There are an increasing number of issues facing mental health services. Sadly, these issues span far and wide and we regularly see the media reporting on criticisms and allegations of systemic failings across a range of services.
The picture is particularly bleak for vulnerable young people, many of whom simply do not have access to the specialist support they require. A recent case looking into a possible detention of a 15-year-old girl under the Mental Health Act 1983 highlighted the lack of suitable secure accommodation for young people.
The girl in this matter ("P"), who grew up in care following the death of her mother, had a long history of mental health issues, including a pattern of self-harm and suicide attempts. P's attempts at self-harm were so severe she required care at a ratio of four-to-one. Despite this, P had no permanent accommodation and was residing in a hospital. The Judge in P's case noted: “This position appears to ignore what is almost universally recognised elsewhere, namely that there is a chronic lack of secure accommodation for our young people with serious mental health and behavioural problems.”
Senior family judge, Sir Andrew McFarlane has subsequently noted that high court judges were spending “a fair proportion of their time on cases of this nature, and much of that time is generated because there are not sufficient, suitable secure children’s homes for those who need secure accommodation".
Adult mental health services are also under increasing pressure, and sadly we see that where there simply is not enough timely support available for those most in need, the consequences for the safety of individual patients, and the public, can be unthinkable.
Following the recent conviction and detention in a high security hospital of Valdo Calocane for the killings of Ian Coates, Grace O’Malley-Kumar and Barnaby Webber, the Secretary of State for Health and Social Care commissioned the Care Quality Commission (CQC) to review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) pursuant to s48 of the Health and Social Care Act 2008.
The review made a number of recommendations to NHS England that were of wider application and relevance to other NHS Trusts, including the need to clearly define and agree standards in waiting times for community mental health services and the monitoring of such services. The CQC also recommended that a specific pathway should be developed for individuals who require ‘assertive support’ and may be hard to engage.
The review also highlighted communication issues between services resulting in a lack of joined-up care, and that high demand coupled with staff shortages meant patients were not always being kept safe.
Similar themes were noted in the recent Inquest into the deaths of James Furlong, Joe Ritchie-Bennett, and David Wails who were fatally attacked by Khairi Saadallah in June 2020. Judge Coroner Sir Adrian Fulford concluded there were multiple failures of state agencies and that the deaths of these three men could have been avoided. The lack of continuity and communication between state agencies was highlighted and the Coroner will now issue a ‘prevention of future deaths’ report to the Secretary of State for the Home Department, the Secretary of State for Justice, and to the police and health authorities involved.
Sadly, in the inquests team we see similar issues arising in suicide cases, where those supported by community mental health services fall ‘through the gaps’. Patients cease to engage, or stretched services are unable to review the level of their needs, or escalate care when they are in crisis. Although such cases are less widely reported than those involving public violence, the issues with continuity of care and multi-agency communication are often similar: - patients may not be reviewed as regularly as they should be by senior clinicians, concerns raised by family members are not escalated, failures to engage in support or to take medication are not followed up quickly enough. Despite best efforts, it is often the case that agencies, and health and social care professionals are not communicating effectively to ensure joined up care and risk management.
Tragic and high-profile deaths continue to bring the current challenges for mental health services into sharp focus. Significant progress has been made in de-stigmatising mental health in our everyday lives and talking about it in the same way we address physical health. However, can health services cope with unprecedented level of demand, and the significant range in the levels of treatment and support needed? Ultimately, change will only happen when mental health concerns are channelled and escalated swiftly and appropriately at the point of access – via GP surgeries and hospitals following urgent admission. Swift and decisive action must also be taken to address the current status of waiting lists, staffing shortages and a lack of acute mental health beds (and as always, funding will be central to the conversation). These may not be popular topics during an election year, but they are of fundamental importance to the values of a civilised society.
