1. Introduction and methodology

The NHS Patient Survey Programme is delivered by the Care Quality Commission (CQC) on behalf of NHS England and the Department of Health and Social Care. The Survey Coordination Centre at Picker, coordinates the NHS Patient Survey Programme on behalf of the CQC. There are five surveys within the Programme: Adult Inpatient, Maternity, Children and Young People, Community Mental Health and Urgent and Emergency Care Surveys.

This report has been produced by Solutions Strategy Research Facilitation Ltd (Solutions Research) and NHS England to share national insights from qualitative thematic analysis of written responses provided by respondents that took part in the NHS Patient Survey Programme. The aim of this endeavour is to identify opportunities for learning and improvement through an in-depth understanding of experiences of care.

The focus of this report is on the Community Mental Health Survey 2024, which captured feedback from 14,619 patients aged 16 and over who received treatment for a mental health condition between 1 April and 31 May 2024.

Further information on the survey is available on the CQC website.

Qualitative data analysis

Three open questions were included in the survey which allowed respondents to use their own words to respond. The questions were positioned at the end of the survey and included the instructions as follows: ‘If there is anything else you would like to tell us about your experiences of mental health care in the last 12 months, please do so here.’

Respondents were then invited to write into a box about their experience, with the following questions posed:

• QA: ‘Was there anything particularly good about your care?’
• QB: ‘Was there anything that could be improved?’
• QC: ‘Any other comments?’

To ensure a robust approach a purposive sampling method was used for thematic qualitative analysis:

• QA: 658 comments were analysed as a sample from 7,537 viable comments.
• QB: 641 comments were analysed as a sample from 6,510 viable comments.
• QC: 644 comments were analysed as a sample from 4,186 viable comments.

Once the total sample of 1,943 comments had been analysed it was seen that data saturation had been reached i.e. no new themes were emerging from the data. Had this not been achieved, additional comments would have been added to the sample as necessary, in line with best practice in qualitative analysis. Further detail can be found in Appendix 5: Methodology and Appendix 6: Sampling Approach.

Use of illustrative quotes

Throughout the report, quotes are included to illustrate respondents’ experiences in their own words and substantiate the findings. Please note that the data is not edited in the interests of correct spelling and punctuation for example, to stay as true to the words of respondents as possible.

Certain information from the qualitative comments used in the report has been redacted to protect the identity of survey respondents and any other individuals referenced. Information that has been removed includes:

• names of patients or staff replaced with “[name]”
• names of wards, units or hospitals replaced with “[location]”
• names of specific services replaced with “[service name]” or “[mental health service]”
• names of county replaced with “[county]”

Where acronyms were used in comments, the full wording has been provided in the Appendix 7: Glossary.

There is a degree of duplication in the use of quotes in this report to substantiate insights. This reflects that written feedback is often complex in that it is rich in detail and spans several parts of patients’ care journey, providing a depth of insight as to several themes and/or sub-themes.

Use of quantitative data

Where possible in the findings section, themes are presented in context of the most relevant quantitative survey data. This allows for insights to be considered more holistically and to provide a greater opportunity for reflection and learning.

Context to support interpretation

Content warning: This report includes references to experiences of mental health, including mentions of suicide, which some readers may find distressing.

Further information about safeguarding procedures during data collection is available via patient.survey@cqc.org.uk.

Some responses in the analysis were very brief and lacked detail, which limited the insights that could be drawn. For example, answers such as “everything” or “nothing” suggested strong sentiment about what was good, while comments like “too much to list” indicated strong feelings about what could be improved. Although these responses were useful in showing the intensity of feeling, they did not provide enough detail to identify good practice or areas for improvement. For this reason, they were not included as insights in the main report but are presented here as contextual information.

A small number of respondents focussed on details of their mental health as opposed to the care that they received. It is unclear from the comments why this was the case, and helpful to note that this detail was out of scope for analysis. A further small number of comments could not be analysed due to the meaning being unclear.

In a few cases it was clear from the responses that the questionnaire had been completed by a partner or relative on behalf of the person who had received care.

There is evidence that some respondents were describing experiences of care beyond the NHS Community Mental Health services focussed upon in the survey. While some respondents stated they had been inpatients in mental health settings, the specific types of care, treatment or settings were not always specified. Similarly, some respondents were not always commenting on the recent experience they were asked about in the survey. Some patients would share their full story, which could include multiple interactions with mental health services and/or wider NHS access over periods of time not explicitly stated though inferred to stretch beyond the scope of the survey.

Comments reveal varied reasons for accessing mental health services, for example there is feedback from patients experiencing dementia, PTSD, ADHD and conditions requiring antipsychotics. Significant diversity in prior experience was also observed. These factors shaped how patients responded to their care, creating a challenging environment for delivery. Themes are closely interwoven and often interlink, and this report highlights these connections throughout. For instance, feeling confident in the care being received was influenced by multiple factors spanning the themes of ‘Access’, ‘Staff,’ ‘Treatment’ and ‘Communication.’

2. Headline findings

Thematic analysis of the qualitative data revealed the following key themes:

3. Thematic analysis findings

Key themes

Seven key themes were identified from the thematic analysis, listed below. Within each key theme are several sub-themes which support interpretation and use of the insights. There are 31 sub-themes in total.

• Gratitude
• Access
• Staff
• Treatment
• Personalised care
• Communication
• Outcomes

This section of the report contains the detail of each theme with a range of quotations shared to substantiate and exemplify the experience of respondents using their own words.

Theme: Gratitude

What does the quantitative survey data tell us?

• Of all respondents who answered this question, 33% rated their overall experience a 9 or 10 where a score of 0 represented a ‘very poor experience’ and a 10 a ‘very good experience’ (Q39).
• Of respondents who left a viable comment, 33% rated their overall experience a 9 or 10 (Q39).

Many comments made across the three questions were expressions of gratitude for the care patients had received. While there was a substantive volume of gratitude the feedback largely lacked detail or specifics about what created a good experience, with patients simply saying they were happy or that everything was ‘good’.

Theme: Access

What does the quantitative survey data tell us?

• 33% reported waiting 3 months or more between their assessment with the NHS mental health team and their first appointment for treatment (Q3).
• 84% felt their mental health either got worse or remained the same while waiting (Q5).

While there was a range of feedback about accessing community mental health services, from experiences of waiting through to physical access, the sentiment was predominantly negative with a focus on what could be improved about their experience. There were opportunities identified for improvement from very first contact through to treatment.

Waiting times

Experience of waiting times being lengthy for assessment and/or treatment stood out as the most prevalent theme in responses to the question asked about improvements. Please note, there are additional insights about waiting detailed within sub-themes later in this report regarding ‘Crisis care’ and ‘Contacting services.’

Where patients described the impact of waiting for support this often included a significant worsening of their mental health. Patients also described how deteriorating mental health had negative impacts on other aspects of their lives. Some made the point that earlier intervention would have led, in their view, to better outcomes.

Some patients suggested that having clearer information about waiting times for treatment and where they were on the waiting list would be improvements that help manage expectations and reduce the anxiety attached to not knowing how soon treatment would begin.

Patients rarely mentioned being offered and/or accessing support while waiting which could indicate that it was not commonplace. Amongst those who referenced interim support there was mixed feedback as to how beneficial it was while waiting.

In contrast to comments about long waits, there were noteworthy exceptions sharing positive feedback about how quickly patients had been seen. While some cases related to emergency care, in other feedback it was not always clear whether being seen quickly related to treatment or an assessment.

No access to treatment

Some patients commented that they had been unable to access any treatment or a particular type of treatment that had been recommended. Feedback did not always clearly state why treatment was not received. When this was shared, some patients understood they had been refused care because they were already receiving support from another team.

In other cases, patients shared they had been told there was nothing the mental health service could offer them. The subsequent impact was that patients could be left feeling dismissed and this reduced the likelihood of them asking for help in the future.

In other comments patients suggested the lack of access they experienced could be linked either to long waiting times or capacity issues.

Responsiveness

A theme with mixed sentiment was the responsiveness of services – that is, the extent to which care and support was provided when needed and adjusted to the changing needs of individuals. Positive comments focused on there always being a source of help available if needed.

Lack of responsiveness when trying to access services due to changing symptoms or circumstances was a clear theme in feedback on areas to improve. The difficulty contacting a clinician, particularly those who could handle prescriptions, was also mentioned by several patients. There is related insight shared later in the report within the sub-theme ‘Contacting services.’

Physical barriers

What does the quantitative survey data tell us?

• 56% had not been asked by their NHS mental health team if they needed support to access their care and treatment (Q35).
• 35% reported that they need support to access care and treatment (Q36).
• Of those respondents that required support, 74% required emotional support and 30% required support in accessing online appointments (Q37).

Some patients highlighted physical barriers to them being able to access in-person treatment and services. Feedback covered travel distance to services, the importance of help with transport to appointments, and in one case a building not being wheelchair accessible.

Theme: Staff

What does the quantitative survey data tell us?

• 65% felt they were ‘always’ treated with care and compassion by their NHS mental health team (Q13).
• 51% reported they were ‘definitely’ given enough time to discuss their needs and treatment (Q8).

Staff clearly played a critical role in shaping the patient experience. Feedback covered a wide range of roles demonstrating the impact all individuals in the workforce can have. The evidence suggests that continuity of care is critical but systemic pressures and evolving patient needs create a challenging context to achieve this.

Personal attributes

A strong theme in the positive feedback was references to individual staff members or teams. A wide range of roles were singled out for praise, from clinicians such as therapists, psychiatrists, and nurses to care co-ordinators, and receptionists.

A few patients reported that individuals had gone ‘above and beyond’ what was expected.

The importance of staff demonstrating kindness and a caring attitude in particular came through strongly. There were many descriptions of staff being friendly, compassionate, non-judgemental, empathetic and supportive.

While there were fewer negative comments about staff personal attributes, lack of care and lack of kindness was highlighted in feedback. Some patients described staff as unsympathetic, dismissive, and patronising.

Professional attributes

Many patients highlighted the professional behaviour of staff. This included positive comments on staff being competent, polite, respectful and treating patients with dignity.

A few patients highlighted the competence and specialist knowledge of staff who supported them having a positive effect on their care.

In contrast, some patients described unprofessional behaviours of staff, a few of which were described as serious incidents. These included being significantly late for appointments, breaking patient confidentiality, and making inappropriate comments that could cause harm.

Staff training

Responses included calls for better staff knowledge or training, including on specific types of mental illness and neurodiversity. Feedback highlighted a mix of training needs for both specialist mental health staff and other healthcare professionals. Some patients held a view that staff had lacked necessary expertise or were underqualified.

Continuity of care

What does the quantitative survey data tell us?

• 36% said they ‘often’ had to repeat their mental health history to their NHS mental health team (Q12).

Patients described the importance of having the same clinician or support worker over an extended period. Feedback demonstrated that this could be affected by staff being off sick or unavailable as well as high staff turnover. Changing therapist or consultant was often described as stressful. A few patients described clinicians or support staff leaving and not being replaced, the consequences of which were a lack of support for periods of time.

One of the impacts of not having continuity of care was reported as creating a need to repeat their story – which could be described as re-traumatising. Outside of situations where staff changed, being asked to repeat information made patients feel unimportant, and was felt to be a waste of time. Feedback demonstrated how crucial it is to patients that staff are aware of personal details and their previous history, whether this was from memory or reading notes. Something as simple as remembering someone’s name made a positive difference.

Positive comments where continuity had been experienced make it clear how important this is to the patient experience including how it helps patients feel cared for, safe and removes the need to repeat themselves and relive their personal journey.

Theme: Treatment

What does the quantitative survey data tell us?

• 48% stated that the support was ‘completely’ appropriate for their mental health needs (Q7).

Feedback demonstrated a lack of confidence some patients had in their treatment, particularly when they felt unclear on their diagnosis, their care plan and/or feeling listened to about their needs. Further, there was evidence that difficulties in accessing therapy or other treatment they felt was appropriate and timely, contributed to a lack of trust in the service overall.

Diagnosis

Where patients mentioned diagnosis this was most often to highlight its importance at both practical and emotional levels – including helping them to move forwards. Those who shared that they had received a diagnosis indicated that this was helpful to them. Others expressed frustration and sometimes suspicion at not getting a diagnosis or not having the opportunity to explore and treat the underlying causes of their mental health problems rather than just the symptoms. For a few, receiving a diagnosis had been important in unlocking access to treatment, understanding themselves better, or securing additional support such as reasonable adjustments at work.

Medication

What does the quantitative survey data tell us?

• 83% reported that they had received medication for their mental health needs in the last 12 months (Q20).

Feedback about medication was mainly negative, with a variety of issues shared including:

• lack of information on side effects
• unable to find medication that works for them
• desire for therapy or other support as well
• lack of support for side effects
• lack of support when changing dose
• infrequent medication reviews

Length

In the same way as intervals between appointments, the length of each appointment had mixed feedback. Positive feedback included patients who did not feel rushed, which made them feel more confident and that they had the ability to ask questions.

The opposite was found in comments where this was flagged as an area for improvement, with patients sharing they felt rushed and unheard.

Being listened to

What does the quantitative survey data tell us?

• 52% felt they were ‘always’ listened to by their NHS mental health team (Q9).

Feeling listened to was a thread in feedback, most notably relating to therapy sessions though other examples were shared. Patients highlighted that when they felt heard, this made them feel safe, relaxed and that they could be honest.

Conversely, when patients did not feel heard or did not feel that they were being ‘taken seriously’, it was harder for them to trust and engage with support. Impacts shared by patients who did not feel they were listened to were feeling they were a ‘problem/burden’ or that they were not being treated as an individual but as a number. This links strongly to the insights on attributes captured earlier within the ‘Staff’ theme, demonstrating the value of feeling important and being treated as an individual.

Further, some patients reported feeling frustrated that their views were not heard which could have detrimental impacts on their mental health.

Suitability of therapy

What does the quantitative survey data tell us?

• 61% reported that they had received any therapies for their mental health needs in the last 12 months (Q24).

A positive theme that emerged was how receiving specific therapies were helpful and made a positive difference to mental health and quality of life.

A very small number of patients highlighted types of therapy that they felt had been unhelpful for them personally, inferring their needs may not have been assessed sufficiently to provide effective treatment.

Crisis care

Some respondents made specific reference to crisis care provision, with largely negative feedback evident. Many of the comments reflected sub-themes elsewhere in this report, including but not limited to ‘Choice’, ‘Waiting times’, ‘Contacting services’, and communication ‘Between staff and patients.’ A summary of the feedback shared pertaining to crisis care is as follows:

• unsympathetic staff
• no one answered or no one called back
• uncertainty about which number to call for access
• need for access on behalf of patients who are unable to seek help themselves
• lack of communication between crisis care and other CMHT teams
• positive experiences described services as quick and caring

Patients could be scathing about the quality of crisis care, describing the experience from the service or staff as unsympathetic, reporting not receiving any help or feeling worse after calling the crisis line.

Negative feedback often related to the difficulty in contacting crisis teams or emergency helplines. Patients describe being unable to get through, long waits, and calls not being promptly returned. Some patients had called what they believed were crisis helplines only to be directed elsewhere or to call back. There also appeared to be a lack of understanding as to the role of NHS 111 in relation to mental health crises, including within the service itself.

A few patients highlighted the problems of crisis help being available by telephone as they could struggle to make the call themselves. This could lead to suggestions that crisis phone numbers should be accessible to family or carers of patients to make a call on their behalf.

Other comments demonstrated the high value placed on in-person assessments when in crisis and included examples of the positive impact this could have on experiences with the service.

Better communication between crisis care and other mental health teams was also occasionally recommended.

Some patients reported positive interactions with crisis services and praised the quick and caring support they received.

Transition to adult services

Individuals aged 16-35 consistently identified the transition between child and adult mental health services as an area requiring improvement. Descriptions included the experience of ‘losing’ support once aged 18 alongside a lack of handover being described as disruptive.

Support for family/carers

Feedback suggests that when offered, support for family and/or carers could be very valuable. Other feedback highlighted this as an area for improvement, including calls for more education for families/carers on mental health to reduce stigma. Some comments interlinked support with involvement which is detailed further in the ‘Involvement of family/carer’ sub-theme within ‘Personalised care.’

Theme: Personalised care

This theme demonstrates the high value patients place on receiving personalised care. This included being offered greater choice and the ability to engage with support for other parts of their lives which influenced mental health as well as treating specific symptoms.

Choice

What does the quantitative survey data tell us?

• 64% said they were given a choice on how their care and treatment would be delivered (Q16).

Feedback included several areas where patients would welcome greater choice in whether they had therapy as part of their treatment, and how their therapeutic care was delivered including:

• method
• location
• mode
• practitioner

Some patients commented that they had a desire to access a specific type of therapy but indicated they were not given a choice. Often this related to individual talking therapy, with some sharing that not being able to access the approach they would choose for themselves left them feeling dismissed.

Positive feedback was notable when patients had home visits, particularly when this enabled individuals to access care when they might otherwise have struggled to attend an appointment.

A strong desire for face-to-face rather than telephone or video contact emerged as an area for improvement. However, choice and flexibility were key as the evidence suggested that what might be the preference of one person would not work for someone else.

Finding a therapist or support worker whose style worked for the patient was also an important element where patients were looking to make a choice for themselves. Some patients described getting on better with one therapist than another, and where they had been able to express a preference or change therapist, this was appreciated.

Tailored adjustments

Where support was flexible and could be tailored to the individual, this was reported as making a positive difference. Patients appreciated when staff took time and effort to get to know them, and when adjustments to accommodate individual preferences and circumstances were made.

In contrast, when care was not tailored to needs or preferences this was highlighted as an area to improve as it undermined confidence for patients in their treatment.

Holistic care

Feedback was mixed about support for patients outside of clinical support for mental health. Where this had been experienced it was reported to enhance both the experience of care and the impact of treatment for the individual.

What does the quantitative survey data tell us?

• 46% said their NHS mental health team ‘definitely’ considered how areas of their life impacted their mental health (Q11).
• 29% felt their NHS mental health team ‘definitely’ supported them with their physical health needs (Q32).
• The following percentage reported ‘definitely’ receiving help or advice from their NHS mental health team with finding support in the last 12 months for: 29% joining a group or taking part in an activity; 14% finding or keeping work; 17% financial advice or benefits; 11% cost of living (Q33).

Patients highlighted positive experiences of care when they felt their needs as a whole were addressed, including getting help with welfare benefits and addiction for example.

The importance of attending to other aspects of patients’ lives, such as physical health, was raised as an area to improve. Comments included requests for support around housing, finances, employment and benefits, with improvements suggested in signposting to social and leisure activities.

Involvement in decision-making

What does the quantitative survey data tell us?

• Of those with a care plan, 71% said they were involved to ‘a large’ or ‘very large extent’ in agreeing their care plan with their NHS mental health team (Q15).
• Of those who wanted to be in control of their care, 29% said they ‘definitely’ felt in control (Q19).

There were both positive and negative experiences shared about the level of involvement patients felt they had in decisions about their care. Positive examples from patients described how care plans and decisions were developed collaboratively between patient and clinician.

In contrast, some patients highlighted a lack of involvement in decision-making about care plans or treatment options.

Involvement of family/carers

What does the quantitative survey data tell us?

• 45% said that NHS mental health services ‘definitely’ involved a member of their family or someone else close as much as they would like (Q34).

Patients and carers highlighted the importance of involving family/carers in decisions, noting a thread in this feedback was the context of patients having a diagnosis of dementia.

Theme: Communication

Feedback on communication was predominantly negative and highlights the important role it has in building trust and confidence. In turn, positive communication experiences encourage patients to engage and support self-management.

Between professionals

There was mixed feedback on experiences of communication between professionals, with comments not always clear whether this was within teams or between teams and/or organisations. Most feedback highlighted this as an area for improvement, with patients describing a lack of, or minimal, communication between professionals leading to frustration and delays in accessing treatment.

Positive feedback included examples of effective co-ordination across different professionals and services.

Between GP and CMH

The communication between GPs and community mental health services was identified as an area for improvement when feedback about communication between professionals was attributed clearly to specific services. Examples of impact shared included a lack of clarity on who was responsible for the next steps in treatment and delays to treatment.

Between staff and patients

There was mixed feedback from patients about their communication with staff. Although predominantly this was raised as an area for improvement, there were also positive examples shared. There were links to insights detailed within the ‘Between professionals’ and ‘Contacting services’ sub-themes.

Patients shared a range of communication issues between staff and patients as follows:

• lack of clear explanation, such as diagnosis or care plan
• not checking patient understanding
• not tailoring information to the individual
• lack of explanation for the purpose of therapy and/or medication
• not keeping patients informed of changes
• not explaining potential side effects of medication

Where patients shared detailed examples, the impact of communication issues was often that patients were left feeling concerned or that they were missing important information.

Further evidence of the importance of clear explanations and feeling fully informed about the purpose of treatment was evident in the positive feedback. Patients placed importance on transparency from staff involved in their care, linking to the positive examples shared in earlier sub-themes on ‘Personal attributes’ and ‘Professional attributes’ within the ‘Staff’ theme.

Contacting services

What does the quantitative survey data tell us?

• 78% said they knew who to contact out of office hours within the NHS if they had a crisis (Q27).
• Of those who knew who to contact out of office hours, 45% said they had done so in the last 12 months (Q28).
• Of those who had contacted out of office hours, 40% said they ‘definitely’ got the help they needed (Q29).

Having the ability to contact services was highlighted as an area to improve, adding weight to the earlier sub-themes on ‘Waiting times’ and ‘Crisis care’ which further evidenced difficulties patients had experienced. A range of issues were raised in the feedback relating to contacting services, including:

• not knowing who to call
• multiple contact details causing confusion
• inability to contact services outside office hours
• unsure which team or organisation to contact
• calls not returned
• long waits for calls to be answered

Feedback also drew attention to the complexity and difficulty of navigating the ‘system’ to access the care that they needed. Patients described feeling confused at having multiple staff or departments to contact, and frustration at being referred to services that did not exist or which they felt were inappropriate for their needs.

Administration issues

Patients shared a variety of examples in areas for improvement that evidenced administrative errors and their impact on the patient experience. This included referrals being sent to the wrong team or overlooked, causing delays in getting assessments and care. Other issues included letters which caused confusion and upset, and incorrect or incomplete record keeping.

Accessibility

Feedback indicated that limited methods for communicating with services presented a barrier to accessing care for some patients. This includes feedback from patients who had difficulties using the telephone and requested other communication methods and for those needing interpreters.

Theme: Outcomes

What does the quantitative data tell us?

• 38% felt they ‘definitely’ got the help they needed (Q10).

Moving on from care was mainly raised as an area for improvement. Feedback suggests that patients need to have expectations about outcomes managed, and that it is important to ensure there is clarity on next steps before discharge.

Ongoing support needs

There was feedback that the time-limited nature of treatment was insufficient in addressing patients’ needs and left some feeling issues were unresolved when they reached the end of treatment. This echoes the ‘Frequency’ and ‘Length’ subthemes earlier in the report, which explored how the length and frequency of appointments could be insufficient in meeting the needs of patients for ongoing and/or longer-term care.

Discharge

Patients shared feedback on their experiences of being discharged from treatment. Comments on discharge were often negative, with patients describing the experience of being discharged without notification or feeling that it was an abrupt ending. A few patients lacked clarity on why care had concluded, inferring they still had needs.

Patients also described being discharged without follow-up support, and that they felt abandoned. Examples of impact describe the worsening of patients’ mental health because of this experience.

A few examples were shared by patients who were discharged because of non-attendance at appointments, despite still having mental health needs. Other comments indicated patients felt they had been ‘threatened’ with discharge for non-attendance or non-engagement, with suggestions that any difficulties in attending were not accounted for.

Impact

Responses included positive feedback from patients who felt that they had received the help and/or treatment they needed, even if it took a while.

Many patients described the positive impacts their care had on them. Examples shared by patients included greater understanding of their condition; developing coping strategies; increased confidence and wellbeing; and getting back to their ‘usual selves.’ In some cases, the support was said to have been lifesaving.

A lack of positive impact was also shared, with some of these comments capturing how engagement with mental health services had in their view exacerbated anxiety and stress. Some patients expressed frustration that their situation had not been adequately addressed or improved.

Other observations

Below is a list of other topics commented upon in the data that were noted during the analysis process. There was a lack of volume of comments or depth and detail to inform themes and sub-themes but suggestions are noteworthy:

• Observations from patients on staff shortages and suggestions to increase funding
• Dissatisfaction in how formal complaints were handled
• Experience of digital therapy platforms being unreliable
• Mixed perceptions of involving students in therapy sessions

4. Conclusions

This is the first national qualitative analysis delivered for the Community Mental Health Survey, and the breadth and depth of the insights demonstrates the value of inviting respondents to share their experiences in their own words. This approach has enabled respondents’ voices to shape the focus of the findings, highlighting what is important to them and what impacts their experience of care.

Overall, the report demonstrates the height of the stakes in delivery of mental health care, whereby a positive experience can be life-changing if not lifesaving, and a negative experience can worsen patients mental health and in some cases, result in trauma. There are significant challenges in access and delivery that can undermine confidence in the service. Systemic pressures and inconsistencies in care delivery undermine reliability, quality and at times, patient safety. The insights underline the importance of addressing structural challenges alongside improving relational aspects of care.

From the patient perspective, high quality community mental health care should be timely – especially in crisis – easy to access, and delivered by staff who show kindness and consideration. Personalised care is fundamental: patients need to feel heard, have some agency over their care, be treated as individuals, and receive support that adapts to their needs. Treatment should be frequent and long enough to address underlying issues or help patients manage their condition. Clear information and regular updates are also essential about their condition, care plan, waiting times and medication. Continuity of care, avoiding repeated retelling of traumatic experiences, and effective coordination across services, all feature strongly. The findings also suggest improvements are needed both in pathways into services and within them to build trust and support navigation.

The diversity of patients, their expectations and needs identified in this analysis demonstrate a varied and challenging context. The findings highlight the need to alleviate systemic pressures on staff, as workforce shortages and capacity constraints directly impact on care quality and can be seen throughout, e.g. gaps in crisis care, waiting lists, handover issues, missed referrals, ‘early’ discharge. Addressing these pressures is essential to enable staff to deliver the standard of experience of care described by respondents.

This report offers a comprehensive view of improvement opportunities though has limitations in determining which matter most and would make the biggest impact for patients. Triangulation with other datasets and targeted engagement activities are recommended to identify high-impact priorities. Ongoing listening and involvement of service users will be vital to ensure that national and local improvement efforts deliver the most meaningful gains.

5. Appendix: Qualitative analysis

Survey methodology

In 2023, the Community Mental Health Survey underwent a large-scale redevelopment, revising both methodology and questionnaire design. The 2024 survey continued to use the push-to-web methodology, with the questionnaire available to be completed online as well as in paper format.

The Community Mental Health Survey looks at the experiences of people aged 16 and over who received treatment for a mental health condition between 1 April and 31 May 2024. The survey received feedback from 14,619 people – a response rate of 20%.

Qualitative analysis

Thematic analysis was undertaken to achieve a deep understanding of the findings from the open questions asked in the survey. This sought to facilitate reflection and learning across services delivering community mental health in England.

To analyse qualitative data, the standard six steps of thematic analysis were used to identify patterns of meaning within the data and explore commonality and contrast – see Figure 1.

Thematic analysis approach

An inductive approach was undertaken for the data analysis of responses to QA and QB, which is a systematic method where themes emerge from the data without any pre-existing framework being used. As a high level of consistency was found between the themes that emerged and the responses to QC, a deductive approach was used for the analysis of QC comments. This means that the thematic codes created in the analysis of responses to QA and QB were used to analyse QC.

The results of the thematic analysis have been reviewed and are shared in context of the relevant quantitative survey findings. This exploits the value of both the quantitative results, which tells us the proportion of respondents feeling a certain way, and the qualitative findings, which tells us why people feel that way. For example, where there is a high degree of agreement / positive experience evidenced in the survey data, the thematic findings offer an opportunity to understand why there was not 100% agreement / positive experience and therein, where the opportunities lie for reflection and learning.

Sub-group comparisons

Sub-group comparisons were not the focus of the analysis. Where variations were observed in the national sample, this has been included within commentary. It is recommended that further focused sampling would allow for in-depth exploration of how experiences of community mental health may vary for different groups. Observations included will unlikely be exhaustive due to the national sample and focus.

6. Appendix: Sampling approach

9,090 individuals (62% of the survey sample) provided a written response to at least one of the three open ended questions.

Qualitative data cleaning

Before sampling, further data cleaning was carried out to identify and remove extremely short comments which were of no analytical value, for example those which simply stated ‘No’, ‘N/A’ or consisted of a single character.

For QA, 1,553 comments were removed in this way, leaving 7,537 comments for the sample to be drawn from. For QB, 2,580 comments were removed, leaving 6,510 comments for the sample to be drawn from. For QC, 4,904 comments were removed, leaving 4,186 comments for the sample to be drawn from.

Sampling

It was decided to sample each of the questions separately so that all respondents with viable response to each open question had the potential to be included in the final sample for analysis. A total sample of 1,943 responses (658 (QA), 641 (QB), 644 (QC)) were analysed.

To ensure a robust approach to sampling, a purposive sampling approach was taken. This is an established best practice technique when analysing qualitative data, as it ensures that the data has enough diversity across the most relevant criteria to allow the impact of the criteria to be explored and compared. For example, if age is a criteria, including responses from all the different age groups in sufficient volume means that differences in experiences between age groups can be explored.

The criteria chosen to sample on were the age, ethnicity, gender identity, and deprivation level of respondents, as these were key demographic groups recorded in the data. A sample matrix was drawn up to establish how many comments from each of the demographic groups were to be included in the analysis to allow for sufficient coverage.

In addition to the three key demographic groups a minimum of 30 comments were included on all other characteristics including sexual orientation for instance. Please note that as there was a low volume of data from respondents identifying as Intersex, all of this cohort were included in the sample. The breakdown of the volume of comments in the sample by these different criteria is provided below.

Once the original sample of 1,943 comments had been analysed it was seen that data saturation had been reached, i.e., no new themes were emerging from the data. Had this not been achieved, additional comments would have been added to the sample as necessary, in line with best practice in qualitative analysis.

The tables below show the number of comments in the analysed sample per question. The sampling approach ensured sufficient coverage across key demographic groups to allow for exploration of how experiences may vary.

Table 1: Number of comments in analysed sample per characteristic for QA

Table 2: Number of comments in analysed sample per characteristic for QB

Table 3: Number of comments in analysed sample per characteristic for QC

Appendix: Glossary