A recent review in the NHS indicated that of 255 people who required urgent mental health care, 30% could not be treated in an NHS facility because of a shortage of beds.
For example recently a Norwich man with mental health problems was kept in a police cell for more than 24 hours and then sent to a private hospital some 175 miles away from his home and family. There were no urgent NHS beds available.
The crisis in urgent beds is not the only area of mental health care which is causing concern. Some people are being assessed as not needing urgent beds when they require those services. The suspicion is that where beds are not available, decisions as to care might be influenced by resource availability rather than patient need.
Therefore even in cases where an urgent admission is needed, a “make do” mentality may be in place, leaving seriously ill people in the community.
In other words the reduction in funding for mental health services has been so acute and at such a level those who are very ill cannot be guaranteed that they will receive the care they actually need. Resources have been cut so much that even the basics cannot be provided.
The other part of the problem for the mental health patient is that often they are seen by the people without medical qualifications and experience. Mental health has been reorganised into community teams made up of social workers, community psychiatric nurses, mental health workers and others. Despite their titles not all of these are either medically qualified or experienced. These teams rarely include consultant psychiatrists or senior nurses.
It is increasingly difficult for mental health patients to actually see a psychiatrist and to have a plan of action and care organised appropriately. They often see only the lower less qualified and less experienced members of the team, some of whom have very limited training if any. If someone was presenting with an acute abdominal complaint we wouldn’t ask a social worker to attend. We wouldn’t be asking a junior nurse to make the diagnosis. We would be asking a senior doctor to review the tests, make a diagnosis and come up with a treatment plan.
This level of care is simply not available for the acutely ill mental health patient. The obligation to provide the care has not however changed.
I recently took on a case in which my client had a previous history of violence which was not recent. As a result of a deterioration in his condition, which he recognised, he committed an awful act. A couple of days previously, he was asking for an admission into hospital. He was seen and talked to by a number of people some of whom were experienced but the majority of whom had limited qualifications and no more than an academic understanding of mental health. He was told there were not beds. He was told he didn’t need an urgent bed. The consequences of these failings have been devastating.
My client was seriously ill. When he needed help he wasn’t seen by senior medical professionals. His only contact with the consultant psychiatrist was meeting him by coincidence in a corridor. If he had an acute cardiac condition he would have been triaged by an experienced nurse who would have arranged for urgent medical care by senior medical professionals. As an acutely ill mental health client he wasn’t reviewed by any senior medical professional. How can that be correct?
Mental health services have been starved of funding for a very long time. Community care has its place but there should be adequate provision of proper crisis beds, managed, staffed and supported by adequately qualified and experienced practitioners.
From a lawyer’s point of view the argument that there was no bed available is not a sufficient defence. It simply isn’t good enough for trusts to rely upon lack of resources as an excuse. If somebody was coming into the emergency department with a ruptured spleen nobody would accept the defence of no resources if they subsequently died as a result of a failing in staff or quality of care. The same applies to mental health.
Mental health patients are ill; they deserve to receive treatment in the same way as people who have a more physical illness. It makes no difference. The commitment of the NHS is to provide care for all at the point of need. To date that remains a problem.