In the week the government announced a major mental health workforce plan, a distressing case brought into focus just how urgently action is needed.
A 17-year-old girl who had made a large number of determined attempts to take her own life was due to be released from a secure unit. Although she was at acute risk of taking her own life, no NHS bed could be found for her, despite a judge having ordered two months ago that a proper care plan be put in place.
In a further judgement on the case, Sir James Munby, head of the high court’s family division, said he was “ashamed and embarrassed”, and that the nation would have blood on its hands if no suitable bed could be found.
Legal judgements tend to be written in opaque and unemotional language, but Sir James pulled no punches. “It is a disgrace to any country with pretension to civilisation, compassion and, dare one say it, basic human decency, that a judge in 2017 should be faced with the problems thrown up by this case and should have to express himself in such terms.”
“The mental health professionals I speak to describe services in increasing crisis.”
While the story hit the headlines in the mainstream media, it will come as no surprise to anyone involved in mental health care; indeed many will probably have worked on equally distressing cases.
The mental health professionals I speak to describe services in increasing crisis. They are overworked because they cannot recruit replacements when people leave; patients are sent hundreds of miles from their families to the nearest available bed; community services are outsourced to independent providers who make them cost-effective by relying on volunteers to provide significant amounts of face-to-face support. The list goes on.
While the new mental health strategy is to be welcomed, the government has a mountain to climb to achieve its ambitious aims. These include creating 21,000 additional mental health posts – including at least 4,600 new crisis care nurses – by 2021.
Some have questioned where these nurses will come from, pointing out that in order to hit deadline, new nurses would need to start training next month. One potential source is to entice back the 5,000 mental health nurses lost to the NHS since 2010; unfortunately previous initiatives aiming to persuade nurses to return to practice show that this is far from easy – when people lose their jobs due to cutbacks or outsourcing, or leave due to burnout, they are difficult to tempt back.
“When people lose their jobs due to cutbacks or outsourcing they are difficult to tempt back.”
While the bright future for mental health care promised in the strategy may inspire some to return, I suspect many will remember the publication in 2010 of No Health Without Mental Health, a cross-governmental strategy from the coalition government that aimed to establish parity of esteem between mental and physical health. Seven years on, 17-year-olds at risk of suicide cannot be offered a place of safety and the care they need.
Strategies that languish in the Department of Health’s digital archive are not enough. The government needs to take an active lead in achieving this strategy and proving that this time it really does mean to properly resource and support mental health services.