Avoidable misery, damage and death must not be tolerated

by Andrew Molodynski

This country needs to do right by people with mental illness and prioritise the NHS services that can help them

Location: England
Published: Thursday 12 May 2022
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In the UK we are witnessing a deterioration in mental health services that is beyond anything we have seen before.

Regardless of life stage, pressures on mental health services for children, adults, and older people all grapple with hugely increasing demand and a threadbare and exhausted workforce.

A decade of austerity has led to core NHS services that are ‘stripped to the bone’ and that now depend on temporary staff to cover workforce shortages. There are gaps everywhere. The traditional safety nets of social care and the third sector have suffered too and cannot offer as much support as is needed or they would like.

While all this has been happening, demand for services has risen inexorably, especially since COVID-19, and with no end in sight. The Government tell us they are putting more money than ever into mental health services with ‘record levels of investment’ but after a period of sustained austerity, this is not enough to address historic underfunding.

So, what does this all mean for some of the most vulnerable in our society? Last year, it was estimated  that 8 million people in England with mental health problems couldn’t get specialist help because they are not considered sick enough to qualify.

Mental health services are so understaffed and overworked that the threshold for being able to access care has been made higher. This leaves people whose needs are not being met with increased stigma, discrimination, and marginalisation. This is not a sustainable solution for addressing the mental health crisis.

Meanwhile, coroners up and down the country are issuing ever more section 29s (so called ‘preventable death notices’) to mental health providers because of long waits and gaps in services. What this means is a coroner saying, ‘if this service had been available or this help had been offered, this person might not have died’.

While these should be wake up calls, they are becoming commonplace and eliciting ever less of a response. Each represents a deeply personal tragedy and points to faults in our systems of care.

There are heart-breaking stories of critically ill adults and children not receiving the care they deserve and being sent all over the country, without warning, to be kept in private hospitals which the NHS has now become endemically reliant upon.

Care in these places can be good, but often it is not. Being transferred across the country is a dehumanising and stigmatising experience that would simply not be tolerated in physical healthcare.

There have been accounts of horrific abuse, for example at St John’s House in Suffolk where the mistreatment of vulnerable adults at a specialist private hospital for adults with learning disabilities and associated mental illness was uncovered in 2019. There have been several other tragedies due to gaps in follow up and in information sharing.

There are also stark inequalities within mental health treatment. The use of the Mental Health Act rises year on year and is disproportionately used for black men. People with severe mental illness live around 15 years less than the general population and we witness their deaths in circumstances we should not tolerate.

Children from the poorest 20% of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20%. The mistreatment of people with a mental illness amounts to nothing less than a civil rights issue.

As I typed all the above, I began to ask myself how I could be writing this about the situation in a large wealthy G7 economy that can afford to lose billions of pounds from covid fraud and unpaid taxes. The UK has well established health and wealth inequalities and mental health problems are grossly overrepresented in marginalised communities. We live in a society where conspicuous wealth and waste are flaunted while we tolerate avoidable misery, damage, and death.

Whilst all the above may paint a picture of a hopeless situation, there is plenty of opportunity for the UK government to turn things around so that everybody with a mental health condition is able to access appropriate treatment and the care they deserve.

To achieve this, we firstly need to double the additional ringfenced spending announced in the NHS Long Term plan. We are also calling for a £1 billion cash injection over the next financial year to cope with additional demand from COVID-19.

Secondly, the government’s target to eliminate acute out of area mental health placements by April 2021 was an entirely appropriate one but one that has failed to be met. Renewed efforts must be made to end this dehumanising practice.

Thirdly, a cross government strategy to reduce health inequalities must be drawn up, with a commitment to addressing mental health inequalities at its heart. Finally, the mental health workforce must be prioritised. With an average vacancy rate of at least 1 in 10 (and probably a lot more in reality) amongst consultant psychiatrists like me, mental health services do not have supply to meet patient need. Only when patient need is met, we can really say we are doing right by people with mental illness.

Andrew Molodynski is a consultant psychiatrist, Oxford Health NHS Foundation Trust, National Mental Health lead BMA consultants committee and deputy chair BMA community care committee