CRISIS IN MENTAL HEALTH SERVICES in Norfolk – an open letter

[wendy]

CRISIS IN MENTAL HEALTH SERVICES – an open letter to all users of mental health services, mental health professionals and members of the public (we are all vulnerable to mental illness)

Mental health services in Norfolk and Suffolk are in a state of acute crisis. Norfolk & Suffolk Foundation Trust (NSFT) has decided to accelerate a £20 million cost-cutting programme, over two years instead of four. To achieve this aim:

* It is closing or reducing in-patient units, with Meadowlands secure unit the next to close and either Northgate or Carlton Court acute units next in line. There are no longer any in-patient psycho-geriatric units in the Kings Lynn area, and plans are afoot to reduce the beds on Sandringham Ward at the Julian Hospital, Norwich, from 22 to 10. This is a national strategy, with over 1700 beds having been lost in the last two years, leading to the spectre of mental health care trusts across the country scrabbling around in competition for private beds.

* At a time of great demand for mental health services NSFT is making staff redundant or downgrading their posts.

* It has decimated community teams and disbanded important, specialist mental health teams such as the Assertive Outreach and Homelessness teams, both of which provided a service to those with the most severe mental illnesses. At the time of writing, there are almost 200 unallocated referrals in Norwich community mental health teams alone. Access to a psychiatrist has become very difficult; staff morale is at an all-time low.

* In Primary Care NSFT has got rid of the GP-attached link-worker service, which acted as an accessible, preventive service. It was replaced with a centralized Access & Assessment team, which is poorly resourced and struggles to cope with the high number of referrals.

* In Acute Services, the Crisis Resolution Home Treatment (CRHT) team is no longer able to provide a safe alternative to hospital admission, operating as it now does at 25% below capacity. The team is constantly called on to plug the many gaps in the existing service and is now expected to carry out urgent, acute psychiatric assessments as lone workers. (Until now, such assessments have been done in pairs, both for a more thorough assessment and for the health and safety of both patient and staff.)

* Patients are being prematurely discharged - both from in-patient units and community teams - without adequate support, bringing back into existence the ‘revolving door’ phenomenon.

* Wards are operating at over 100% capacity, often with only one qualified staff member on duty, trying to manage a ward staffed by agency nurses who are not familiar with the patients or the procedures and who often do not have the necessary training or qualifications. Staff morale is low because workers are unable to carry out their duties to an acceptable professional standard.

* Approved Mental Health Professionals (AMHPs), who are responsible for carrying out assessments for detention under the Mental Health Act, are finding it almost impossible to function in a safe and legal manner, frequently being told: ‘no beds in East Anglia’, so

that patients are admitted to hospitals as far away as Kent and London, often to private hospitals, at a huge cost and disruption to any form of continuity of care. Even worse, there are often delays in essential admissions - both voluntary admissions and compulsory admissions under the Mental Health Act - when at times an AMHP is unable to make an application for detention because the papers cannot be completed for lack of a named hospital.

All this is happening at a time when – due to the recession – the demand for mental health services has increased markedly, and when local government care services have also been slashed. The background to all this is the Coalition Government’s drive to privatize the National Health Service (NHS). The new Health & Social Care Act encourages Clinical Commissioning Groups (CCGs) to seek tenders from private companies. The Norfolk and Suffolk Foundation Trust (NSFT) admits that their drive to cut costs is partly fuelled by the pressure to compete with potential private-sector providers.

A similar process is taking place in the voluntary sector where essential support services that are provided by such organizations as Mind, Julian Support, Rethink etc. are being cut due to reduced funding, while access to such services is now narrowly restricted to those patients fortunate to qualify for the Care Programme Approach (CPA) and a Personal Budget. Personal Budgets themselves are incredibly bureaucratic and subject to ever increasing strict scrutiny by senior management, leading to long delays in the provision of vital support services. Care Coordinators are now being told that their caseloads will treble in size, going from a current average of 25/30 to 75/90. The concept of a therapeutic relationship with the service-user (which is the best way of preventing suicide) will no longer exist, while risk management and monitoring will get even worse. This is what the Trust calls a “community-based approach to care “. THIS IS WHAT WE CALL A SEVERE CRISIS IN MENTAL HEALTH SERVICES.

The Trust management has a very short memory or a poor knowledge of mental health history: the care management approach was brought in the early 1990s because the care and treatment of severely mentally ill people was fragmented and uncoordinated, with many people slipping through the net and becoming very unwell. Assertive Outreach teams and the National Service Framework standards were brought in as a result of a series of high-profile tragedies such as the suicide of Ben Silcock, who – while psychotic - jumped into the lions’ enclosure at Regents Park Zoo, and the death of Jonathon Zito at the hands of Christopher Clunis. A caseload of 70-90 people makes effective care coordination impossible.

We congratulate the Eastern Daily Press for highlighting the fact that the mentally ill themselves are the ones most at risk from cuts to our service, as opposed to the Sun’s dreadful scapegoating of those with mental illness. The tragedies referred to above occurred in London. In Norfolk and Suffolk we have even greater problems of social isolation, rural deprivation and difficulty in accessing essential services, which will now be compounded by the transfer of Community Mental Health Team bases from Holt to Hellesdon and from central Norwich to Hellesdon/Wymondham. We have had many tragedies already and further tragedies are highly

likely. The Trust’s response to the dramatic increase in suicides over the last five months had been complacent in the extreme.

As professionals, we are initiating this campaign because we are no longer prepared to remain silent any longer; we do not want to find ourselves in a Mid-Staffs situation - whereby standards of care sink to an unacceptable level - without our having spoken out. Therefore we want to launch a campaign to save our mental health service – a service which at times is literally a matter of life and death. We are going to plan for a public meeting in Norwich – with prominent national speakers - to draw attention to the crisis in mental health services and to formulate a plan of action. Suicides can be reduced by effective, well-resourced mental health services, and the creation of emergency respite care such as that offered by the Maytree sanctuary in London.



We particularly want to join with service users and their relatives who are experiencing problems with obtaining help from mental health services.

If you are unable to attend the meeting, but would like to be involved in some way, please contact Terry Skyrme, tel 01263 825967 or email WSallyL@aol.com

Signed

This campaign already has the backing of the following organizations and individuals:
Chill4us Carers

Norfolk & Suffolk Foundation Trust NHS Unison Branch

Norfolk & Suffolk Foundation Trust NHS Unite Branch

Norfolk County Council Unison Branch

Equal Lives

Norfolk Peoples Assembly

North Norfolk Trades Council

Norfolk Coalition against the Cuts

North Norfolk Labour Party

Norfolk Social Work Action Network

North Norfolk Green Party

[wendy]

a reminder

[Jeanne]

What a pity it is so far for me, I would love to attend, if able. The Emergency Clinic for the mentally ill has been closed here for some time and people are having to go to Accident and Emergency, which is distressing in many cases for both the patient and others waiting to be seen. I have sat with a friend, who desperately needed to be sectioned, for a whole night and it was very painful to be there. God help us the way Mental Health Services all over the country are going. x Jeanne

[Misspears]

tha22222

[mumxtwo]

Oh dear this is very worrying on a personal and wider level. Thank you for bringing it to our attention.

[annie]

tha22222

[wendy]

the meeting is tonight