Meltdown: Mental Health Faces The Perfect Storm
Widespread shortages of specialist nurses and psychiatrists, chronic stress among social workers and failings of mental health charities is deepening the chasm between the government’s so-called ambition for the care of people with mental health needs and the reality of services they are receiving on the frontline. It’s a perfect storm that will end in more tragedy.
Mental health knows no boundaries of race or education; there was a prominent story in the Washington Post of a homeless man with schizophrenia who told a judge that he didn’t need a lawyer, that he was a lawyer. When the judge reacted with bemused skepticism, the man informed the judge — accurately — that they had been in the same class at Harvard Law School.
There was a time, many years ago, when I to would have reacted with a degree of bemused skepticism, but after a difficult, 20-year journey of serious mental illness with my talented brother, which, God forbid, could quite possible end in tragedy, I have a different attitude.
My brother has schizophrenia and experiences delusions, which involves believing, seeing or hearing things that aren’t there. His also experiences disorganised thinking in which he is unable to properly care for himself. This combined with various addictions and a life on benefits in a flat provided by a mental health charity that offers little in the way of caring or useful support, is a dangerous cocktail indeed.
Unless you have first hand experience of this awful vicious circle, it can be difficult to comprehend the tragic nature of mental illness, or the tragic failure of the ‘system’ to find ways to help reduce the pain and the costs, in money and heartache, that come with the care of people like my brother.
There are occasions, many of them actually, when I am certain he could do more to help himself. I, and my family, are frequently infuriated by his lack of responsibility, apparent selfishness, laziness and lack of effort to try and improve his situation. The bottom line, however, is that he is poorly, afflicted, cursed with the worst of conditions, which is not his fault.
The system, which is itself afflicted, has a habit of sticking the knife in. Taking his benefits away and forcing him to attend job seeker interviews when his mind is raging with all manner of confusing and destructive, crazy, dark and menacing thoughts.
I often wonder if his mind is a backdrop of shadows and fleeting memories and vague images, like some kind of Victorian shadow-light theatre, only played at speed, where puppets rush around, gabbling incoherent messages. “Are you looking for work?” Or just looking into a maelstrom?
There have been times of hope. Once, before the public sector recession, and before his mental health charity Rethink misplaced it’s priorities, my brother had a brilliant, caring support worker who used to take him on days out, chat with him, help him. Once he had a very good CPN (community psychiatric nurse), who went out of his way to shed light on the darkness that often threatened to absorb us all. Once he found a friend in a fellow sufferer, someone who opened the door to a life less lonely.
But the support worker was a victim of the first wave of cuts; the CPN burned out through work stress and the fellow sufferer who became a friend in need, disappeared, whisked away overnight to a facility for mentally ill patients. My brother was devastated, heartbroken. No one, from Rethink, or social services or the NHS, bothered to soften the blow, or even let him know. And then, if all of that was not enough, fresh hope in the shape of a caring, pragmatic and motivated support worker from Rethink, someone who had experienced mental illness themselves and had bags of empathy, was crushed.
My brother had misplaced £70, given to him by his mother, and, in his confusion, thought maybe he had given it to his support worker. He hadn’t, of course, but it was too late. Rethink found out and the mechanism of procedure swung into action — the same procedure that encourages, but not always upholds whistleblowing — quickly resulting in the support worker being forbidden from spending time alone with my brother. Any future support would need to be provided in the company of a colleague and, in the current climate of a chronic lack of staff, due to a high turnover, this was never going to happen.
I have a friend, a lawyer, coincidentally, who has a sister with schizophrenia, and has experienced similar problems arising from the broken machinery of public and third sector mental health support, the components of which often appear to be spinning independently of each other, occasionally clicking or clashing, but never working properly together, like cogs with missing teeth.
The one constant in all this unpredictable and unreliable mishmash of procedures, schemes and systems, is the police or the paramedics. One can always count on the local constabulary or ambulance crew to save the day, whether it is escorting a disoriented and distressed semi-naked woman, wearing only a pyjama top and wellies, from outside the local supermarket, where she was found slumped against a stack of trolleys sobbing like a child, or reassuring an equally distressed man who is under the very real delusion of imminent death from the final onslaught of some terminal illness. Both myself and my friend the lawyer have been in this situation many times — those phone calls spent giving the brief history of a loved ones mental health condition and then thanking the police officer or paramedic for being there, when no-one else was.
The truth is, if the police or paramedics get called to deal with someone with a mental health crisis, then there are a number of other agencies that have already failed. And the times when they don’t get called, or get their too late? Well, society is littered with such tragedies. This is the stark picture of mental health services struggling to keep up with a growing need for care.
The system needs help. The mental health outcomes of people continue to decline and the system supporting their emotional and physical wellbeing is more fragmented than ever before. People, like my bother and my friend the lawyer’s sister, are in more need, but less support is available from the organisations that play a vital role in providing information, advice and guidance.
There are so many problems that need to be addressed. Some involve a commitment of resources, such as the severe staff shortages that are limiting mental health trusts and community mental health teams ability to improve services. Problems recruiting and retaining enough mental health nurses and psychiatrists are getting worse with departments struggling to find sufficient staff to deliver their current services, let alone find new staff to extend, transform or innovate services.
The community mental health team responsible for administering intramuscular antipsychotic injections to my brother, at the time of writing, are trying to recruit more staff in India and China as it had a significant shortage of consultants.
This chronic HR issue, coupled with the inadequacy of some social workers that results in an inability to comprehend the enormous pressure being put on family carers, plus the ludicrous procedures and protocols decreed essential by social services, are all components of the perfect storm.
My brother is arguably, if not clearly, in need of 24-hour care for his own safety and that of others. Yet the decision as to his state of mind is taken not by the GP or a psycho-geriatrician, but by social workers with no medical training.
Too many social workers are entirely ill-equipped to do the job. I can only assume that these workers fell into the job because it is the least popular public service category. Sick leave among social workers is on the rise in midst of working conditions pressures, and the majority of current social workers are considering leaving the profession within the next 18 months due to the stress of too many demands on their time and from those effects of poor working conditions which impacts upon social workers well-being. With a sense of cruel irony, these people are being referred to, within the profession, as “SWs mental health.”
Those poor working environments include poor management, no support, high case loads and the naming and shaming of social workers subject to Health and Care Professions Council (HCPC) competency hearings and so on and so on. This problem also effects the recruitment and retention of skilled social workers, and it is as a direct result of being burnout and suffering ill health due to the treatment from their employers and poor working conditions.
This is part of a “system meltdown.” Not my words, but the words of the social worker who used to support my friend the lawyer’s mentally ill sister, before they went on long-term sick for anxiety and depression.
During one dark afternoon in November last year, filled with frantic, manic and mad phone calls between, my friend the lawyer, and her deranged sister — the two siblings separated by 100 miles of M1 motorway — the lawyer called the social worker’s mobile phone. “It’s Erika, she sounds very bad. I think she may be in danger,” the lawyer said.
The social worker suggested she phoned the police. “I’m off sick,” he said. “I can’t help, sorry. Have you tried Rethink?” The lawyer had, but it was 430pm and Rethink had gone for the day.
I hate to say this, but Rethink are of little use in these kind of regular crisis that we, as carers of mentally ill people, have to deal with. In fact, I do often wonder what Rethink actually do to help. They will say that they might help (mentally ill people) with things like benefits, budgeting, maintaining their tenancy, life skills such as learning to cook, or accessing care, local activities, education, training or advocacy. I think, probably, this does happen, at least in some cases, but in my own experience, and in the experience of at least half a dozen other carers of mentally ill people I have spoke with, Rethink appear to be more concerned about looking after the property their “tenants” inhabit than the actual people they are supposed to be caring for.
Like many mental health trusts and social services, Rethink also have a chronic lack of staff, due to a high turnover of support workers and management. “A significant number of staff are signed off for mental health problems,” a current Rethink employee told me. “Most people working in general support roles feel unprepared and unsupported.”
This is an organisation that spends money on sending whistleblowing cards to all new employees, but is unable to follow up all whistleblowing procedures due to lack of resources.
And so the cycle continues and the perfect storm builds up on so many fronts one can’t helping wondering when it will all come to a head and blow apart what flimsy protection currently exists for those struggling with mental health illness.
