Who pays the penalty when mental health services fail?

by Moira Tombs

I have personal experience of being the subject of a safeguarding alert. My story highlights why the six guiding principles of safeguarding (empowerment, prevention, proportionality, protection, partnership and accountability) matter and how failing to put them into practice can be so costly.

There were many missed opportunities to support me from what started as a simple, polite request for help after the death of a loved one, and which ultimately escalated into a traumatic and shocking experience for me, and those around me.

Police intervention

My tale highlights the challenges in our current mental health system where those left on the benches can find themselves unsupported in crisis and so instead come to the attention of the police who are increasingly called on to act as faux mental health crisis teams, but who can only do so much to keep patients safe.

Use of section 136 of the Mental Health Act is one option open to the police but, as we know, demand for beds is such that not everyone can be admitted. Many are simply assessed and released back onto the streets, often without any follow-up, to be picked up again.

Safeguarding relies not only on policies and protocols, but on capacity and co-operation and patients are being let down by the blight of dwindling resources and low morale where organisations appear unable or unwilling to take responsibility.

So, patients are left in limbo, on a waiting list for months on end, with little or no support in the interim. They may become more agitated and reckless in their attempts to get help. Take someone who is on a rooftop threatening to take their own life and they break a roof tile. The mental health team says there’s no capacity to admit them, but they are on a waiting list and have threatened to take their own life before, so what do the police do?

Should the individual be supported to access mental health services or is the criminal justice route justifiable because they broke the tile – and besides, using the latter route will mean the police will be able to get them a psychiatric assessment, which in turn will give them leverage to lean on mental health services to act?

Striking a balance

What if the alleged offence is more serious than a broken tile? Does that make the person any more bad than mad? Is there a threshold between the two?

My case highlights problems in labelling people ‘mad’ or ‘bad’ and has far-reaching implications for Britain today. Decisions have to be made – and justified – to protect the rights and wellbeing of the individual and of society at large. A balance has to be struck, thus mental illness is not always a ‘get out of jail free’ card, but who pays the penalty when it is the system that has failed? Who is accountable? Whose duty is it to safeguard the individual: the practitioner, the provider, the commissioners, the government?

And what is the cost? The current mantra in public services is ‘cut costs’ but when this happens there are costs to the individual, and as you will hear, I paid a heavy price.

Moira Tombs is a freelance consultant in mental health and suicide prevention. She will be speaking at Community Care Live London in September. Register here for your free place.