Why couldn’t Dean Saunders get a secure hospital place?

Picture of Dean Saunders, a young white man with a short beard and moustache, wearing a two-tone grey sweatshirt, holding a young childLast Friday an inquest jury gave its verdict in the case of Dean Saunders, who killed himself in Chelmsford Prison in January 2016 having been remanded there having injured his father who tried to stop him self-harming during a mental health crisis in December 2015. The charity Inquest has published the full verdict on its website including statements from the family and their lawyers. The jury concluded that he took his own life while the balance of his mind was disturbed and that his death was contributed to by neglect. The jury criticised the police, the prison service and the private contractor (Care UK) which provided mental health care at the prison. The inquest heard much evidence, and found, that decisions made about Saunders’ care were made with a view to minimising cost, a claim strenuously denied by the head of healthcare.

As Deborah Coles of Inquest says in the charity’s statement, Saunders should not have been in prison at all, but in a secure mental health unit, but no beds were available (it is not clear how far afield the search went) until the day he died. This, of course, is a common problem: people have to be transferred hundreds of miles from their homes because no beds are available locally, because they have been closed because of funding or bureaucratic reasons, often when they are in fact well-run and well-regarded. The worst problems seem to be faced by adolescents and those with learning disabilities, but it goes on throughout mental health services. Only this past week, a women’s inpatient unit was closed in Purley, south London, after the local NHS trust decided it no longer represented value for money (the local paper also reported on this). The Independent notes that the closure will only save the trust £500 per year; it does not mention whether this includes the sale of the property, which is in a very desirable and expensive area.

A less obvious aspect of why Dean Saunders could not get a secure unit place quickly is who is in the units already. They are equipped to house forensic mental health patients under hospital orders, but also hold sectioned patients who may not need the security they provide (patients are not allowed internet access, mobile phones or recording devices of any sort, in contrast to the usual regime in most adult mental health units) but need therapies which are not available, or at least not immediately available, anywhere else. Some of them are plainly unsuited: a medium-secure forensic unit in Sussex (run by Partnerships in Care, now part of the Priory Group) took Claire Dyer in 2014, despite her having a learning disability outside their expertise and coming from 250 miles away in Wales, although it discharged her three months later; more recently, a forensic unit in Wales, Ty Catrin, run by the same profit-making chain, admitted a young lady with a personality disorder and an eating disorder last May and allowed her weight to drop dangerously before transferring her to a general hospital in her home area just before Christmas. Judging by the leave both were allowed before transfer to the secure unit (documented by them or their family on social media), neither needed secure conditions when in their previous hospital setting, so why are they being subjected to secure conditions in institutions that do not even come close to meeting their needs? It is cruel to them, and it shuts out people who really do need their services. (Of course, neither of these units could have taken Dean Saunders, but no doubt a place he needed was occupied by a man who should have been in a non-secure therapeutic placement.)

It is encouraging that this inquest looked at the wider issues of Saunders’ detention rather than, say, merely the decision to downgrade his observation from constant watch to every 30 minutes; previous inquests of people who died in NHS carem such as Nico Reed and Stephanie Bincliffe, did not look at the matter of why they were in the institution which neglected them and in the latter case found no neglect, despite the wretched conditions of her captivity over seven years. However, the reason he was unable to access the care he urgently needed was political: we provide secure units, because they are needed to contain the type of patients that scare the public and make headlines (the Christopher Clunises of this world) but other inpatient mental healthcare is an easy target for cost-cutting, yet lives depend on both types of care.

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