When I moved back to East Kent for a role with a local newspaper group, my first job involved covering a suicide at a railway crossing. In my naïveté and slightly shell shocked, I left the crossing to snap a photo of the scene that could never be used.
British Transport Police had moved the body, but there was blood and there were bits of brain on the tracks. It was very quiet by the railway side; just gravel and steel and brambles. Anguish had been snuffed out and with it, options; chances for help.
Sitting later for inquests in the hushed basement of Canterbury Magistrates Court, I learned a number of things (amongst them the depth of the pathologist’s descriptions: “The brain 1540 grams, the right lung 665 grams, the heart heavy: 546 grams”) and that with all the weighed and heavy hearts, there are a lot of suicides.
A quiet, but pronounced mental health crisis was evident; not just in the news of the deaths as they came in, but institutionally in incidents like high-risk patients being able to walk out acute mental health wards in Kent without staff realizing and going on to hang themselves or jump off bridges.
It was apparent in the closure of NHS mental health centres across the area and it was notable in the fact that despite much-trumpeted investment in a new clinical centre in Canterbury, there had been a reduction in acute ward bed numbers across Kent over the years, despite protestations to the contrary.
This week I went through the recently published annual reports of Kent & Medway NHS and Social Partnership Trust (KMPT), who provide mental health, learning disability, substance misuse and other specialist services for 1.6 million people across Kent and Medway.
KMPT—under funding pressure, like all public bodies under a government dedicated to the slash & burn of public services—have closed acute wards in Thanet at the QEQM hospital and more recently, the Arundel Unit in Ashford over recent years.
They think a centre of excellence in Canterbury, plus “care in the community” is the answer—and like to say that shutting down and selling off the real estate of mental health centres is a good thing, because there was a stigma attached to them anyway (a nice post hoc rationale for raising a few quid by an asset sale, if I ever heard one…) The problem is, bed numbers on acute wards are very important, as the number of people being sectioned rises.
(People were detained or treated under the Mental Health Act more than 50,000 times and community treatment orders were imposed more than 4,600 times in 2012/2013; the most recent year for which the Care Quality Commission has full data available. There has been a 12% rise in the number of people subject to the Mental Health Act in the last five years, with 17,000 people detained at the end of 2012/13, the CQC highlighted earlier this year).
With the pressure on beds, mental health staff are also under pressure to discharge people as soon as possible to clear them. The fact that nearly a quarter of patients discharged from KMPT wards in Q4 of last year were readmitted to acute wards within just 28 days is a definite warning signal and an alarming sign of pressure on services. Mental health staff describe an environment under which patients that are judged most settled are discharged or moved from ward to ward; eventually either discharging themselves or becoming more disturbed, or at the very least taking longer to make a recovery because they can never quite settle. Those sent home under the care of community services frequently find that although a community nurse is supposed to visit them frequently, they are run so ragged it happens far less than it should.
As the group Healthwatch Medway also noted this year to KMPT, responding to their quality report: “We found no mention of the difficulties faced by families, patients and carers following the closure of A [Arundel] block ward in Medway and the subsequent transfer of patients to either Dartford, Maidstone and Canterbury… This affected the Kent and Medway NHS and Social Care Partnership Trust service provision in Medway as it resulted in moving away services from the Medway area, resulting in an increase in distance for people to use services and as a direct result of this change negatively affecting patient experience.”
KMPT has made some good progress by the looks of it in other areas. For example, the trust highlights that: “In comparing the first six months of the year to the second six months we have achieved a 70% reduction in service users going absent without leave on our inpatient wards. Between April 2013 and September 2013 there were 78 such incidents. In the following 5 months there have been 23 such incidents.”
That’s a promising trend. Seventy-eight high risk patients walking out of mental health wards in six months without staff permission is an alarming record, so improvement is most welcome. There have been 26 new suicides and 26 incidents of serious self-harm across all community mental health teams, meanwhile, (22% of out patients were readmitted to acute wards in Q4).
Treating mental health issues is a complex subject and one I’m not qualified to discuss; the rise in mental health problems and a kneejerk reach for antidepressants as an answer to depression by GPs is likewise a topic for another day.
But the funding and the institutional capabilities, the nurses and the facilities for those who need help have to be there. And something has to change. NHS mental health services are “running dangerously close to collapse”, psychiatrists have said, whilst an investigation by the Health Service Journal (HSJ) show that there are 3,640 fewer nurses and 213 fewer doctors working in mental health in April this year compared to staffing levels two years ago.
This takes takes a massive toll on some of society’s most vulnerable people. Focusing on this would be one of my priorities if elected – and will be as I campaign.
Small local organisations like Herne Bay’s excellent Umbrella Centre do a great job helping people who are struggling—but are themselves constantly struggling for funding—as do charities like MIND; there are also active and excellent local user groups.
But they are up against a programme of cuts that puts the concerns of society’s most vulnerable somewhere near the bottom of the state’s concerns. It has to stop.
When one of you falls down he falls for those behind him, a caution against the stumbling stone. And he falls for those ahead of him, who though faster and surer of foot, yet removed not the stumbling stone.