Where to go for help?

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.

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13 responses to “Where to go for help?

  1. Absolutely spot on OMM! Damn right we ought to be angrier and do more to hold the shambles of the coalition gov to account. The majority of long term psychiatric service users are not in a position to campaign for better services and most of the rest of us turn a blind eye. Thank you for raising these issues so articulately here x

    • It isn’t just this Coalition Govt who have done this – the drive for competition and an internal market was ferociously pursued by the Labour Govt too. Not that that excuses what is going on now with the further privatisation by stealth of services or us for not doing more about it.

      • Couldn’t agree more Fiona. The political consensus that competition and a market is good for healthcare has been hugely damaging and the current government are doing no more than walking through the door opened by the previous one. What we need is co-operation and accountability and resources spent on delivering rather than the transactional costs of contracting and commissioning. I also genuinely fear a GP led service which will undoubtedly see marginalised services overlooked and starved of resources.

  2. When each of those services decides someone it well enough without support, even if like the woman in the news, view are asking for help… If you haven’t fallen apart enough then you can’t get that support… Stop holding yourself and your world together, fail university, let people down, do just what you fight against everyday and curl up in the corner in tears… Because right now you’re too well functioning despite wanting to die, until you’ve nothing left, your world totally falls apart, then we might be able to talk to you about support…no guarantee we’ll do much then either!
    Really sorry, shouldn’t vent my frustrations here. Sometimes I just wonder what I’m going to have to do to fight the darkness or even if I want to anymore. Hugs xx

  3. This is an absolutely brilliant clear and concise explanation of something I have been trying to explain for years now. Thank you, dear one.

    This is not a failing of any one government but a successive “sticking an elastoplast on a fracture” that has been going on for far too long. Decentralisation gone mad.

    Gah!

  4. Thank you OMM for clearly and concisely sharing the reality of how the NHS works. I read this and am so sad for what is happening there in the UK and it scares me about where we might be headed here in the USA.

    Indeed we do all need to be speaking up, often and everywhere. Thank you!
    Becky Henry
    Hope Network, LLC

    • Hi Becky – the problems started in the NHS when we moved away from centralisation and direct public accountability (or state control as some call it!) The notion that there needed to be a market in healthcare is the problem, but the security of knowing it is a free service, with no fears about whether insurance companies will pay out, is brilliant and something I would defend to the bitter end. The old style centralised NHS had a single health authority responsible for provision and all services, which was hugely easier to understand. When a healthcare system is designed for the needs of business, rather than the needs of the people, it is a disaster. As a family, we have had amazing NHS support, through three children, where we had home midwife care, health visitor support, including home based care for post natal depression.

      I am a huge fan of the NHS – and thought America movng to a baseline level of care for everyone was a good thing – but the successive tinkering of governments, who are in thrall to private healthcare companies, has produced a marketised system that is hugely complex

  5. OMM

    Thank you for setting the record straight with Becky. That is what I wanted to say but you are better at it than I.

    Becky, under successive governments most of our nationalised systems have been privatised, with varying degrees of success. Other nationalised industries have been closed down altogether.

    Sadly, the NHS is no longer what it purports to be i.e. a “nationalised” health system but is more of a free market system, without the safeguards or structure that is needed to make such a system work successfully.

    Some areas are unequalled – my cancer care, the birth and development of the children, emergency care (not psychiatric). Some areas are horrific – understaffing, overmanagement of hospitals being one area and psychiatric care another.

    It is not a perfect system but, like OMM, I would defend it to the hilt – I have never seen a credible alternative.

    • Thank you so much ladies for the clarification. So do I understand correctly that it is the centralised system that you find so workable and the complex system that intermingles with privatized systems that is not workable?

      If this is the case then I hope USA lawmakers and designers of our new system will take heed.
      Thanks much,
      Becky Henry

  6. I’ve lived in the uk and USA and I find the two incomparable. In England you never pay a penny out of pocket for all care which a doctor deems necessary. Apart from prescriptions which are roughly $12. And if you can’t afford it then they’re free. My friend in this country has excellent insurance however still has to pay just to visit the doctor and any kind of procedure even though its reduced. Areas of the country also differ. My eating disorder care, when I got it, was excellent. Everything is more complicated in America. Want to visit a doctor? Literally phone, walk in the next day and walk out, no money, no signatures, no requirements, no conditions. Also it’s nice for young people to be independent from their parents which seems much harder in the USA when you might be on your parents health insurance until you’re 25.

  7. My parents weren’t on the ball, they didn’t want me to get treatment until very late and even then were extremely resistant. If they’d have had to pay for my treatment then it would have been out of the question and I quite likely would have died.

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