Evidence of staffing problems in mental health care is nothing new, but an authoritative report today warns starkly that if difficulties of recruitment and retention are not addressed "there is a danger that large sections of existing mental health services will not be sustainable". Based on a review led by Sir Graham Hart, former permanent secretary at the Department of Health, the report says there is also a risk that it will not be possible to achieve the government's national service framework for mental health without more staff and rapid improvement in their skills and competencies. According to Andrew McCulloch, one of the report's authors: "We are in potentially serious trouble". The review was commissioned by the Sainsbury Centre for Mental Health in order not only to get a clear perspective on staffing problems, but also to point the way forward. The report says services need to break out of a costly and destabilising cycle of short-term solutions, exemplified by a reliance on agency workers, and to set strategic goals of making mental health more attractive to recruits, creating stronger leadership for the sector and doing far more to support and sustain staff.
Beyond this, though, the review group is calling for targeted solutions to specific problems - not all of them local in nature. The government, it says, should, among other things, reappraise NHS pension rules to determine what negative effect they are having on efforts to retain older mental health workers whose role is likely to be vital in keeping services going.
The report, Finding and Keeping, comes a week after the annual conference of the Royal College of Psychiatrists heard dire warnings of the state of mental health care. Peter Kennedy, co-director of the Northern Centre for Mental Health, told the conference in Edinburgh: "We have stood like rabbits in the headlights wondering what to do and where to start, knowing that the situation is worsening. There is an urgent need to explore methods of developing standards and implementing them on a broad front over relatively short periods of time."
Kennedy was referring to acute care, but the state of many community services is little better. Overall, more than third of NHS trusts employing psychiatrists report trouble recruiting them and, at the last count, 14% of consultant posts were vacant. While the picture for mental health nurses looks rather better on paper, almost a quarter of them are aged 45-54 and many have the old "mental health officer" status, entitling them to retire on pension at 55.
As if maintaining existing services is not challenging enough, the report estimates that the national service framework's standard of 24-hour access to care services might require an increase of 10-30% in staffing of community mental health teams alone - the equivalent of 1,000 extra nurses. Similarly, supporting just the 50,000 most hard-pressed informal carers, in line with the framework's ambitions, could require almost 1,700 more social workers.
The attractions of working in mental health are not immediately obvious, however. Health and social care as a whole has problems competing for young recruits, but mental health suffers the added handi- cap of a negative image. "Many of the staff we spoke to in the course of the review felt that mental health nursing was seen as a job with low pay and low status, but with high levels of risk," says the report.
In view of this, the review team is urging a focus on retaining and making full use of older staff. But it says those who could be persuaded to stay on in their late 50s and 60s, perhaps on shorter hours or with a switch to a less pressured role, can be deterred by rules linking their pension to their final three years' salary.
McCulloch, senior adviser to the Sainsbury centre, says: "There is a big disincentive, almost an overwhelming one, to changing to a less high-powered job and a smaller disincentive to going part-time. Surely it can't be beyond the wit of man to do something about it. We would be stupid not to, because this is a group of people with a lot of experience to offer."
With mental health facing such difficult workforce issues, a period of organisational stability might be indicated. Yet the break-up of combined community and mental health trusts continues apace, with community services going to the new primary care trusts. The jury is out on whether the emerging specialist mental health trusts, often very large indeed, will fare any better.
One area where they should be able to improve their act, thinks McCulloch, is in meeting a crying need for a robust human resource (HR) function. "The big trusts do provide an opportunity to produce really good HR managers," he says. "There are some talented people out there, but they are not properly supported. The best that can be said about HR in mental health is that it is variable -variable from the good-but-struggling to the awful."
• Finding and Keeping is available (price £15, plus £1.50 p&p) from the Sainsbury Centre for Mental Health, 134-138 Borough High Street, London SE1 1LB
