Mental Health – the poor relation

Mental Health

I asked our members who are involved with mental health services  to tell me about what was going on in their area, and what policy areas we should be concentrating on.  This is my reflection on what they told me.  I’m not an expert in this area, and the mistakes are mine.  Please contribute to the debate below.

NHS acute trusts are now almost all in deficit.  Less than half of the mental health trusts, however, are, because it’s much easier to deny services to people who are mentally ill.   Since 2010 the number of English NHS mental health beds has been cut by 25% (from 25,503 to 19,249), and the number of beds available per head is way below the EU average.

Many councils have been forced to pull out of the partnership agreements that were put in place to deliver integrated mental health services across health and social care and there are severe staff recruitment problems.

We need a comprehensive and evidence-based approach to mental health promotion.

Not everything is bad: there has been some progress in diagnosing people with dementia. Nationally 68% of those thought to be affected are diagnosed, which is a very considerable improvement.

Children’s services

Children’s mental health services remain lacking in resource and direction. There needs to be a clear  and more extensive model of service which really integrates with education and social services. Waiting lists are long and services only provided to a minority who could benefit. An 8 month waiting time for a child of 6 is not acceptable. A false economy.  Adult disorders mostly start in childhood.  We go round looking to diagnose physical illness before the symptoms show, but with mental illness we refuse to start treatment even when symptoms are apparent.

There has been an explosive rise in children’s self harm and the suicide rate is rising.

There is a severe and ongoing shortage of beds for children so they are admitted to adult wards, or transported hundreds of miles, which is particularly inappropriate.  There is no system for locating those that are available, which leads to huge waste of staff time.

Mental health professionals should work with paediatric teams in an integrated way all over the country, as is already done in the best centres.

Severe mental illness

Services for people with psychosis and similar long-term illness seem to be surviving a bit better than the others but they are severely affected by cutbacks in social care, and the lack of integrated services.  Some of the problems recounted to me were:

  • People discharged from secure facilities to sheltered housing complexes without sufficient day-to-day support. Typically no support available in the evening or at weekends.
  • Inadequate arrangements for acute episodes. People taken by the police or ambulance to A&E departments of hospitals where there are no psychiatric wards, and put in which is said to be a place of safety – a locked cupboard. People sent, at huge expense to private mental health institutions, often hundreds of miles away, because there are no beds available locally.
  • A two week wait for access to services for people with their first psychotic episode

More properly supported housing would help, as would 24 hour support, possibly by telephone. Recovery communities could to help people with severe and enduring mental illness to be well enough to lead the life they want to Shared records between acute services, community services, GPs and social care would help.

Common mental illness

  • There is plenty of advice for people with common physical problems about what they should do if they are worried, and when they should, or should not, go to A&E. Nothing for mental illness.
  • The Work programme does not work for most people with mental health problems.  A coercive approach which does not address their problems is counter-productive.  It drives up the suicide rate, not the employment rate.
  • alcohol services do not have time to get to the underlying issues which drive people to drink.

We need a comprehensive and coordinated approach to people with less severe forms of poor mental health.

Most people who claim benefits because they cannot work do so because of mental illness, either on its own or compounding other problems.  To get them back to work a more therapeutic and holistic service is required.  Couldn’t the NHS offer that?

When the NHS was established there were proposals to provide an occupational health service, but that didn’t happen.  So now only the largest and most enlightened employers have an occupational health service. If the NHS provided this service it would be more comprehensive and more effective (employees are often suspicious of such services provided by their employer) and would support small employers.

Increasing the availability of employment where people could engage in productive work in a supportive environment would help improve mental health , and reduce the huge burden of related incapacity benefits. The competitive, target-driven, insecure nature of modern-day employment has driven many vulnerable but capable people onto benefits.

Mental or physical?

People with severe mental illness live much shorter lives.  People with long-term physical illness often develop psychiatric complications.  Large numbers of people with what are now called medically unexplained symptoms get a poor deal without any effective treatment.

Addictions such as alcohol, cigarettes and food have their root in poor mental health, stress, psychological or personality difficulties. Much physical illness is caused or aggravated by these addictions or habits. Spending more on mental health will reduce the physical health funding need.