The first national survey of acute inpatient mental health wards paints a grim picture of staff shortages and failure to provide therapy.
Senior consultant posts are unfilled
The Sainsbury Centre for Mental Health surveyed 300 wards in over 50 NHS trusts across England.
It found many wards lack senior medical and nursing staff, and have to rely on bank and agency workers.
As a result, many wards are unable to offer therapeutic activities such as cognitive behaviour therapy.
The survey found:
- On an average day, a ward of 16 beds would have a combined shortfall of two whole-time nurses and health care assistants and use four whole-time agency or bank staff
- Nearly half of wards lack a lead consultant psychiatrist, while 13% are without a ward manager or senior nurse above grade F
- One quarter of wards had lost staff to community teams in the year before the survey
- Less than a quarter of wards had the services of a psychologist
The survey also found that, as a result of the successful creation of new community teams, many ward managers reported their clients had increasingly severe mental health problems and high levels of need.
Yet one-fifth of wards lacked access to a psychiatric intensive care unit.
SCMH chief executive Angela Greatley said: "Acute inpatient mental health care is in need of urgent attention.
"There is no doubt that mental health services have improved in recent years, but in many places progress has been slowest in inpatient services.
"Our survey shows the scale of what remains to be achieved in acute wards to offer the quality of care service users want, need and deserve.
"In particular, we need to tackle the urgent staffing problems many wards face and to make the many good practices that do exist much more common across the country."
The survey - Acute Care 2004 - was commissioned by the National Institute for Mental Health in England (NIMHE).
Paul Rooney, of the NIMHE Acute Inpatient Care Programme, said acute inpatient care was identified as a key priority area for action in the recent five year review of the government's National Service Framework for Mental Health.
The document acknowledged improvements were under way, but that much more needed to be done.
Mr Rooney said: "Acute Care 2004 provides a valuable snapshot of a service that faces many challenges in order to offer people the quality of care which they have a right to expect.
"We hope this survey will stimulate local dialogue between service providers, users and commissioners and act as a spur to inform future service improvement priorities."
Tim Loughton, Shadow Health Minister, said 40,000 patients a year needed acute inpatient mental healthcare.
"There is simply not the infrastructure to care for them adequately.
"There is too much dependency on agency staff, which leads to increased costs and means vulnerable patients do not receive continuity of care.
"This wouldn't be tolerated elsewhere in the NHS, so why should mental health patients be treated as second class citizens?"