Croydon’s mentally ill need stronger support services
Croydon’s mentally-ill residents need to have stronger support services, according to a report by Healthwatch Croydon, published today. The organisation calls on health and social care providers to make the changes needed to deliver better care. This includes improving accessibility to services, users and their carers more involved in decision-making, more support and less emphasis on medication.
Croydon’s Annual Public Health Report states that 67,000 people has a mental health condition at any one time, which equals to one in six adults in the borough. This is costly to the borough and wider society. With Croydon’s population set to grow, there will be more and more people with mental health problems living in the borough.
Healthwatch Croydon, the local champion for better health and social care, heard the views of over 90 residents (including carers and family members) and with an additional 654 items of feedback on our database. This is what was reported:
Long waiting lists: People tell us about waiting lists of 18 months for specialist psychological services, with one family still waiting over two years after referral.
Lack of user involvement: The phrase ‘nobody listens’ is one we have heard often. Many residents tell us they are not involved in decisions about them, or aware of what’s in their care plan. Many residents also express lack of aftercare, with limited or sometimes no, options.
Low carer involvement: We have heard that residents have been sectioned, and admitted to hospitals that are two hours away’, while one family said they were ‘offered a specialist bed in Scotland’. Next of kin, and main carers, tell us that they have been denied information, with providers citing confidentiality.
Lack of support: Residents tell us that calls often go unanswered, with messages not being responded to timely, if at all, by social workers in particular.
Too focused on medication: Clinicians can be too quick to reach for the medication and patients are concerned about side effects.
The report makes the following recommendations:
- Improve integration for lower waiting lists: While the Local Transformation Plan will bring additional funding and service redesign, and lower waiting lists, a two-year wait shows lack of integrated services. Service users, families and carers should be able to ‘raise the alarm’ on clearly excessive waiting times.
- Better consultation in care decisions: Service users, families and carers should be consulted when drafting and updating care plans, and have ways of influence, and challenge decisions.
- Listening to patients: GPs and mental health professionals should listen clearly to patients before making referrals to services which may not be necessary or appropriate.
- Priority on local admittance: More patients should be admitted locally, or if not, as close to their home as possible, as the impact of long distance admittance is costly to the service, but crucially to the patient’s wellbeing. While there are plans at national level, it will be necessary to look at practical alternatives in the interim.
- Consistency in access to information: A main carer should be able to access the same information whether she is in Lambeth, Croydon or another borough as information governance protocols are trust wide, there needs to be regional consistency in sharing information with family and carers.
- Side effects should be taken more seriously: Documented medication side effects such as swollen limbs, should be taken more seriously by the psychiatrists. Patients should be respected when reporting side effects which cause anxiety, discomfort and potential harm.
Charlie Ladyman, CEO of Healthwatch Croydon said “This report raises significant issues about delivery of services for one in six people in Croydon. It is acknowledged that the health and social care system alone cannot solve the problem – housing, education and employment, among other factors, must also play a central role. However, there needs to be a significant improvement in waiting lists, better communication between patients, carers and providers, and a priority on admitting people locally, where they can be supported more effectively by friends and family.”
“Healthwatch Croydon, and those tasked with commissioning and delivering services, such as South London and Maudsley Foundation NHS Trust (SlaM), the Croydon Clinical Commissioning Group (CCG) and Croydon Council, must continue to work towards increasing access to mental health services, strengthening partnership working and integration of physical and mental health, promoting mental wellbeing, and improving the lives of those with mental health conditions.”
A spokesperson for South London and Maudsley NHS Foundation Trust said:
“People in Croydon deserve the best mental health care available, on a par with the rest of London and the UK. This report provides some useful feedback and we will take on board the recommendations to see where we can make improvements to the care we provide in Croydon.”
“The report acknowledges the particular challenges in Croydon relating to high levels of deprivation and a rapidly changing demographic. We are seeing more patients presenting to us for the first time with acute psychotic illness and complex needs which is resulting in high demand and pressure on our services. The Trust has been aware of these challenges for some time and we are working closely with the Clinical Commissioning Group to address issues relating to the funding and commissioning of mental health services across the borough.”
A fuller statement appears on www.slam.nhs.uk/media/news/response-to-healthwatch-croydons-mental-health-report
A spokesperson for Croydon CCG said:
“Croydon CCG welcomes this report, which highlights some of the difficulties patients and carers have faced in accessing mental health services in Croydon, and sets out the challenges that we had previously identified in our Integrated Mental Health Strategy for Adults. We have listened to patients and carers, and we have invested £8.8 million over the last two years in providing more mental health services for our local population, with waiting times for most services now meeting national standards.
“We have expanded and developed the Croydon IAPT Psychological Therapies and Wellbeing Service based on service users’ feedback, with patients now able to refer themselves directly, and a 77% increase in the number of people entering the service during 2015/16. We recognise the need to support people earlier to avoid crises, and we have therefore launched a 24-hour Mental Health Crisis Line. We have also invested in our Early Intervention in Psychosis service to meet national standards.”
“We know there is more to do to improve mental health services for people in Croydon, and we will continue to listen to all patient feedback in developing and improving services.