Mental Health Services Under-Resourced ? Yes ! Suicide Prevention Minister And Related Reports Covering The Meltdown

For issues specific to caring for someone with mental ill health.
Brilliant from The Eye again ?

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yes, that was a laugh out loud one! poor woman probably will end up in psychiatric ward I should think....possibly by tomorrow morning even!

However, re the cartoon captions, a friend of mine had a relative who was in a psychiatric ward after a breakdown and when she visited, she was told that he seemed to have delusions, and kept going on about how he used to have lunch with Cherie Blair....

My friend had to tell the nurse that actually, he was a senior barrister before he retired and yes, DID used to have lunch with Cherie Blair....
Cherie Blair ?

You're wish is my command :

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Mental health patients detained in hospital wards for up to 21 years.

Guardian finds many people confined far from families, sometimes for decades.



A patient locked in a secure ward for more than 21 years is among hundreds of people with mental health problems being kept in what one MP has called “old-style asylums” in NHS hospitals, an investigation can reveal.

Keeping people in so-called “locked rehabilitation wards” has been condemned as “outdated and sometimes institutionalised care”, by the NHS watchdog, with many patients housed far from their homes. This is despite a 2017 report by the Care Quality Commission (CQC) that said the model of care had no place in a modern healthcare system.

Using freedom of information laws, the Guardian has found that:

At least 435 patients spent time in locked rehabilitation wards in 2018, up from 404 in 2015.

One patient at Birmingham and Solihull mental health NHS foundation trust spent 7,914 days – more than 21 years – in one of the wards.

The average length of stay in a locked unit at Sussex Partnership NHS foundation trust was 602 days, almost two years.

There is no set definition of a locked rehabilitation ward, but it generally means a unit where patients are unable to leave as and when they want. They started being used about 10 years ago, mainly provided by the private sector to treat people who were considered high risk to others, so with serious conditions such as psychosis.

But critics have condemned the approach “which has no place in modern Britain”, according to MPs. A report from the CQC in 2017 warned that the practice leaves already vulnerable patients feeling isolated and less likely to recover.

Rajesh Mohan, chair of the Royal College of Psychiatrists’ rehabilitation psychiatry faculty said that a lack of clear definition of “locked rehabilitation” care means, there are no agreed quality standards and it’s hard to “say whether a person’s liberties are deprived”.

“If the principle of care is based on locking the doors, people cannot leave the building, then you cannot have voluntary patients at all there … It means restrictions are applied to everyone rather than there being a focus on recovery,” he said.

Liberal Democrat MP Norman Lamb said: “They are like old-style asylums that have no place in modern Britain. What we are doing is a fundamental breach of people’s human rights.

“It is a complete contradiction in terms: locked rehabilitation ward. Their [the CQC’s] conclusion was that many people in these wards don’t need to be there. That means that there are lots of people who are capable of living independent lives with support who are locked up.”

Mohan said that in the last 10 to 15 years more than a third of NHS rehabilitation services have been wiped out. “The need for these services has not gone away. People with lots of complex and enduring symptoms need rehabilitation treatment and the private sector stepped in to bridge this service gap, but people may become isolated in these units for long periods of time.”

He said he would not describe these services as old-style asylums but the problem is people end up in these units for too long as there is no step-down provided and no community services to support people leaving wards.

“People in rehabilitation units should be able to move on to less restrictive rehabilitation settings. But that will only happen if they have places to be discharged to, such as supported accommodation with 24-hour supported community care. There will be some people whose illness and symptoms are very severe, but that does not mean they should be stuck in hospital for 21 years. There needs to be more focus on community rehabilitation teams and high quality supported housing.”

The Guardian found that 404 patients in NHS hospitals were in locked rehabilitation wards in 2015, rising to 435 in 2018. A freedom of information request sent to all mental health trusts resulted in 11 trusts saying they had such wards, compared with 32 who said they did not. Thirteen trusts did not respond in time.

Central and North West London NHS foundation trust had the highest number of patients, with 104 staying in secure wards in 2018. The longest stay of a patient was 2,914 days – six days shy of eight years.

The trust said it runs specialist rehabilitation services for people with “complex mental health problem” and are one of the largest providers because they cover a large local and neighbouring area.

”We’re very different from old style asylums; our facilities are hospitals, modern and bright … The majority of people stay between six and 18 months … There are a few people who need to stay longer (eg Home Office restriction orders), and we work to identify other options for them.”

Birmingham and Solihull Mental Health NHS foundation trust had a patient stay for 7,914 days, more than 21 years. Another patient stayed for 6,174 days, almost 17 years.

They did not comment on these individual cases but said: “There remain a small number of patients within our locked rehabilitation wards in Solihull who have required long-term treatment in a hospital setting. There are currently no alternative settings in Solihull offering appropriate residential care for this group, who need specialist support. Cases are reviewed regularly.”

At Sussex partnership NHS foundation trust the average length of stay in a locked unit was 602 days, almost two years. The trust said: “Our priority is always to ensure that the people who need our specialist services receive the best possible care, at the right time and, crucially, in the right setting and that they remain in that setting only for as long as they need to.”

In 2017, a report by the CQC found that more than 3,500 patients in 248 mental health wards were kept locked-in, the majority in private mental health hospitals.

The report stated: “Our inspectors were concerned that some of these locked rehabilitation hospitals were in fact long stay wards that risk institutionalising patients, rather than a step on the road back to a more independent life in the person’s home community.

“We do not consider that this model of care has a place in today’s mental healthcare system.”

Paul Lelliott, deputy chief inspector of hospitals at the CQC, said: “These findings echo our own concerns highlighted last year that some people in mental health rehabilitation wards experience long stays in services, some situated a long way from the patient’s home. Rather than helping people get well these factors can increase their sense of institutionalisation and slow down recovery.

“Rehabilitation wards are an essential element of a comprehensive mental health service but they should live up to their name and be focused on helping people recover rather than being ‘long-stay’ wards in disguise. ”

An NHS England spokesperson said :

“As the CQC make clear, ‘inpatient’ rehabilitation wards are a key part of good mental healthcare and while no one should stay any longer than necessary, in a tiny number of cases, it might remain the safest and most appropriate treatment setting for both the individual patient and wider community.

Patient confidentiality of necessity means individual details must be kept private, but absent this specific information known to patients and their clinicians it behoves commentators not to jump to ill informed generalisations.”
Child mental health: UK provision " Worse than in much of eastern Europe. "

Research places UK behind countries such as Estonia and Latvia in numbers of hospital places and psychiatrists.



Britain has one of the lowest numbers of hospital beds in Europe for young people struggling with serious mental health problems, EU-funded research has found.

It is lagging far behind the level of provision in many much poorer countries in eastern Europe, such as Latvia, Estonia and Slovakia, according to a study of care for troubled under-18s across the EU.

Britain has 9.4 specialist inpatient beds per 100,000 young people for those who are suffering from conditions such as anxiety, depression, psychosis, self-harm and suicidal thoughts. That places it 18th in a league table of the 28 EU countries, researchers say.

Germany has the most, at 64 beds per 100,000 young people, and Sweden has the least, at just 1.2 beds. Latvia, Lithuania and Estonia have 39.5, 31.5 and 21 beds per 100,000 under-18s.

The UK is even lower down the EU league table for the number of psychiatrists specialising in child and adolescent mental health services (CAMHS). With just 4.5 psychiatrists per 100,000 young people, it comes 21st. That is far fewer than Finland, which has the most, at 36 such specialists per 100,000 under-18s.

On that measure, Britain is again behind a raft of east European countries such as Estonia (16.8), Lithuania (14) and Latvia (11.2). Bulgaria, the country with the fewest, has only 1.9 psychiatrists for every 100,000 children and young people.

Experts warned that the UK’s low rankings meant that troubled under-18s were not getting the care they needed.

“Our youth deserve better than what they currently receive. Despite being the sixth-richest country in the world, and with a health service that is said to be the ‘envy of the world’, when it comes to mental health provision for children and young people, the UK sadly lags behind other EU countries on many indicators, especially on the number of CAMHS psychiatrists”, said Prof Swaran Singh of Warwick University, referring to the NHS’s child and adolescent mental health services.

Singh is one of the academics involved in the Milestone project, to which the EU has given €6m (£5.18m) to look into CAMHS care, including its availability, across the 28 countries.

“The Milestone project has shown how far we are from providing much-needed help and care to vulnerable young people at the time of their greatest need. Despite repeated promises by successive governments of increased funding into youth mental health care, the state of the services remains parlous,” added Singh.

Tom Madders, director of campaigns at the charity YoungMinds, said that the UK’s lack of beds was forcing young people in a mental health crisis to travel far from home simply to get a bed in an NHS unit.

“If young people are so unwell that they need inpatient care, it’s vital that they can get it quickly and as close to home as possible. But, at the moment, families in the UK are too often forced to travel long distances to inappropriate out-of-area placements because services are overstretched,” Madders said.

Meanwhile, new research has also found that GP services need to be able to offer longer appointments to people who are thinking about killing themselves, if GPs are to help reduce the number of those deaths.

While only 2,000 of the 6,000 people a year who kill themselves have contact with NHS mental health services before their death, many more have seen their family doctor. Better GP training in support for those at risk, and more emotional support for them, would offer more potentially life-saving care to those with thoughts of self harm, according to findings published by the Centre for Mental Health thinktank and the Samaritans.
More mental health patients sent " Hundreds of miles " for care.

More mental health patients are being sent hundreds of miles from home for treatment, new figures have revealed.


NHS figures showed more than 3,000 patients were placed over 100km (62 miles) from home for treatment because of a lack of beds - a 35% increase since last year.

The NHS spends an average of £9m a month on so-called inappropriate Outside Area Placements (OAPs).

The Government has pledged to eliminate inappropriate placements by 2020-21.

Vicki Nash, head of policy and campaigns at the mental health charity Mind, said: "We have heard repeated promises from the NHS to completely eliminate inappropriate out of area placements, and yet we know the number of these placements has increased.

"Too many of us with mental health problems are being forced to travel hours from friends and family to receive the treatment we need.

"This can worsen people's chances of recovery, as well as being expensive for the NHS."

" My entire reality was ripped away. "

A few months before her 18th birthday Katie Scott was sectioned under the Mental Health Act.

She was moved 160 miles (257km) away from her Wokingham home to a hospital in Norwich to continue her treatment for borderline personality disorder and anorexia.

"I remember when I got there lying on my bed for four hours and just crying. I didn't want to eat, I didn't want to move," Ms Scott told the BBC.

"The fact that it was so far away meant that there was probably a four-month delay in my recovery."

"It felt like my entire reality, everything I had known ever known, had been ripped away".

Her mother Hazel made an eight-hour round trip every weekend for seven months to see her daughter.

She said mental health treatment was "woefully underfunded".

"Having young people or adults placed great distances from their home doesn't just impact the patients, it impacts their family massively.

"Your mind goes into overdrive thinking about how she's doing and how she's coping.

"Local mental health care is essential. The more we can have the better it will be."

The NHS has published monthly figures on mental health placements since October 2016 and detailed statistics have been available for two years.

Between March 2018 and February 2019 - the latest period available - the NHS spent £109m on placing mental health patients outside of their local area due to a lack of bed space.

On average 80% of placements were in private mental health care units, funnelling money away from stretched NHS services.

Last year 8,545 inappropriate OAPs were started.

The average placement lasted 27 nights but 255 placements lasted more than three months.

Of the 275 patients moved more than 300km (186 miles) for a bed last year, nearly half were from the South West of England.

A 99% reduction

"All I knew was I was going to be away from home, I didn't actually know where I was going."

Terry Proudfoot has suffered with mental health difficulties throughout her life, which led to bouts of serious self-harm.

In 2010 her condition worsened and she was placed in a hospital in Bradford, 40 miles (64km) from her home and family.

She did not return home for four years, bouncing between two hospitals.

It was during this time Ms Proudfoot's home NHS Trust in Sheffield instituted a "radical" new health programme.

Since 2014 Sheffield Health and Social Care NHS Foundation Trust has offered people with complex mental health needs a home, through the South Yorkshire Housing Association.

The LivingWell partnership provides the patient with in-home medical care and a key worker to help maintain their property.

"Everyone knows you can't do rehabilitation away from someone's community," Mike Hunter, executive medical director of Sheffield NHS Foundation Trust, told the BBC.

The programme has "drastically improved" mental health outcomes in the area, Mr Hunter said.

"We've achieved a 99% reduction in hospital bed placements for people in severe mental health need," he said.

Since returning home Ms Proudfoot said her mental health had drastically improved.

"You can't really get back to your normal level of function when you're in an unfamiliar institution," she said.

"It's about a sense of belonging.

"I do still get anxious, I do get worried, but it feels more manageable."

A Department of Health and Social Care spokesperson said: "It is completely unacceptable for patients to be sent away from their family and friends for treatment — that is exactly why we've committed to end inappropriate out of area placements by 2020-21.

"We are transforming mental health services with a record spending of £11.98bn in 2017-18 and, as part of our Long Term Plan for the NHS, announced a further expansion of mental health services, with an additional £2.3bn every year in real terms by 2023-24."

A spokesperson for Northern, Eastern and Western Devon CCG, which had the highest number of inappropriate OAPs last year, said: "We know how hard it can be for people and their families to receive treatment away from their local area and we only ever arrange care outside Devon when it is absolutely necessary.

"We are working closely with our providers to reshape community services so that people can receive care as close to home as possible."

The CCG merged with South Devon and Torbay CCG on 1 April - outside the period covered by the figures.
More mental health patients sent " Hundreds of miles " for care.

More mental health patients are being sent hundreds of miles from home for treatment, new figures have revealed.


NHS figures showed more than 3,000 patients were placed over 100km (62 miles) from home for treatment because of a lack of beds - a 35% increase since last year.

The NHS spends an average of £9m a month on so-called inappropriate Outside Area Placements (OAPs).

The Government has pledged to eliminate inappropriate placements by 2020-21.

Vicki Nash, head of policy and campaigns at the mental health charity Mind, said: "We have heard repeated promises from the NHS to completely eliminate inappropriate out of area placements, and yet we know the number of these placements has increased.

"Too many of us with mental health problems are being forced to travel hours from friends and family to receive the treatment we need.

"This can worsen people's chances of recovery, as well as being expensive for the NHS."

" My entire reality was ripped away. "

A few months before her 18th birthday Katie Scott was sectioned under the Mental Health Act.

She was moved 160 miles (257km) away from her Wokingham home to a hospital in Norwich to continue her treatment for borderline personality disorder and anorexia.

"I remember when I got there lying on my bed for four hours and just crying. I didn't want to eat, I didn't want to move," Ms Scott told the BBC.

"The fact that it was so far away meant that there was probably a four-month delay in my recovery."

"It felt like my entire reality, everything I had known ever known, had been ripped away".

Her mother Hazel made an eight-hour round trip every weekend for seven months to see her daughter.

She said mental health treatment was "woefully underfunded".

"Having young people or adults placed great distances from their home doesn't just impact the patients, it impacts their family massively.

"Your mind goes into overdrive thinking about how she's doing and how she's coping.

"Local mental health care is essential. The more we can have the better it will be."

The NHS has published monthly figures on mental health placements since October 2016 and detailed statistics have been available for two years.

Between March 2018 and February 2019 - the latest period available - the NHS spent £109m on placing mental health patients outside of their local area due to a lack of bed space.

On average 80% of placements were in private mental health care units, funnelling money away from stretched NHS services.

Last year 8,545 inappropriate OAPs were started.

The average placement lasted 27 nights but 255 placements lasted more than three months.

Of the 275 patients moved more than 300km (186 miles) for a bed last year, nearly half were from the South West of England.

A 99% reduction

"All I knew was I was going to be away from home, I didn't actually know where I was going."

Terry Proudfoot has suffered with mental health difficulties throughout her life, which led to bouts of serious self-harm.

In 2010 her condition worsened and she was placed in a hospital in Bradford, 40 miles (64km) from her home and family.

She did not return home for four years, bouncing between two hospitals.

It was during this time Ms Proudfoot's home NHS Trust in Sheffield instituted a "radical" new health programme.

Since 2014 Sheffield Health and Social Care NHS Foundation Trust has offered people with complex mental health needs a home, through the South Yorkshire Housing Association.

The LivingWell partnership provides the patient with in-home medical care and a key worker to help maintain their property.

"Everyone knows you can't do rehabilitation away from someone's community," Mike Hunter, executive medical director of Sheffield NHS Foundation Trust, told the BBC.

The programme has "drastically improved" mental health outcomes in the area, Mr Hunter said.

"We've achieved a 99% reduction in hospital bed placements for people in severe mental health need," he said.

Since returning home Ms Proudfoot said her mental health had drastically improved.

"You can't really get back to your normal level of function when you're in an unfamiliar institution," she said.

"It's about a sense of belonging.

"I do still get anxious, I do get worried, but it feels more manageable."

A Department of Health and Social Care spokesperson said: "It is completely unacceptable for patients to be sent away from their family and friends for treatment — that is exactly why we've committed to end inappropriate out of area placements by 2020-21.

"We are transforming mental health services with a record spending of £11.98bn in 2017-18 and, as part of our Long Term Plan for the NHS, announced a further expansion of mental health services, with an additional £2.3bn every year in real terms by 2023-24."

A spokesperson for Northern, Eastern and Western Devon CCG, which had the highest number of inappropriate OAPs last year, said: "We know how hard it can be for people and their families to receive treatment away from their local area and we only ever arrange care outside Devon when it is absolutely necessary.

"We are working closely with our providers to reshape community services so that people can receive care as close to home as possible."

The CCG merged with South Devon and Torbay CCG on 1 April - outside the period covered by the figures.
Mental health spending varies widely across England.



There is nearly a two-fold difference in mental health spending across England, an analysis suggests.

Mental health charity Mind looked at investment across 42 NHS regions.

It found that Surrey Heartlands spent the least - £124 per person last year - compared with South Yorkshire and Bassetlaw, which spent more than £220.

The charity said the differences were huge and would affect the quality of care but, despite the variation, spending was still rising everywhere.

The findings have been released to coincide with Mental Health Awareness Week.

Mental health spending has been made a priority in recent years.

In 2016, extra funding was announced and this was added to last year when the government announced its 10-year plan for the NHS.

The analysis by Mind showed all areas were increasing their mental health budgets in line with the overall increase in spending - part of a requirement set by the senior leadership in the NHS.

But that masked the big variations that still existed, according to the projected spending levels in 2018-19.

The biggest spenders ( Per person )

South Yorkshire and Bassetlaw £220.63. ( Top of the league ... for once ? )

Cornwall and the Isles of Scilly £207.97,

North Central London £205.11.

The lowest spenders ( Per person )

Surrey Heartlands £124.48.

Shropshire and Telford and Wrekin £134.77,

Gloucestershire £137.00,


Is some variation to be expected ?

Certainly some of the differences will be linked to the variation in overall health budgets.

More deprived areas with greater level of illness get more money.

So that means while there is close to a two-fold difference in spending in cash terms, the proportion of the regional budget going on mental health is closer.

For example, Surrey Heartlands set aside 10% of its budget to mental health, compared with more than 16% in South Yorkshire and Bassetlaw.

Geoff Heyes, of Mind, said while there was some "positive change" with budgets increasing, the "long-term historic postcode lottery" was still a concern.

"The treatment you get shouldn't depend on where you live.

"The NHS and government have made it clear that mental health is a priority. Some local variation is to be expected but the scale of the difference is huge and we know that the need outstrips resource even in the areas that are performing well."

He said as the extra money started to become available - between now and 2023 mental health is in line to get £2.3bn of the extra £20bn going on the NHS - local areas needed to address funding levels.

A spokeswoman for NHS England said spending has, and would, continue to increase.

She said in the next five years an extra 700,000 people would get care and support.

"Funding for mental health services will grow faster than the overall NHS budget," she added.
Sturgeon urged to hand over inquiry report on young people who died after mental health service failures.


NICOLA STURGEON was today challenged to give access to an inquiry report to families of young people who died after mental health service failures – after one relative complained the process had been “definitely not transparent.”

The inquiry was established after the deaths of a number of patients who had sought help from the Carseview mental-health unit in Dundee.

Scottish Labour leader Richard Leonard – at First Minister’s Questions (FMQs) last May – raised the case of David Ramsay, who killed himself at the age of 50 having been twice turned away from Carseview.

Today Mr Leonard returned to the case at FMQs, saying Mr Ramsay’s niece Gillian Murray was unhappy with the progress of a public inquiry into the deaths.

Mr Leonard quoted Ms Murray as saying: “Nothing seems to have happened. We’re not kept involved. It’s definitely not transparent.”

The tragedies came amid a scandal of financial mismanagement at NHS Tayside.

One of the local MSPs, Shona Robinson, was the SNP health secretary until she resigned last year.

On Thursday, Ms Sturgeon said she “would want to learn lessons from the experiences of the kind narrated by Richard Leonard” and that the inquiry report would be “fully scrutinised by this chamber and the government and the health service more generally.”

She said: “I think it would be wrong to pre-empt the outcome of that inquiry but I will give an assurance we will take forward any recommendations it makes.”

Mr Leonard said: “This inquiry was launched over a year ago and the families feel like their voices have been lost. They have no confidence in the upcoming report because they feel cut out from the process that was supposed to provide them with answers and ensure necessary changes are made going forward.”

Locally our MH services have been cut to the bone. So many different consultations on the go here too, and yet many interconnect.

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