It’s hard writing about mental health services these days without feeling a profound sense of loss and pessimism. Looking over my shoulder I can remember a time when patients didn’t get sent in secure ambulances all over the country, spend several days in emergency departments, or routinely give up waiting and go private.
I certainly don’t recall even private psychiatrists being overfull and having waiting lists as seems increasingly common now.
To avoid getting swept away by my personal worldview and feelings, I try to look for the evidence. The BMA has made this a lot easier with its new dashboard of mental health service indicators mental health pressures data analysis.
Sadly, it does not make reassuring reading. Sending ill people far away from their homes and friends and families continues apace with the underlying tale of human misery this brings. Demand on services continues to climb, with mental health services having received 4.3 million referrals in 2021 alone and 1.6 million people being in contact with services at the end of June 2022, a rise of 38% since April 2016.
During the same period mental health spending as a proportion of the overall NHS budget has decreased, despite what our politicians spout. We also know that the suicide rate in the UK remains stubbornly high and is possibly creeping up again and there are huge disparities. Men in Newcastle are almost twice as likely to take their own lives as those in London.
Is it any wonder things are getting worse?
We are in a terrible workforce crisis in the NHS as a whole; within that there are desperate shortages of mental health nurses and trained psychiatrists. In the absence of a coherent national workforce plan and a government that appears deaf to calls for more medical school places and nurse training bursaries, mental health trusts are increasingly looking abroad. This presents its own problems, as these doctors and nurses are needed where they are, often much more so, making it ethically problematic and certainly no panacea.
The miracle is that, given all that is said above, many people still get excellent person-centred care. This is down to the increasingly burnt-out individuals who turn up every day, often early to arrive and late to leave, and help their fellow human beings navigate around a broken and cash-starved system. We need to be careful in these difficult times and always speak the truth that the fault is not in the NHS and its founding principle that care should be free at the point of need.
My colleagues and I know an alternative system reliant on private companies would not heal our wounds. The NHS we all know and love can work and indeed it did work when it was properly funded but it has since been drained of staff, money, and goodwill. We are at breaking point and without a return of these valuable resources, the NHS will continue to lose staff, and even more patients will fail to access the care they need.
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