In May we saw yet more headlines about how our mental health services are failing, with the BBC reporting that a review by the Children’s Commissioner has found that more than a quarter of children referred to mental health services in England last year – including some who had attempted suicide – received no help.
This latest story follows an independent review of mental health services published earlier this year- the Five Year Forward View for Mental Health which made clear that those suffering poor mental health are not getting the care they need, when they need it, and that mental health services are underfunded.
The report found that suicide in England is rising “following many years of decline”, with 4,477 people killing themselves in an average year. There has been a 10% increase in the number of people sectioned under the Mental Health Act over the past year, suggesting the needs of the mentally ill are not being met early enough. Furthermore, a quarter of people with severe mental health problems need more support than is currently on offer, with many at serious risk of self-neglect.
The report paints a shocking picture and has led the government to promise £1bn a year of additional funding in NHS care by 2020/21 and the NHS to pledge a range of measures including increased access to psychological therapy and improved support for physical health by 2020. New targets have been set including plans to ensure all areas have multi-agency suicide prevention plans in place by 2017 that are reviewed annually. It is hoped that this will with reduce suicides by 10% by 2020.
These are bold pledges but the question is, will this really make a difference to those who suffer from mental illness? Will the changes lead to better care and a better quality of life and will they ultimately save lives? As a former NHS nurse and as a clinical negligence practitioner who sees the impact poor care has on patients, some of whom end up taking their own lives and some who die from avoidable physical conditions, I think that real improvements in care require far more deep rooted change.
Currently there remain fundamental problems with how society views mental illness. It still carries a considerable stigma and there is a sense that individuals are somehow to blame for their problems. This perception has an impact on care and although mental health services have moved on from the days of asylums, psychiatric services are still the poor relation of general medicine. Whilst treatments for physical conditions continue to make great strides, treatments for mental health problems have not kept pace.
This, combined with poor resourcing and the harsh reality of working with patients who in many cases may never be ‘well’ means the profession often struggles to attract the best people. Morale is low as funding cuts, constant restructures and cycles of mass recruitment followed by redundancies take their toll. Our services are only as good as the people who work in them and I believe more needs to be done to recruit, retain and train healthcare staff.
Creating an environment where staff feel valued are able to perform to the best of their ability will not be achieved by putting in place yet more targets. Instead this can create a tick-box mentality where practitioners consider that they have done their job if they adhere to the processes and plans required of them. Mental health services in this country need committed, experienced, compassionate staff who fully understand the importance of their role in their patients’ well-being and an ability to look at their patients’ problems in the wider context. All too often practitioners are focused on treating the symptoms of the patient’s illness, usually with drugs, and see all of their problems as a result of the mental illness they suffer from. This means that serious physical conditions are overlooked and remain untreated. Training is needed to ensure factors such as poor housing, loneliness, poor diet or physical illness are identified and where possible referrals are made.
The importance of experience and expertise is particularly critical when patients are being risk-assessed. In my caseload I see situations where inexperienced junior staff have been required to make judgements about an individuals’ suicide risk – a decision which should be made by an experienced psychiatrist – and in some cases have got it wrong. Whilst they may consult with a senior doctor to check their decision, this does not replace a face to face consultation between an experienced doctor and a patient and can mean serious problems go unrecognised. In one case involving a depressed woman going through the menopause, her GP recognised she was in crisis and referred her to a psychiatrist for an urgent consultation. She was given an appointment and was seen by a nurse, rather than a psychiatrist as expected. Her husband queried whether a change of medication might help which the nurse duly prescribed. She missed the signs of an acute crisis and the patient went on to take her own life.
At inquests where I represent the families of mental illness sufferers who have died, I have also witnessed a lack of individual responsibility from those working in mental health services. There is a drive to promote Multi-Disciplinary Teams (MDTs) that draw together consultants, nurses, social workers and others who share responsibility for caring for a patient. These make a great deal of sense and when they work well and communicate effectively, meaning that vulnerable individuals get joined-up care. I have, however, seen how MDTs have led to a dilution of responsibility. No one individual considers that they alone have responsibility for a patient and in most cases will concur with the diagnosis or treatment recommended by a colleague on the team. At inquests we see the blame for a death being passed from practitioner to practitioner. I believe this needs to change and the buck must stop with one individual who works within the team.
So whilst I welcome the spotlight that has been put on mental health and the extra resources that have been allocated to the field I fear we are focusing on the wrong things. Instead of setting out fresh benchmarks we need to go back to basics, understanding how services operate on the ground and working on training and retaining our staff. Poor care can exacerbate patient’s conditions and in some cases I see, sufferers would have been better off receiving no treatment at all.
One in four people will experience a mental health problem in their lifetime and the cost of mental ill health to the economy, NHS and society is £105bn a year. It is high time that mental health is treated on a par with physical health, with well-trained staff its heart.