Mental Health Matters: Uncomfortable truths

Frustration and anger were (quite rightly) the public response to yesterday’s report from the Children’s Commissioner, which revealed hundreds of children with learning disabilities are stranded in mental health wards.

But the Care Quality Commission’s interim report into the use of segregation, published today, will likely elicit even worse public outrage.

The opening story of 11-year-old Adam – locked in a padded room, not taught how to use the toilet, and left “naked sitting under a blanket” for much of his time – will leave readers horrified.

Patients like Adam with the most complex needs, the report says, are “stuck” in segregation and have been failed by the current system of care.

The safety regulator has now recommended an independent review be carried out into the care and discharge plan for every child or young person who is being held in segregation.

Health and social care secretary Matt Hancock has acquiesced, and also promised to convene an expert group to develop a new model of care.

This is a step forward and will hopefully provide an important insight into how the treatment of these patients can be improved.

However, development of a new care model is a less thrilling proposal, considering this was supposed to have happened by now under the failed Transforming Care programme.

Will the review enable the discharge of patients like Adam into community settings or prevent them being admitted in the first place?

As the CQC put it: “People will continue to be hospitalised and placed in segregation, and become ‘stuck’, unless a different and better system of care is put in place.”

A blinkered approach

Several mental health trust executives tell HSJ the political focus of Transforming Care, on closing inpatient wards, has been “blinkered”.

They argue the singular focus from government and national NHS leadership on reducing inpatient beds has ignored the uncomfortable truth that some patients do need admission.

The controversy around Calderstones Hospital – a large inpatient facility which NHS England has said must close – is a prime example.

In March HSJ revealed Mersey Care Foundation Trust, the trust now running Calderstones, was struggling to access funding to provide replacement facilities for those patients who cannot be discharged

But its proposals to retain Calderstones as a “multipurpose community site” drew silence from NHS England, leaving lots of uncertainty for patients and staff. NHS England did much to toxify the image of Calderstones, and despite its services now being rated “outstanding”, remains stubbornly committed to closing it.

Also, by refusing to acknowledge the need, sometimes, for inpatient provision, have we neglected the need to improve these environments and the training of those staffing them?

The focus on reducing beds has also so far neglected the fact that the needs of these patients cannot currently be met within the community or at home.

As one medical director said, even if the money and processes were in place to discharge patients, there is currently no provider market to support them.

This is not to suggest national focus on reducing the number of patients within inpatient beds was incorrect. However, equal impetus should have been given to improving the quality of inpatient wards and the treatment within them.

Had this been a focus from the beginning, we would perhaps be in a situation where, if people are unnecessarily admitted, they are not subject to horrific experiences.

Quality placements

The reports from the CQC and Children’s Commissioner have shone a very welcome light on the quality within inpatient environments for children with learning disabilities and autism.

But the quality of those services into which these children will need to be discharged into is also a major concern.

Last year, HSJ revealed more than half of local clinical commissioning groups had failed to provide a crisis support service for children and young people with learning disabilities. Around a third did not provide the required community support service.

Meanwhile, simple questions to CCGs over the number of patients who had been referred to the community services suggested a worrying lack of oversight and scrutiny.

“The CCG does not hold this information, please request this from the service provider”, was a common response.

If knowledge of even simple details about the community services they commission is lacking, can there really be confidence in the oversight of the quality and safety of patients treated by them? 

Mental Health Matters is written by HSJ’s mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.