Too little money, too few beds. Why mental health is in crisis

https://www.theguardian.com/society/2018/jul/21/mental-heath-crisis-beds-shortage-detentions-soar

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What was once a taboo subject is now the stuff of commercials and celebrity confessions. Today, stars are lining up to discuss their mental health issues in public. Sheridan Smith and Simon Pegg are two high-profile names who have recently shared their problems, and recounted how they sought help from friends and professionals.

A Lloyds Bank television advert raising awareness of different mental health problems, featuring the likes of Countdown’s Rachel Riley, Olympian Victoria Pendleton, rapper Professor Green and journalist Jeremy Paxman, marked the crossing of another rubicon.

But raising awareness about a problem that one in four of us will experience during our lives is one thing – treating it another. Stung by criticism that for decades mental health has been a Cinderella service, in 2014 the NHS launched its Five Year Forward View plan which has seen overall mental health funding increase by £1.4 billion in real terms compared with three years ago.

An additional 120,000 people are now receiving specialist mental health treatment. There has also been a significant increase in “talking” therapies: 60,000 more people will get treatments for common mental health conditions by the end of this year, the NHS claims.

But there is a long way to go.

As the Observer reports today, in England there has been a near 30% decline over the last decade in the number of available “mental illness beds” overseen by a consultant. “It’s always worrying to see such a dramatic drop-off in beds in mental health units,” said Mark Winstanley, chief executive of Rethink Mental Illness. “When people can’t get a bed they end up stuck in A&E or sent miles from home for treatment. They tell us that this makes an already difficult time even more distressing.”

In 2015 the King’s Fund warned: “A lack of available beds is leading to high numbers of out-of-area placements for inpatients. Out-of-area placements are costly, have a detrimental impact on the experience of patients and are associated with an increased risk of suicide.”

Dr Helen Gilburt, fellow in health policy at the King’s Fund, said the model for mental health treatment had changed, partly due to financial pressures on mental health trusts. “There’s been a strong emphasis on reducing bed numbers … because in-patient services are the most expensive component of the system.”

Community services are still a long way behind where they need to be, and crisis care is overstretched as a result

Beds are allocated by crisis resolution home treatment teams – the gatekeepers to mental health services – but this does not appear to be working well, Gilburt suggested. “Data from 2016 shows few of those teams functioning effectively, and therefore they’re not really supporting people’s care at home when they’re in crisis or supporting people when they can be discharged early from beds,” she said.

Last year the fund revealed a 72% decline in the number of overnight mental health beds between 1987/8 and 2016/17 which it said “was underpinned by a policy shift to providing care for people with mental health problems and learning disabilities in the community”.

But herein lies another problem.

“Community services are still a long way behind where they need to be, and crisis care is overstretched as a result,” Winstanley said. “The dramatic rise in detentions under the Mental Health Act demonstrates that people aren’t getting the support they need and still reaching the point where they need to go hospital.”

Between 2006 and 2015/16 – when the recording system changed – there was a 47% increase in detentions.

A government-commissioned interim review of the act, published in May, suggested multiple reasons for this increase: “We have been told people are not receiving the care they need in the community, and which might have prevented them from reaching crisis,” the review said.

“We have also been told that a reduction in acute bed numbers has made the use of the act more important to get someone a bed when needed, although compelling evidence on this is unclear. More broadly, there are wider concerns about increased risk aversion among professionals following high-profile judgments and inquiries.”

Ultimately, the problem boils down to a lack of money. Mark Rowland, a director of the Mental Health Foundation, said mental health services had been chronically under-resourced for years and that meeting the current demand for their services would require huge new investment.

“That is unlikely to happen in the short term so we must take prevention of mental ill-health more seriously,” Rowland said. “Increasing access to parenting classes, peer mentors in schools, community volunteering, training teachers to understand mental health and reducing working hours are just some of the examples of interventions that are effective in prevention.

“Prevention is always better than cure, and we need a nationwide commitment to finding and addressing the sources of mental health problems.”