What’s the current situation in our Mental Health system?
You, or a loved one, become seriously mentally unwell. You would think that if admission was needed to a psychiatric unit, that would happen. However, this is becoming increasingly unlikely. 30% of psychiatric beds have closed in the last 10 years. So what you are likely to be offered is
- A wait, with access to the Crisis Team, who MAY be able to support you at home
- A psychiatric unit many miles away – out of your area.
- Admission to a very stretched unit – where there is little therapeutic input, staff are extremely busy.
Our mental health system is not functioning well – it is poorly resourced and understaffed.
Hospital beds are over occupied
How would you feel if your loved one was expressing suicidal plans, was agitated, not themselves. They are assessed (professionally) as a danger to themselves, but an acute mental health bed was not available? This is the situation day in day out for people all around England.
Meanwhile the doctors and nurses on our wards are trying to “manage” bed capacity at over 100%. Which means patients going home on “leave” will have their beds occupied whilst they are away. It is very distressing to come back to a bed with someone else occupying it. Medication is provided, but other therapeutic interventions are “as available”. This means they will be cancelled if the ward is too busy – which they are a lot of the time. “One to one’s” are cancelled, patients feel the staff are “too busy” so they don’t “bother” them. So these rare beds, so difficult to find, are not always the therapeutic environment that they should be.
The only available bed is over 100 miles away
“Out of area” placements are increasingly being used because of the shortage of beds. The British Medical Association found that over half of admissions to psychiatric care mean journeys of over 100 mile for families. For young people – especially those with an eating disorder, the situation is even worse. 7 out of 10 are placed in units far from home. These are children at their most vulnerable, being sent on long frightening journeys – their families unable to visit when they want or need to.
This matters. In 2015 the King’s Fund warned: “A lack of available beds is leading to high numbers of out-of-area placements for inpatients. Out of area placements are costly, have a detrimental impact on the experience of patients and are associated with an increased risk of suicide.”
Is precious money being well spent?
Unfortunately, a lot of money is being spent on staff who are paid through an “agency” or as “locums”.
Staffing shortages are particularly severe in mental health services. There are more than 20,000 vacancies for mental health staff in England. BUT the number of available psychiatric nurses has fallen – 12% since 2009. Nurses are heading towards retirement age more quickly than they are qualifying.
Agency staff are sometimes the only option. In 2015 agency nurses cost, on average, about £39 per hour. This compared with around £27 per hour for a bank nurse (in-house equivalent of an agency). And just £11 per hour for a band 5 staff nurse, and £16 per hour for a band 7 ward sister. Even when employer costs are added, permanent staff working at usual rates are a much more cost-effective solution for employers. See here
What more can the NHS do to attract permanent staff? It is imperative that this is addressed, so that working in NHS mental health services is seen as a positive career. With good remuneration and conditions.
It is difficult to make plans to improve services, provide resources, when you have a massive financial leak going on. And when you haven’t got an adequate pool of qualified staff – and Brexit will reduce staff from EEA areas coming to fill our gaps.
What’s the alternative?
Whether it is the Community Mental Health Teams, the Crisis and Home Treatment teams or other Community providers, cuts have been happening and the effects are concerning. People are not receiving the support in their communities to keep them well and to prevent hospital admissions. Their recovery is not supported. People report being discharged from hospital and services before they are well enough and left to cope.
The opposite of this needs to happen before we will see progress.
Two crucial community services
Crisis and Home Treatment Teams (CRHTT) services
Many CRHTT need to be completely overhauled – patients complain about the way they are treated by these teams – often making them feel worse, so they don’t contact them. Or they contact them, get an answerphone message and are left languishing for a call back – sometimes when it is too late. Patients complaints are long and consistent. CRHTT’s appear to be poorly resourced, staff are stressed and are not listening in a way that patients feel heard. In fact many CRHTT’s tell patients to call the Samaritans, which is a good idea – Samaritans will listen. But Samaritans cannot do the other functions of a CRHTT, such as arranging services.
Recovery Colleges need to be provided everywhere, everyone should have access to one. They need to be bolstered to provide their students with the skills and knowledge to build their recovery, to become self resilient, to be empowered. Recovery services and language need to be central to planning mental health services – yet they are not. Some areas don’t even have a Recovery College. Have you heard of them before? Is there one in your area? Make full use of it if there is. Recovery stories are amazing, unique and we should be enabling and promoting them – whilst still providing therapies etc to support that recovery.
We need things to change
Today these two articles were published – https://www.theguardian.com/society/2018/jul/21/mental-heath-crisis-beds-shortage-detentions-soar and https://www.theguardian.com/society/2018/jul/21/nhs-beds-number-mental-health-patients-falls
We could sit and wring our hands and despair. Or we could say “This is not good enough. This is wrong. We can do better”. Because the truth is we CAN do better if we put our minds to it. It is NOT rocket science, but it does require commitment and resources to be used in different ways. We will always need specialist units and inpatient beds. But our care and compassion in the community can reduce that demand with hope and better quality lives.
Want to find out more about Recovery Colleges?
IMROC are the organisation leading on this. Check out their website for information and support in building Recovery Services and finding out more about the Recovery Model. “Recovery” is the future of mental health services – lets get to work on it now.
Unlock Your Wellbeing works with Recovery Colleges delivering Wellness Recovery Action Plans (The cornerstone of any Recovery College) as well as other Recovery sessions
Please call The Samaritans – 116 123 – do not suffer in silence on your own.
Contact us for more information