CQC community mental health survey finds poor care

The Care Quality Commission (CQC) recently published the results of its 2023 Community Mental Health Survey, which revealed that people’s experiences of community mental health services are generally poor.

The CQC's report into community mental health services reveals people's experiences of care are often poor

The watchdog says that the survey, which received feedback from 14,770 people who received treatment for a mental health condition between 1st April and 31st May 2023, specifically found problems with the quality of care, crisis care, support while waiting, planning and involvement in care, and support with other areas of life.

The survey, which focuses on NHS mental health services provided in the community, revealed a few limited areas where the majority of people reported positive experiences. These included:

  • The review of medications – 77% of survey respondents said their NHS mental health service had reviewed how they were getting on with their medications within the last 12 months. The vast majority of respondents (97%) also said they had either ‘definitely’ or ‘to some extent’ discussed the purpose of their medication, while 93% had also had some discussion around its benefits.
  • The privacy of care settings – almost 3 in 4 respondents (74%) said they ‘definitely’ had enough privacy to talk comfortably duringMost people said they could talk comfortably during talking therapies provided through NHS community mental health services the delivery of NHS talking therapies.
  • Older people’s mental health services (OPMHS) – older people accessing mental health care generally reported positive experiences, with 85% saying they were always treated with care and compassion and 86% agreeing that they were always treated with dignity and respect.

Key areas for improvement in community mental health care

However, the Community Mental Health Survey mainly identified a number of key areas for improvement. These were:

  • Quality of Care – less than 4 in 10 respondents said they were ‘definitely’ given the help they needed the last time they saw someone from mental health services, while only half were ‘definitely’ provided with enough time to discuss their needs and treatment.
  • Crisis care – 1 in 5 people (22%) said they didn’t know who to contact out of hours if they experienced a mental health crisis, whileMany people said they didnt get the community mental health care they needed when experiencing a mental health crisis over a quarter of respondents (26%) said they did not get the support they needed when they did make contact.
  • Support while waiting – More than 4 in 10 (42%) respondents said they did not receive any support for their mental health while waiting for their first appointment for treatment following an initial assessment with the NHS mental health team. Almost half (44%) said their mental health deteriorated while they waited to begin treatment.
  • Planning and involvement in care – Over a third of respondents said they did not have a care plan in place, while 44% had not had their care reviewed in the last 12 months. More than half (59%) said they were not asked if they required any support to access their care.

Experiences of community mental health services varied for different groups of people. For example, survey respondents with a disability were more likely to report negative experiences for 14 of the 20 questions analysed, including being treated with care and compassion, being given the help they needed from services and being supported to make decisions about their care and treatment.

Other groups that reported worse than average experiences across multiple areas of focus were younger people (those aged 16-35), autistic people and people who access services over the telephone.

The CQC will use the survey findings to build an understanding of the risk and quality of community mental health services and those who organise care across an area. The results will be used alongside other sources of data to inform targeted assessment activities.

NHS Trusts, and those who commission services, will also use the results of the Community Mental Health Survey to identify and make the changes needed to improve peoples’ experiences of care. Meanwhile, NHS England and the Department of Health and Social Care (DHSC) will also use the data for performance assessment, improvement and regulatory purposes.

First-time survey focus on community mental health services for children

Changes to the community mental health survey meant that care provided for children and young people could be scrutinised for the first timeThe survey underwent several changes this year, with alterations made to methodology, eligibility and the content of the questionnaire. People were given the option to complete the survey online, as well as a paper version, for the first time.

The eligibility age for the survey was also lowered to include 16 and 17-year-olds for the first time. This significant change means that the CQC was able to collect data from people using child and adolescent mental health services (CAMHS) for the first time. This step enabled the survey to capture the realities of a lack of community support for children and young people, who face long waits for mental health treatment amid rising demand.

The CQC’s Community Mental Health Survey found that people using CAMHS are having worse experiences across most areas of care covered, but particularly in relation to access, quality of care and crisis care. The results show:

  • A third (33%) of people using CAMHS did not feel in control of their care
  • 4 in 10 said they did not have a care plan in place and almost half (47%) had not had a review meeting in the last 12 months
  • More than a quarter (27%) had been left out of decisions about their care and treatment

In a blog exploring the 2023 Community Mental Health Survey results, Chris Dzikiti, Director of Mental Health at the CQC, said:

“We know that access to mental health care is a widespread issue, but the survey shows that it is particularly poor for people seeking support from child and adolescent mental health services.

“Overall, only 25% of people said they were given the help they need from child and adolescent mental health services. This is a shocking and saddening statistic, particularly when coupled with the fact that 24% of respondents said they waited for 6 months or more between their first assessment and their first appointment for treatment.

“Young people are waiting too long for treatment and are not offered enough – or any – support while they wait. When they do access care the quality is not good enough and 41% of respondents said they had to repeat their mental health history often.”

Community mental health survey will inform inspections and improvements

Crisis care was a top concern for children and young people Crisis care was also a top area of concern when it came to those accessing CAMHS. Only 2 in 5 respondents (38%) said they knew who to contact out of hours if they experienced a mental health crisis. Of those who did know how to get in touch, however, only 40% said they received the help they needed the last time they contacted crisis care services, while over a quarter (26%) said it took them too long to get through to the crisis team.

Dzikiti added:

“Clearly the picture here is far from what we want to see, but we are grateful to have this data which we have not had before from the survey.

“We’ll use the results from the survey to continue to build our understanding of the community mental health landscape, and to inform our targeted assessment activity.

“NHS England are also well aware of the issues in this part of the sector – the NHS Long Term Plan aims to embed support for children and young people in schools and colleges, and new NHS-funded mental health support teams working in educational settings should be rolled out to between one-fifth and a quarter of the country by the end of 2024.”

This NHS England video provides more detail about how they are working to improve services for children and young people with a mental health problem.

The CQC will also use the results of the Community Mental Health Survey to inform future projects, such as its annual Monitoring the Mental Health Act report, which has previously highlighted the high demand and lack of specialist beds in services for children and young people, which often means that those with mental health needs are cared for in inappropriate settings.

National children’s charity the NSPCC has previously raised concerns about in-patient mental health care for children, while a BBC investigation found that parents and teachers had lost faith in mental health care for children and young people, amid “agonisingly” long waits for treatment.

Dzikiti concludes with a hope “that in future years we will be able to report on more positive findings and can see where improvements are being made.”

Learn more about mental health support

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A trainer from FRT says:

“We are living through something of a mental health pandemic at the moment and so it is vital that mental health services and the care and treatment they provide are being closely monitored and regulated and that improvements are made where necessary.

“Every person struggling with a mental health disorder deserves to receive appropriate and timely treatment and support, whether in the community or in hospital. People should be involved in their care plan, which must be tailored specifically to them, and they should be treated with dignity, compassion and respect at all times.

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Helpful resources

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Further support for mental health concerns