The airline industry’s take on life preservation is often put on the pedestal in patient safety debates.
When a single mistake – or oversight – can cost hundreds of lives, it’s taken very seriously indeed.
So could the same logic apply in mental health services?
This was the question posed by psychiatrists at the BMA annual representative meeting in Belfast on Wednesday.
BMA consultants committee mental health lead Andrew Molodynski invited the audience to imagine they’d boarded a mid-sized aeroplane.
‘There’s about 120 to 150 passengers. Imagine that they’d all taken their own lives this week,’ he said. ‘That they’d got to a point in their lives where they had no hope.
‘Think about the plane you will get on tomorrow, the same size. About 120 people. Imagine they’ve all died from alcohol-related disease at one time or another this week. Because they have.’
The Office for National Statistics recorded 5,821 suicides and 7,697 alcohol-specific deaths in the UK in 2017.
The airline industry would pull out all the stops if so many were dying each week.
‘What patients and their families, including many of us, need and deserve, is parity of resource, parity of access and parity of outcome; not parity of esteem,’ Dr Molodynski said. ‘We’ve had that for many years and we are where we are.’
Mental healthcare is 25 per cent of healthcare activity, but ‘our funding settlement is around 12 per cent of healthcare funding, if we’re lucky,’ he said. ‘We need to steadily move towards 25 per cent of NHS funding within the time of the 10-year plan.’
Middlesbrough GP Rachel McMahon challenged the idea that a quarter of NHS resources should be earmarked for mental health services. ‘What about patients who have complex physical and mental health problems, who present with physical symptoms which clearly have a psychological component?’ she asked. ‘Headaches, chronic pain. Panic attacks, turning up at A&E departments. Health anxiety. Some people know that these are psychological issues. Some will never accept that they have a psychological component.’
But retired Bristol psychiatrist Robin Arnold said doctors should follow the logic that his long career in the service had taught him – that mental health services were vital.
‘Despite being a psychiatrist, dedicated to mental health services, in my heart I think ITU and A&E are more important than mental health services,’ he said. ‘In my head, I know that mental health services are vital. This is a deep, cultural value we all absorb. People suffer and die if mental health services are not effective. We have to ensure that they are resourced by logic, not deep unconscious prejudice.’
Doctors at the ARM followed this logic with their feet and their votes. They agreed overwhelmingly with the need to align mental health resources with activity at a quarter of the NHS budget.
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