The media is full of reports about the case of the mentally ill patient who begged for help, but was ignored and went on to kill. Commentators line up to warn that this must not happen again and to castigate those in authority who did nothing. And indeed the accounts of the efforts the woman went to in order to get help are pretty harrowing. But, where do those who are in need of psychiatric emergency care go?
The emergency services present as a united service via 999, but in reality are three separate services – an ambulance trust, a fire service and a police force. Go to Accident and Emergency and you are in the hands of another organisation, the acute trust. Acute generally means medical or surgical, ie a physical disease or an operation on a part of your body, because psychiatric services will generally be part of the partnership trust. Or will they? Because in an NHS in which different organisations ‘bid’ for business, it may be that different contracts are awarded to competing hospitals. In our area, our local health centre is run by a social enterprise, A&E by the university hospital trust, CAMHS and L’s adolescent unit are run by a neighbouring trust and adult service are run by the partnership trust. All of these organisations are in competition with each other, all of them have differing geographical boundaries and none of them have any power whatsoever to decide what services they offer or how much to spend because these decisions are taken by primary care trust, that will disband at the end of the month and hand over that role to a new commissioning body run by GPs. None of this takes into account the prospect of private companies lobbying hard to be given the chance to bid for services, in order to make money and take a share of the NHS budget. Nor does it include the role of social care, which for those with mental health or a learning disability plays a vital role, yet is another body to navigate, with different boundaries and different rules.
The fragmented nature of our NHS means patients can lie on ambulance stretchers for ages waiting for A&E to accept them, when the waiting time clock will then start ticking. Ambulances sit idle as these two organisations tussle over targets. It explains how parents can sob on the phone to social services begging for help, when the power to refer to CAMHS rests with the NHS, not social care. And in this confusing maze, where on earth is a person in psychiatric distress supposed to turn? Arriving at A&E with a broken limb is straightforward, an X-ray will diagnose and treatment starts. But what about a broken mind or spirit. How does that show up on an ultrasound and what if the person is in such a distressed state that they lack the cognitive capacity to explain? And in a system which has been progressively dismantled by successive Governments on the failed premise that competition breeds success, and buying and selling care is imperative, how the hell is even the most rational, educated person supposed to work out where to go to even ask a question, still less, find acute emergency psychiatric help, for themselves. How do parents or carers find help for their loved ones in a system where the decisions about what services to provide are kept explicitly apart from those who provide the services? It is one thing to ask for a service to improve, but what if it doesn’t even exist in the first place – those who can afford it will be driven to pay themselves, while those who can’t will be driven to despair. Meanwhile, those with psychiatric illnesses wander our streets, being shunned by those who consider themselves normal, scurrying away from their disordered behaviour or mocking “the nutter on the bus”. Where are they to go? Turned away from A&E, moved on and warned by the Police, banned from their MPs offices after repeated visits and left alone by all of us.
In the coming months there will be reports and inquiries and no doubt those lower down the chain will face consequences. But really, we are all to blame. For not being angrier, for not demanding change and not being more ashamed that in a civilised world the people who need help most have nowhere to turn.