Mental health services have been under an inordinate amount of pressure over the past few weeks, with no inpatient beds in the public or private sector available in the whole of England, according to several clinicians. Ever since asylums closed down in the 1980s, and their lands sold to property developers to plug budget gaps, pressures on inpatient psychiatric beds have been tremendous, while successive governments have pushed through untested and unproven policies based on ideologies.
The so-called Nicholson challenge, to make efficiency savings of £20bn by 2014, has led to major budget cuts in the NHS. These come at a time when the most vulnerable patients, and their families and carers, are feeling the brunt of the economic downturn and desperately need services that are being cut.
The fault lies with structures, processes and personnel. Our inquiry into the future of mental health services sought to explore what these services might look like in 20 to 30 years’ time. The inquiry panel, which I co-chaired, was made up of senior representatives from a range of professions, alongside mental health service users and carers.
We heard that processes that allow policies to be developed without evidence are harmful to vulnerable people. Continual changes in regulatory frameworks and structures make it difficult to understand what is required. Would it be possible to have a moratorium on changes, say, for a decade at least?
Inpatient units urgently need investment in their physical structure and to improve their therapeutic environment with permanent trained staff. Having visited and seen services in many countries, it is obvious that bureaucracy and management are killing off professionalism in the UK. Demoralisation in the NHS is at its worst. When someone, including professionals, is attacked, and feels entrapped, it is inevitable that, for their own protection, they put barriers up and withdraw into themselves. This withdrawal is symptomatic of depression, and sometimes depression leads to suicide. Professions are walking towards a cliff.
But the inquiry suggests the solutions are relatively simple. Professionals should be allowed to practise freely. The barriers between primary care and secondary care must be made more porous so that patients can move freely. Commissioning needs to be abolished and the bureaucratic nightmare brought to an end, with the money saved invested in patient care. Patients should be allowed to attend hospitals when they need to, without being controlled.
Integration between physical and mental health in primary and secondary care, and between health and social care, can be achieved without too much disruption if the political will is there. We must also invest seriously in public mental health and education so that future generations emerge healthier. The evidence is there, but it needs translating into action.
This article first appeared on The Guardian on 24 September, 2013.