The Care Quality Commission (CQC) published an important report yesterday looking at the state of mental health services across England. The report is based on inspections they’ve carried out across all NHS and independent specialist mental health services in England, between 2014 and 2017.
"In too many cases, people's care plans don't include any discharge planning at all."
Overall, the CQC found a lot of good examples of services that were supporting people well and safely. However, when we turn to the chapter looking at services for people with a learning disability and/or on the autism spectrum, there is some cause for concern, particularly around the number of autistic people in inpatient settings and excessive restraint and over-medication.
Increasing number of autistic people in hospitals
Transforming Care is the NHS’ plan to reduce the reliance on inpatient mental health beds in England by up to half, by supporting people in the community where they can be nearer their families and support networks. But the latest NHS data suggests this isn’t working for autistic people. In fact, the number of autistic people in mental health hospitals appears to be increasing. And, worryingly, the CQC have identified that in too many cases people's care plans don't include any discharge planning at all. This should be in place as soon as someone is admitted.
In order to make Transforming Care a success, there needs to be high quality services in the community to meet the sometimes very complex needs of autistic people who also have mental health issues or challenging behaviour. That requires staff training and understanding of the best ways to provide support.
Waiting for community support
Too often these services aren’t available and the CQC note that autistic people and people with learning disabilities are often having to wait long times to get support in the community. As a consequence, many are stuck in inpatient hospitals for far longer than necessary, sometimes a long way from home and family. This can be extremely damaging and often causes people’s mental and physical health to deteriorate.
One of the most noteworthy things that the CQC outlines is the difference between quality ratings of community services and inpatient ones. In the report, the CQC says: "It is striking that there is a 28 percentage point difference between community mental health services for people with a learning disability or autism and acute wards for adults of working age and psychiatric intensive care units, in terms of the proportion that we rated as good or outstanding (89% compared with 61%). This is further proof that the quality spectrum can look very wide indeed."
Over a quarter (27%) of inpatient services were rated as requiring improvement. The CQC raises particular concerns about safety, including how often restraint and medication were being used, in some inpatient units. This has to be addressed. Autistic people are at greater risk of being over-medicated and that can have serious effects on their health and wellbeing – as does restraint. The National Autistic Society has signed up to the STOMP pledge and we think other providers should too.
The findings also demonstrate the importance of people’s rights in mental health hospitals. This is an issue we and Young Minds have been campaigning on, calling on the Government to set out strong, enforceable rights to protect children in mental health hospitals, and their families, when they need it most.
This latest report is part of a growing body of evidence showing what needs to change to make Transforming Care a success. We need leadership from the Government and NHS England, backed up by funding, to refocus efforts on improving community support for autistic people and making sure this is provided by professionals with excellent training. Autistic people must not be left behind.
Find out more about NHS England’s Transforming Care programme, and how you could help shape decisions in your area here.