In an analysis of services across England, the think-tank found that around 40% of mental health trusts experienced a cut in income in 2013/14 and 2014/15. This is in contrast to the acute sector, where more than 85% of hospital trusts saw their income increase over the same period.
In an effort to reduce costs, trusts are implementing reforms, but the King’s Fund said these often take the form of a move away from services which have an evidence base to care pathways and models of care for which the evidence is often limited. There has also been little formal evaluation of the impact of these changes.
King’s Fund mental health policy fellow Helen Gilburt said that, historically, mental health services have often been the first to see their funding cut, so many trusts felt forced to look at what savings could be made through transformation programmes. “Trusts looked to move care from the hospital to the community, focusing on self-management and recovery,” she said.
“Few would dispute the intention and rationale for this – the problems arise with the scale and pace of the changes, which lack the necessary checks to evaluate their effectiveness and the impact on patient care.
“Mental health trusts now need the security of stable funding, supported by a national focus on evaluating the changes to date, improving practice and reducing variations in care.”
Among the changes highlighted in the Mental health under pressure report are moves to merge specialist crisis resolution home treatment teams and early access to psychosis services into generic community health teams.
Evidence suggests these teams are often unable to provide the level of support required by patients, reducing care quality and increasing pressure on inpatient beds, it stated.
Overall, only 14% of patients say that they received appropriate care in a crisis, while bed occupancy rates routinely exceed recommended levels.
Stephen Dalton, chief executive of the Mental Health Network representing provider bodies, said the King’s Fund report was “a helpful and timely contribution”.
“It exposes the institutional bias that exists in the NHS and local authorities when it comes to funding for mental health,” he said.
“Much of this is well known to policy makers and politicians and despite the rhetoric about giving equal importance to physical and mental health this hasn't translated into any new money.
“If this government is serious about prioritising mental health they need to ensure new funding gets directly to providers of care and not channelled through layers of bureaucracy where it is lost.”
