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The mental health service in England is in crisis and unsafe, says one of the country’s leading psychiatrists.
Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust, spoke out as an investigation by BBC News and Community Care magazine reveals more than 1,500 mental health beds have closed in recent years.
Many trusts have all their beds filled.
Care Minister Norman Lamb said the current situation was “unacceptable” and provision must improve.
While there was a drive to treat more people in the community, he said beds must be available when patients needed them.
System ‘inefficient, unsafe’
Freedom of Information requests were sent to 53 of England’s 58 mental health trusts, by BBC News and Community Care, and 46 trusts replied.
The figures show that a minimum of 1,711 mental health beds have been closed since April 2011, including 277 between April and August 2013.
This represents a 9% reduction in the total number of mental health beds – 18,924 – available in 2011/12.
Three quarters of the bed closures were in acute adult wards, older people’s wards and psychiatric intensive care units.
Northumberland, Tyne and Wear NHS Trust has cut its inpatient beds by 157, while St George’s and South West London has removed 155 beds.
Behind the statistics lie the consequences for staff and patients.
On the morning Dr Baggaley spoke to the BBC, he said a severely distressed patient had been transferred from Croydon to Hertfordshire as there were no beds in London.
He has 50 patients in beds outside his trust, some as far away as Somerset.
He said: “We are in a real crisis at the moment. I think currently the system is inefficient, unsafe.
“We’re certainly feeling it on the front line, it’s very pressured, and we spend a lot of our time struggling to find beds, sending people across the country which is really not what I want to do.”
Lucy Bowden sought voluntary psychiatric help, and was told no beds were available
Lucy Bowden ended up in the back of a police van due to a lack of beds after voluntarily seeking help.
The 33-year-old, who self-harms, was left wandering around the grounds of her local accident and emergency unit after being told there were no psychiatric beds available after she’d been treated following an episode.
Eventually the police were called, who had to section her to force her local psychiatric hospital to provide her with care.
She recalls: “They couldn’t find anywhere so they were saying I’d have to go in to police custody, in a police station which would mean I’d have to go into a cell. Eventually they found a bed and I had to go into the back of a police van, in the cage in the back. It was horrible.”
The bed closures are only part of the problem.
There is also increasing demand for mental health services, according to Dr Baggaley.
Dr Martin Baggaley: “There seems to be a genuine increase in demand”
“There seems to be a genuine increase in demand,” he said. “That’s partly explained by a reduction in beds, by resources coming out of the health system, the squeeze on social services budgets, and by the general economic situation.”
Average occupancy levels in acute adult and psychiatric beds are running at 100% according to the FOI figures from 28 trusts.
Half of these trusts had levels of more than 100%; all of them had occupancy rates above the 85% recommended by the Royal College of Psychiatrists.
The problems of running at capacity are highlighted by the tragic case of Mandy Peck. The 39-year-old told psychiatric staff she was feeling suicidal but her local mental health service centre said they had no beds available. A day later she jumped to her death from a multi-storey car park. A subsequent investigation found that a bed had actually been available.
Care Minister Norman Lamb said: “Current levels of access to mental health treatment are unacceptable. There is an institutional bias in the NHS against mental health and I am determined to end this.
“More people are being treated in the right settings for them, including fewer people needing to go into hospitals. It is essential that people get the treatment they need early and in the community but beds must be available if patients need them.”
Dr Geraldine Strathdee, National Clinical Director for Mental Health from NHS England, said the key was to strike the right balance between providing sufficient hospital beds and helping patients to be treated at home, or in the community.
“We need to make sure the people who are commissioning services have the information they need about the level of need in their area. We have to get this right for people.”
Marjorie Wallace, chief executive of the charity SANE, said: “It is all too easy to find the cuts demanded by NHS efficiency savings in mental health.
“If a patient has heart failure or is in a coma, a bed has to be found. But for a person in mental distress, this is not seen to be as necessary.
“Being turned away when seeking help only reinforces patients’ feelings of rejection and hopelessness and can in our experience drive them to suicide.”
Via http://www.bbc.co.uk via Bridget
Too many people who use community mental health services are not being involved in decisions about their own care.
A major national survey of more than 13,000 people who use community mental health services in England published today (17 September) by the Care Quality Commission (CQC) shows the care people receive in the community needs to improve. Of particular concern is people’s lack of involvement in their care plans and having their views taken into account when deciding which medication to take.
The 2013 survey of people who use community mental health services asks about the experiences of more than 13,000 people during the past 12 months. The survey involved 58 trusts in England who provide mental health services.
People were asked about the care and support they received from mental health services outside hospital, such as those offered by outpatient clinics, local teams providing crisis home treatment, assertive outreach, early intervention for psychosis, and generic community mental health services.
Care for people who have complex mental health needs and require multi-agency support is co-ordinated within a framework called the Care Programme Approach (CPA). Policy guidance states that people who are on the CPA should also receive support with day-to-day matters such as employment, housing and financial advice. The survey includes people who received care under the CPA as well as those who do not.
The survey results show that that some respondents said that they do not have a care plan, and many of those that do have one, do not fully understand it, this suggests that people are not being adequately involved in the decisions that are made about their care. Responses suggest that some care plans do not explain what people should do if they have a crisis and too few people have had a care review meeting in the last twelve months to discuss their care:
Fourteen per cent of respondents on CPA said they do not have an NHS care plan. Of the remainder, fewer than half (46%) ‘definitely’ understand their NHS care plan (down from 48% in 2012).
When asked if their NHS care plan covered what they should do in a crisis 58% of respondentson CPA responded ‘yes definitely’ though this is down from 60% in 2012. Less than half of thosenot on CPA (49%) responded ‘yes definitely’. Some respondents say they have not had a care review in the last 12 months to discuss their care:
Almost half (47%) of respondents not on CPA said they had not had a care review in the last 12 months.
The proportion of people on CPA who said they have not had a care review meeting in the last 12 months has increased from 24% in 2012 to 26% this year.
Although the majority of respondents know who their care coordinator is and were generally positive about them, results had declined from 2012:
Seventy two per cent said they could ‘always’ contact their care coordinator (or lead professional) if they had a problem, down from 74% in 2012.
Sixty per cent said their care coordinator (or lead professional) organised the care and services they need ‘very well’ down from 61% in 2012.
The survey also shows that some people are not being adequately involved in decisions about their medication, with almost a third (32%) saying their views were only taken into account ‘to some extent’ when deciding which medication to take and less than half (43%) of those who had been prescribed any new medication were ‘definitely’ told about possible side effects.
However in line with last year’s survey, most people responded positively to questions about the health or social care worker they saw most recently, with the majority (70%) (although down from 72% in 2012) saying they ‘definitely’ had enough time to discuss their condition and treatment, 78% saying they were ‘definitely’ listened to carefully and 72% of people saying their views ‘definitely’ were taken into account.
In a new question, respondents were asked to rate their overall experiences on a scale of 0-10 Most people (67%) responded positively rating their overall experience as a ‘7’ or above.
David Behan, CQC chief executive, said:
“This survey provides valuable intelligence about the experiences of people who are being supported by community mental health services. The survey describes some very positive experiences and flags where services can and must improve.
“People should always be at the heart of decisions about their own care. Care planning helps to make sure that people feel in control of their lives and illness and it can be vital in aiding their recovery. It is unacceptable that fewer people have adequate care planning than last year. It is also unacceptable for care plans not to include adequate crisis care management or for people to be poorly informed about the drugs they take.
“One of CQC’s key objectives this year is to focus on the care being provided to people by mental health services. The results of this survey will help our inspection teams under the Chief Inspector of Hospitals Prof Sir Mike Richards home in on the poorest providers and be able to challenge this poor performance though inspection.
“Trusts should look at their own results carefully and consider whether, firstly, they are assessing people’s needs properly in the context of the CPA policy, and secondly, whether they are giving them the appropriate level of support.
For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.
For general enquiries, call 03000 61 61 61.
The results are primarily intended for use by NHS trusts to help them improve their performance. The CQC has included data from this survey in its Quality and Risk Profiles to assess compliance with the essential standards set by the government, and has published data for all NHS trusts on the CQC website. NHS England will use the results to understand patients’ experiences of NHS services and to drive improvements.
A set of tables showing the year on year results for each question is available on the CQC website, together with a national summary highlighting the key findings and the results for each NHS trust: Community mental health services survey 2013
About the national NHS patient survey programme
The Community Mental Health survey is currently under review and is expected to change ahead of the next survey.
The NHS patient survey programme was established by the Department of Health in 2002, and taken over by the Commission for Health Improvement later that year. It then passed to the Healthcare Commission, followed by CQC. The programme covers a range of topics including mental health services, adult inpatient and outpatient services, maternity care, and ambulance services.
The surveys are funded by NHS trusts, using a standard core questionnaire and methodology prescribed by the co-ordination centre, run by the Picker Institute Europe. Most trusts will use a contractor approved by CQC to undertake the survey on their behalf.
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England.
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.
We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.
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