Crisis Care in Mental Health – both community and inpatient – is inconsistent and increasingly unable to deliver quality services. Mind published a report today following an independent inquiry which they have carried out called ‘Listening to Experience’. This inquiry looked at evidence from 400 patients, professionals and providers and was intended to provide a qualitative shapshot of care in England.
While the press release points out that some outstandingly good levels of care were reported, it is useful to note some of the main points of criticism that were raised.
When looking at some of the examples cited in the statement from Mind, it’s hard to separate these issues from the agenda of cuts that is currently underway in public services and despite the government’s vehement denial that this is not going to lead to reductions in clinical staff, all I can say is that on the ground, I see it happening with my own eyes.
We have, and this is personal experience, wards closing, staff with redundancy hanging over them, downgrading of professionals and replacing qualified staff with unqualified staff. These are not management posts. These are all clinical posts. Staff remaining are pushed further and yes, eligibility is rising and service delivery is reaching a smaller group of people.
So back to the Mind statement, it claims the worst cases include
Eligibility thresholds too high: Mind heard from some people who asked for help to avert an impending crisis, but were told they weren’t yet ill enough to qualify for help
Should that happen? No. Does it? Well, I refer to my point above about lack of staff. Our practice is switching from prevention to ‘fire-fighting’. We have shouted long and hard about this. This, unfortunately, is the result.
Calls for help go unanswered: A number of patients left messages on crisis help lines and no one responded; many spoke of long delays before receiving responses; inadequate advice was given to suicidal people such as being told to have a warm bath, hot drink or go for a walk
Again, while not excusing poor advice (although I can’t see how replacing experienced staff with ‘cheaper’ staff will help), it points to a poor management and lack of people ‘on the ground’. Long delays are unacceptable but often it is about balancing risks between the 5 calls you have taken.
Some of the other issues raised relate much more closely to staff availability and overstretched staff not having the time they feel they need to spend with patients. The issue of rude and unresponsive staff is also raised and I will not explain that away. It should not happen under any circumstances of course but with time and short staffing, it is easy to see how more mistakes are made – just as they are in general hospitals.
Another issue raised is a lack of capacity of inpatient beds. This is something I’ve again got experience of as I’ve seen wards closing and the impact that this. Of course admissions should be avoided but sometimes they are actually necessary.
Mind gives a list of potential positve responses which is helpful – such as more adventurous commissioning and more creative type planning for care.
I don’t think it’s possible to move away from the ‘more money’ issue though that everyone is dodging because money has to be cut from all services at the moment.
That’s not to say different approaches shouldn’t be taken towards listening, supporting and providing good levels of care and abusive and rude staff should never be tolerated at all but it feels like there is something more fundamental missing from the list of ‘answers’ and that is providing good quality, well-training and effective staff in enough numbers and providing good quality hospital settings without having to beg for a bed when it is absolutely necessary.
Interesting too that the report was undertaken by Mind and not the CQC. I wonder if we’ll see similar reports from the CQC in the light of their renewed inspection vigour.
Quick self-plug before I comment – I’ve just submitted a post for the Mind blog for this very campaign. I’ll let people know when it’s online.
It’s true that the cuts are impacting on crisis and acute care, but there were problems even before they came in. One thing that’s an issue is that when the crisis teams were brought in, far too much was expected of them. Don’t get me wrong, a lot of good work is done by crisis teams, but because wards were closed to pay for them, sometimes they wind up having to look after people who really need 24 hour care.
And with the increase of crisis teams and reduction of acute wards, that means a higher concentration of much more mentally ill people on the wards themselves. This makes it a lot harder to maintain any sort of therapeutic environment because the milieu has become much more challenging.
The money doesn’t have to be cut from health and social care services and welfare, it’s what this government has decided it will cut. Most of them would never need social services/social housing etc and could afford private healthcare so what do they care. The cost of people ending up homeless or dead or too sick to do anything is an acceptable price to them because these are groups of people they hold in contempt anyhow.
It’s fast reaching the point where only the most devastating of crises will merit any kind of response but as you point out the response even at that point leaves a lot to be desired. I’ve seen brilliant Home Treatment and I’ve seen dire Crisis services I wouldn’t wish on anyone, a mere doorstep medication delivery service with no other interaction [as per inpatient care]. Mind commissioned the report but frankly they are not exactly standing up to government in any big way
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I do not think it is a good idea to go to telephone crisis lines if you are feeling suicidal,or depressed or have a problem. My friend phoned up Saneline and they have a policy of only allowing 20 minutes on the line per person.
And because my friend was so upset and the conversation with the advisor exceeded over the 20minutes. The advisor told my friend,we can only give you 20 minutes and your time is up now. And hung up on her without saying goodbye.Which made her feel worse.
So telephone crisis lines don’t work,as the person at the other end does not know you and may not be aware that you may have an emotional or even a mental health problem or how desperate you feel. And they can just put the phone down on you making you feel worse as they did my friend. So it is best to talk to some one face to face like a Councillor or a professional
that you can get to know, rather than someone over a telephone.