It has been quite the week of highs and lows for mental health. The undoubted high was the second annual Time to Talk day run by anti-stigma campaign Time to Change on 5th February. People were encouraged to take 5 minutes to talk about mental health over a cuppa, make a quick call or send a text message. As I write this blog over 21 days’ worth of 5 minute conversations have been logged. #timetotalk trended throughout the day and the day culminated in Deputy Prime Minister Nick Clegg handing awards to 9 Mental Health Heroes, from a nomination list of 900. Radio talk shows, newspapers and websites were buzzing with positive mental health stories. It felt like progress was really being made in the fight against stigma and discrimination.
However there were also a number of significant lows this week. First, figures published by Norman Lamb MP showed that over 400 people were being sent more than 30 miles away for inpatient mental health treatment. The Care Quality Commission (CQC) then published a damning report into the use of the Mental Health Act in 2013/14, which has increased by 30% in the past decade. And the Home Affairs Select Committee published their inquiry into policing and mental health. The report highlighted many of the issues that have been covered in previous editions of this blog – local variation in responses, problems with transportation, challenges of local partnership between police and other health services and a lack of effective data about what is actually happening to people in crisis in contact with the police.
For me, these are all indicative of a complex range of issues facing the mental health system. These include stigma, funding, legislation, commissioning and, crucially, human rights. The Mental Health Act Code of Practice talks about the principle of treating people in the ‘least restrictive’ setting, but it is clear that this is not happening in many cases. Police involvement in mental health crisis situations is just one example. In the Home Affairs Select Committee report, Mike Penning MP, Minister of State at both MoJ and the Home Office states:
If you have a mental health issue, you will invariably come into contact with the police, as the professional involved…It is not the job of the police to be that first point of contact, they should be the last resort (page 8)
Although the Minister is challenging this status quo, there is an inevitability to this scenario that is widely accepted. The report highlights that two thirds of people detained by police under s136 of the Mental Health Act are already known to mental health services. This makes the situation even more indefensible – if people are in contact with mental health services, there should be other systems in place to support them in a crisis. The fact that police are too often called to these scenarios shows the huge gaps in provision of mental health crisis care – an issue that needs to be acted on, and fast, by NHS commissioners. The Crisis Care Concordat is a hugely positive step in the right direction, but local areas need to see this is a priority in the coming months.
The CQC report paints an even bleaker picture. An 8% decrease in inpatient beds means that professionals are under pressure to detain people under the Mental Health Act in order to get them bed. This is a horrendous situation, not just for people needing a bed, but also for professionals put in this position. It flies in the face of a commitment to the ‘least restrictive’ setting and puts people under legal restrictions just to receive treatment. Where people are detained, over 20% don’t have their legal rights explained to them. Access to independent advocacy continues to be a concern for the CQC.
This is not to knock the positive work being undertaken by street triage pilots and liaison and diversion schemes. Within mental health services there are a large number of professionals committed to promoting recovery and autonomy for people using services. But this issue of people’s rights is not getting anywhere near the attention it deserves. It continues to get overshadowed by conversations about risk and funding pressures. The whole system needs to be rebalanced so that people’s rights are at the very centre of how we are measuring and improving care, not sitting at the periphery. This is surely one of the biggest forms of stigma we need to challenge.