Crisis in mental health: Can quality improvement help?

By Rachel Hammel & Jan Walmsley

At the Quality Improvement Clinic we have been thinking about mental health. And in particular, if we can share our commitment to using the Model for Improvement to drive quality improvement and make a difference.

As so often in health care, calls for massive changes in the way we manage mental health abound. This week has seen two important pronouncements on mental health.

Firstly Sir Nigel Crisps’ independent Report OLD PROBLEMS, NEW SOLUTIONS: Improving acute psychiatric care for adults in England made important recommendations including ending the practice of sending patients across the country for a bed, a waiting time pledge of a maximum of four-hours for admission to acute psychiatric wards, and greater involvement of families and carers.

Secondly, on Wednesday 10th February, Hazel Watson, Mental Health and Learning Disabilities Lead for NHS England, tweeted that they were going to stop the practice of over-prescribing anti-psychotics to people who do not have a psychotic illness.

Hazel Watson tweet - mental health (2)

So many problems and challenges in an already overstretched system where staff will tell you there just isn’t time even to do the basics – and sometimes that includes the basics of humanely caring for very sick people.

Amidst this landscape – in which mental healthcare is often characterised as a ‘forgotten service’ -there are glimpses of promising change initiatives. East London NHS Foundation Trust’s (ELFT) mental health and community services improvement programme have embarked on a partnership with the Institute for Healthcare Improvement (IHI). Their aim is to incorporate quality into their trusts business strategy, develop improvement capacity and capability and involve patients and carers at all levels of improvement. But the wider picture across the UK is still patchy and quality improvement methodology has yet to be fully explored within the context of mental health services. The Crisp report may be swimming with references to ‘quality’ and ‘improvement’ but none of the answers being advocated are framed in a way that considers why the system is delivering such poor results (other than to blame a lack of resources) or how we can design a system that delivers better outcomes.

At the Quality Improvement Clinic we see the enormous potential for the Model for Improvement to have transformational impact across mental health services. And we would welcome the opportunity to apply Improvement thinking, based on the following three questions:

MFI image - mental health blog

What are we trying to achieve, for whom and by when?

What change(s) might we make to achieve that aim?


How will we know if a change is an improvement?

Even better – let’s start by placing patients and their families at the centre …. What will make their lives better, and how can the system be designed to respond? Who knows, they might even tell us that we can STOP doing some of the things that take us time, and do them no good – following in the footsteps of Hazel Watson!


The Model for Improvement, Langley, Nolan, Nolan, Norman & Provost, The Improvement Guide, Josse Boss, 1996

Authored by Jan Walmsley and Rachel Hammel

Associates, Quality Improvement Clinic