“Inadequate” is such an insipid inadequate term to describe an abject failure to manage critical mental health services and to continue over 5-years to fail to improve.
Norfolk & Suffolk NHS Foundation Trust is the seventh largest mental health trust in the UK, running over 100 community
services across 50 sites and GP practices for 1.6 million people in an area of 3,500 square miles for £227m a year. In any one month they may have 25,000 patients being seen or served. No small feat.
I’ve had great NHS care and compassion, supported by superb individuals via NSFT, Wellbeing, CMHT, Therapy services within Norfolk Mental Health – indeed CQC scored it “Good” for caring. However, the waiting lists for many are criminally irresponsible. This isn’t even my usual rant about transgender waiting lists, although they form a part of mental health. The Government austerity cuts and CCG and NSFT financial and provision managers are presumably to blame as every other trust must be facing similar challenges. Mental Health services remain grossly underfunded and in crisis. Parity for mental health services with physical health and its 18-week guarantees are years away. NSFT tops the table in the worst possible way, making national news today. Norwich topping the football – great; NSFT topping the worst mental health care trust for 5 years – fail!
“NSFT doctors first raised concerns over cuts in January 2013, as more than 500 mental health jobs faced the axe in what was known as a radical redesign of services. Senior psychiatrists warned at the time that patient safety would be put at risk and said the trust was being “downright dishonest’’ for failing to state that the cuts would have detrimental effects on patient care.” – EDP
I had to fight for well over a year to get seen, assessed (I was “lost” in the system three times but with zero response to internal complaints raised), and keep my care – which I am losing in 3 months – apparently, long-term mental health symptoms can be in “recovery” (mine can be episodically), and bipolar and anxiety disorder be signed-off.
“36 people had waited five years to be seen and 2,732 were waiting for their first contact with services… 2,400 adult patients across the trust had not been allocated a care coordinator in community mental health services.” – EDP
This is the problem when capitalist market budgeting is applied to health, and recovery models applied to long-term ailments. I prefer a “discovery” model that supports but doesn’t focus on discharge until you yourself know you are ready. Instead, a benefits and unemployment model of punishing mental health as if it was an aspect of an alleged “work-shy” culture leads to shaming those in need of its services and a seemingly deliberate or incompetent policy of actually signposting ease of access to services resulting in many people never even finding the door, let alone making it through it. Whilst I am currently being “shown the door“, having had an exit strategy meeting, others are shown the door but not let in. As many friends of mine know all to well, just as with PIP applications and appeals, if you weren’t ill when you asked for help by the time you eventually get it the very wait will have made you ill, and certainly resulted in a deterioration of any conditions you have.
“The Care Quality Commission found patients desperately needing care were waiting so long for help they harmed themselves or took overdoses during delays – or were being turned away completely…Staff were covering up the length of waiting lists by allocating patients to staff or running several lists whilst agreeing that nothing would be offered until space was available. And some patients had been waiting five years for help.” – EDP
During a suicidal day, several years ago, I rang the 24hr acute line at Hellesdon on a Friday night and got a locum of some form who said: “I can’t help you, I can’t access your notes at a weekend” and was generally unintelligible and useless in several other ways. I never rang them again.
With a history of suicide, I’ve learned to stay alive by building my own care package and it includes my partner, friends, Wellbeing, CMHT – the “severe and enduring mental health needs” service (keeps getting renamed!), cats, honesty, whisky, and avoiding pills as an accessible suicide kit.
I have nothing but praise for 95% of the frontline staff who’ve helped me. I would not have survived continuing mental health challenges and rebuilt some of my life had it not been for my care team who have gone above and beyond their job descriptions to support my whole wellbeing and not just my mental health. That has included helping me with referrals to physio and general health, and applying for Housing Benefit, PIP and ESA for me, when I was in no state to do so. They are my heroes. The system of cuts and carelessness elsewhere that meant I needed them has probably meant that others have had less support or are still waiting.
“We want services which are provided for those who most need care. That may mean those who don’t have as much need wait a little longer.” – Antek Lejk, Chief Exec NSFT, EADT
Clearly, they are people that carry on caring despite the system and resources they are forced to work with. It is a wonder why so many keep working and don’t leave. Indeed, NSFT has 1-in-4 unfilled nursing posts.
“A perfect storm of cuts, incompetence and stigma has seen services unravel, with people struggling to access services, being discharged too soon, and staff under intolerable pressure with unmanageable caseloads. Following a savage real-terms budget cut, the number of doctors has been reduced by 51 (around 25pc) and the number of nurses by 163 (1 in 8) compared to when the trust was formed in 2012, while referrals have rocketed. The number of patients referred but still awaiting their first contact is 2,732 (as of October 12). That’s a lot of people in distress, without support.” Emma Corlett,EDP
When the CQC interviewed me for a previous report, I said that continuity (and accessibility) of care were critical as my care team kept getting changed or staff going off long-term sick themselves (probably stress at work based).
What happened? Three months later they shuffled the deck chairs (a “radical redesign” no doubt) and changed my care-co again, and I’ve had 3 more since. NSFT is that Titanic on which the deck-chairs get regularly rearranged rather than addressing the approaching iceberg of yet more service-users drowning in a cold heartless sea where the lifeboats are knocked-off the list of necessary equipment to save money.
“The key to keeping people safe is a trusting relationship. How can that be possible with repeated, persistent disruption. Worse of all, it’s deliberate disruption as like you describe, inept managers with a lack of a clue about what else to do opt to do another reorganisation, over the heads of staff and in some cases not even bothering to tell the service user.” – Emma Corlett, Nurse and Norfolk Councillor
Yesterday was #InternationalMensDay (IMD) – not a simple awareness retaliation day to Women’s Day but an acknowledgement, since 1999, that privilege and difference are often relative and contextual. Society does make it harder for men to talk, share, open up, acknowledge depression, career pressures etc. Men’s mental health is such that suicide can be their biggest killer, indeed, silence kills. Yes, feminists can argue that every day is men’s day, but in the particular sphere of suicide, there needs to be a spotlight on men and the fiscal and fragile crises that so often masculinity prefers to conceal. Similarly, whilst young LGBT people have high suicide risks, one group most prone to it is white men aged 85+ whose suicide rate in the US is six times the national average, closely followed by Native American males.
World Suicide Prevention Day, 10 Sep
Men are more than 3 times as likely to take their lives as women (4 times in the USA), with rates of 16.8 per 100,000 for men and 5.2 per 100,000 for women in the UK. Women try suicide more than men, but male suicide methods are more likely to result in death.
The highest suicide rate in the UK in 2014 was for men aged 45-49 at 26.5 per 100,000 with the North East of England most vulnerable. Whilst the overall suicide rate fell 1981 to 2007, austerity and cuts to services have seen annual rises since with the male rate last year, the worst since 2001.
385 men-a-month take their own lives in the UK; it is even worse in the USA, at 2759, 1.5x more likely per capita. In Japan, it is the leading cause of death in men aged 20-44.
Even so, Japan is not the worst. Lithuania is twice as high at 51 per 100,000 and Guyana at 71 per 100k is ashamedly the world ‘leader’. The USA ranks #46 and the UK #101 for male suicide.
Not a laughing matter
World Toilet Day, access for all by 2030
Men’s mental health is not a joke. November 19 was also World Toilet Day, and whilst jokes about leaving the toilet seat up abounded on twitter – including by me, whilst not directly aimed at men’s health, sanitation and sanity are not laughing matters when one billion lack a toilet and half-a-million men each year die by suicide and many millions more try. Whilst depression and mental health issues account for the majority of cases, for men in particular, financial and career pressures are significant factors. Education, because it brings with it greater economic opportunities and perhaps better communication skills, is a reducing factor, except among certain professions whose jobs give them access to pharmaceutical drugs.
Learn to Talk & Listen
The old Second World War adage and poster campaign that “Careless talk costs lives” could be turned on its head – “Learn to talk and save lives”. Partners and friends of men in crisis, similarly, need to learn to listen and not diminish the pressures that drive them to drink, depression and suicide. Suicide, at one every 40 seconds and on the rise (predicted to be one every 20s by 2020) is preventable is we make it ok for everyone to talk about mental health, men in particular, and we also end the worst effects of austerity where health and welfare cuts are exacerbating the problem and denying access to solutions.
The language of austerity and recovery (the Tory version or Labour’s “austerity-light”) has all been about working to pay off the deficit, whereas the reality of much of it was about cutting public sector jobs and the benefits of those out of work. The language of Ukip has been about preventing others coming here to work, or labelling migrants as “benefit/health tourists”. According to many international bodies the UK has done well – economically, but socially we are falling apart. Socially and in microeconomics terms, rather than the surface macroeconomic recovery, the Coalition isn’t working, also “Labour Isn’t Working“, the political opposition has been ineffectual.
Measuring the Health of a Nation
Labour: The Doctor Can’t See You Now General election poster 2015
In health service resources terms we are 28th out of 30 OECD nations, 19th in terms of our actual health. The health of society should not be measured in mere economic terms. Education, welfare, mental health, attitudes to those that are different, migrants, or asylum seekers, are often a better guide to how we are really doing as a society. When a million people are using foodbanks, something is clearly wrong.
Working Families
“Britain isn’t eating” Church Action on Poverty 2013
The language of Labour and Conservatives this election has all been about “hard working families“, with Ukip adding British-only workers to that, but then even Labour wanted to push for British jobs first. On paper, the unemployment rate is almost back to its 5.3% pre-crisis figure along with a massive shift away from public sector towards the private sector. After 5 years of austerity certain types of jobs are growing (self-employment, small business, zero hours contracts – 700k/2.3% of workers), but those without are being left behind – something Cameron promised not to do.
“I want to, if I’m elected, take the whole country with me. I don’t want to leave anyone behind. The test of a good society is you look after the elderly, the frail, the vulnerable, the poorest in our society. And that test is even more important in difficult times, when difficult decisions have to be taken, than it is in better times.” – David Cameron on the Andrew Marr Show, just before the 2010 General Election
Whether disabled, unskilled, mentally ill, being a carer, or struggling with some other difficulty that makes the 9-5 “Arbeit macht frei” ethic not appropriate or possible for all, many are being abandoned, and forgotten. The very purpose of the modern state, the welfare state, even something once quoted but not fulfilled by David Cameron, is to care for the weakest and neediest in society – without scapegoating them as sick scroungers.
Ed Miliband and the #EdStone
Ed Miliband – Six Pledge/Promises Stone #EdStone
Even Ed Miliband in his Cecil B. DeMille Mosaic stone Tablets announcement this weekend put the economy as the number #1 priority and “higher living standards for working families” as number #2, apeing UKIP and the Tories at number #4 is “Controls on Immigration“.
What no welfare?
Nowhere among Labour’s 6 priorities were people in need, on welfare, even mentioned. For welfare to remain a “dirty” word even with a so-called socialist party shows how times have swung and the extent to which a party will spin and abandon its principles in order to regain power.
Austerity isn’t working UK Uncut poster 2012
“Cuts” has been the message of austerity and debt reduction. But those cuts have fallen on the neediest in society, those on disability or welfare, not those most able to pay, or indeed – such as the banks, most responsible for the economic collapse in the first place. In 2012 UK Uncut protested the March budget with a “queue” outside Downing Street and an “Austerity Isn’t Working” poster campaign mimicing the 1978/9 Saatchi poster done for Margaret Thatcher and the Tories.
The verdict of a successful government is not just something measured in economic terms but also in moral and social ones.
Is the economy the only measure of a successful country? If I starve my kids to pay off my overdraft am I a great parent? #BBCDebate
David Cameron’s Easter message interview with a Christian magazine summed up Christianity as about “hard work and responsibility“, not Christ’s work on the Cross, meaning that, soteriologically, everything was actually already done for mankind.
Jesus said that the “truth would set you free”, the truth seems to be the thing furthest from modern politicians, with all their spin and question-dodging. No wonder 35% of the electorate don’t vote.
Less about Economic Wealth what about Mental Health?
The real hard truth is that “Britain isn’t working”. Inequality is increasing. Our communities are fractured and our countryside fracked. Those not in work are being punitively capped and cut until they can take it no more.
The irony of a government forcing state-funded CBT onto the unemployed yet unable to deliver self-requested CBT via mental health services for those that want to work is clearly lost on the Big Brother worker state. Hundreds of therapists, counsellors, and mental health experts, have written to outline their fears about the emotional and psychological toxicity of austerity and how it is being carried out. Suicides have increased over the last 5 years, especially amongst men.
Big Society or Broken Society?
Is the Big Society broken? Does society even exist or matter? Thatcher’s “there’s no such thing as society” is falsely interpreted though under a Tory-LibDem watch has been almost a self-fulfilling prophecy.
“There is no such thing as society. There is living tapestry of men and women and people and the beauty of that tapestry and the quality of our lives will depend upon how much each of us is prepared to take responsibility for ourselves and each of us prepared to turn round and help by our own efforts those who are unfortunate.” – Margaret Thatcher, 1987
Labour isn’t working Conservative’s Saatchi poster 1978/79
Saatchi and Saatchi designed the 1978 poster that helped Thatcher win the 1979 election with the tagline “Labour [Still] Isn’t Working“. The Labour Party has spoofed the self same poster nearly 4 decades later. It is time to think outside the box not just rattle and rebrand it.
The truth is society is more broken than 5 years ago even if the economy may be on the mend. Austerity has been toxic. Our health, transport, housing, and education sectors have declined after being starved of resources or sold off to the private sector. Now it is society that needs rebuilding, not the economy. That is the true measure of recovery.
Post-Election Update
Labour isn’t working BOB cartoon Daily Telegraph 9 May 2015
With the Conservatives returned to power, not just coalition but a slim but workable majority, and achieving a rare (once in a century) feat of increasing their vote share, how much did their victory owe to spin and emphasis on the economy not those in need? Are the democratic majority simply selfish? The majority view does not mean it is the right view – ethically, morally, socially. In the meantime the 37 year-old poster image is still doing the rounds with Daily Telegraph cartoonist BOB re-posting “Labour isn’t working” with a queue of unemployed Labour MPs snaking back from the dole office.
