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Crisis in mental health staffing

By Lilian Anekwe

GPs are battling to deal with ever more complex mental health cases in primary care with the support of fewer trained staff and lagging investment, a Pulse mental health investigation reveals.

Two new studies have also exposed the growing burden on community mental health teams and problems with graduate mental health workers.

The first study – published in Psychiatric Bulletin - has shown that over the past decade CMHTs have dealt with increasingly complex caseloads of patients with increasingly severe mental illnesses.

A comparison of caseload complexity in six mental health trusts in England showed that between 1997/8 and 2004/5, the mean MARC2 (a measure of case complexity) score of a patient under the care of a CMHT was 8.5 in 2004/5, compared to 3.1 in 1997/8.

Data obtained separately by Pulse also shows that investment in CMHTs, at a 9% increase in budget between 2003 and 2006, is trailing behind that of Early Intervention Psychosis teams, which have seen a 426% budget increase in the same period.

Lead researcher Professor Peter Huxley, a professor of social work and care at the University of Swansea, said GPs were being left ‘increasingly frustrated' by not being able to refer patients classed with moderate mental illness on the Fair Access to Care Services (FACS) tool.

‘GPs are increasingly frustrated by their inability to access the sorts of services they could at the beginning [of the reforms]. There is more focus on severe mental illness and less on common mental illnesses, of which there is a huge amount to deal with in primary care.'

The second study has criticised Department of Health policy on graduate mental health workers - introduced in 2000 to help GPs manage and treat patients with common mental health problems - as ‘relatively unsupported and inexperienced novices as agents of change in the NHS'.

Dr Chris Manning, chief executive of Primary Care Mental Health and Education, said: ‘Common mental health problems are a key area, and though the Government will now argue that this is covered by IAPT it is not effective to have endless reconfigurations that simply take people back to places they were at 7 years ago.'

Graduate mental health workers- key concerns:

Graduate mental health workers- key concerns:

Graduate mental health workers- key concerns:

• Widespread variation in quality of supervision
• Terms of service and payment vary widely between PCTs
• Significant dropout in the first cohort of workers (2005)
• Many PCTS had no structure to support their work

Source: Health and Social Care in the Community.

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