35% bed occupancy, people sleeping on mattresses, dilapidated wards…one could be forgiven for thinking, on the basis of the Mental Health Act Commission’s recent report Risk, rights and recovery, that we needed a massive injection of cash into inpatient units.
But when we asked Rethink members what they wanted from an ideal mental health system, more inpatient care was not the answer.
Current inpatient services don’t achieve much for the people using them, as one service user told us: "When the crisis hits, you’re grateful for the first few days of inpatient care, and then you spend the rest of the time trying to get out of the wards because you see, they achieve nothing."
Instead of more beds, people want access on a wider scale. Why should people have to wait to be in crisis to get help? 1 in 3 people who ask for help from mental health services are turned away. People are often told not to come back until they’re "sick enough" to pass stringent criteria for access to support. This doesn’t help anyone: not the people turned away, their families, staff or even the Treasury. In mental health, a stitch in time saves nine – and millions of pounds as the earlier treatment occurs, the easier and cheaper it is.
We need a range of services for people at different stages, starting before people even become ill. We’re getting better at investing in prevention for physical conditions, but we need to look at the risk factors for severe mental illness and start minimising them as well. There are well known links between the development of severe mental illness and factors like social isolation, difficulties during birth, teenage cannabis use and poverty, to name but a few. We can’t legislate to prevent these, but we can make sure information and preventative services exist in every community for everyone – because everyone needs to protect their mental health.
When someone asks for help, they need an immediate response, not gatekeepers like GPs, restrictive criteria or crisis services that are only funded to operate 9-5. We wouldn’t accept a ‘working hours only’ ambulance service and nor should we accept a 9-5 crisis resolution team.
In 2005, the IPPR posited a new kind of ‘community health centre’. These centres could signpost people on to specialist services and bring together groups to discuss coping mechanisms. It might be learning what triggers a crisis for someone and learning to stay away from that behaviour. Or simple advice like taking out a mobile phone to talk into if you hear voices while in public. Both physical and mental health could be covered by such centres, ending the current Cartesian split in the NHS. This isn’t a million miles away from Lord Darzi’s much-vaunted ‘polyclinics’ – let’s hope he includes mental health within their scope.
Making sure that people are supported in the long-term will free up resources for better crisis care when it is needed. Instead of large hospital wards, we need more crisis houses, like the one Rethink runs in Rotherham, which has been commended by DH’s Director of Mental Health. This is a genuinely therapeutic environment, which should be the most basic requirement for any crisis service. As one service user told us, “what you need is a secure hotel basically…country house hotel, that’s what we need”. Outside space should be standard at all residential services.
We need to put trust back in the heart of the mental health system. People with severe mental illness and carers should be trusted to ask for help when needed and not abuse the system. People should be trusted to design services and work out what outcomes services should achieve rather than have this decided by professionals.
And on the most basic level, the NHS should trust people with severe mental illness to work as professionals, whether in paid or voluntary roles. One Rethink member, who is studying at a London University, has applied 5 times to different NHS Trusts to work as a volunteer and been turned away every single time because he is considered a ‘risk’.
We need to direct resources into services designed, monitored and cherished by people who use them. In some local areas, this is happening on a very small scale. But only when this is the national norm will we have a mental health system we can be proud of.
Jane Harris is head of campaigns at the mental health charity, Rethink