Chronic underinvestment leading to misery for mental health services and patients.
The chronic underinvestment in mental health care is evident when in just one-month last year 745 patients had to travel out of their local area simply to get a bed, with NHS patients often farmed out to private providers at premium cost. This is a cost the system can ill afford, with mental health taking up to 23% of NHS activity, yet the funding allocated for mental health is just a quarter of that. The creaking, overburdened mental health system, means the number of suicides is at its highest level since 2002, and despite the numbers of beds falling, admissions to psychiatric wards have nearly doubled since the Conservatives came to power in 2010. With such a depressing state of affairs, you would think a new Prime Minister, keen to distance himself from his own Party, and damaging policies, would want to make change a priority with this intention expressed in the Queens Speech. But no, although mental health did get a mention, it was only in relation to the Mental Health Act of 1983 amended in 2017. Still, although the Act is only a small part of the overall system there are problems that need addressing. Also, it gives those of us eager for an overall change to the provision of mental health services chance to once again make our case. The figures from NHS Digital show that since the Conservatives gained office in 2010 the number of people detained under the Mental Health Act has nearly doubled from 26,481 in 2008/2009 to 49,998 in 2018/19. Within these figures there are groups of patients who are being continually let down by the mental health system. These include BAME patients, with a black person being four more times likely to be detained than someone who is white. This is not a new finding. The Royal College of Psychiatrists in their report ‘Racism and Mental Health’ pointed to the 2014 Adult Psychiatry Morbidity Survey which showed that black British adults had the highest mean score for severity of mental health symptoms but were the least likely to receive help. When they did have contact with services, they were more likely to be detained on a section. With the pressure within the system it would be a pertinent question to ask what the care, assessment and treatment those detained under the Act receive, because it can be a vulnerable position to be in, unable to leave, ‘living with’ other patients and dealing with staff. For example, a patient can be at risk when on a mixed-sex ward as The Health Service Journal found in their report of 2017 with over 1,000 sexual assaults. The figures in the report were only the trusts who responded to the Freedom of Information request so the actual figure will be considerably higher. Of these assaults, 491 led to safeguarding actions and 104 were reported to the police. One can only imagine the terror if you are miles away from home, on a section, and then you are subject to a sexual assault. Patients with a dual diagnosis of learning disabilities and mental health problems have long been looking for The Green Light Framework to be enacted. This framework is from the last Labour government, but the Tories still haven’t done this, which potentially places such patients at more risk. Evidence of this risk was shown on BBC Panorama where at Wharton Hall patients were regularly physically and verbally attacked by yobbish staff. Many were put into long term seclusion in degrading conditions. Similar issues were found at St Andrews Healthcare who had many young patients with dual diagnosis put in seclusion for weeks and months at a time. The damage this would do to someone with learning disabilities and mental health problems would be with them for life. In Middlesbrough, the Forest Lane unit was ordered by the CQC to be shut down, after two teenage patients died within two months. The Director was able to stand down from his 200k- a- year post, with no action against him. There’s no doubt that the rise in admissions is putting pressure on hospitals, units and staff, however, that doesn’t give a defence for treating anyone with additional needs in a way that fails to keep them safe, supported and helped with a genuine commitment to protect and promote recovery. Joining the dots for contributory factors that could explain the rise in admissions is not difficult with Austerity cuts leading to the loss valuable back-up services such as in the voluntary sector, charities working in this field and supported housing places. Added to the almost annihilation of key services is the ongoing onslaught against those with additional needs through changes to benefits, which are leaving some of the most vulnerable in society to cope with the turmoil of multiple assessments and tribunals, trying to manage when given petty but devastating sanctions and attempting to navigate the unfathomable Universal Credit system. The issue of these contributory factors was raised by Sophie Carlett, Director of External Relations at MIND who said: “The government must address the overall state of mental health services as well as implement a cross-party solution to address issues like benefits and housing which have an enormous impact on the lives of people with mental health problems.” All this is still happening with the government fully aware their own policies and cuts have had a direct impact on the mental health of the nation. By the shredding of the safety-net, far more people are falling through. A rational response would be to stop detaining people so much and instead give them a proper chance at life, with all the support structures in place, including decent housing. This might help to reverse the life expectancy for people with a mental illness, which could be 10 or 20-years loss. Instead, the government are choosing to ignore or deny any connection between their policies and the devastating reality of mental health services today. They are far too ready to tinker around the edges of the Act while the mental health system is disintegrated into chaos around them. This article was first published in The Morning Star