Community-based teams care for 97% of mental health patients. And nurses play a pivotal role, building up trust between patients and their families.
However, since 2010 the total number of NHS mental health nurses in England has dropped by 15% – in parts of London, about 20% of job vacancies are unfilled. Helen Gilburt, a fellow in health policy at thinktank the King’s Fund, says: “Community mental health teams are supporting people to stay well, so if you haven’t got sufficient workforce to deliver that care, people are more likely to relapse.”
The nursing shortage is caused partly by an ageing workforce that is not being replaced quickly enough. In 2013, more than 32% of mental health nurses were aged over 50, and the abolition of bursaries for student nurses may also have had an adverse effect on the number of new recruits.
As a result, individual nurses are taking on a higher caseload. Research last year found that some community mental healthcare coordinators – not all of whom are nurses – have caseloads as high as 50 patients.
Ben Hannigan, reader in mental health, learning disabilities and psychosocial care at Cardiff University, who co-authored the study, says: “You will firefight with that number of people – it’s very difficult to do all the things you would aspire to.” Therapeutic care, aimed at helping people to recover, will be harder to provide, he says.
The shortage is affecting the whole service; a 2015 report by the Care Quality Commission revealed that only 14% of mental health patients said they received appropriate care in a crisis. And a review of psychiatric care by the Commission on Acute Adult Psychiatric Care found that 16% of patients per ward could have been treated in an alternate setting, including crisis houses and rehab services, if they had been available.
Trusts are struggling to deal with the shortages. Many, says Neil Brimblecombe, director of nursing at South London and Maudsley NHS foundation trust, are employing agency nurses, meaning that patients “have less opportunity to develop long-term relationships with individual nursing staff”.
Instead of “chasing an increasingly diminishing pool of nurses”, Brimblecombe believes trusts should take a different approach to workforce design. His own trust has joined two neighbouring trusts to develop a new assistant practitioner role to take on some of the work traditionally carried out by registered nurses.
In the long term, Brimblecombe believes the community mental health workforce should include more peer workers with “lived experiences of mental health problems” and more occupational therapists: “There will be an increasing range of new roles. The days when we have doctors, nurses and social workers, and that’s it, have gone.”
Mental health nurses in short supply as NHS struggles to fill vacancies
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