I’ve been getting care from a community mental health team for a couple of years now. I’ve also had spells of home treatment and hospital care when I’ve been in crisis. Nowhere is perfect but overall the trust that runs my services is well managed. The staff are good and qualified and enthusiastic. But everyone is being hamstrung by the lack of funding and it is leaving a lot of unwell people without the care they need.
One example is access to services. When I was first referred a few years back I was told it would take three months to be seen (it actually took six, because I was referred to the wrong service at first). At the time, I remember thinking that three months seemed quite a long time. Now I’m told it’s fairly standard because services are so busy. Professionals have told me that the thresholds for getting into our service are higher. It certainly feels like you have to reach quite a desperate stage to get help.
It doesn’t matter how good you are or how committed you are – there is a limit to what you can do if you simply don’t have the money and staff
When I was under the care of the home treatment team – which I found pretty good – I remember one staff member telling me that they were so oversubscribed that they didn’t have any space left on the boards where they listed the names of everyone needing to be seen. I know that demand is always going to fluctuate but I don’t think it’s safe to have a crisis service running like that.
Someone else I know was told that our community team was full at one point and couldn’t take on anyone else until people were discharged. There are hundreds of people on the caseload at any one time. One of the staff told me they needed 20% more staff for them to provide the level of care they would want to. I certainly know people that have been accepted onto the team’s books but still haven’t been allocated a care coordinator because the staff already have full caseloads.
Bear in mind everyone in my team is supposed to be on the Care Programme Approach – that means everyone is considered to have complex needs. To be without a care coordinator is quite an important thing. Some people have been given interim care coordinators. That is better than nothing but it still means the person isn’t doing the job full-time where you can build a relationship with them. Even if you are able to have a full care coordinator, the pressure on the service means you can have limited contact and struggle to reach them.
‘My care coordinator is good’
My care coordinator is good. She’s an Approved Mental Health Professional (a social worker who carries out Mental Health Act assessments) as well so she works a lot of nights. It means about half the month she’s not available to speak to. I personally find that OK but some people really need that ongoing support where they can talk to their care coordinator once a week, even if it’s just over the phone.
I know people in my trust and elsewhere that find even getting that phonecall a real difficulty. They either can’t get through or get told people can’t call them back because they’re too busy. It’s very difficult because you get it drummed into you that you should be phoning before things go too far and you really start to deteriorate and feel really unwell. If you can’t call your care coordinator and can’t get through to the home treatment team (which is another big issue. It often goes to answerphone), have you got any other option apart from turning up at A&E?
Focus on physical risk
With so many people to see and so little money, I think there’s far more focus on physical risk than emotional distress or social functioning. Teams are down to the bare bones and face the question of ‘what can we afford not to offer?’. And they know that the thing they can’t stop dealing with is the physical risk side – the possibility of someone harming themselves. So instead they slowly have less occupational therapy, or support workers, or referrals to day services. I think I get higher levels of support than people who are equally emotionally distressed on the basis that I’m considered a physical risk to myself.
The thing is, I know all the staff are trying their best. I’ve genuinely never met a professional that I thought was lazy or disorganised. I can see them frustrated with the levels of service they are able to offer. That comes through very clearly. No-one is even pretending to hide it any more. I think they are at the point now where they are willing to say to service users ‘there is no money’. I’ve had someone say to me that their team even has to ration stationery. If we’re at the rationing office supplies stage you worry what it means for care.
My trust has been forward thinking on lots of things. I think it is well-led and has a clear idea of what it would like to offer. I think that has all insulated us a bit from the worst damage of the funding cuts of the last few years. But even the best plans drawn up by trusts to limit the funding impact must be in tatters by this point given the year-on-year pressure. It doesn’t matter how good you are or how committed you are – there is a limit to what you can do if you simply don’t have the money and staff.