In the past few days, the closure of Kids Company has dominated the news. To an outsider, their rapid demise has come out of the blue. There were undoubtedly financial issues as Kids Company struggled to keep up with the volume of self-referrals from young people, operating an open door policy. I have a lot of sympathy for all those affected. Kids Company was a life line for an incredible amount of children and young people, many of whom had been failed by statutory services. The staff, who were paramount in delivering the services and support that these young people so desperately needed, are equally as dismayed.
The situation has made me reflect on the role of charities as opposed to statutory services. As someone who receives support from both CAMHS and a charity it raised some questions for me. Are charities picking up the slack? We know that there is a real issue when it comes to funding health and social care services. I was horrified to read an article in the Guardian which mentioned that only 1 in 9 children in need can be supported by social services. That isn’t right. It’s imperative to look out for the most vulnerable young people in order to give them the best chance of getting on in life. How much of that is the job of charities and how much of that is a job for statutory agencies? In an ideal world, I’d say that it’s a job for both. When agencies such as CAMHS and social services have the capacity to work with young people in need, the voluntary sector can compliment the work. However, when the burden of care falls almost entirely on a charity as local agencies cannot cope, it’s a risky position. Many of the young people who turned to Kids Company did so as they were not able to receive help from anywhere else. Now who will they turn to? If statutory services were unable to pick them up initially, will they be able to now?
The voluntary sector is amazing. I am a firm believer in the brilliant change that charities can bring about. If the government will not commit to spending what is needed for statutory services to do their job, then they would do well in not reducing their contracts and grants to charities. Is it any surprise then, that that’s exactly what they’re doing? Between 2010-2013 government funding for all charities fell by 11%, but funding for children and young people’s charities fell by 18%. When you couple that with the gaps in statutory agencies, it doesn’t paint a picture of a society run by those who particularly care whether or not the most vulnerable are protected.
Camila Batmanghelidjh has said that she feels silenced by the government as they felt she was too outspoken and raised issues around child protection which they’d rather keep quiet. I wouldn’t be surprised. The reality is though, that thousands of young people who desperately need support will be left without. Those who never reached Kids Company’s doors, who have never reached the case load of social services and most likely never will, are still in need. The issues that young people face are still just as prominent, the only difference being that we have now lost one thread of hope. I sincerely hope that the government finds a shred of humanity and starts to look out for those who need it.
Earlier today the Guardian published an article (here) claiming that Theresa May is to put £15m of new money into appropriate, health-based Places of Safety for those held under s135/136 of the Mental Health Act (MHA).
£15 million? Straight into new Places of Safety?! Great! As long as this investment doesn’t overshadow the genuine need for consistent, high quality mental health services. I don’t agree with the practice of seeing people detained under the MHA taken to police cells, but I also don’t agree with people being left without adequate support, leading up to a crisis (and potentially a detention under the MHA).
We cannot carry on this culture of sticking plasters over issues and expecting them to go away. An increase in Places of Safety is warmly welcomed by me, however we need to address the underlying issues that are causing people to come to contact with the police in crisis. Of course every case is different, but funnily enough, ensuring that we have a supportive mental health system in place wouldn’t strike me as a bad idea?! I know that effective help costs £££. I appreciate the stresses and strains that the NHS is under, and that we would all love a system that works for everyone. Nor am I saying that changes to the current structure would result in no-one ever having a crisis again, or needing help, but I personally have no doubt that it would make a large amount of difference.
What I am muddling along and saying is that £15m isn’t going to solve everything. We desperately need sustained investment across the board, from CAMHS to crisis services, CMHTs to LD services. The pledge to stop people from being held in police cells is ‘fashionable’ almost, thousands are outraged when we hear the news that teens are being held in cells for lack of 136 suites. We often draw the “but would someone with a broken leg be held in a cell?! I think not!!” parallel. But all areas of mental health services need to be seen as worth investing in, not just a small portion. Mental health services are vital for so many, life-savers even (myself included!) and it is our duty to ensure that they are not failing anyone when they need the support.
This morning I woke up to my Twitter timeline being flooded with the talk of suicide prevention and the hashtag #MHConf. After some rooting around I found that Nick Clegg was holding a conference in order to address suicide – more importantly, calling for the NHS to adopt a “zero suicides” policy. I had seen an article last night announcing the Lib Dem’s proposition, however hadn’t realised that it would be being discussed today.
Here’s the link to a transcript of what was said this morning if anyone was interested: https://www.gov.uk/government/speeches/nick-clegg-at-mental-health-conference
I am all for any measures being taken to reduce suicide levels and help those at risk of suicide. Everyone who works in mental health services and the NHS work tirelessly to prevent suicides. But as many people were saying on Twitter, it goes beyond saying “well we’ve had an x amount decrease in people completing suicide since whenever so clearly everything is going well”. A decrease would be welcomed, of course, but what about people’s quality of life? Just because the suicide rates may go down, it doesn’t necessarily mean that people are thriving and living their lives to the full.
It’s also struck me recently that there has been a lot more talk around mental health and a lot of promises being made by politicians. We’re also fast approaching the General Election, with pools of new potential voters who have come of age in the past 5 years and can now vote. Nick Clegg has been a part of a government that has overseen mental health services being cut to the bone, cut 1600 mental health beds and left people in crisis with little consideration to their mental health. I heard little objection over the past 5 years from the Lib Dems. However with the next GE on the horizon, Clegg is now “passionate” about mental health. I, and many others, failed to see that “passion” being demonstrated over the past few years. Towards the end of last year however, people like Norman Lamb started to speak up about the importance of funding in mental health, especially in CAMHS.
This is all well and good but I can’t help but see it as a publicity stunt to some extent. A “look at us, look how much we care” last ditch attempt to try and swing some more potential voters. They don’t have the backing, nor the money, nor the dedication to make the change they claim they want to make. I’m sure that mental health is a concern, and having met Norman Lamb, I know that he does want to see a difference. But having spent 5 years dismantling the services which they now want to see working again to the best of their capacity is bordering on rude.
Ask anyone in Britain right now about the state of the NHS at the minute and they’ll tell you this: “it’s in crisis”. This fact is everywhere at the minute, and rightly so. The media reports and statistics are very much focused on physical health, a&e waiting times and the unavailability of GP appointments. Hospitals are declaring major incidents left right and centre as they struggle to cope with the demands on such underfunded services.
This is causing outrage – how can the NHS be struggling so much at the minute? It strikes me that this is a mirror image of what mental health services look like in many places, and have done for quite some time now. In 2013, whilst waiting for an inpatient (CAMHS) bed, I was told there were none in the country. None. I was later told that the closest bed was in Birmingham – I live in London. Thankfully a bed became available in London for me. I don’t recall the media having a field day over the fact that there were no beds in the entire country for young people. I was lucky, but some young people find themselves on adult wards, stuck in general hospital for prolonged periods of time, or even in police cells following a s135/136 where no alternative places of safety were accessible. Rarely do these instances make the headlines and even if they do, by no means do they dominate them with the same ferocity as we have seen recently.
Budgets in mental health services are consistently low. CAMHS only receives 6% of the total MH spending, of which £50m has been cut recently. How on earth are services meant to provide a well-rounded service with such little funding? Mental health problems present in adulthood are quite often prevalent in childhood/adolescence, so why does CAMHS get such a raw deal? Increased funding a resources put into CAMHS could change the face of AMHS – early intervention in youth could save lives and prevent problems from escalating. As I write this I am aware that this is well known, so I won’t waffle!
The reality is this: mental health services are in crisis. What seems to be an often overlooked crisis. Staff work incredibly hard and everyone I have come into contact with has been 100% dedicated to helping people. Despite being understaffed and over worked (as was so often apparent when I was an inpatient). Sometimes there’d only be one nurse on shift, co ordinating, bed managing, having to somehow look after the 11 people in their care, call the ETL to dispense meds whilst trying to find other young people a bed up and down the country. Not my idea of a relaxing Saturday morning! But despite that, everyone strives to do the best for those they are looking after. A nurse once said to me “if I could have you all on 1:1 to give you the nursing you all need, I would. But I can’t. ”
I digress. Just a small piece in recognition of all those who work in the NHS.
The media has been inundated with headlines about the A&E crisis recently. Well, the whole of the NHS is really. Around New Year’s Eve professionals were worried about how A&E would cope with a notoriously busy time of year on top of the current over stretched system.
Recently there has been an influx of posters and other resources being used by the NHS to help people decide whether or not they really need to visit A&E for treatment or if out of hours GPs, walk in centres etc may be better to go to. It strikes me as kind of “self triage” system. However what these resources seem to omit is what to do when you are in a mental health crisis. In all my years in mental health services, the thing that has been communicated to me the most is that in crisis you should go to A&E. Even crisis teams tell you to go to A&E in crisis. Seems fairly straightforward. But what happens when you get there?
I appreciate that A&E departments are primarily used to treat those in urgent need of physical treatment. But where do you go if you’re in psychological distress? Especially if out of office hours and you have no crisis team. In my experience, a majority of the time, unless you are in immediate physical danger then many staff have no time for you. (There are exceptions and I have had some amazingly positive experiences but on the whole it’s been largely negative.) While I understand that if you present at A&E in distress but not having harmed yourself you probably won’t be seen immediately, there is a difference between waiting a reasonable amount of time to speak to someone and being blatantly ignored. I feel that crisis is not being taken seriously unless you have harmed yourself/others. For instance you can tell anyone who will listen that you’re suicidal but unless you actually attempt then many won’t listen. Actions do not define the extent of someone’s distress. We should not have to wait for someone to act in a risky way to acknowledge their crisis.
This then leads to the “but am I really ill enough? Do I deserve this treatment?” Because you cannot see mental illness, it can be hard to judge the severity of someone’s difficulties by looking at them. It’s not like a visible wound where a doctor could say “yes… That needs stitches”. But when crisis is not acknowledged it can stir up a whole load of questions in an individual – why are they not listening? Do I not actually need the help I think I need? Someone who had just broken their wrist would probably not question whether or not they need a plaster cast. So why do we question whether or not we are worthy of help? Where does the government urging people to stay away from emergency departments fit into the needs of those experiencing a crisis who don’t feel as though they can go to A&E? I can’t help but feel as though many vulnerable people are being put off going to emergency departments despite needing help urgently for their mental health. The tone of many articles I have read could definitely be misinterpreted as telling people to basically stay as far away as possible from hospital.
If you are in crisis and and feel as though you are unable to keep yourself safe, please do reach out. If you do not want to go to A&E, the Samaritans are an amazing organisation.
I’m not sure that I actually got to the point that I was trying to make but I hope that it did make some sense somewhere haha. I just felt like reflecting on things that I had heard in the news over the last few weeks.