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.
Violence in mental health can't be ignored, but nor can the pain of punitive policies.

Modern understanding of disability takes account of the barriers people face. Let’s do the same for mental health policy.

When Anna* became physically unwell as a student, her GP referred her to a psychiatrist and she agreed to voluntary treatment. After interviewing her for less than an hour, the psychiatrist diagnosed her with schizophrenia and told her there was a risk she would kill her mother.

“I have never been violent in my life, ever,” she says. But for 35 years Anna has had to live with this information, knowing it is written in her medical records and has limited her life opportunities for two decades.

She has since successfully held down a responsible permanent job, bought her own home and been a pillar of the community, but as she observes: “There do not seem to be any spent convictions in psychiatry.”

Violence is sadly commonplace in our world, and it is a spectre that can hang over anyone experiencing distress. But discussion about mental health and violence is largely tied to the punitive attitudes and assumptions of a different age.

There is now an emphasis on mental health service users telling their stories, on challenging prejudice against them, and on treating mental illness like any other health problem. But when people’s mental health problems are linked with killings or violence, the story takes a different turn.

Very sharp distinctions are drawn by politicians and media between the public, who must be protected, and service users, who must be controlled and segregated. This is despite the fact that many high-profile cases have been associated with the failure of mental health services to respond to urgent pleas from service users and their loved ones to intervene and keep them safe. It also ignores the reality that mental health service users are much more likely to be left without adequate support and kill themselves.

Any death associated with the psychiatric system must always be a matter of major concern. But the evidence has long suggested that political and media preoccupations with violence and mental health service users has not been reflected in any major increase in deaths or attacks. The point is not to belittle the problem of violence in relation to mental health but to examine it from broader, fresher perspectives.

Just as modern understanding of disability takes account of people’s circumstances and the barriers they face, so mental health and violence should be re-examined, noting the powerlessness, poverty, racism and other discrimination service users can experience disproportionately.

Drawing on first-hand accounts such as Anna’s, a new book I have co-edited explores how “slow violence” – activity often not even recognised as violence – has been inflicted on mental health service users and people experiencing distress, damaging people over time no less than any physical or emotional assault.

Such slow violence includes public policies that sustain or exacerbate inequalities and poor health for marginalised people, such as gentrification policies that force people out of their neighbourhoods and increase their isolation. It’s also a consequence of psychiatric systems still employing coercion and restraint, in which people are neglected, abused, discriminated against, put at risk and in some cases even die unnaturally.

Far from protecting human rights, many criminal justice systems and laws in areas such as housing, planning and employment push people to the margins of society. Welfare reform policies such as the bedroom tax force people out of homes and communities where they have networks of support into homelessness, poverty and greater distress.

Violence in relation to mental health service users should be seen as a direct consequence of the slow violence of inadequate policy and antiquated treatment.

The latest thinking in physical healthcare focuses on patient participation, prevention and holistic approaches to wellbeing. The same issues apply to mental wellbeing too.

Mental health services have been starved of resources, but much more is needed than simply pumping more money in, however important that is. A radical reassessment is required of how we respond to people’s distress, to move far beyond a narrow emphasis on diagnosis and drugs. We need a fresh eye on the issue of violence in relation to mental health service users, putting it into a broader social and cultural context. This is critical for all our mental wellbeing. Physical health and care has been reimagined for the 21st century, and the same is essential for mental health policy.

* Not her real name

• Peter Beresford is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives. He is one of the editors of Madness, Violence And Power, A critical collection, published by Toronto University Press.
Inspectors discover poor standards at 28 mental health units.

Psychiatrists call for inquiry after report on private units, many occupied by NHS patients.

Inspectors have found 28 privately run mental health units to be “inadequate” in the past three years, prompting fears that vulnerable patients are receiving poor and unsafe care.

The disclosure of such widespread substandard care in mental health facilities run by non-NHS providers has prompted psychiatrists to call for a public inquiry to investigate.

The Care Quality Commission (CQC) has rated 16 independently run mental health units as inadequate so far this year. It put four others in the same category last year, and eight in 2017.

In its latest inspection report it disclosed how it found a patient with “unexplained injuries”, opportunities for patients to kill themselves and staff asleep while on duty at Cygnet Newbus Grange hospital, in Darlington. It has since been put into special measures and its 10 patients moved elsewhere.

It is the sixth time this year that the CQC, England’s regulator of standards in health and social care, has deemed a mental heath unit run by Cygnet to be inadequate.

The watchdog has expressed serious concern about what its inspectors found at Newbus Grange, including residents – men with autism, learning disabilities and complex needs – being restrained by staff using “inappropriate techniques” and no effort made to reduce obvious risks of suicide.

Cygnet is a specialist mental health provider which operates more than 150 facilities across the UK, which between them have more than 1,000 beds. The large majority are occupied by NHS-funded patients, including those with autism and learning disabilities who spend months or years there.

Earlier this month Sean McNulty, a member of staff at Newbus Grange, was jailed for abusing and ill-treating residents. Sentencing him to two years and eight months in prison Judge Peter Armstrong said he was a “sadistic bully”. CCTV footage had shown McNulty punching, kicking or slapping one patient 15 times.

Cygnet is also the company which ran Whorlton Hall, in Durham, another unit for people with learning disabilities and autism, where a BBC Panorama investigation in May showed staff abusing residents. Ten people were arrested by police.

Three of the 28 units slated by the CQC are run by the Priory Group, which in April was fined £300,000 over the death in its care of 14-year-old Amy El-Keria. Another three are run by St Andrew’s Healthcare.

Prof Wendy Burn, the president of the Royal College of Psychiatrists, said: “We were horrified by the Panorama documentary … Now we learn that yet another hospital looking after this group of patients has been put into special measures by the CQC.

“In view of the seriousness of this, we have written to the secretary of state urging him to commission a public inquiry led by a high court judge.”

Burn is concerned that CQC inspections have repeatedly found serious failures by private providers to care properly for people with a range of mental health conditions.

“We must have a thorough understanding of what is repeatedly going wrong and what needs to be put in place to ensure that this vulnerable group of people, some of whom are detained under the Mental Health Act, receive the high standard of care that they deserve,” she added.

The CQC deemed Newbus Grange “inadequate” after an inspection in May, just a few months after declaring the hospital to be “outstanding”. Prof Ted Baker, the CQC’s chief inspector of hospitals, said: “There had clearly been an unacceptable deterioration in the managerial oversight of this hospital, and subsequently in the physical environment and the quality of care.”

He said inspectors often found “substantial variation in the quality of care between mental health services ... both [at NHS] mental health trusts and independent mental health hospitals”.

A Cygnet spokeswoman said: “Whilst 85% of our services are rated ‘good’ or ‘outstanding’, the regulatory inspection regime has changed in recent times and this means both independent and NHS providers across the industry are having to adapt. This is not exclusive to Cygnet.

“Most of our inadequate facilities are from a recently acquired portfolio and we are undertaking an extensive level of renovations, transforming care plans and adapting to local commissioning demands.”
Government announces £70 million for community mental health services.

Some 1,000 specialists to be recruited at 12 pilot areas around England.

Mental heath providers in 12 areas of England are being given the green light to recruit 1,000 additional staff, as the government announces £70 million of spending on pilots of new specialist services.

The cash, announced on the first day of the Conservative party’s annual conference in Manchester, is the first tranche of a £975 million investment promised for community mental health services.

Mental health minister Nadine Dories said it would help care services to “transform the lives” of tens of thousands of patients suffering with problems such as eating or personality disorders, alcohol addiction, psychosis and bipolar disorder.

The 12 pilots will be run in Cambridge and Peterborough; Hertfordshire and West Essex; North West London; North East London; Herefordshire and Worcestershire; Lincolnshire; Humber Coast and Vale; South Yorkshire and Bassetlaw; Cheshire and Merseyside; Frimley; Surrey Heartlands; and Somerset.

Service providers will be told to bring together staff with expertise in treating a range of mental health issues and to build closer ties with charities and local councils to help support those with the most severe mental health issues in their communities.

Ms Dorries said: “Today’s announcement will pave the way for a huge step-change in how the health service supports those with mental health issues in their communities. We know there are many causes behind mental illness – including significant life changes, problems at work or addiction – so it is only right that the NHS brings services together to serve patients in their communities.

“This funding, the first step in our extra £975 million investment in community mental health care, will allow local areas to recruit extra staff to run brand new specialist services, helping them transform the lives of those suffering from poor mental health.”

The pilots will be funded as part of an extra £2.3 billion a year investment in mental health under the NHS Long-Term Plan.

Around 1,000 extra staff will be recruited to the 12 pilot sites, which will aim to offer consistent treatment and ensure patients stay in contact with care teams even as their condition improves. People with severe mental illnesses are promised better access to psychological therapies and other specialist treatment as soon as they need it.

The experience from the pilots will inform new investment in all parts of England from this year, with all local health and care systems receiving additional funds for community mental health care from 2021/22.
Decrepit NHS mental health wards put lives at risk.

Government ignoring needs of vulnerable patients, trusts claim.

Mental health patients are at risk of suicide because so many of the units they are treated in are dangerously decrepit, say NHS chiefs.

Crumbling old buildings are unsafe as they offer opportunities for mentally vulnerable people with conditions such as depression and schizophrenia to try to hang themselves or fall from a height, according to mental health trusts in England.

New figures show that patient safety incidents in mental health units caused by problems with staffing, facilities or the enviroment in which people are treated have risen by 8%. In all, 19,088 such incidents occurred in 2018-19 compared with 17,693 the year before.

Seven “never events” – incidents which are supposed to never happen – occurred in mental health trusts in 2018 involving a shower or curtain rail that failed to collapse. In another, someone fell from a window.

In a stark warning, NHS Providers, which represents health trusts, categorises the risk to patient safety from “infrastructure failures in mental health trusts” as severe. “Continued under-prioritisation of the mental health estate is having a real impact on patients,” it says. “Mental health trusts continue to be neglected despite clear evidence that critical improvements are required. Mental health trust leaders are increasingly concerned that the lack of investment places their patients at increased risk.”

The trusts have been prevented for years from replacing out-of-date buildings because ministers have repeatedly raided the NHS’s capital budget to help pay for the service’s day-to-day running costs, said Saffron Cordery, NHS Providers’ deputy chief executive.

The organisation is urging Boris Johnson to show his commitment to mental health by funding a generation of modern psychiatric hospitals to complement his £13bn pledge to build 40 new hospitals for physical illnesses.

Last year the Care Quality Commission (CQC), the NHS regulator, voiced its concern that too many mental health wards were “unsafe and provide poor quality care” in “old and unsuitable buildings”.

Several trusts have been prosecuted for safety lapses linked to the poor quality of their buildings, in cases that have sometimes involved a patient dying.

Ageing facilities, some of which date back to Victorian times, are also hampering patients’ chances of recovering from serious mental illness because they are so cramped and noisy, trusts say.

Bradford District Care trust is worried that the adult acute wards at the 1960s-built main facility it runs in the city are potentially unsafe because they have too many “blind spots” where patients with personality disorder or schizophrenia may try to harm themselves.

“The layout of the wards in unhelpful because it means staff don’t always have a clear line of sight of certain patients at all times”, said Liz Romaniak, the trust’s director of finance and estates.

“We have installed CCTV to monitor blind spots, moved the nurses’ stations into the middle of our male and female wards in order to keep a better eye on people, and installed nurse call alarms for patients to use.

“But it’s a constant battle with the environment on the wards, because they don’t provide an ideal calm and therapeutic environment and give us proper lines of sight,” she said.

The trust installed the call buttons at patients’ bedsides after CQC inspectors last year highlighted that “staff could not clearly see all areas of the wards” and asked the trust to put in the alarms – which are common in more modern units – to help reduce the risk of self-harm and suicide.

The trust wants to gradually replace the wards but does not have the £40m it would cost.

Between 2014-15 and 2018-19, ministers diverted £4.29bn from the NHS’s capital budget into the revenue budget used to pay day-to-day running costs. That left NHS trusts with less money than planned to carry out urgent repairs, modernise facilities, erect new buildings and buy equipment such as scanners. In 2016-17 alone, £1.2bn earmarked for that purpose was raided.

Cordery claimed mental health was being overlooked in the hospital building programme outlined by the prime minister. None of the six new hospitals awarded £2.7bn or any of the 21 others given £100m to develop plans for replacements provides mental health care.

“Incredibly, there was not a single mental health trust included in any of these plans. How can that be?” said Cordery.

“We have seen repeated warnings of the risks – sometimes fatal – arising from the long-term neglect of our mental health estate. And we have heard repeated pledges from government to ensure parity of esteem for mental health conditions. How bad does the situation have to get before these warm words translate into practical steps to ensure a safe therapeutic environment that respects ths dignity and privacy of patients who rely on these services?”.

The Department of Health and Social Care said: “Mental health is a key priority for this government. We have announced over £400m to improve mental health estates since 2017 and we are transforming mental health services with a planned record spend of £12bn this year.

“We are transforming services through the NHS Long Term Plan – backed by an additional £2.3bn a year – so that 385,000 more people have access to vital mental health support.”
Mental healthcare hit by " Alarming " shortage of psychiatrists.

Report finds one in 10 UK posts unfilled with young people and mothers worst affected.

A UK-wide shortage of psychiatrists is forcing children with eating disorders and other troubled young people to wait longer for NHS care, it has been claimed.

About one in 10 consultant psychiatrist posts are unfilled and the rate of vacancies has doubled in the last six years, a major workforce survey by the Royal College of Psychiatrists found.

Services for those with eating disorders, under-18s with mental health issues and mothers struggling after the birth of a child are experiencing particular shortages, data collated by the college shows.

Prof Wendy Burn, the college’s president, said the findings were “very alarming” and raised doubts as to whether ambitious government plans to improve mental healthcare would be delivered.

The report warns that increasing gaps in the psychiatry workforce “come at a time of soaring demand for mental healthcare, with a shortage of psychiatrists contributing to the lengthy waits for treatment many patients face. The impact on patients’ lives can devastating, including divorce, debt and job losses.”

In England, 9.9% of full-time consultant posts in psychiatry are vacant, almost double the 5.2% which were unfilled in 2013, according to the college’s biennial workforce research report. In all 568 posts are vacant out of what should be a total workforce of 5,730 consultant psychiatrists.

However, Wales has the highest vacancy rate of the four home nations – 12.7% – while in Scotland 9.7% of posts are unfilled and in Northern Ireland it is 7.5%, giving a UK-wide rate of 9.6%.

Vacancies are widespread in England in key areas of the mental healthcare service, which the government and the NHS long-term plan have pledged to improve as part of a drive to reduce waiting times, increase the numbers who get help and give mental health “parity of esteem” with physical healthcare.

For example, one in six consultant posts in eating disorders services are empty. It has the highest rate of unfilled posts among the 13 specialist areas of psychiatry – 15.6%. The shortage is most pronounced in the east of England, where one in three posts have no doctor. In both the south-west and the south-east of England, almost 17% of posts are vacant.

But about one in eight posts in perinatal mental healthcare for new mothers (13.1%) and in child and adolescent mental health services (CAMHS) (12.1%) are unfilled. For example, 25% perinatal psychiatric posts are vacant in the west Midlands and 21.4% in the south-west.

Vacancies for CAMHS consultants are running at 10% or more in every region of England apart from the east and south-west. They are worst in Trent (16.9%) and the west Midlands (16.7%).

There is also a significant shortage (11.8%) of liaison psychiatrists, especially in the north-west (19.4%) and London (19%). They work in A&E units to help people undergoing a mental health crisis who turn up seeking help.

Eating disorder and children’s mental health charities voiced concern at the findings and warned that the major shortages in those areas of care could have serious consequences.

“We know eating disorder services are struggling to fill vacancies, which is impacting the ability of those services to treat patients as quickly as possible”, said Tom Quinn, director of external affairs at Beat Eating Disorders.

“This in turn has a detrimental effect on those patients, as early treatment is key to a full and sustained recovery.”

Support for patients with anorexia nervosa, bulimia nervosa and other eating disorders is a key part of NHS mental healthcare because of the high rate of death, including by suicide, linked to them. Sufferers are twice as likely to die as the general population, while those with anorexia – mainly girls and young women – are almost six times as likely to die, the highest risk for any mental disorder. However, some people wait at least 41 weeks to start their treatment as a result of what the royal college says is a “postcode lottery” in the availability of care linked to psychiatrist numbers.

CAMHS care is also important because of rising rates of self-harm and suicide in young people. Tom Madders, the campaigns director at YoungMinds, said:”We know from calls to our parents helpline that young people too often have to wait months to access support. With more and more young people looking for help, it’s crucial that action is taken to recruit and retain professionals specialising in children and young people’s mental health.

“But we need to do more than this. There has been welcome investment in the NHS, but services will remain overstretched unless more young people get help early on, before their problems escalate. That’s why we need a new government strategy that focuses on tackling the factors that lead to poor mental health and improving early support.”

The college wants ministers and NHS chiefs to improve working conditions for psychiatrists by, for example, having hot food available on nightshifts. And it wants the government to increase the supply of homegrown doctors by doubling the number of places in medical schools to 15,000.

The Department of Health and Social Care said it recognised the problem the college had identified.

“Expanding the mental health workforce is a key priority. We know more work is needed to meet rising demand on services and to ensure patients are getting the best treatment”, a spokesperson said.

“Our interim NHS people plan set out immediate actions we will take to fill vacancies and secure the staff we need for the future, including addressing pensions tax concerns, increasing university clinical placements by over 5,000 more and bolstering the workforce through greater international recruitment.”