England's mental health services 'in crisis'
- 16 October 2013
- From the section Health
The mental health service in England is in crisis and unsafe, says one of the country's leading psychiatrists.
Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust, spoke out as an investigation by BBC News and Community Care magazine reveals more than 1,500 mental health beds have closed in recent years.
Many trusts have all their beds filled.
Care Minister Norman Lamb said the current situation was "unacceptable" and provision must improve.
While there was a drive to treat more people in the community, he said beds must be available when patients needed them.
System 'inefficient, unsafe'
Freedom of Information requests were sent to 53 of England's 58 mental health trusts, by BBC News and Community Care, and 46 trusts replied.
The figures show that a minimum of 1,711 mental health beds have been closed since April 2011, including 277 between April and August 2013.
This represents a 9% reduction in the total number of mental health beds - 18,924 - available in 2011/12.
Three quarters of the bed closures were in acute adult wards, older people's wards and psychiatric intensive care units.
Northumberland, Tyne and Wear NHS Trust has cut its inpatient beds by 157, while St George's and South West London has removed 155 beds.
Behind the statistics lie the consequences for staff and patients.
On the morning Dr Baggaley spoke to the BBC, he said a severely distressed patient had been transferred from Croydon to Hertfordshire as there were no beds in London.
He has 50 patients in beds outside his trust, some as far away as Somerset.
He said: "We are in a real crisis at the moment. I think currently the system is inefficient, unsafe.
"We're certainly feeling it on the front line, it's very pressured, and we spend a lot of our time struggling to find beds, sending people across the country which is really not what I want to do."
Lucy Bowden ended up in the back of a police van due to a lack of beds after voluntarily seeking help.
The 33-year-old, who self-harms, was left wandering around the grounds of her local accident and emergency unit after being told there were no psychiatric beds available after she'd been treated following an episode.
Eventually the police were called, who had to section her to force her local psychiatric hospital to provide her with care.
She recalls: "They couldn't find anywhere so they were saying I'd have to go in to police custody, in a police station which would mean I'd have to go into a cell. Eventually they found a bed and I had to go into the back of a police van, in the cage in the back. It was horrible."
The bed closures are only part of the problem.
There is also increasing demand for mental health services, according to Dr Baggaley.
"There seems to be a genuine increase in demand," he said. "That's partly explained by a reduction in beds, by resources coming out of the health system, the squeeze on social services budgets, and by the general economic situation."
Average occupancy levels in acute adult and psychiatric beds are running at 100% according to the FOI figures from 28 trusts.
Half of these trusts had levels of more than 100%; all of them had occupancy rates above the 85% recommended by the Royal College of Psychiatrists.
The problems of running at capacity are highlighted by the tragic case of Mandy Peck. The 39-year-old told psychiatric staff she was feeling suicidal but her local mental health service centre said they had no beds available. A day later she jumped to her death from a multi-storey car park. A subsequent investigation found that a bed had actually been available.
Care Minister Norman Lamb said: "Current levels of access to mental health treatment are unacceptable. There is an institutional bias in the NHS against mental health and I am determined to end this.
"More people are being treated in the right settings for them, including fewer people needing to go into hospitals. It is essential that people get the treatment they need early and in the community but beds must be available if patients need them."
Dr Geraldine Strathdee, National Clinical Director for Mental Health from NHS England, said the key was to strike the right balance between providing sufficient hospital beds and helping patients to be treated at home, or in the community.
"We need to make sure the people who are commissioning services have the information they need about the level of need in their area. We have to get this right for people."
Marjorie Wallace, chief executive of the charity SANE, said: "It is all too easy to find the cuts demanded by NHS efficiency savings in mental health.
"If a patient has heart failure or is in a coma, a bed has to be found. But for a person in mental distress, this is not seen to be as necessary.
"Being turned away when seeking help only reinforces patients' feelings of rejection and hopelessness and can in our experience drive them to suicide."