A group of approved mental health professionals has issued a direct plea to Jeremy Hunt to address failings in mental health provision it says are placing vulnerable patients and families at risk.
In a letter to the health secretary, seen by Community Care, the Yorkshire AMHP leads network warned a shortage of mental health beds meant some patients assessed as needing to be detained under the Mental Health Act for their own safety, or that of others, were being forced to wait days to get hospital care.
The group said some patients had been held in A&E departments, police stations or care homes until a bed became available, but others were left at home relying on families or friends to manage their “acute mental health crisis”.
“We are asking you to give the situation your immediate and highest priority before any more patients and their families have to experience this very distressing and potentially dangerous situation again,” the group’s letter said.
Andy Brammer, a member of the Yorkshire AMHP leads network, said the group raised its concerns with Hunt in March but had yet to receive a reply.
A Department of Health spokesperson said Hunt had sent a response to the group’s concerns on March 31. The spokesperson said the government was investing in mental health services to make sure the right support was in place.
Speaking to Community Care yesterday, Brammer said the issues raised in the letter remained “live” and AMHPs still often faced “significant delays” securing beds for people in crisis.
“There is a lot of consideration that goes into detaining someone under the Mental Health Act. It is a last resort. People being detained are often those at most risk to themselves or others, and in the greatest level of distress,” he said.
“To have that detention delayed for hours, or even days, just increases that level of distress for the person and their family. It’s very stressful for workers as well who are having to manage the situation.”
Brammer added: “Previously AMHPs were waiting hours for beds to become available in virtually all circumstances. Then we saw it shifting to waiting 24 or 48 hours, and that tended to be with people who were in places like A&E – it wasn’t ideal but at least they were somewhere safe.
“We’re now looking at people being in their own homes and being left with a phone line for services. It’s an invidious position for everyone involved.”
Ruth Allen, chief executive of the British Association of Social Workers, said the concerns raised by the Yorkshire AMHPs echoed those raised by practitioners in other parts of the country.
“The feedback we get from AMHPs is that the bed situation has not been resolved in most areas,” she said.
“The focus on improving mental health crisis services, through the government’s crisis care concordat policy, does not appear to have led to better preventative resources for people to avoid admissions or opened up pathways into beds when they are most needed.”
Figures published last month revealed almost 6,000 mental health patients were sent out of their local areas for care last year due to no beds being available locally. This marked a rise of 40% over two years. NHS England has pledged to end inappropriate out-of-area admissions by 2021.
An investigation by Community Care and BBC News published in 2014 found seven suicides and one homicide had been linked to mental health bed shortages over the previous two years.
In December 2013, Nigel Meadows, senior coroner in Manchester, alerted Hunt and NHS England to problems with bed availability following the suicide of a patient who had been assessed as needing ‘urgent admission’ but faced an eight day wait for care.
A Department of Health spokesperson said: “We are clear that inpatient services should be available for all who need them. Decisions about bed numbers are based on a local assessment of need. We are making sure the right services can be put in place, with annual spending on mental health services increasing, now at more than £11 billion.
“In addition, getting community support right is vital, that’s why we are investing £400m a year by 2020 to expand the Crisis Resolution Home Treatment teams which will help open up in-patient beds.”
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This is a worsening problem across the country. The platitudes from Jeremy Hunt & his cronies are insulting to the patients & carers suffering as a direct result of Tory policies & deliberate underfunding of the NHS as a whole & mental health in particular. Sadly, it is likely to be the individuals doing their best in a creaking system that has long been sustained by massive amounts of their unpaid overtime who are criticized in the event of a serious incident. It’s about time the blame was squarely placed where it belongs.
As a Yorkshire AMHP, I was very pleased to see this letter from our AMHP leads, expressing the collective sentiments and experiences of our YAMHP group. It’s astonishing, insulting – but frankly not surprising – that Hunt has neither the grace nor the courage to respond.
Detention is an absolute last resort. When I became an ASW (as was) 17 years ago there were supportive alternatives to detention – increased housing or daytime support, crisis centres, user-led crisis centres, day services, even, in extremis, crisis residential care. Little or none of those wider support services now exist; or, they are so overworked and circumscribed in their reach as to be inaccessible as crisis, short-term, or supportive/preventive measures.
As for hospital beds – the last resort …Until 2013, even as an EDT worker, I had never had to admit a patient to an out-of-area hospital bed. Now I’m relieved beyond words if there’s a bed available in the Trust. Of late, this has even started to be the case for admissions of older people.
And people with learning disabilities? I was utterly shocked to return after a run of night shifts and leave, to find a young man still waiting for a bed over a week after he had been assessed in A&E, and it had been acknowledged that he needed urgent admission.
There has been a lot of government talk about CAMHS. I tend to think this is being used to deflect from the wider crisis in mental health services and – more broadly – the overall impact of the cuts/austerity/neoliberal policies upon all aspects of public service provision. It is of course an utter disgrace that Hunt has not responded to the YAMHP letter, but not surprising given the contempt this government shows for public services, public servants and service users. The problem is that real people are suffering asa result of his contemptuous (and contemptible) neglect.
Hunt cannot respond as, in my view, he himself has MH problems in the form of a personality disorder which prevents him feeling even a shred of empathy. He is motivated only by his addiction to wealth and power, like every other cabinet minister, and views access to state resources as a means of furthering his addiction through the carve up of the public sector and outsourcing to business corporations in which he has a massive financial interest. The only solution is to overthrow this nasty, self-interested government beginning with mobilisation for all-out strike action. ‘Oh but our clients will suffer’ is no longer a tenable refrain since they couldn’t suffer much more than currently and if we do nothing, which this government relies on, we face complete social breakdown and even civil war fomented by this government’s divide and rule strategies, so COME ON!
The situation is not as bad in Northern Ireland but is heading in the same direction! Whilst Crisis Response and Home Treatment Services can offer good interventions and support for many individuals/families/carers they can never provide the ‘asylum’ purpose of psychiatric hospitals at their best. They cannot provide ‘theuraputic separation’ of distressed patient and family or other carers. Certainly an admission to hospital is not always necessary but in the absence of sufficent respite facilities sometimes a hospital admission becomes inevitable. Obviously lack of finance is a factor but the present emphasis on community care ( meaning usually care by family) with the ‘hospital bed’ being now in the family home has moved too far as fashions often too. Additionally( although not yet in NI) the proportion of private psychiatric provision to NHS is now disproportionate.
It is not just days but weeks now that a person can wait for admission, in the community and at risk. We regularly now have people waiting 2 weeks or more for a bed. With some people we cannot even assess before a bed is available because of the distress and potential risk that would cause. As a West Country authority we are this week sending a young person to Glasgow! Yorkshire and London are regular bed placements for us.
This has serious knock on effects: we are often required to spend a whole day and travel some distance to carry out a s3 assessment when the local team cannot or will not do it for us (and this is understandable where AMHP teams have large private hospitals on their patch). Also the ambulance service contracted to do our MHA conveyance are often not available because they are in another part of the country with a patient, thus delaying the conveyance of detained people to hospital and leaving them and us potentially at risk in the community.
The Police and Crime Act, by increasing s136 authority beyond public places and reducing the time a person can be held in a Place of Safety, combined with the fact that the police are attempting to withdraw more and more from dealing with mentally disordered people in the community, means that even more pressure is to come.
Lilybright above echoes my own experience working as an EDT AMHP in a London Borough. I have seen up to 3 assessments on one patient over a period of 72 Hours in a Police cell. Just not good enough Mr Hunt.
Put the problem firmly back with the NHS they are responsible for beds. It is not the AMHP’s duty to find a bed it is the doctors. AMHP’s are so used to solving problems that the NHS never has to solve their own problems becuase someone always does it for them. When the problem is actually left with the doctor rather than the AMHP how quickly will it be solved? The police have recently solved the problem of s136 and police stations, just watch out how quickly 136 suites spring up because it has firmly been made an NHS problem, before that they dragged their heels because it was being solved by the police.
Mental and most other services have always been three years away from being properly resourced!!
The difference now is that there have been years of deliberate cuts so we are now always three years away from being returned to bare minimum acceptability.
This is a huge scandal, a neglect of citizens whose acute vulnerability requires statutory intervention. Laws are being broken and lives put at risk on a daily basis. Well done Yorkshire AMHPs. I hope all other AMHPs get behind you.