Mental illness has for too long been the Cinderella of the NHS.
It has been often regarded as an afterthought by successive governments and easy pickings when it comes to making cuts. Many mental professions and mental health service users welcomed the promises of Jeremy Hunt and the then Prime Minister David Cameron that they were going to invest in mental health services. But like most promises from Jeremy Hunt and this government on the NHS, the initial optimism that at last mental healthcare would be properly funded has faded into yet another broken promise on the NHS and evidence that in fact the Mental Health Services are facing the worst crisis in living memory.
The Kings Fund in a recent report found that there was a lack of robust data, to make an accurate assessment of the state of the Mental Health Services, but found from the evidence there is that the sector was under a huge pressure. It found that around 40% of mental health trusts had in fact reported that they had suffered cuts in investment from 2013 to 2015. Whilst 2016 data is not available yet, I think one can safely assume we would find similar cuts. These cuts prove that the promises made by Jeremy Hunt and David Cameron like mirages were full of emptiness. These funding shortfalls are fuelling the worse crisis in mental health care in a generation.
In the 1970s and early 1980s with the promise of new drugs and treatments the old Asylums were closed rapidly and there was a move to smaller mental health units and what was euphemistically called “care in the community”. What that meant in reality, was that many long term patients were suddenly moved from the only home they had known for years to an often hostile and very stressful world with what would prove in many cases to be inadequate support. Meanwhile the closed hospitals were sold off, very often ironically to property developers who converted them to luxury homes or demolished them to build houses. From the early 1990s to the present we have seen a lack of funding for mental health services that has led to many units being closed causing a serious bed shortage for those people who do need inpatient care. Whilst those who require support and treatment in the community are also inadequately supported. In simple terms Mental Health Services have hit rock bottom.
Very often people who use the mental health services feel their care is substandard, in a recent Care Quality Commission report they found that 86% of people using the Mental Health Services felt they received poor or inadequate care. Now it is easy to scapegoat the mental health professionals for this poor and inadequate care, but the reality of the situation is that one of the main reasons for poor and inadequate care has been the lack of adequate resources and staffing.
This is best illustrated by the chronic shortage of mental health hospital beds throughout England. Since 2011 over 2100 mental health service beds have been lost from Mental Health Trusts. Undoubtedly this has created the situation where the mental health services in England are severely over stretched and inpatient care is now at breaking point. There have been times when there are literally no inpatient mental health beds available anywhere in England and where there have been this has meant that people who are severely ill, for example with a manic phase of bipolar disorder are having to be sent out of their home area and often up to several hundred miles from their family and friends and support networks, which is distressing for not only the sufferer but also their families. This inevitably leads to a feeling of isolation that leads to delayed recovery and a feeling that the service and care are not as good as it could have been.
This shortage of beds has also led to cases where the only safe place for sufferers who are extremely distressed or disturbed has been a police cell and there have been cases where people as young as 16 have been cared for in such a way. This has led to Simon Sawyer, the Chief Constable of Devon and Cornwall threatening to sue Devon Partnership NHS Trust over the lack of mental health beds in the county. He has vowed to stop the inappropriate use of police cells and the inappropriate use of section 136 of the Mental Health Act in his area. So one consequence of this mental health beds crisis is the knock on effect to other services such as the Police and Prison Services. Marjorie Wallace Chief Executive of Mental Health Charity SANE said of the mental health bed crisis that it is “profoundly worrying”.
Community Care in conjunction with better medication was meant to take up the slack from the closure of mental health units and the reduction in inpatient beds. But what has happened in reality is that care in the community has been under resourced and underfunded, that combined with a lack of direction as trusts transformed the services offered, the workforce and the corporate management all based on implementing spending cuts. What this has meant is that there has been a shift from the evidence based National Service Framework for Mental Health to care pathways and models of care that lacked an evidence base and had a negative impact on the quality of care.
These changes have led to a lack of consistency in care across the country and a lack of qualified mental health nurses and staff shortages. Which has also had a negative impact on care as staff experience unsustainable workloads which will affect their morale and the standard of care will be below what they would want to deliver. It would appear that all too often the care given and where it is given is not decided by the mental health professionals but by accountants and managers who are detached from the realities of the needs and the aspirations of clinicians and other mental health professionals along with service users and their families, who want a better, more appropriate service than that offered at the current time.
The tragedy is that this current Government are not learning from the mistakes of the past and in their intransigence to recognise the proportions of this crisis and the need for an urgent and in my view overdue restructuring of the services provided to people with mental health problems. This total restructure needs to be evidence based and a more balanced approach to care. There needs to be a better balance between inpatient and community care with investment in both areas and better integration between the two, so users of the service receive a seamless pathway of care. We need to ensure that no one who is experiencing a mental health crisis has to face the added stress and burden of being treated away from their home area or being treated and cared for in inappropriate environments such as a police cell.
I believe such failings in the service fall squarely at the feet of Government ministers past and present, who have consistently treated the mental health service as a poor relative in the NHS and as an easy target for cuts. It is their underinvestment in mental health care that has caused the current crisis. If they continue to break the promises that they made to make mental health care a priority and fail to invest in the service then they will betray the trust of both mental health sufferers and the professionals who care for them and more lives will be blighted by mental illness and undoubtedly lives will be lost. We cannot afford to allow the Mental Health Service to continue in this terminal decline. The Government’s broken promises are leading to broken lives.
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