Written: January 29, 2020
One of our clients recently described how she had got down on her knees and begged for mental health crisis care, because she feared that she was going to end her life. It is a reflection of how hard it can be to access crisis care now.
In recent months, we have become a replacement crisis team for people who are under psychiatric services – because they cannot get the emergency mental health help they need.
Our Suicide Crisis Centre was originally set up for people who are “off the radar” of services: people who would not seek help from their doctor or mental health service, or people who had disengaged from services.
However, almost all of our current clients are under a psychiatric team for long-term mental health care in the community. When they are in crisis, they are coming to our Suicide Crisis Centre, though. This is despite the NHS providing mental health crisis teams and admission to psychiatric hospital, when necessary.
They tell us that the mental health crisis team will not take them onto their caseload. The crisis team tells them that they can phone the team when they want to. However, they are not providing the ongoing crisis care, which would usually include daily face to face support. This intensive support and ongoing connection with a team is so important. So we are providing it for them instead. But this means that we can no longer provide a service for people “off the radar” – the people who never contact their doctor or other NHS service – because we are so full.
My impression is that the mental health crisis teams are unable to meet the demand for their services and so the bar for accessing their care becomes ever higher.
The shortages in psychiatric hospitals are just as severe. Last weekend one of our clients under psychiatric services was desperately trying to access a bed. His community mental health team told him there were no beds available in the whole country. Psychiatric hospital admission can be life-saving. It may be the only way to ensure a person’s safety, when they are at high risk of suicide. It is patently wrong when so many people are, in effect, being denied the right to life – a basic human right.
I am alive today because I was admitted to psychiatric hospital and sectioned in 2016. But the lack of resources means that, for most of us, psychiatric hospital is a place of containment, rather than a place to be treated. Families are often shocked that their loved one describes being in their bedroom all day, with nothing to do. That was the reality when I was there, too. In a two-week period, the only treatment I received was a couple of one-hour sessions in the art therapy department, where I coloured in pictures. It was therapeutic, but it was not a form of treatment to help me recover. There was no access to psychologists or psychological therapy. We are told by staff and managers that there is no psychological input or therapy provided in our local psychiatric hospital. This is a significant omission because it can be so hard to access it in the community.
Wards appear under-staffed. That was certainly my impression, when I was a patient. It was why I was able to walk off the ward, and out of the psychiatric hospital, despite being sectioned. There were no staff around to watch the ward exit doors. I spent twelve hours out of the hospital, despite being vulnerable and unwell.
The shortage of staff means that when patients need to talk to someone, there may be no one available. This is why patients in psychiatric hospital are contacting us while they are in there – because they cannot find available staff to provide the care and support that they are seeking.
In the community, the waiting lists for psychological therapy grow ever longer. It used to be the case that the long waiting times were for complex psychological therapies. Now, though, we regularly see clients waiting up to six months for “Improving Access To Psychological Therapy”. This was intended to be a service which people could access quickly, to provide evidence-based treatment (such as Cognitive Behavioural Therapy) for depression or post-traumatic stress disorder.
People deteriorate while on these long waiting lists, and many experience mental health crisis. Some attempt suicide, as I did, having given up hope of ever getting the therapy I needed for post-traumatic symptoms. We know, from our research into deaths by suicide, that too many people end their lives while on these waiting lists.
We have a separate Trauma Centre which was set up precisely because of these long waiting lists for psychological therapies, but our Trauma Centre is full, too.
I see headlines and comments referring to a “broken” mental health service. I would be reluctant to use that phrase because there is so much evidence of excellent, life-saving work being carried out by psychiatric teams in the NHS. It is a national crisis situation, though. Where is the national response to really address it?
Joy Hibbins is the founder and CEO of Suicide Crisis, a registered charity which runs a Suicide Crisis Centre and a Trauma Centre: www.suicidecrisis.co.uk