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Mental health services commissioning ‘in crisis’

GPs should have wide-ranging mental health training to support people before they reach crisis

Louise Prime

Wednesday, 04 October 2017

Mental health services commissioning is in crisis with a “shrinking workforce, growing expectations and exhausting demands” putting increasing pressure on staff nationwide, according to a report that urges “radical reform” of mental health services so they can better meet people’s future needs. It calls for GPs and their primary care colleagues to be much better trained in preventive mental health care.

The future of the mental health workforce, commissioned by NHS Employers and supported by Health Education England, is based on insights from service users, carers and professionals. It outlines a series of recommendations for a sustainable mental health workforce and emphasises the importance of prevention, including the role of GPs in supporting people before they reach crisis point.

The report’s authors noted that although a third of GP consultations involve mental health, only 46% of GPs do a mental health placement in their training. They called on the General Medical Council, the Royal College of GPs and education providers to ensure that all GPs – and other practitioners in primary care – have “significant and wide-ranging training in mental health”. They said similar approaches should be taken with other professions in building up their knowledge about mental health.

They pointed out: “There is perceived to be a ‘huge gap’ between primary and secondary mental health care, and Improving Access to Psychological Therapies (IAPT) services as currently commissioned do not fill that gap.”

The report’s authors recommended that mental health professionals should be given the time and training to consult with GPs and other public service staff to help them to respond to more people’s mental health needs. They said mental health services commissioners should include consultation in their contracts with mental health providers, to enable staff to share their expertise – for example with colleagues in primary care, the voluntary and community sector, and more widely in schools and general health care and other settings. They insisted that consultation within primary care, in particular, should be a core duty and not an ‘add on’ for mental health services.

They also urged education and training providers to develop specific training and development opportunities for mental health commissioners. They said: “Mental health commissioning must be recognised as a skill set in itself that requires specific training and continuing development.”

Their other recommendations include greater involvement of service users in service design; more positive promotion to young people of mental health as a career option; and for mental health service providers to better support the wellbeing of their own workforce.

Chief executive of the Centre for Mental Health, Sarah Hughes, said having the right workforce for mental health care is “crucial for its effectiveness”. She commented: “The future mental health workforce will need to be skilled in coproducing services with those who use them; in educating and supporting GPs, teachers and hospital staff; and in engaging with communities. We need to attract young people to mental health work from school age and create lively, varied and challenging careers that change as people get older. And we must create compassionate organisations that support the wellbeing of those who work in them.”

Dr Phil Moore, chair of the NHS Clinical Commissioners Mental Health Commissioners Network and deputy clinical chair of NHS Kingston CCG, agreed that having the right workforce was “absolutely essential” to achieving high-quality mental healthcare amidst the huge pressures and competing demands on the NHS.

He said recently: “Mental health is a priority for CCGs … Working in partnership with mental health providers, voluntary sector, primary care and national bodies we are determined to improve it and ensure that the money is spent on getting the right services in place, with the right staff, to ensure our patients get the support and care they need.”

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