Before you trust the Tories on mental health …

The entrance to a hospital, with a sign on a red-brick wall saying "Humber NHS Foundation Trust: West End, 2062-2068 Hessle Road". A red brick building with a bright blue door stands in the background, while right behind the sign stands a tree whose leaves droop down to partly obscure the building.So, today it was announced that Theresa May has promised new legislation on mental health if her party wins next month’s election, which will “rip up” the 1983 Mental Health Act under which people can currently been detained (the term ‘sectioning’ refers mostly to sections 2 and 3 of that Act) on the basis that “it has allowed the unnecessary detention of thousands of people and failed to deal with discrimination against ethnic minority patients”. According to the Observer’s advance copy of her announcement:

“On my first day in Downing Street last July, I described shortfalls in mental health services as one of the burning injustices in our country,” May will say. “It is abundantly clear to me that the discriminatory use of a law passed more than three decades ago is a key part of the reason for this.

“So today I am pledging to rip up the 1983 act and introduce in its place a new law which finally confronts the discrimination and unnecessary detention that takes place too often. We are going to roll out mental health support to every school in the country, ensure that mental health is taken far more seriously in the workplace, and raise standards of care.”

The Observer correctly states that campaigners consider lack of funding to be as big a problem as badly-drafted laws; opposition politicians, including former Coalition care minister Norman Lamb, have dismissed her proposals as being based on “thin air”. From my contacts with current and past mental-health service users, I’m aware that one of the worst problems is lack of locally-available mental-health inpatient care, which has regularly resulted in people having to travel out of their home area, sometimes hundreds of miles, to access a bed as a result of a mental health crisis. This has been the case in far-flung rural areas like Cornwall, which is only now getting an adolescent inpatient unit as a result of years of local campaigning, in small cities like Hull where the well-regarded West End adolescent unit was closed in 2013 as NHS England was no longer willing to support five-day inpatient facilities and would not fund a week-long unit in Hull (a replacement unit is going to be built new, to large cities including London. I have regularly seen messages on social media that there is only one bed, or no beds at all, for an entire large population group (e.g., women, adolescents) in the country.

It is not only with minority-ethnic patients that legal reform is needed to curb abuses. The use of the MHA to enforce decisions about the care or housing of people with learning disabilities, particularly autism, needs urgent attention also. A major part of the problem is that clinicians who are trained in mental health apply their training to behavioural issues stemming from autism; thus someone is sectioned as a result of an incident, usually in an institutional setting, leading to the person remaining sectioned for an extended period because their likely behaviour when living in the community is judged by their behaviour in a closed, unfamiliar, unfriendly institutional setting. In some cases, it has been apparent that someone has been sectioned on a pretext so as to facilitate their transfer, as clinicians and managers can have a patient transferred out of area, such as to a secure unit, without there being means for the affected person or their family to challenge the move. Any new law must also address the abuse of the secure unit system and its use to treat people who need long-term care but not secure conditions, as well as making sure they cannot take patients who are outside their remit.

It is not only the lack of funding itself that is the cause of the mental healthcare crisis; it is the funding culture, the attitude that we cannot have too many beds, such that if a unit is deemed to be ‘surplus’ to requirements, it is closed. In November 2014, it was reported that 468 beds had been closed over the previous year and that occupancy rates had hit 120% in some mental health trusts during some months; the recommended level was 85%. Over-supply must not be a dirty word; there must be empty beds, so that if someone needs a bed, there is one available. (Of course, a service persistently unused over a long period cannot be continued, but if this happens, a similar use could probably be found rather than simply closing the ward.) It is not only poor funding for mental health care that results in unnecessarily long detentions; getting the staff to care for people with learning disabilities at home also costs money, and it is difficult to recruit or retain staff, or train home-care staff adequately, when wages are poor and better-paid work is available in other sectors, or abroad. It is well-konwn that local authorities have had their funding cut drastically since the Coalition came to power and have cut services accordingly.

Finally, for many people with mental health issues or autism, a major source of anxiety is money, and if you are reliant on benefits because you cannot work reliably or at all, financial instability or the threat of benefit withdrawal can have a serious impact. Someone I used to know once told me that most of her mental health problems cleared up when her housing and finances were secure and this security was based on benefits that were axed in the Coalition’s “welfare reform”. Many of the disabled people I know dread the arrival of the “brown envelope” informing them that their Disability Living Allowance is to be re-assessed for the new Personal Independence Payment (PIP), often because it is based on criteria that exclude their impairment and disregards its complexity or impact on their life. Physical impairment is often associated, either as a result or a cause, with severe illness, violence and trauma and all of this has mental health ramifications. The Tories, since they came to power in 2010, have subjected disabled people to continual harassment by interfering in the benefits system which gave them some degree of security and peace of mind.

The Tories are trying to win parts of the country which have traditionally voted Labour, at least partly on the strength of Brexit and Labour’s ambivalent stance on it, and some of these places are those badly hit by health and social care funding cuts and bed shortages. No doubt their publicity will include a few heartstring-tugging stories about teenagers sent far from home and promises to end this kind of thing. However, talk to those affected, other than those who are very wealthy, and they will tell you it has got worse since 2010 and they know who to blame. Legal reforms are certainly necessary but unless Theresa May is willing to disavow the past decade of Tory policy, including the “flagship” welfare reforms policies, and face up to the dire need for new money, we should all know that her rhetoric is empty and will deliver only limited results.

Some of the stories I’ve featured on this blog since 2010:

  • Joshua Offer-Simon, a teenager with autism from London who spent more than two years in mental health units in Manchester and Birmingham (also here)
  • Maisie Shaw from Hull, sent to numerous units out of area on multiple occasions because of the West End unit’s closure. This also featured in the documentary Kids in Crisis which also featured two young people from Cornwall, reviewed by me here.
  • Thomas Rawnsley, who died of unexplained injuries (inquest pending) in a care home in 2015; his family wanted him home but were denied this by courts
  • Claire Dyer, who was sectioned and later sent more than 200 miles from her home. Currently awaiting a bespoke housing/care placement; one has fallen through because of local authority incompetence.
  • Connor Sparrowhawk who died of neglect in a mental health unit in Oxfordshire in 2013. Inquest found neglect contributed to his death.

Some of these people could have been helped by reforms to the mental health laws, but a recurring theme is lack of local inpatient treatment and of places to live outside hospital after discharge, if a hospital admission was ever necessary. As far as I know, the issue of how the Mental Health Act applies to people with autism as opposed to mental illness has not been addressed.

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