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Mental Health Services Under-Resourced ? Yes ! Suicide Prevention Minister And Related Reports Covering The Meltdown - Page 6 - Carers UK Forum

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.
62 posts
NHS cancellations of child mental health sessions jump 25%.

Staff shortages and growing demand reported to be behind annual rise in England.

Growing numbers of troubled children are having appointments with NHS mental health services cancelled, the organisation’s data show.

Figures obtained by the mental health charity Mind reveal that CAMHS (child and adolescent mental health services) in England cancelled 175,094 appointments with vulnerable patients between August 2018 and July 2019.

That was 25% more than the 140,327 which were cancelled during the same period in 2017-18.

Experts think staff shortages and the growing demand from young people for help with anxiety, depression and other conditions, lie behind the trend.

Although under-18s with mental health problems can pull out of planned sessions, the proportion of appointments cancelled by a CAMHS provider rose as a percentage of all appointments year-on-year, from 3.3% in 2017-18 to 3.7% last year – one in 27 of all consultations.

Mind called the upward trend deeply concerning, especially as some appointments were with young people who were self harming or having suicidal thoughts.

“We know services are struggling to cope with the increasing numbers of people needing help. But no young person should face being stood up by the NHS,” said Vicki Nash, the charity’s head of policy and campaigns. She added that a cancellation could set back both the young person’s relationship with CAMHS staff at and potentially their mental health.

Nash said: “Having a mental health appointment cancelled can break a young person’s trust in the health service. People are often at their most vulnerable at the point they receive professional support for issues as complex as eating disorders, self-harm and psychosis, let alone children who may be interacting with services for the first time in their lives.

“No young person should have to worry about whether their next appointment will happen. Once someone enters the mental health system they deserve timely and consistent support that gives them the best possible chance of recovery.

“It is deeply concerning that the number of cancelled appointments continues to rise, even in proportion to the increase in appointments. As demand grows under-supported staff are leaving in droves, and this can impact the gaps between appointments and chances of cancellation.”

The figures underline the difficulties facing NHS England in honouring its ambitious pledges to transform access to specialist care for children and young people facing mental health challenges, and especially in reducing what are often long waits for care. Experts say the continuing fall in the number of mental health nurses and vacancies for specialist child psychiatrists in many CAMHS teams threaten delivery of the plans.

The number of under-18s in England referred to CAMHS has risen fast. It increased from 343,386 in 2017-18 to 405,479 last year – an 18% jump from the year before. Exam pressure, online bullying, pressure to look good, difficulties within families and dysfunctional backgrounds, as well as a greater openness among young people in acknowledging their condition and seeking help, have all been cited as explanations for the soaring demand.

GPs revealed last week that many of the young people struggling mentally who were referred to CAMHS were rejected for being not ill enough. Sometimes the youngs people faced delays lasting months before they first saw a mental health professional.

Under-18s and their families cancelled about four times as many appointments as CAMHSproviders, the figures obtained by Mind also showed. During 2018 a total of 798,010 appointments were cancelled because the young person called off the meeting or did not attend. Overall, CAMHS services provided 3,734,000 appointments in 2018-19 where the patient did attend.

Emma Thomas, the chief executive of the charity YoungMinds, urged ministers and NHS chiefs to ensure more help for young people as soon as they develop problems, and to go beyond just concentrating on improving access to CAMHS once patients become more ill.

Thomas said: “The next government must ensure service improvements through investment in the NHS, but also make sure that young people can get help when they first need it, whether that’s through youth clubs, drop-in centres, local charities, schools, or online. We urgently need a new strategy that makes prevention and early intervention a priority.”

The Guardian approached Matt Hancock, the health and social care secretary, for a comment but have yet to receive a reply.
New inpatients banned at mental health unit rated unsafe.

Damning CQC report on private Cygnet Acer clinic where patients could self harm and one died by hanging.

A privately run mental health unit has been banned from admitting new patients after inspectors found numerous safety failings, one of which led to a resident dying by hanging.

The Care Quality Commission (CQC) has stopped the Cygnet Acer Clinic, in Chesterfield, Derbyshire, from accepting new inpatients. It declared that the facility was “not safe” for people to use.

Inspectors found that clinic patients had opportunities to hang themselves, and the unit had soaring levels of patient self harm, and a huge shortage of trained staff.

The CQC’s report is one of the most damning it has issued about poor and unsafe care affecting vulnerable and potentially suicidal patients in a mental health facility.

It is the 33rd time since the start of 2017 that the CQC has rated a mental health inpatient unit in England run by a profit-driven firm as inadequate, and the eighth time that has involved Cygnet.

The Cygnet Acer looks after a maximum of 28 women, at a time; they might have personality disorder and also another mental illness, learning disability or substance misuse problem.

Inspectors uncovered a series of lapses in safety, including the risk that patients could be able to try to end their life.

“In 2019 there had been two serious incidents, one of which led to a patient death by using a ligature,” the inspectors said. One in five staff had not been trained to understand most types of patient safety incidents, despite the highly vulnerable inpatient group.

Kevin Cleary, the regulator’s deputy chief inspector of hospitals, said: “The care provided at Cygnet Acer Clinic fell well below the standard that people should expect to receive. We found that the service was not ensuring the safety of those in its care.

“The number of incidents of self harm by patients had increased in the three months leading up to our inspection [in August] and almost half of the incidents involved patients using a ligature.”

The CQC also found that in one of the hospital’s two wards, Upper House, the number of incidents of self harm had more than trebled from 156 in May to 577 in July; that managers and staff were leaving patients at risk of being able to hang themselves by not getting rid of all potential ligature points; and that “75% of staff were not qualified for the roles they were doing”.

During their visit in August inspectors watched as patients gathered in the unit’s reception and banged on windows to get help from staff nowhere to be seen.

Wendy Burn, president of the Royal College of Psychiatrists, said: “We are deeply concerned by the appalling findings in the report, which has found that another hospital has failed to provide the necessary care for a vulnerable group of patients. Action must be taken to understand why patients in inpatient settings are being repeatedly let down.”

Sophie Corlett, director of external relations at the mental health charity Mind, said: “Many women in mental health services have experienced abuse or violence and their need for compassion and a safe haven is even more acute. And yet, shockingly, we hear about services set up specifically to support women that totally fail to deliver appropriate care.

“Across the board, long-neglected mental health hospitals and other buildings are putting people at risk of slower recovery, of self harming or even taking their own lives. We should not expect people with mental health problems to use inadequate and dangerous services, nor should we expect mental health staff to work in them.”

Luciana Berger, the Liberal Democrats’ shadow health secretary, said: “It is shocking that vulnerable female mental health patients were abandoned instead of receiving the care they need. There are serious questions to answer about why so many privately run mental health units have been deemed inadequate by the CQC in the last three years.”

The CQC, as well as rating Cygnet Acer inadequate, also placed it into special measures, and banned new admissions for six months.

A spokesperson for the clinic called the CQC’s findings inaccurate, adding: “This CQC report is in fact from an inspection in the summer. Since then there has been a further inspection in October and the CQC has recognised the progress made and given us positive feedback.”

The clinic said it had made “substantial improvements” as a result of the CQC’s visit, including extra training for staff and review of risk assessments. “We provide more than 140 services across the UK, the majority of which are rated good or outstanding. Where recently we have seen a relatively low proportion rated inadequate, we have rapidly invested the required resource to improve so they can meet the high standards we expect.”
Mental health : young people in crisis waiting hours for A&E help.

Figures show thousands of under-18s seeking care in England not seen in four hours.

Thousands of young people undergoing a mental health crisis, including those who are potentially suicidal, are having to wait more than four hours for A&E care, NHS figures show.

Almost a fifth of the under-18s who seek A&E help in England for psychiatric problems such as depression and self-harm are not seen within the supposed maximum of four hours.

Figures released by hospital trusts to Labour under freedom of information laws showed that while 82.2% of such patients are seen within four hours, 17.8% are not. Across the 65 acute trusts that supplied data, 11,210 of the 13,205 under-18s with a mental health problem were seen within four hours but 2,357 waited longer.

In all, 26,593 children and young people aged 17 or under attended A&E last year as a result of mental health issues. If the 17.8% of them who had to wait beyond four hours at the 65 trusts was replicated across that entire cohort, that would mean as many as 4,733 waited that long.

The disclosure prompted warnings that troubled young people might harm themselves while waiting for delayed care and calls for under-18s suffering a deterioration in their mental health to be able to access help quicker so they did not have to turn to an A&E.

“Young people should have the support they need for their mental health to prevent them from reaching crisis point and no child should be faced with long waits for help in a crisis”, said Barbara Keeley, Labour’s shadow minister for mental health and social care, who obtained the figures.

Emma Thomas, the chief executive of the charity YoungMinds, warned that long waits could make things worse for a young person in crisis.

“We work with young people who have waited months for mental health support and who have started to self-harm or become suicidal, who then go to A&E because they don’t know where else to turn.

“But despite the best efforts of staff, it’s often a stressful and frightening environment, and not somewhere a desperate child or teenager should have to wait for hours before getting help.”

Thomas added that the “worrying figures” showed that, despite progress by the NHS in extending patients’ access to mental health crisis care, more services in schools and community settings were needed.

“If young people do reach crisis point, there need to be places they can go instead of A&E, where they can get the help they need in a space that feels safe”, she said.

NHS England has pledged in its Long Term Plan to ensure that everyone in England – children, young people and adults – can access mental health crisis services around the clock by 2023-24 by calling the 111 telephone helpline.

It plans to create “24/7 provision for children and young people that combines crisis assessment, brief response and intensive home treatment functions” and set up crisis resolution home treatment services for adults.

It also plans “a range of complementary and alternative crisis services to A&E and admission within all local mental health crisis pathways”.

The Conservatives did not respond directly to Labour’s findings. A spokesperson said: “One of the great changes of our age is to treat mental health on a par with our physical health. Demand for mental health services is rising and the stigma of the past being taken away.

“As a result, the NHS is treating twice as many people with mental health conditions than in 2010 and is delivering the biggest expansion of mental health services in a generation – backed by an additional £2.3bn in real terms by 2023-24.”
Shrewsbury and Telford Hospitals : Concerns over mental health treatment.

Inspectors have taken further action against a hospital trust because of concerns over the treatment of mental health patients, the BBC understands.

It comes as a Care Quality Commission report said maternity care has improved at Shrewsbury and Telford Hospital NHS Trust, but emergency services still require urgent action.

https://www.bbc.co.uk/news/uk-england-s ... e-50679381
Power to detain learning disabled people " Needs reform. "

Some are wrongly held because of flaws in Scotland’s mental health legislation – review.

Significant reforms are needed to stop people with learning disabilities being unnecessarily detained because of flaws in Scotland’s mental health legislation, according to an independent review.

The review said Scotland’s mental health act 2003 breached the human rights of people with learning disabilities and autism because it treated their disabilities as mental disorders.

Andrew Rome, who chaired the review, said there were cases of offenders with learning disabilities or autism being held as patients in secure accommodation for far longer than non-disabled offenders who committed identical offences. They could be locked up without a formal diagnosis of mental illness.

The most severe delays included 15 people whose discharge was delayed for more than 10 years, and another six people held for more than five years longer than necessary because the right support was not available in the community.

The review recommended that the Scottish parliament introduces new legislation to protect the rights of people with autism or learning difficulties, and establish a new commissioner to safeguard their rights.

After the new legislation came into force, those conditions had to be removed from the legal definition of mental disorder in the 2003 act, the report said.

Rome said the current law breached the UK’s legal undertakings under the UN convention on the rights of persons with disabilities, ratified by the UK in 2009, as well as linked duties under European human rights legislation.

The convention gives people the right to family life and to independent living, yet they were often held in facilities which were cramped, noisy, badly maintained or dirty, or have rules and environments which traumatised people with autism.

Previous studies cited by the review found 453 people with learning disabilities were placed in facilities far from home, including about 55 with autism, while almost a third of inpatients with learning disabilities experienced long waits to be discharged.

The review, set up by the Scottish government two years ago, said other public services failed to uphold the convention’s codes, which meant new duties were needed to ensure local councils and public bodies fully met the needs and views of people with autism or learning disabilities.

Those duties should include embedding the UN’s convention on the rights of the child in legislation, to ensure schools, the NHS and social services provided appropriate services.

“We, as a society, have been making decisions based on what we think is best rather than what the person wants,” Rome said. “Some of that has been done on the basis that the person can’t tell us. What the UN convention says is that people don’t lack the capacity to tell us: [instead] it’s up to us to find the best way to allow them to.”

The Scottish government said the report would feed into a wider government review of Scotland’s mental health legislation by John Scott QC, and another review into forensic, or crime-based, mental health policy.

A spokeswoman said ministers were clear that physical restraint should always be a last resort, and for the shortest time possible. “We will now carefully consider the recommendations within the report to ascertain how to better fulfil our obligation to promote and protect the human rights of autistic people and those with learning disabilities,” she said.
Just one mum ... out of low millions of others ?

Worksop mum's call for changes to mental health services after teenage daughter reaches " Critical point."

The mum of a Worksop teenager who reached out for help with her mental health says she doesn’t think enough was done.

The 33-year-old mum took her 15-year-old daughter to Bassetlaw Hospital on November 22 as she had reached a ‘critical point’ and was calling out for help but the teenager – who we are not identifying to protect her during this vulnerable time – was given an amber rating and advised she could return home.

“When [she was] questioned about how low she felt, she told the nurse she wanted to kill herself and if she went home she would consider taking her own life,” her mum said.

“After this, she was assessed and ranked with an amber rating and told she could return home on the conditions that I could watch her for 24-hours until the crisis team came out to visit her. Two days later they told her she would have access to the crisis team on the phone.

“I explained that watching her for 24-hours was not possible as I have two other children and I demanded that she stayed in hospital. She was admitted overnight and then discharged the following day.

“Child and Adolescent Mental Health Services (CAMHS) didn’t come out to see her, as promised, two days after she had been discharged.”

However, the mum praised the accident and emergency nurses and said: “If it wasn’t for the nurse, and had been down to CAMHS, my daughter wouldn’t have been admitted – CAMHS told us not to go to the hospital and advised staff to send her home.”

The teenager has suffered with mental health problems for around five years after her mum was diagnosed with cancer in 2014. There has been CAMHS involvement over this time, but she dropped out of group sessions because of her anxiety.

Her mum added: “After her school had noticed the issues, family services offered emotional support in school but discharged her without myself and the school being made aware. The waiting list for CAMHS is sky-high, they’re in high demand and at breaking-point.

“My daughter was classed as an amber rating so then what does it take to be classed as red? This concerns me. Are they really doing enough for children with mental health issues and is the suicide rate getting higher because of this sort of approach to children’s mental health conditions? Change is needed.”

David Purdue, Director of Nursing, Midwifery and Allied Health Professionals at Doncaster and Bassetlaw Teaching Hospitals, said: “All patients who arrive at our Emergency Departments undergo medical observations to ensure they are physically well. If the clinician is concerned about an individual’s mental health, a process is followed to assess their condition, and, if required, a referral is made to the local mental health specialist, or in the case of a young person, Child and Adolescent Mental Health Services.

“If we believe a patient presents a significant risk to themselves or others, a range of options are available to our health professionals, from offering the patient a bed under observation for a 24 to 48 period to sectioning the individual under the Mental Health Act.”

Four in 10 GPs suggest seeking private care for mentally ill children.

Survey finds 43% of doctors tell parents that NHS services are too overwhelmed to help.

Four in 10 GPs are advising parents of children with mental health problems to pay for private care because NHS services are too overwhelmed to help.

In a survey, 43% of UK family doctors said they told parents whose children were struggling with anxiety, depression, self-harm or eating disorders to seek treatment privately if they could afford it because NHS care is heavily rationed and involves delays of up to 18 months.

The fact that so many families are being directed to private treatment highlights the inability of NHS child and adolescent mental health services (CAMHS) to cope with the growing demand for care from under-18s who have mental ill health.

Many GPs who took part in the research, undertaken by the mental health charity Stem4, criticised CAMHS for not being available to see children and young people they referred for care. Some described CAMHS as “dire”, “extremely lacking”, “non-existent” and “totally, horrifically, grossly inadequate”. One GP said: “Seeing a psychiatrist is more difficult than seeing the pope."

Dr Nihara Krause, a consultant clinical psychologist and founder of Stem4, said: “Parents want support for their children and young people as soon as possible and so will often stretch themselves financially to pay for treatment. Parental anxiety about the mental health needs of young people is high and sobering statistics on, for example, suicide being the primary cause of death in young people adds very real fear.

“Parents whose child has cancer or a serious physical health condition would never have to pay for private care, so why should it be OK for those whose children have mental health problems to be told to do that? This again shows that the much-vaunted ‘parity of esteem’ between physical and mental health services is still a far-off goal.”

GPs’ advice to go private has prompted concern that it results in a two-tier system in which children from poorer families are denied any care and leaves parents who can pay the fees involved confused as to which private mental health professional is best placed to help.

“These findings are a cause for serious concern. Timely access to mental health support is essential, and asking parents to pay for their children to get help will exacerbate inequalities that are already very stark,” said Andy Bell, the deputy chief executive of the Centre for Mental Health thinktank.

Krause said: “From a GP’s perspective it makes sense that they are offering parents something to help the escalation of a potential problem. However, it concerns me that so many parents of children and young people are being advised to pay for private care.

“Some parents are concerned about making the right choice of private practitioner since it is confusing to check on who is regulated and suitably qualified, and at the same time some are also sometimes disillusioned about the long wait, potential rejection and the level of care they receive from CAMHS.”

The private sector cannot always provide the specialist assessment and intervention that under-18s with complex mental health conditions need, she added.

The survey also found that:

Fifty-four per cent of children and young people aged 11 to 18 are rejected for treatment by CAMHS, even though GPs only refer those in greatest need.

Those who are accepted face long waits for care of between three and six months (27%) and up to 12 months (28%).

GPs trying to help troubled youngsters refused CAMHS care have few other options except for schools and charities, which are already overburdened by demand.

Four in five (83%) GPs say there has been a rise in the number of young people seeking help because of anxiety while 79% have seen more coming with depression, 64% with self-harm and 35% with eating disorders. Experts believe the increase in mental ill health in under-18s is linked to exam stress, bullying on social media, poverty, pressure to look good and be popular, and dysfunctional backgrounds.

A separate poll of 1,000 parents found that many believe the difficulty of accessing CAMHS care for their child means they have been left to fend for themselves. Seventy-six per cent said they worried about their child’s mental health, 72% feared their child might come to harm, and 56% felt they would be ill-equipped to deal with difficulties if they arose.

Only a minority of parents – 31% – said they had been able to access treatment for their child through CAMHS. Of those who did, 71% rated the care as good or very good.

An NHS England spokesperson said: “Actually, record numbers of children and young people are being treated for mental health conditions, waiting times are improving significantly and the NHS is ahead of its target to treat 70,000 more children every year by 2021, as part of the NHS long-term plan.”
Children refused NHS mental health care for not being unwell enough.

GPs warn more children need help as research finds most trusts in England restrict referrals.

Children with mental health problems must be severely unwell before they can get help at NHS trusts across England, an investigation has found.

Data obtained via freedom of information requests shows a third of mental health trusts only accept patients with “severe” or “significant” conditions for specialist child and adolescent mental health services.

The research conducted by Pulse – a specialist publication for doctors – analysed data on referral criteria used by 29 of the 56 facilities in England. Just one in five (six NHS mental health trusts) accept referrals for children with all levels of conditions.

Dr Bernadka Dubicka, the chair of the Faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists, said the situation for many young people was “stark”.

“Nearly one in four older teenage girls have a mental health disorder and half of those have self-harmed. What we are seeing is the result of increasing demand, historical under-investment and a growing workforce crisis,” she said.

“There are many children and young people with mental illness who urgently need help now.”

Emma Thomas, the chief executive of the mental health charity YoungMinds, described the findings as worrying. “Thresholds for treatment are often too high, which means that young people who need urgent help simply can’t get it. We hear time and again on our helpline from desperate parents whose children are self-harming or too anxious to go to school, and who just don’t know where to turn,” she said.

Pulse sent out freedom of information requests to all 56 NHS mental health trusts in England about the criteria they use for referrals, plus three other health trusts that provide these services in certain regions.

Pulse received responses from 23 NHS mental health trusts with comparable data, and retrieved comparable information for a further six from their websites.

A Pulse survey of 935 GPs found nearly 30% said criteria for adolescent mental health services (CAMHS) referrals have become stricter in the past year.

The lack of NHS specialist treatment on offer means people experiencing problems are often told to seek help from charities instead, but these services often offer help from counsellors as opposed to doctors.

GPs have warned that children are being forced to wait until their condition escalates before being seen by a specialist. Referrals for children’s mental health services are rising – up by 18% between 2017-18 and 2018-19.

Dr Maddi Ridley, a GP in Essex, said: “Referrals come back saying they don’t meet the criteria and suggesting where the child or adult can get support locally from counselling services run by charities.

She added: “We’ve seen quite a number of deaths by suicide in teenage children in our area. Children are really struggling with mental health and we don’t have a lot to offer. For instance, the waiting list for counselling is 18 months.

“These children do need professional help, there just doesn’t seem to be any facilities available within the NHS.”

An NHS England spokesperson said: “This data is based on less than half of all mental health trusts and does not include other NHS-funded organisations that provide mental health support.

“The NHS is actually ahead of its target on ensuring as many children as possible receive mental health care, and the long-term plan has committed to ensuring an extra 345,000 children and young people get the care they need by 2023, backed by extra funding for mental health services of more than £2bn.”
" Repeated failings " at St Andrew's Healthcare mental health charity.

A mental health hospital charity has been told it made "repeated and systemic failings" in its leadership by health inspectors.

The Care Quality Commission (CQC) raised several concerns at St Andrew's Healthcare, based in Northampton.

They included a two-year backlog to address issues found by the CQC in previous inspections.

St Andrew's Healthcare said it had new leaders who were committed to making improvements.

Kevin Cleary from the CQC said: "These failings hindered the ability to provide safe and effective care."

St Andrew's Healthcare treats up to 900 mental health patients in Northampton, Birmingham, Nottinghamshire and Essex, with 90% of referrals from the NHS.

The CQC inspectors, who visited the charity's headquarters on 23 and 24 October, found the use of physical restraint had increased despite a plan to reduce it.

They also found the process of telling a patient's family when something went wrong was "not fully effective".

They noted in their report an employment tribunal found a member of staff was unfairly dismissed because he had been a whistleblower at a previous workplace.

The inspectors also found staff were not always confident to raise concerns without fear of reprisals.

The report said senior leaders had "not fully accepted the serious nature of concerns raised" by the CQC in previous inspections, causing a two-year backlog to address patient safety issues.

Mr Cleary, CQC deputy chief inspector for mental health and community services, said St Andrew's Healthcare had "processes that supported good care".

But he said: "There were also repeated and systemic failings relating to procedures and clinical governance."

He said the management at the charity "had comprehensive knowledge of challenges faced, but many of their plans were in their infancy".

St Andrew's Healthcare said: "Cultural change can take time, especially in a complex mental healthcare setting."

The charity said it had implemented changes to its restraint, seclusion, and long-term segregation processes following a review.

A spokeswoman said: "We have a new leadership team in place who are committed to making improvements and creating a culture of complete openness, honesty and transparency."
NHS patients on mixed-sex mental health wards " Have been sexually abused more than 1,000 times " in the last three years, shock figures reveal.

Statistics show 1,019 reports of mixed-sex sexual assaults made in 2017-2019.

Many NHS boards have policies which dictate people stay in same-sex wards.

But overloaded services cannot always stick to the rule and make " Breaches. "

https://www.dailymail.co.uk/health/arti ... years.html
62 posts