Mental health: too many patients, not enough beds

Every morning Rebecca Julian (pictured above with son Tom) drives across Norwich to her son Tom’s house to give him his medication. That bit is important, but actually it is mostly to check that he is in fact still alive. And every morning the same thoughts go through her mind.

Tom has a history of severe depression and self-harming and he has tried to take his own life several times. So when his mother called the local mental health trust’s crisis team at Easter it was because she believed that he was in danger of killing himself.

But it took them 20 hours to arrive. Mrs Julian firmly believes it is because they knew there would be no beds for him at the local mental health trust. And although, Norfolk and Suffolk NHS Foundation Trust will not comment on individual cases, the chances are she was right.

Beds full

There have been times in the past couple of years when they have sent 30 or 40 people sometimes hundreds of miles away because their beds have been full. A new management team has recently been brought in and they have managed to reduce this to seven or eight.

But when I asked the new chief executive Michael Scott how they were faring this week, he said they were “very busy”. And I was left with the distinct impression that this was an understatement.

A campaign to improve mental health services in Norfolk and Suffolk was started last year by a despairing social worker, Terry Skyrme. He works for one of the crisis teams, so is at the frontline, when patients are feeling their worst. He booked a room for 100 people. Three hundred turned up.

‘Never known it this bad’

“I have worked in mental health since 1972 and I have never known it this bad,” he said. “Yesterday I was on duty for referrals under the mental health act. We had eight referrals but there were no beds available.”

This is not a situation that is just affecting Norfolk and Suffolk – it is a problem at mental health trusts right across England. There are too few beds, too many patients, there is too little money and according to our research, the funding is only getting worse.

For the first time, Channel 4 News can reveal the extent of the cuts across England's 47 adult acute mental health trusts. Under the freedom of information act. we asked them for their budgets in 2013-14 and 2014-15.

Of the 34 who responded, 22 - nearly two thirds - said their funding had been cut. But we can also reveal that 16 have cut their crisis team budgets, and 18 - more than half - have taken money away from their community mental health teams.

So the services needed for the most ill, the crisis teams, or those which help keep patients out of hosptial and well, are feeling the brunt of these cuts. And it is not just the pressure on beds, these cuts are also being felt by the police.

Channel 4 News has been passed a letter written less than a month ago by an inspector. The letter says a man, detained in King’s Lynn, should have been assessed under the mental health act, but no bed could be found.

‘Unlawful imprisonment’

The letter states: “Our Custody Officer now finds himself in a position where they are being asked to detain someone in a cell without clear lawful authority to do so, which may amount to unlawful imprisonment.” It also says this was “inappropriate” and it was an ‘”unsuitable environment” for such a person.

In February this year, the Health Minister, Norman Lamb, announced a concordat on crisis mental health care, designed to specifically address this situation. Twenty-two national organisations, including the Association of Chief Police Officers, the Home Office and the Royal College of Psychiatrists, signed up to it. The charity Mind is overseeing its implementation.

But as with everything, it is about the money. There is not enough and there is no sign of it improving. Mental health has historically been underfunded – disproportionately so. But there was outrage when NHS England and the health regulator Monitor recommended cutting funding for mental health services by 20 per cent more than for acute hospitals.

Broken promises

Not only was this unfair, it broke the government’s promise to put the two services on an equal footing – parity of funding, they call it. These are the figures, though: mental health accounts for 28 per cent of the disease burden but gets just 13 per cent of the budget.

When we put our FOI figures to the Department of Health, they were very keen to point out it is the clinical commissioning groups (the CCGS) who are responsible for ensuring local mental health services are properly funded. Then they wanted to ensure we knew that it was NHS England which had made the decision on the recent funding round.

My impression is that the mental health charities, like Mind and Rethink, and the Royal College of Psychiatrists, do not give a toss who cut what where. They just want people with mental illnesses to receive the care they have every right to.

‘Equal priority with physical health’

Care and Support Minister Norman Lamb gave this statement to Channel 4 News –

“Mental health care is given through a range of services from the public, private and voluntary sectors. Mental health trust budgets do not give the full picture of funding. Every local area must give mental health equal priority with physical health. That’s why I’ve asked NHS England to introduce access and waiting time standards for mental health to make sure the money goes where it is needed to give patients the best possible care.

“It’s essential that anyone experiencing a mental health crisis gets urgent care. Our plans will mean that A&E departments around the country will be able to offer people with mental health problems fast access to high quality, effective care.

“Our Crisis Care Concordat is also making progress and we’ve seen a reduction in the use of police cells across the country. But there is still work to do and we expect every local area to sign a crisis care declaration by the end of this year so that, in future, no-one in mental health crisis will be turned away.”