Mental health services in the spotlight

As Mental Health Awareness Week puts mental health issues in focus, the Getting It Right First Time (GIRFT) programme is making preparations for its three-fold approach to reviewing services across England.

There has been huge interest from the profession since GIRFT announced the appointment of leading clinicians for crisis and acute mental health services (Dr Ian Davidson), rehabilitation (Dr Sridevi Kalidindi CBE) and child and adolescent mental health services (Dr Guy Northover) to conduct national reviews of their own specialty.

Work will soon begin on compiling data packs and discussions are taking place with stakeholders ahead of the three leads heading out to meet with staff in trusts, with the aim of improving the quality of mental health care by reducing unwarranted variation. The three workstreams will run separately but will incorporate some common themes, such as ensuring patients get timely access to treatment, issues around out of area placement and sharing best practice to bring about improvements.

This year’s Mental Health Awareness Week, which runs from 13-19 May, focuses on body image and how we think and feel about our bodies. It follows recent calls from the Royal College of Psychiatrists for clinicians to routinely ask young patients with mental health issues how long they spend online and what they use social media for, amid concerns about how screen time impacts on mood, sleep, diet and behaviour.

Child and Adolescent Mental Health Services (CAMHS)

Dr Guy Northover, a consultant child and adolescent psychiatrist at Berkshire Healthcare NHS Foundation Trust, will be carrying out GIRFT visits to the 40 providers of inpatient CAMHS services and 52 crisis services.

“There is a huge amount of excitement about the GIRFT review across the CAMHS landscape,” he said. “NHSE is looking to make sure we work towards the same aims, the Royal College of Psychiatrists has been very positive – everyone is coming together to make sure we are looking at the right data sets and asking the right questions.”

Among the issues he hopes to review are:

The crisis care pathway – specifically, the interface between community crisis care and inpatient care. “There is still a huge amount of variation around mental health service provision at the moment, possibly with even greater variation in CAMHS crisis services,” said Dr Northover. “We need to have an idea of what good looks like. Using the data available and through service visits we will be looking at best practice, and identifying what we see as the pathway that provides the best, most positive and most efficient care.”

Out of area placement – “Young people are still being sent too far away from home,” said Dr Northover. “According to 2017/18 figures, one in eight CCGs sent an under-18 more than 200 miles from home, with the furthest going 285 miles. It’s not just a capacity issue – there has been a big increase in CAMHS beds over the years, and bed occupancy last year was around 72% – which means we need to look at where these beds are and how they are being utilised. I am looking forward to looking into that in greater detail.”

Quality improvement – Helping services to maximise the recording and use of data, so they can identify and make the changes that will lead to better patient outcomes and system performance through continued learning cycles. 

Crisis and acute mental health services

Dr Ian Davidson is consultant general adult psychiatrist at Cheshire and Wirral Partnership NHS Trust and leads the GIRFT review into crisis and acute mental health services.

He said: “It is important that the GIRFT crisis and acute mental health programme is not seen in isolation. In my previous role as a clinical adviser to NHS England and NHS Improvement programme supporting the reduction of acute out of area mental health bed usage, I was very aware of the impact of problems in the system and their impact on people, their families and supporters, local communities and staff – especially difficulties in accessing services and the impact of having to go out of area or face long delays for a bed when needed.

“I also saw and heard about multiple innovations and how people are increasingly using data and tools such as QI to learn and make improvements. The GIRFT programme will build on and learn from that work and will closely co-operate with national and local systems in delivering further improvements.”

In his GIRFT review, Dr Davidson hopes to address:

Local service improvement – building on and developing knowledge to reduce unwarranted variation in adult acute mental health bed usage, including eliminating need for out of area acute bed usage by enhancing and improving local services.

Enhancing the crisis/acute care pathway – ensuring that existing resources and the new money available within NHS Long Term Plan is used to best effect by commissioners, providers and partners to enhance the crisis/acute care pathway, including equitable access for all parts of the community.

Making best use of data – developing a robust set of routine data so that progress in driving best quality can be monitored effectively and used to deliver maximum benefits to the local community. This will also help to create robust and sustainable evidence on inputs, outputs and outcomes to help future planning, delivery and review of services.

Mental health rehabilitation

Dr Sridevi Kalidindi CBE is a consultant rehabilitation psychiatrist at South London and Maudsley NHS Foundation Trust. She will be visiting the 54 NHS mental health trusts in her review.

Dr Kalidindi will be looking at:

Providing whole system rehabilitation services – using data to understand the current provision and identify unwarranted variation in local care pathways, which is directly linked to out of area placements for rehabilitation. Dr Kalidindi said: “GIRFT provides an incredible opportunity to ensure local areas understand the population needs for, and value of, a whole system of rehabilitation services within every mental health system. Ensuring rehabilitation services are commissioned and provided as effectively as possible, close to home, and with the best possible patient experience and outcomes, is a key deliverable.”

Quality improvement – understanding the evidence base and using best practice models to tailor and co-produce each local rehabilitation system. “This approach provides the best opportunity for safe and high quality outcomes for patients and the wider system, in a sustainable way,” she said. “Currently some models are not evidence-based, are not based on updated best practice and are not sufficiently evaluated. The use of standardised and systemised data through GIRFT will support data-led, continuous improvements, including safety and quality outcomes.”

Patient experience and staff health and wellbeing – supporting each locality to co-produce clinically-led and patient-led action plans to identify and take forward improvements. In particular, empowering clinicians and patients. Dr Kalidindi added: “Rehab clinicians around the country are incredibly positive and welcoming of finally receiving the central backing that rehab has needed to improve the situation for this patient group, who are among those with the highest needs and vulnerabilities.

“Supporting staff health and wellbeing is the right thing to do, and it improves patient outcomes. To help many more patients achieve their goals and live as full a life as they wish to is the aim.”

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