Tackling the problems of our ‘underfunded and understaffed’ mental health services stem from Victorian times
I write with reference to Sam Morton’s article Our mental health services are ‘underfunded and understaffed’ (Middy Feb 14).
As a former senior clinical charge nurse with a career spanning 30 years and as a former trade union branch secretary, the familiar cry of underfunding and understaffing, now repeated by Rick Fraser, chief medical officer at Sussex NHS Partnership Foundation Trust, is not news to my ears.
As far as institutional psychiatry is concerned the only time when this ever seemed satisfactory was when the Retreat in York opened and was run by the Quakers in 1796.
The problems really bedded in with the opening of the Victorian asylums when the industrialization of the treatment of the mentally ill took off in a big way.
But with the closing of these psychiatric hospitals and the simultaneous and subsequent strides made in rehabilitation, improved medication and the talk therapies, the beginnings of community care and the huge advances made in the public and political parties’ attitudes towards mental illness, we have undoubtedly come a long way since then the mid 19th century.
Now we have a prime minister who has vowed to allocate funds to psychiatric services in order to bring them into parity of funding with physical illness in the NHS. That was a promise made by her outside 10 Downing Street on the occasion of the Conservatives’ last return to power. I am certainly generous enough to give her and her government time to allow the promised allocation of new finance to seep through the bureaucratic process of government before we see real change though I am not of her political persuasion.
There are the shoots of hope in evidence. Specialist mental health nurses working with the police, accident and emergency access to specialist psychiatric assessment, our own Sussex NHS Partnership Foundation Trust receiving a ‘Good’ rating in the Care Quality Commission (CQC) report of January 2018 even though many areas still require attention, are all pointers to the possibility of a better service.
These promised and actual improvements have to be viewed alongside a previous history within the Trust of earlier years of bad performance as evidenced by patients having to travel hundreds of miles to access in-patient treatment (2013), the ten killings involving patients of the Trust between September 2007 and March 2015 and the systematic closure of day centres which provided social lifelines for those adults with enduring mental health problems.
Rick Fraser gives us a blow by blow, statistical analysis of the numerical increase in referrals to the Child and Adolescent Mental Health Services (CAMHs) but what we, the public, really want to know is whether Mrs May’s promise of the mental health service’s portion of the £20billion for the NHS is ringfenced for psychiatry and exactly how much the Sussex NHS Partnership Trust will receive and whether that still unknown portion will address Rick’s concern for meeting the needs of the increase of referrals to CAMHs and for the increased costs in meeting the needs of the growth in referrals for dementia care in the elderly and for understaffing generally?
Unless we - and particularly Rick and his colleagues - know what their promised new budget will be, then how can they ever see the promise of parity of financial treatment with physical illness ever become a reality?
Historical financial constraints imposed upon an underfunded and understaffed service during a long period of national NHS cutbacks inevitably has a more serious effect upon an already grossly underfunded and understaffed mental health service.
Norman Lamb, Minister of Health in the coalition government, intended that NHS England would ensure parity of funding by 2015 in line with his government’s promise of 2011 which, as we know, did not become a reality! In fact, there was a disproportionate cut for mental health services in 2014 when mental health was cut by 1.7 per cent and physical care by 1.5 per cent!
Rick Fraser has my respect in what is clearly a difficult job but when the Mid Sussex Times uses the Freedom of Information Act to request information which specifically asks for, and I quote, ‘the total number of referrals for all age groups’ and reports a 22.5 per cent increase then we would like to hear from the Trust how the entire range of services is affected and not just CAMHs, the elderly care services and information on suicide rates.
Of particular interest would be how the Trust involves itself in the many areas which today often lead to mental health problems such as the use of cannabis in young adults and substance misuse generally, family breakdown and the social pressures affecting families generally.
A greater social emphasis on prevention rather than attempts at cure/relief, whilst not denying the need for treatment services, should be a priority in a comprehensive psychiatric service and undoubtedly is but we’d like to know the detail.
Well done Sussex NHS Partnership Trust with your recent achievements but can we also have a comprehensive statement from you on all aspects of the service and, more importantly, a description of the initiatives you are taking, including using digital platforms to appeal to young adults, and how - with limited resources - you expect these to be achieved and when?