‘It feels like some lives are worth more than others’: working on the mental health frontline

by Emma Corlett, Unison representative and mental health nurse

Mental health services across the country are in crisis. For more than six months, I have been part of efforts to highlight serious problems with services in our area both in my role as a Unison representative and as a member of the campaign to save mental health services in Norfolk and Suffolk (a group involving staff, people who use our services, carers and many more).

We have been successful in getting local and national media coverage of the crisis in our services. You would think the spotlight on our services might provoke those in power to address the failings we have highlighted. Yet that hasn’t happened.

In fact, things have got worse. Our Approved Mental Health Professionals (AMHPs) – the (mostly) social workers that carry out Mental Health Act assessments – have raised a dispute over severe problems accessing beds for patients in need. They had previously written to the care minister and NHS commissioners to warn that they felt unable to operate safely, but it led to little change. The whole situation is taking an incredible toll on staff and the people we support.

I was asked to write about what it feels like for staff on the mental health “care” frontline at the moment. I sent a message asking my colleagues in services to share their experiences. I thought I’d get a good response, but I wasn’t quite prepared for the outpouring that I received within an hour of contacting people. Here are just a few examples.

‘I dread the day in the week I’m on AMHP duty’

One AMHP wrote:

“I dread the day in the week I’m on AMHP duty. I don’t really sleep the night before. It’ll be the same problem; a person well known to us relapsing and now in crisis as their community support has reduced drastically over the past few months. There will be no bed and I will be stuck there, with a person in distress and a distressed family at the end of their tether. You want to make it OK but you can’t. You have the sensitive but frank conversation with the nearest relative. They agree that their loved one needs to be in hospital. Then the wait begins. ‘We are trying to find a bed. There isn’t one currently. We need to wait’, we’ll be told, as the bed manager frantically rings round the country.

“Relatives are generally kind, they make us all a cup of tea and we wait. And wait. Tempers fray, the person becomes increasingly distressed and I ask for police assistance. We’re in for the long haul. ‘We’ve found a bed, but I’m really sorry, it’s in London’, we’ll be told. A mixture of relief and fear or anger from the family.

“Then we’ll get the call: ‘We’re trying to get an ambulance, but there is at least a four hour wait’. We wait. ‘I’m really sorry, the private unit in London has now decided not to accept the admission. No, there isn’t anything we can do. Yes they are allowed to pick and choose. Yes I agree, it’s not fair or logical but that’s the reality of the situation we are in’. Hours pass again. A bed is found. If I’m lucky it will be in Norfolk or Suffolk, in to a bed as someone goes on overnight leave to their own home. At worst, ‘there is a bed, but it’s in Yorkshire… Or Lancashire’.

“There are no words to describe the look on the face of the scared individual I’m now sending away, or their family. I feel sick to my stomach and ashamed. By the time I get home I’m too wound up to sleep. I feel sick. I’ve barely eaten all day. I feel ashamed of the ‘service’ we are providing. I lie awake, then it’s only a couple of hours until I’m back in work to my day to day job. I start by going through the urgent messages from people on my caseload who couldn’t get hold of me yesterday because I was on AMHP duty. I feel literally sick and tired. I do my best to show compassion but I’ve had it. I don’t know how much more I can take.”

‘It is unfair on patients’

Another AMHP wrote:

“I recently coordinated a Mental Health Act assessment for someone acutely unwell in their own home. This went ahead at 10am & by 11am it was clear that a formal detention was needed. It then took until 3.30 pm to confirm this person was to go to a private hospital 3.5 hours away from their family. A private ambulance was requested which arrived at 4.15pm. Given rush hour traffic this meant they would not arrive til approx 8pm meaning this person had to spend not far from 10 hours with a variety of health professionals intruding into their home which they appeared to find distressing. This was not even a late call out for me, which are also on the increase. So much time is spent waiting for beds to be allocated but this is just one example of how it is unfair on patients.

“This then means local AMHPs are now being asked to travel out of county to conduct MHA assessments for our patients who need section 3 considerations. This is difficult when most of us are care coordinators in community teams and our daily diaries are rammed full with too high demands due to too high caseloads. Long days are very draining for all involved and have a knock on impact into our next working days.

“I find it embarrassing to tell carers and families that there are no local beds which happens more frequently. Sending people far away from home is wholly inappropriate to their recovery and development of consistent support. A lot of time is wasted waiting around. Sometimes we go out thinking we have a bed reserved only to find out that this has then been lost. We cannot sign off our paperwork until we know which hospital a patient is to be admitted to. The whole process is becoming very long winded & stressful and I cannot see how any of it is cost effective.”

Impact on professional pride

Colleagues also wrote about professional pride being eroded. One said:

“I know that the police are short staffed but I have had recent incidents when police have not attended to help execute section 135 warrants. I think they too are getting annoyed at having to wait with us during such assessments or section 136s as they get “stuck” with us AMHPs for very long periods of time. The result is that I don’t think they prioritise our requests for support as willingly as they once would as they get caught up in the waiting for a bed issues too. It’s professionally embarrassing and I feel I’m always having to make excuses for things out of my control. It’s demoralising, exhausting and at times humiliating.”

Over the last year I’ve spoken at a few rallies and conferences to raise awareness of these issues and others facing our services. There is something that I leave to the end of my speech but I’ve never got that far as I always get choked by my tears.

The truth is that it feels like some lives seem worth more than others. In response to a rise in the death rate of people in our care, I have heard officials talk about how the death numbers were “in line with the national average”. I have heard the situation referred to as “not statistically significant”.

Those words stop me in my tracks every time I think about them. In the past year two young men under the care of our services died after falling from the top of our local shopping centre. I can’t help but think that if either of them had walked in waving a knife around as a result of their distress and torment rather than harming themselves, then “something” would have been done. Our MPs would have demanded “urgent action” and courted all the media to say so.

As I say, some lives it seems are worth more than others. Where has the humanity gone? It’s a damning indictment of our society and the state of our services that the local shopping centre has now erected safety hoardings to prevent similar incidents. I have no words.