Is the UK delivering effective mental health services?

Over the last few months, there has been increasing reports of failures to meet the needs of patients with mental illnesses in the UK. Open Access Government examines the impact of cuts on the sector

Mental health services are in trouble, it seems. Last year an investigation by Community Care magazine and the BBC revealed that more than 2,100 mental health beds have been lost since April 2011 1. This amounts to a 12% decline in the total number of beds available.

Funding for the sector has always been sub-par, but the latest string of grievances aired by patients is enough to make your toes curl.

A few months ago, it was reported that mental health services were so underfunded that a 16-year-old girl had been kept in a police cell as there were no beds for her.

The story, which emerged in November last year, caused an outcry, and the government pledged to end the practice, agreeing that police custody could only be used in cases were adults displayed extreme behaviour. It was probably of little comfort to the girl who endured the events, but at least going forward things may be better for vulnerable children.

There is no doubt that the mental health care system is at a breaking point. The Royal College of Psychiatrist said there were days last year when there were no mental health beds available for adults in England.

President of the college Simon Wessley said: “There is mounting evidence – such as the doubling of the number of patients having to be sent out-of-area for care between 2011/12-2013/14 – that there are simply not enough mental health beds available in some areas. “This is a system at breaking point, and patients are being put at serious risk as a result. “The college’s position is very clear – everyone who requires an acute mental health bed should be able to access one in their local NHS trust area.”

Marjorie Wallace, the chief executive of mental health charity Sane, said it was “profoundly worrying” that there are occasions when the NHS had no beds for patients. She said: “It is a cruel result of a longstanding agenda to reduce mental health beds and treat all mental health patients–no matter how unwell–by already overstretched mental health teams in the community.”

A recent report from the NHS’s Health and Social Care Information Centre (HSCIC) revealed that more than 400 adults with acute mental health problems were being forced to seek treatment from hospitals more than 30 miles from home.2

Since 2012, sadly 7 people have killed themselves after being told there were no beds for them, and this cannot continue. People must be given the help they need. It is not acceptable for the government to fail to provide vulnerable people with the correct care. It is also not acceptable to expect a vulnerable person to travel miles from home and their family to receive the help that should be available to them in their area.

Problems in mental health are hardly new. The service has been woefully underfunded for years, but the problems have been compounded by severe austerity measures across all government departments. Mental health services for children have, in particular, suffered. At the beginning of the year, the Labour party revealed that since the coalition government took power in 2010 nearly £50m has been slashed from the budget.3

In the final year of the Labour government, 2009-10, spending on children’s mental health services was equivalent to £766m (at 2013-14 prices). In 2012-13 the figure fell to the equivalent of £717m.

The Care Minister countered this by pointing out that an extra £7m has been spent on more psychiatric beds. The new investment will also be plugged into tackling self-harm and eating disorders. Given the scope of the cuts, however, £7m seems like a drop in the ocean. Charity YoungMinds said problems were so deep because children’s services had been hit with a “double whammy” of cuts to both local government and NHS budgets. The organisation found last year that more than half of councils in England froze or cut the budget for child and adolescent mental health services between 2010-11 and 2014-15.

Speaking in January, Chief Executive Sarah Brennan said: “These are deeply worrying figures. “Children and young people’s mental health services have been chronically underfunded for decades and the current cuts to their funding have just added to the crisis that many local services face.

“These figures along with YoungMinds’ previous research demonstrates the ‘double whammy’ that children and adolescent mental health services face as both local NHS services and local government cut funding.”

Additional concerns about mental health budgets have also been raised by Healthwatch England, who warned last month that the practice of discharging patients from the hospital without the necessary information about their condition and future needs was putting vulnerable people at risk.

The state-funded organisation found that numerous patients suffering from suicidal behaviour and engaging in self-harm were only offered a crisis support phone number after being discharged.

Further research from the science world came last year. A paper published in The Lancet Psychiatry revealed that while suicides on psychiatric wards had more than halved in recent years, patients treated at home by crisis resolution home treatment teams had seen their numbers double 4. Researchers said it indicated a need to offer more support to crisis teams on the ground.

Professor Louis Appleby, Director of the National Confidential Inquiry, said: “CRHT (Crisis resolution home treatment teams) has been an important alternative to hospital admission for patients who are acutely ill, but we need to ensure that it is used safely, especially at a time when bed closures are putting pressure on mental health services.”

At the beginning of February, Care Minister Norman Lamb said the government had invested a total of £120m to improve care. He said: “We are pleased that NHS England’s guidance to commissioners for 2015/16 is to give real terms funding increases to mental health. “I have set about getting data for the first time ever on out of area placements so that we can see clearly which areas are failing.

“I am clear that sending people a long way from home is intolerable. I have asked the Monitor and the Trust Development Authority to identify the problem areas and find solutions to these failures.”

But more needs to be done, and it needs to be done quickly. Cuts to mental health services are having a detrimental impact on people who suffer these illnesses. Expecting people to travel miles for a hospital bed or having no beds available at all is not acceptable. Mentally ill children have no place in police cells.

The government needs to step up efforts to turn things around and invest in services that are efficient and offer the right support to vulnerable people.






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