11 to an expected £6.6 billion in 2014/15”).

 

3 responses to “NHS mental health “early intervention” running on HALF staffing – costing lives and money

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