Just last week, data obtained from freedom of information requests led to claims that the NHS treated mental health care as a “second-class service”. Indeed, thousands of mentally ill patients have been forced to travel “hundreds of miles” for treatment in recent years. Extreme cases have seen patients being forcibly sectioned so that they can receive care in overcrowded wards. Even medical students have resorted to asking for greater teaching on psychiatry, highlighting the derisory attention that mental health issues receive. Yet the state of mental health services is unsurprising considering that they receive only 13 per cent of the NHS budget, despite mental illness affecting around a quarter of the UK population.
Worse still, national spending on mental health has consistently decreased over the past three years. And the trend isn’t limited to adult care; mental health services for children and adolescents have also seen a fall in funding. This decline seems even more irrational considering adolescence is the period when many mental illnesses first manifest, and that hospitals are recording a rise in hospital admissions for conditions such as eating disorders.
The budget cuts have had a noticeable impact, with doctors citing the changes as a cause of “avoidable deaths and suicides,” while mental health organisations claimed that the cuts “put lives at risk”. Mental illness also has a significant impact on a patient’s quality of life, and is thought to contribute to poor physical health, having been associated with diabetes, cancer and cardiovascular disease. As well as the ethical concerns of these cases, such neglect of the mentally ill also has practical implications; a report by the London School of Economics found that the NHS could save over £50m a year by reversing budget cuts to preventative and early intervention therapies.
Yet perhaps the most striking aspect of the decrease in funding comes from the comparison with other areas of health care. The government, for instance, took great pride in announcing that the Cancer Drugs Fund would be ring-fenced until 2016. While it would be wrong to question the severity of diseases such as cancer, it is worth considering that this budget is reserved for treatments that aren’t ordinarily commissioned because they are not cost-effective. Given the nature of the NHS’s funding crisis, it seems unfair to fund relatively inefficient treatments, while the NHS’s most vulnerable patients are left without basic care.
This is the problem. Eager to brand their “reform” of the NHS as good for patients, the coalition has protected the emotive areas of health care that already benefit from public awareness. Aware that severely cutting the budget for paediatrics or cancer care would result in public outrage, the government are cynically withdrawing care from those most lacking a voice in society: the mentally ill.
Although this current crisis is alarming, such disregard of mental health isn’t a recent phenomenon. Plagued by a history of taboo and prejudice, mental health care has historically been chronically underfunded. With a media happy to brand mentally ill people as “psychos” and a threat to society, it has been relatively easy for politicians to excuse this injustice. But public perceptions are changing; a report by the charity Rethink Mental Illness found that public understanding and tolerance of mentally ill people is improving, while 63 per cent were aware of a close friend having a mental health problem.
This is important; for a politician to stand up for mental health care now wouldn’t just be a principled action, it’d be a popular one. With time, and the excellent work of campaign groups, this positive trend in public attitudes will only continue, allowing society to grow in confidence to discuss one of our greatest health challenges. The mental health charity Mind suggests that the next government commits to a 10 per cent rise in the NHS’s mental health budget over the next five years. Considering the state of mental health care and the current funding disparity between health services, this is not an unreasonable request.
Past governments have chosen an area of health care to focus on, in order to target voter demographics. In 1999, Blair announced his “crusade against cancer”. Seeking the “grey vote”, David Cameron called for a “national challenge” to beat neurological diseases such as dementia. But the disgrace of the NHS’s mental health provision goes beyond party politics. Regardless of who wins the general election, the next government must embrace bold reform to end our longstanding neglect of the mentally ill.
Two Mental Health Advisors needed in Lewisham http://ow.ly/z2opZ Deadline: 28/7/14
A lack of beds is forcing mental health patients in England to seek treatment in other NHS facilities up to hundreds of miles away, BBC research has found.
The number of patients travelling to seek emergency treatment has more than doubled in two years – from 1,301 people in 2011-12 to 3,024 in 2013-14.
Earlier this year one patient was admitted to a deaf unit as no beds were available anywhere in the country.
Health minister Norman Lamb said out-of-area treatment was a “last resort”.
The care and support minister added that it was “unacceptable” if patients had to travel “hundreds of miles” for treatment and said he was determined to drive up standards of care in the NHS.
Leading charities have called the situation scandalous and a disgrace.
One mental health trust spent £345,000 last year placing patients in bed-and-breakfast accommodation in order to free up much-needed beds.
Mental health trusts are having to cope with cuts of more than 1,700 beds over the past two years, and the problems in the system have come to light following a joint investigation between BBC News and the online journal.
But the data from 30 of England’s 58 mental health trusts shows that overall the number of patients sent out of area has more than doubled between 2011-12 and 2013-14.
The increase comes despite the number of patients being admitted to hospital for mental health problems falling slightly from 167,285 in 2011-12 to 166,654 in 2012-13.
One patient complained she was made to sleep on a mattress on the floor due to the lack of beds. The trust said there was unprecedented demand for beds last year.
In Sussex, the number of patients sent out of area increased from 28 in 2011-12 to 227 last year.
Lisa Rodrigues, chief executive of the Sussex Partnership NHS Foundation Trust, said rising demand for mental health services and cuts to community services by councils were creating problems.
“We are seeing people coming to hospital who are much, much iller when they arrive so we have higher numbers of detained patients but, much more than that, we’re seeing people have to stay in hospital for longer.”
One patient who knows what it’s like to be transported far from home is “Alison” (not her real name).
Though she praises her treatment, she says it was a “shock to the system” and the distance was difficult to cope with.
“With me not being near friends and family I suffered, I had anxiety, I wanted to speak to people and have familiarity around me,” she said.
Other patients have had to travel even further, with people being sent from Devon to West Yorkshire (300 miles), and Oxford to Teesside (240 miles).
A London trust – Barnet, Enfield and Haringey – has been reprimanded by the regulator, the Care Quality Commission (CQC), for using seclusion units as bedrooms.
It also started to move patients out of beds and into bed-and-breakfast accommodation. The figures show that 132 people were sent to B&Bs last year.
The trust said the patients were fit to be discharged from hospital but had accommodation problems – however, it admitted it was not ideal for patients.
A board meeting of the Birmingham and Solihull trust in January heard a complaint from a patient who was admitted to a deaf ward despite not being deaf, which she says made her feel stressed and unable to communicate with staff and patients.
An investigation by the trust found this had happened because there were no female beds available in the country. Procedures have now been changed, the trust says, which should ensure it never happens again.
Marjorie Wallace of the mental health charity SANE said: “This situation is a result of the longstanding agenda to reduce the number of psychiatric beds, the most expensive element of care. But this is a false economy – leading to misery for many who struggle to access the treatment they need and undermining their chances for recovery.”
“This is the latest in a long line of clear signals that, at least in some parts of the country, NHS mental health services are in crisis. Continued cuts to funding for mental health services are taking a significant toll on the quality and availability of services.”
Mark Winstanley, chief executive of Rethink Mental Illness, added: “It’s absolutely scandalous that people with serious mental health problems are being treated in such a terrible way.
“Anyone going through a mental health crisis should expect to get help in a therapeutic environment where they can get better.
“The last thing they need is to be shunted to a hospital hundreds of miles away or, even worse, left to fend for themselves in a bed and breakfast.”
Karen Wolton, a member of the Mental Health Lawyers Association, commented: “We’ve noticed a sharp increase in the last year with inappropriate admissions for out-of-area beds. We’ve had people admitted from where they live in Margate to Weston-Super-Mare which is a trip of 225 miles.
“We’ve had people overdosing in order to obtain a bed. They’ve told us that they deliberately overdosed because that’s the only way to get a bed.
“We’ve also had people who are inappropriately discharged after long spells in psychiatric hospitals; they’re being discharged to bed and breakfast accommodation.”
Mr Lamb admitted there was an “institutional bias against mental health” in regard to waiting-time targets.
“When the 18-week maximum waiting time was established in the last decade it applied only to physical health,” he told the BBC.
“That left out mental health and incredibly, politically significant targets of that sort dictate where the money goes.”
The situation “has to change,” he added.
But Labour’s public health spokeswoman Luciana Berger said mental health services were “suffering from repeated government budget cuts”.
“Under David Cameron, wards are operating beyond safe occupancy levels and patients are turned away,” she said.
“Ministers must ensure that mental health services are accessible. They claim to support parity of esteem between mental and physical health but patients are being badly let down.”
Approximately half of people who take their own life have previously made a suicide attempt. People who survive are therefore at high risk of ending their own life later.
A new project, led by Dr Rina Dutta at the Institute of Psychiatry (IoP), King’s College London, will aim to predict who is most at risk, and when, by analysing data from electronic medical records. Identifying warning signs may then allow healthcare professionals to intervene before a serious suicide attempt is made.
The project, called e-HOST-IT (Electronic health records to predict HOspitalised Suicide attempts: Targeting Information Technology), is being led by Dr Dutta, from the Department of Psychological Medicine at the IoP at King’s. The funding was awarded by the Academy of Medical Sciences, as a Clinician Scientist Fellowship.
Dr Dutta will use data from South London and Maudsley NHS Foundation Trust’s anonymised electronic mental health records system, CRIS, developed by the National Institute for Health Research Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London.
Dr Rina Dutta says: “What we know about why people make suicide attempts lags behind our understanding of other life-threatening problems. One reason is stigma. Studying risk factors in detail has also been difficult, because health records have been handwritten and kept in paper files. Predicting who is most at risk and when is the riskiest time is a huge challenge.”
She adds: “The NHS aims to be paperless by 2018. Now is the ideal time to see whether warning signs of a serious suicide attempt could be picked up early using anonymised electronic medical records. These warning markers could be changes in symptoms, behaviours or healthcare service use, which happen before a suicide attempt.”
With help from Mind, Dr Dutta has actively involved patients in the design and planning of the research to ensure it is patient-centred. The aim of the project is that the information be used to help health professionals personalise care for people most at risk. The long-term goal is that as professionals use the electronic records system in their day-to-day work, they will be directly alerted to high risk times for their patients. Finally, Dr Dutta also aims to develop prevention strategies and self-management tools by feedback of patterns indicating risk to individual patients.