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Mental Health Act reform plans 'do not show nurses they are valued'


I agree with many of the recommendations, as a mental health nurse, but the underlying problem with a move to less coercive mental health care is lack of funding and resources for community mental health care as an alternative to admission, and a lack of experienced staff. What does not appear to have been mentioned in the document, which does report a shortfall of 14% in mental health nurse vacancies, is that many posts have simply been cut, so that 14% shortage figure appears to be a gross underestimate. I would suggest that in community mental health teams the reduction in MH nursing posts is as high as 50%, that's based on the last 2 CMHTs I have worked for: one working age, one older adult. The staff that remain in those teams are often inexperienced, and staff turnover is high possibly as a result. There isn't a varied enough skill mix to ensure support for the less experienced staff. Even if the government were to shake its 'money tree', experienced staff are not prepared to work in these teams as they currently are: unmanageable caseload sizes, increasing documentation (since many trusts have switched to digital documentation the forms have increased massively and often are unwieldy, and the managers audit them more often so clinicians have to keep on top of them), and increasingly risky patients. I know the authors of the report suggest that mental health staff are too risk averse, but that is not my experience. We are currently carrying a lot of risk, and we are professionally liable. Standing in the dock of the Coroner's court is not pleasant, and we did not enter the profession to watch people die. Training budgets for mental health staff have also been cut to the bone. Even if training is available, many trusts have introduced fairly stringent conditions to recoup the costs if you dare to leave the Trust, even if you stay within the NHS. As a result of potentially incurring a £4k liability I recently refused training to become an AMHP, they are in very short supply. The use of personal budgets to support people in the community is also a mixed bag: it is very time consuming to arrange a personal budget, and then to audit them, and they are not always used effectively. Often we have not been able to find suitable support in the private sector for people with personal budgets: put simply no one tenders for the business. In addition, I have tried to interest many patients in having an Advance Statement under the current MHA. I have only had one patient agree to write one, even with support. Finally, suggesting the use of the incredibly slow and already overloaded Court of Protection for ECT under the MHA is potentially deadly. ECT is usually used as the last resort, especially in older adults who are not eating or drinking. How many people would die waiting? I am no fan of ECT but there is a reason it is still used: sometimes it is the only thing that will work.

Posted date

6 December, 2018

Posted time

8:30 pm