‘The beds crisis makes me embarrassed to work in mental health’: a social worker’s story

An extract from a letter sent to Community Care by a frontline social worker and approved mental health professional

We always have high bed occupancy on our acute admissions units to the extent that we have over 40 people in out-of-area beds, some as far away as 175 miles from home. We recently had a psychiatric unit closed and now our trust is spending millions on out-of-area beds.

The impact this has on patients and families is devastating. Service users and families often find journeys of a few miles to one of our remaining NHS units difficult. Imagine what it’s like when we ask them to travel to out-of-area beds close to 200 miles away?

One family member reported having a 15-hour-round trip to go and visit someone. This means that people are not being visited by families and friends when they need it.

In my experience, right now people have absolutely no chance of an informal admission to hospital (as opposed to a compulsory admission under the Mental Health Act) because there are no beds for them.

So people who could have been admitted voluntarily at an early stage in their crisis are instead left in the community while their mental health deteriorates to the point they may need to be admitted under the Mental Health Act for a long admission.

The beds situation impacts us as approved mental health professionals (AMHPs) and community social workers but is also impacts NHS ward staff too.

They have no say in decisions to move patients from ward-to-ward. Instead these calls are made by managers with nothing to do with the day-to-day running of the ward but focused on crunching numbers.

Shifting people about like this harms continuity of care for patients and it harms any therapeutic work or relationship that staff have built up with patients. It must feel soul destroying.

I’ve noticed wards also seem more chaotic when they are over occupied. Ward rounds, ward business and hospital targets are pushed up the agenda at the expense of one-to-one time with patients.

It damages staff morale. Frontline workers are too stressed to function how they would like to. So sickness rates are high and wards turn to agency staff to fill gaps (again impacting the continuity and consistency of care).

From my point of view as an AMHP and social worker, I have turned up to ward rounds to be told that the patient I was here for has been moved to another ward on another hospital because they had to use a bed for another patient.

In the increasingly rare situation where a bed for someone who needs to be admitted to hospital can be found in our area, we are frequently told that the bed is “an unsafe leave bed”. This means that when we fill the bed a detained person on leave would not be able to return to the ward if they needed to.

People are also being discharged prematurely because of the constant pressure on beds. This has led to re-admissions after only a few days in some cases because inpatient teams – under pressure to free-up beds – have not listened to community staff when they have warned that the person is not ready for discharge.

It’s stuff like this that makes me embarrassed to work in mental health and it’s a shame because I feel like a lot of what I have written about here is outside of my control. I also think that there are a lot of very caring and experienced people working my area. It is horrible that any of us should need to feel ashamed by the circumstances in which we practise.

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9 Responses to ‘The beds crisis makes me embarrassed to work in mental health’: a social worker’s story

  1. JL October 16, 2013 at 9:09 am #

    I have been a frequent flyer to psych acute wards for approx 9 yrs now and have seen the system go downhill. The chance of getting staff attention is nil unless you throw a ‘wobbly’ – one to one’s – what are they? Staff are demoralised and leaving/retiring in disgust. They are forever chasing their tails – short term stays are the norm so more admissions and discharges to process – more admin. It is one out the door and another straight in.

    A few weeks ago I was admitted on a Thursday evening following 3 suicide attempts in one week (twice in one day) I was told on the friday I would be discharged on Monday. There seemed little point in me staying – I wasn’t going to be better in 3 days and they knew it, but the 27 bed ward was full with the white board showing 7 patients on leave. Sectioning is not an option for me because they know I get more distressed on the ward but where does that leave me. I never ask for admission when I know that I need it and the crisis team is overstretched and just like a call centre. No continuity of care with that team. They visit once in a while for about an hour at the most – ask me if I’m eating and sleeping and leave knowing that I won’t ask for help before harming myself. I am too scared to ask for admission when I need because the rejection I would feel if there is no bed makes me feel worse. Patients in my area are being offered beds 100+ miles away. The trust ignores the fact that they should find a private bed and just says there is no bed. Staff are being told to section people under a section 2 rather than a 3 so that patients stay less time on the ward. Patients are being discharged before they are ready. Suicide rates are increasing in my area. I feel despair at ever getting the help I need when I need it. I used to. I don’t envy any one who works within the mental health system. It is full of caring staff fighting against an inadequate system.

    Someone needs to be held accountable for this. It needs to be fixed quickly before more people die by their own hands – myself included.

  2. Ruth Smith
    Ruth Smith October 16, 2013 at 9:33 am #

    Dear JL,
    Thanks for your comments on the reality of mental health care – I’m so sorry that you don’t always get the care that you need. Thanks though for being brave enough to highlight the reality of what bed shortages, high occupancy rates and a lack of resources actually mean for individuals like yourself. Hopefully the more people speak out, the more pressure there will be to improve the system.
    Take care,
    Ruth Smith, Editor, Community Care

  3. S Williams October 16, 2013 at 10:39 am #

    With the greatest respect to the social worker, their profession should be shouldering a lot of this responsibility. I appreciate they are under-resourced as well, yet hospital can be utilised as a place to take people off an over-stretched caseload. It is the responsibility of their profession to put forward a strong argument led by their management that can be taken to their comissioners and the wider public for more adequate funding of care in the community. Hospitals are hardly conducive to people’s mental health. Research shows that people get weller, quicker when they are supported within their community where their own social support remains easily accessible.

  4. Ruth Counter-Smith October 16, 2013 at 11:05 am #

    As a carer/family member, I too have noticed the deterioration in the mental health services over the past few years. As far as I am concerned, all the above is absolutely spot on and it is a national scandal. People who are very unwell are not getting the help they need, either from the community services or from hospital admissions. The whole system is in crisis and it seems that nobody is taking it seriously. In my own case, my family member and I were turned away by a duty worker when we asked for help a few months ago, even though we are known to services. I was expected to continue providing care even though I was exhausted and unable to cope. Two days later, my daughter was picked up by the police in an extreme paranoid state and sectioned under the mental health act. She was then admitted to hospital and stayed in for about six or seven weeks, costing the NHS much more at £300 per day, rather than providing the help we were asking for in the first place. Staff at two hospitals were encouraging me to complain – which I did eventually – because they are finding it almost impossible to cope with the situation. It is about time that resources were provided in the community to deal with people in crisis. It is no good closing hospital beds down without providing extra resources in the community, such as crisis houses and teams who can visit people at home, support for carers and family members who want to help out but are often ignored. Community care is a joke in mental health – nothing has been provided since the large Asylums were closed. If nothing is done, things can only get worse, with more suicides and, unfortunately,possibly more homicides as well. It’s no good blaming people who are seriously unwell for committing such acts if they cannot get the help and services needed.

  5. Lucy Maffioletti October 16, 2013 at 4:26 pm #

    Sadly I am aware of a number of nursing homes accommodating those suffering from enduring mental health problems with beds available. Unfortunately they are forced to remain in the community, at risk, or in hospital beds because local authorities refuse to fund them in nursing home beds. Or offer homes fees which are so low that they are facing financial crisis.

  6. frankie heywood October 16, 2013 at 6:56 pm #

    I was until a couple of years ago a public governor of an NHS foundation mental health trust. In 2009-10, the trust spent a fortune on re-building and lavishly re-furbishing part of its existing in-patient facilities, at the same time as spending a great deal of money on a PFI medium and low secure unit. I attended the opening events which were accompanied by posh buffets, with government ministers in attendance. All very nice, but a couple of months ago I learned that this same trust is now closing wards due to ‘financial constraints’. As a governor, I did raise concerns about the vast amounts of money being spent, but I’m not a health care economist, and of course I was assured that the trust and its services were financially secure for the foreseeable future. Also, I did not want to be perceived as suggesting that patients should not be given the best possible environment on the wards.
    I agree with the comments of JL and Ruth Counter-Smith above, and I think that the closure of the large ‘asylums’ (including that of the trust I worked for) has been a disaster, even with all their many faults. The huge loss of in-patient beds over the last few years has had a terrible impact upon patients and carers.
    I disagree with S Williams that ‘hospitals are hardly conducive to people’s mental health’: on the contrary, many patients need sanctuary, asylum and to be in a safe place. Carers need to know their loved ones are being protected and given appropriate treatment. I say this as someone who suffered serious depression many years ago, and I actually wanted, and needed, to be in hospital. Hospital care should not be seen as a last resort or downgraded as a result of ‘community care is best for everyone’ mentality.

  7. J Smith October 16, 2013 at 8:48 pm #

    With regards to the comment left by S Williams October 16, 2013 at 10:39 am – where I work and in most places I know of people are not off your caseload once they are in hospital, it is imperative that you maintain regular contact with them whilst they are in hospital, you also need to maintain contact with family members, there may be accommodation or financial problems which need your support to be resolved, you should be attending regular ward rounds and liaise with the inpatient team. Some Trusts have a policy of community staff visiting every week when someone is in hospital, I don’t have time to visit people once a week when they are in the community, to have to try and do so when someone goes into hospital is impossible. Where I work we are raising these issues on a regular basis with managers and commissioners, we have written to the Chief Executive. I would always prefer to work with someone in the community, or wherever the person wanted to be supported in times of crisis as well as when they are not in crisis, but unless there are places for people to go or adequate services to support them in their community what choice is there? There will always be a need for some people to be in a hospital setting, if hospital settings were better staffed (i.e. more staff, staff who are well trained, not disillusioned and burnt out, able to provide therapeutic interventions to those who were in hospital, under occupied wards) those people who had to be in hospital would possibly not find their time so horrific

  8. Ruth Counter-Smith October 17, 2013 at 12:07 pm #

    Although I agree that hospitalisation is necessary at times, I do feel that a lot more could be provided in the community to prevent hospital admissions. As a responsible family member and carer, I have gone through three crises with my daughter in the past couple of years. On two occasions, admission under mental health section was the result because help was not provided early enough in the community. On the third occasion, we managed to enlist the help of the Crisis Team and thus prevented admission. However, to get the Crisis Team involved took an enormous effort on my part and I am sure things would have deteriorated further if I was unable to take the initiative on behalf of my daughter. I feel that it would be economically more viable to provide Crisis Houses in the community, such as the one in Leeds and other parts of the UK, together with more well trained teams who can help in a crisis. Carers and family members could be supported much more and consulted with – perhaps even work in partnership with professional mental health staff. After all, over time we do become quite expert in working with our family members who suffer from mental health problems. I don’t say that this would always be appropriate, but I think the mental health service senior managers need to start thinking outside the box and looking at alternative ways of providing services. At present, they seem to rely on the bio-medical model of giving people huge amounts of psycho-active medications and leaving them to rot in isolation in the community. Many of these medications are very toxic with side effects that lead to physical problems and a shorter life span. I’ve even read reports that more people are being put on Community Treatment Orders, giving people no choice about taking medication – I wonder if this is why they believe that hospital beds can be closed! However, it won’t work and shouldn’t work as I believe this practice is against human rights and eventually there will be an outcry against such a practice.
    I agree with S Williams above that mental health professionals need to be protesting via their senior managers and demanding that more funding be provided via the NHS Commissioners and that a real effort be made to promote community care – which needs to include the views of service users and carers as well as front-line staff.

  9. sarah October 19, 2013 at 12:44 am #

    In this 5 star Trust in this area of London there are now 3 crisis houses . However none of them will take someone who needs the equivilent of hospital care despite this being what they were set up for.

    So desperately ill people cant access a crisis house and crisis teams dont come out at night. There are no beds for voluntary admission so AMHP’s have to detain under MHA in order to get a bed offer from the hospital – whatever the code of practice states aboout this, let alone the law. Then often the ‘bed’ is actually a chair in a communal area often overnight. Or they play Russian roulette with someone’s life by not assessing at all and therefore leaving them with absolutely no support as no team feels it is their domain.

    Have any of you any idea just how unsafe this is for individuals for carers for humanity? If AMHP’s think this is stressful for them then take on board what it does to the vulnerable, to carers, to the children of people in mental distress. It doesnt compare. If Care Co-Ordinators/Case Managers think this is impossible for them to manage then think how impossible it is for those at the raw end.

    Professionals can bounce patients and excuses around between them for as long as they want. In the mean time they all lose credibility wherever they work and whatever they do.And they will face ltigation and complaints to professional bodies as what on earth do you expect the real victims of this mess to do? And maybe, just maybe if a Duty of Candour is brought in they will eventually speak up with a louder voice than now. Because I can tell you I and others have NEVER heard any single MH worker whether AMHP, Social Worker or ward staff openly criticise their colleagues decisions however poor these have been. Just blame ‘management ‘ and ‘reorganisation’. So to outsiders it looks like you are all colluding whatever your role,

    If you dont want the stress of working in mental health then you can walk away. Those of us in distress or who are carers dont get that option. And we quite clearly cannot rely on ‘professionals’ to do the right thing anymore.

    And I will give you this very current live example of someone trying to get help right now and cant. Severely psychotic (but not violent to others so thats ok then), continual extremely violent suicidal thoughts driven by voices and actions to go with, lives alone, carers have asked for help, history of serious suicide attempts, no community team support, GP cant get MH services to assess, police have asked for MHA assessment.

    And where are MH services in this 5 star Trust? Nowhere to be seen