Mental health services in crisis over staff shortages

Exclusive : Royal College of Psychiatrists warns society will be overwhelmed if ministers fail to fill gap Overcrowded and understaffed psychiatric wards are leaving patients fearful for their safety and unable to make proper recoveries, according to a damning assessment of Britain’s mental health service by its lead professional body. Professor Dinesh Bhugra, the outgoing president of the Royal College of Psychiatrists, told the Guardian that widespread failures in inpatient care for mentally ill people meant many hospital wards did not meet acceptable standards and discharged back into society sick people who remained a risk to themselves and others. Bhugra blamed the problem partly on a “dangerous vacuum” created because British doctors are not training as psychiatrists, while visa restrictions mean doctors from abroad can no longer fill the gap. “Society will be overwhelmed by the demand of those in need if government doesn’t act now,” he said in an interview. A survey by the royal college found that 544 consultants’ posts in the UK – 14% of the total – are either unfilled or filled by a locum. In addition, 209 consultants intend to retire or resign soon, a situation exacerbated by the government’s cap on immigration from outside the EU. “This is a huge, a massive problem,” said Bhugra. “We will be left with a dangerous vacuum of help for people with mental health disorders or will be forced to get special dispensation from the government to recruit heavily from countries who can ill afford to lose their mental health professionals.” His warnings are supported by a study to be published next week in which the royal college describes how about half of patients – mostly women – report feeling unsafe in many of worst-performing hospital trusts. The report also says: • Average bed occupancy rates in English inpatient units are much higher than the 85% standard, with some wards running at 120% occupancy. • Access to psychological therapies falls far short of acceptable standards recommended by the National Institute for Health and Clinical Excellence and other health bodies. • Daily one-to-one contact with nursing staff is less than that accepted as being conducive to recovery. • Outreach links into the community are insufficient in two-thirds of the wards inspected by the royal college’s centre for quality improvement. Bhugra said the failure of wards on the 85% bed occupancy rate was particularly troubling. The report reveals that more than half of all adult general wards run at more than 100% occupancy, with 16% meeting the required target. Just 21% of acute wards meet the 85% target. “Very high bed occupancy militates against quality and safety of inpatient care,” Bhugra said. “It is a main driver of inpatient care standards. [High bed occupancy] can result in patients becoming more distressed and unwell, and likely to need more longterm care. “Given the continued reduction in bed numbers and increased community care over the past decade, inpatient units have become places for crisis stabilisation and are likely to admit only those individuals who are the most disturbed, distressed or unwell. For such people especially, as they are unable to make the choice to leave, the ward is their home.” The report also reveals that wards are failing to provide separate sleeping and toilet facilities for men and women, despite gender-segregated accommodation having been government policy for a decade. Just 85% of wards have segregated sleeping accommodation and less than 60% have separate lounges. “This remains an intractable problem,” said Bhugra. Several dozen psychiatric patients take their own lives while in NHS care every year. Mental health charities such as Rethink claim this shows that care needs to be improved and staffing levels boosted. Rethink spokeswoman Rachel Whitehead said: “Psychiatric wards are not a therapeutic environment. Many people tell us they don’t feel safe there and they are not getting access to the support and therapy they need. Supervision is also a problem, largely due to overstretched staff and wards which are over their occupancy levels.” Another research paper by the college, to be published next month, shows that the number of medical graduates who accepted an offer of psychiatry training posts in England and Wales fell from 184 in 2009 to 158 in 2010. Bhugra said “dangerously few” doctors train as psychiatrists because the specialism suffers from a poor reputation compared with other medical disciplines. “It is wrongly seen as less scientific,” he said. Professor Peter Jones, head of the neuroscience department at Cambridge University, admitted the lack of psychiatry applications was a “terrible state of affairs”. He said the formation of specialist mental health trusts had made psychiatry “seem more remote from mainstream medicine”. He also said stigma “is a huge problem for people with mental health disorders and trickles into professional lives.” Wards are also failing to provide structured therapeutic activities, the royal college report finds, with 35% of patients complaining of too little to do during weekdays, rising to 54% in the evenings and at weekends. Bhugra said: “The value [of this] cannot be overestimated. A lack of regular activities can lead to boredom, frustration and inactivity, which not only impede recovery but also can instigate unsafe, violent and erratic behaviour. Inpatients may be experiencing paranoia, be easily over-stimulated and sometimes frightened and disorientated.” Bhugra criticised wards for falling short in standards of security, risk management, violence prevention and management, medicines and confidentiality. The report highlights evidence revealing that in the worst-performing 20% of trusts, only 50-60% of patients said they felt safe. Overall, less than 45% said they “always” felt safe. “The Care Quality Commission has found that unnecessary and excessive restrictions, and security measures are sometimes imposed on detained patients,” said Bhugra. “Undue restrictions on a patient’s autonomy compromise their personal dignity and rights as an individual. Such excessive restrictions are upsetting for the patient and can delay recovery. “Safety and risk policies are in place to aid patient recovery. Unnecessary bureaucracy and rules can not only hamper a patient’s recovery but possibly exacerbate their mental illness. Whether a person is detained or voluntarily admitted to hospital, general ethical standards that are adhered to in the community should, wherever possible, apply on the ward.” The report found just 52% of patients claimed to have “supportive”, one-to-one meetings with staff for at least 15 minutes every day. In 20% of the worst-performing trusts, as few as 50% of patients felt they were given enough time with a psychiatrist and even fewer said they were given enough time with a nurse. Bhugra said every patient should have a one-to-one session with a relevant staff member once a day. Bhugra also admitted deep worries about the drop in British medical graduates going on to train as psychiatrists. He said that government’s cap on immigration from outside the European Union will make the problem much worse. The Royal College’s survey reported that 544 consultants posts in the UK are either unfilled or filled by a locum: 14% of all posts. In addtion, there are 209 consultants who intend to retire or resign in a short time. “This is a huge, a massive problem,” he said. “We will be left with a dangerous vacuum of help for people with mental health disorders or will be forced to get special dispensation from the government to recruit heavily from countries who can ill-affod to lose their mental health professionals.” A Department of Health spokesperson said: “Mental health is a cross-government priority. We published No Health Without Mental Health, our cross-government mental health outcomes strategy, to drive up standards in services and improve the nation’s mental health. The strategy makes clear that mental health services should be just as important as physical health services such as those for cancer and heart disease. “We have supported the Royal Colleges of GPs and Psychiatrists to develop advice and support for commissioning consortia to commission effective mental health services. The strategy emphasises the importance of improving quality and productivity across the system, while making efficiency savings that can be reinvested in the service to deliver quality improvements. “In addition, we will invest around £400m over four years in psychological therapies for those who need them in all parts of England, expanding provision for the entire population.” Mental health Health NHS Health policy Public services policy Amelia Hill guardian.co.uk

Posted by on June 20, 2011. Filed under News, Politics, World News. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.