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Mental Health Nurses Near Breaking Point Due To Service Pressures
Date Posted: 11/Jan/2020
More than half of mental health professionals say they are too busy to provide the care they would like to give, according to a new survey.
The survey of more than 1,000 mental health professionals, carried out by the British Medical Association in collaboration with the Royal College of Nursing and Association of Clinical Psychologists, suggests workforce shortages are having a major impact on workload, staff wellbeing and morale.
“There are desperate shortages of care staff of all types across mental health"
Dr Andrew Molodynski
The findings also show shortages are affecting the quality of care with 52% of respondents reporting they were too busy to provide the care they would like on the last shift they worked.
Meanwhile, more than two in five – 44% - said their individual workload was mostly or entirely unmanageable.
In all, 1,036 mental health professionals took part in the survey, including 390 nursing professionals such as mental health nurses and nursing associates.
It forms part of a report by the BMA, which warns that despite recent investment and a renewed focus on improving mental health, mental health services across the UK continue to suffer from inadequate funding and staffing amid rising demand.
The Measuring Progress report suggests plans to expand the mental health workforce – including bringing in 4,000 more nurses – are “at risk of being unachievable” in turn threatening much-needed improvements to services.
It shows the overall mental health workforce has grown little in the past 10 years with a loss of 7,000 nurses, health visitor and midwives since 2009.
This is despite the fact the number of people in contact with mental health services is increasing year on year.
While numbers in other key groups have remained static, the report points out there has been a slight increase in nursing numbers more recently with about 2,000 more now working in the field than there were in 2016.
However, 12% of all nursing vacancies are in mental health with similar vacancy rates for doctors working in the field and clinical psychologists.
Based on the data and survey findings, the report warns many of the mental health workforce commitments set out in key policy documents such as NHS England’s Five Year Forward View for Mental Health and Health Education England’s Stepping Forward to 2020/21 mental health workforce plan “are not on track to be met”.
The survey found 63% of participants said they worked in a healthcare setting where there were rota gaps across the team. Nearly 70% said rota gaps happened most or all of the time.
Nearly two thirds of nurses – 65% - said that on their last shift or day worked there was a shortage of one of more nursing staff.
Nearly half – 47% - of doctors said there was a shortage of medical staff while 57% of clinical psychologists said there was a shortage of one or more clinical psychologists.
Clinicians who took part in the survey said staffing shortages were affecting their wellbeing and morale and they felt “demoralised and upset that they could not provide the care they had wanted to”.
Meanwhile, respondents said they had seen little change in key areas that could help improve their working environment.
“Unless there is urgent investment in growing the nursing workforce, the pressures will continue to grow"
Catherine Gamble
More than a third – 35% - said there had been no change in access to occupational health services while more than a quarter – 26% - reported access had got worse or much worse.
Mental health professionals also said access to training and time for reflective practice had got worse in the past two years.
Half said access to training had got worse while 32% said there had been no change. Meanwhile, 57% said access to time for reflective practice had worsened or greatly worsened.
Health Education England has pledged to expand multi-disciplinary teams, bringing in extra support staff such as personal assistants and early intervention workers to free up nurses and doctors to make best of their clinical skills.
However, the survey findings suggest this kind of support may have declined with 43% of mental health professionals reporting access to PAs had reduced or greatly reduced.
More than a third – 36% - said access to early intervention workers had reduced or greatly reduced.
However, 12% said access to early intervention staff had increased while 15% said access to pharmacists had increased.
The majority – 65% - of those that had seen the expansion of wider multi-disciplinary teams were able to give examples of how service had improved as a result including reducing waiting times, shorter hospital stays and better working relationships with other teams.
BMA mental health policy lead Dr Andrew Molodynski said the report showed the mental health workforce was “near to breaking point”.
“There are desperate shortages of care staff of all types across mental health, with doctors and nurses on the frontline overworked and demoralised – and patient care is suffering as a result,” he said.
The BMA has called for additional investment in mental health to ensure true “parity of esteem” between physical and mental health.
“Mental healthcare accounts for 25% of all healthcare activity and yet our funding settlement stands at around 14% of healthcare spending at best. This is not right and has to improve,” said Dr Molodynski.
RCN professional lead for mental health Catherine Gamble said nurses feared lives were being put at risk.
“With so many too busy to deliver care, nurses aren’t able to spend time with families, develop therapeutic relationships and implement psychosocial interventions,” she said.
“Unless there is urgent investment in growing the nursing workforce, the pressures will continue to grow to the point where it will no longer be possible to attract nurses to work in the NHS,” she added.
“Expanding the mental health workforce is a key priority for this government"
DHSC spokeswoman
Professor Mike Wang, chair of the Association of Clinical Psychologists UK, said “dire shortages” of mental health professionals including clinical psychologists was “resulting in serious compromise to the quality and adequacy of care for the public”.
Sean Duggan, chief executive of the Mental Health Network – part of the NHS Confederation, said the BMA report highlighted the challenges faced by staff.
“Mental health and learning disabilities have some of the highest vacancy rates across the system,” he said.
“Successful implementation of the NHS Long Term Plan will require a dramatic increase in the number of people who work in mental health and the upcoming NHS People Plan is an opportunity to make this happen,” he added.
He also highlighted the need for long-term capital funding to improve working environments and help attract and retain staff.
A Department of Health and Social Care spokeswoman said: “Expanding the mental health workforce is a key priority for this government so we meet rising demand on services and ensure patients receive the best treatment.”
She noted actions the department was taking to address workforce issues, including new maintenance grants for nursing and midwifery students, increasing clinical placement opportunities, and boosting international recruitment.
Professor Ian Cumming, chief executive of HEE, said the organisation welcomed the report and “absolutely recognises the challenges it highlights”.
He added that HEE had made “good progress” on implementing its Stepping Forward workforce plan and was on track to have trained more than 5,600 children and young people’s Improving Access to Psychological Therapies practitioners by April 2020.
In addition, HEE had trained 4,650 new staff working in other mental health roles, including nursing associates and physician associates, and had rolled out initiatives to boost mental health support in schools, said Professor Cumming.
“We will now take this important agenda forward through the collaborative production and implementation of the NHS People Plan, with an aim to ensuring the NHS has the workforce required to meet the ambitions set out in the NHS Long Term Plan,” he said.
“Through this process, we will continue to welcome input from the BMA and other partners to help us to secure the right people, with the right skills, to deliver the best possible services to patients in the 21st century.”
By Jo Stephenson|NursingTimes

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