On Monday night, Panorama highlighted the crisis facing our mental health services.
This is an issue that has particularly impacted locally where the mental health trust, Norfolk and Suffolk Foundation Trust (NSFT), was the first to be placed in special measures until October of last year.
While the Care Quality Commission’s (CQC) overall rating has moved from ‘inadequate’ to ‘requires improvement’, please forgive me if I postpone buying a celebratory piñata.
On paper, the trust would have you believe that things have improved dramatically since 2003, when a patient’s body lay undiscovered in a ventilation shaft on ward G8 for several months.
Then there was the death of another patient years later because psychiatry 101 – the identification and removal of ligature points – had been neglected, while there was also the needless death of Kerry Hunter, whose case was featured on Panorama. These three examples are the tip of a deadly iceberg.
Although the NSFT is not alone in its floundering (in July 2016, 64 per cent of mental health trusts were rated as requiring improvement), that is of little comfort to the patients and families faced with a paucity of care.
Staff are justifiably afraid of going on record, but speak anonymously of infighting among board members and a culture of victimisation stemming from the top down.
Admin staff are demoralised, while the loss of senior clinical staff and their subsequent replacement by unseasoned juniors has seriously impacted upon care (some £20 million has been spent paying its most experienced staff to leave trust employment).
Funding cuts have caused the closure of the assertive outreach and homeless teams and led to dangerous gaps in provision for high-risk patients. The ‘one size fits all’ recovery model simply isn’t fit for purpose.
In an interview with the BBC, the president of the Royal College of Psychiatrists, Sir Simon Wessely, voiced his own concerns that services may be about to get worse, with the decommissioning of services next year.
How might this affect us locally? Well, it is rumoured that the sustainability and transformation plan (STP) in Norfolk is considering refusing treatment to dual diagnosis patients (psychiatric illness and substance use).
So what, you might say, people who use drugs and alcohol don’t deserve help, but this ignores the fact that some patients try to self-medicate in lieu of the care they need to manage their illness and it also treats a major risk factor as an excuse to deny treatment.
Their neglect is typical of a system of funding predicated on fiscally conservative, short-term outcomes. Dual diagnosis, in all its variant forms, will not fit tidily into those.
I have skin in the game, I admit. My daughter’s father died last summer after falling through the cracks: not ill enough to retain community support, not well enough to do without it.
His neglect was, in part, a result of the prejudiced attitudes about mental illness that still dog some primary care services. As a consequence, he bled to death from an undiagnosed physical condition after being passed from pillar to post like a human pinball.
Nobody but us took his complaints of pain seriously and the mental health services wrote them off as the actions of a man trying to ‘wheedle his way back into the system’.
My daughter is now fatherless because, despite our best efforts, we couldn’t make up for the lack of care. There was simply no space for him in a broken system.
In 2012/13, the trust reported 53 such unexpected deaths and this figure rose to 105 in 2013/14. In 2014/2015, 139 unexpected deaths were recorded, rising to 157 in 2016.
This rise is not due to ‘better reporting’ of deaths as claimed by Sir Simon Wessely because the NSFT hasn’t changed the way it reports and records unexpected deaths.
When we talk about harm, we need to focus not just upon deaths but all those people struggling to access mental health services, who have had care cut and suffer life-changing psychiatric illness.
Mental illness accounts for one quarter of all disease treated by the NHS, yet it receives just 11 per cent of funding. This situation is untenable.
-- Nicola Miller is author of The Millers Tale blog. Follow her on Twitter: @NicolaMillers