Comment

12.12.18

Right people, right place, right now

Source: NHE Nov/Dec 2018

Sean Duggan, chief executive of the Mental Health Network, raises concerns around the mental health workforce and shares some best practice from Cornwall.

A broad approach will be necessary to tackle the workforce crisis engulfing the mental health sector, and the upcoming NHS long-term plan is a great place to start.

Itʼs great news that mental health is finally receiving the higher profile it deserves, and we have welcomed significant investment from the government to put it on the path to parity with physical health. Worldwide, one in four people will be affected by mental ill health at some point in their lives and there are currently around 450 million people living with mental ill health. We need to be doing more to make sure everyone gets the support they need.

Despite recent announcements in the Budget of an additional £2bn for the sector in the long-term plan, there are significant challenges ahead – and workforce is front and centre among them. We need to enable mental health providers to attract and retain the right colleagues to help put the nation’s mental health on course for the long haul.

It is possible to argue that mental health is disproportionately affected by the widely accepted workforce crisis in the NHS, which was described by The King’s Fund as approaching a ‘national emergency.’ At the end of the first quarter of 2018-19, the latest period for which NHS Improvement figures are available, there were 8,448 registered nurse vacancies in mental health NHS trusts. More than a fifth (20.6%) of all nursing vacancies at trusts were in mental health. Workforce statistics show 35,674 registered nurses working in mental health trusts in England in June 2018, which is a drop of more than 12% on the 40,602 employed less than a decade ago in September 2009.

And this comes at a time when the workforce ought to be expanding. There has been a six-fold increase in children and young people reporting having a longstanding mental health condition over the last 20 years.

Health Education England’s workforce strategy, ‘Stepping Forward,’ said 19,000 additional roles from March 2017 were needed by 2020-21 to implement the Five Year Forward View for Mental Health. In September, the government said that just 917 have been added.

Investment and promising pledges from the Budget – such as more mental health ambulances, crisis services in A&E, and crisis teams for young people – are important steps and represent a golden opportunity. But any investment in the sector must be underpinned by a sound, costed, multidisciplinary workforce strategy and support from the government.

The approach to workforce must be broad and, as part of it, we must make the most of the opportunities to employ people with lived experience, such as peer support workers. We will also need to be about working with the voluntary and charitable sectors and making effective use of the increasing number of digital mental health tools, which are a particular passion project of our secretary of state. But technology alone will not eradicate the need to invest in staff.

Psychology graduates must be welcomed into our ranks with suitable roles identified and rolled out on a national scale.

Cornwall Partnership NHS FT has been pioneering trailblazing work with clinical associate psychologists (CAPs), in which graduate psychologists train and study for a Masterʼs-level qualification in one year. They can then practice in secondary care mental health services and, once they are qualified, they operate as a Band 6 under the supervision of a clinical psychologist. In Cornwall, they believe this could address 50% of their workforce gap.

The British Psychological Society has recognised the role and is amending its charter to allow CAPs to become members.

The sector also needs to fully implement the recommendations from ‘Thriving at Work,’ which will help employers support the mental wellbeing of their staff, to keep their workforce happy and healthy and reduce attrition rates.

If we can get this right and enable mental health services to bring in the right people in the right places, then taxpayers will gets the return they deserve from their not-insignificant investment – a system which provides high-quality treatment for a greater number of people who need it.

 

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