I've just watched the Panorama programme, ‘locked up for being ill’. It exposed the problem of mentally ill people being picked up by police and locked in cells as the only solution to their mental health crisis available!
Whilst I think it is absolutely shocking, I am not surprised. Our (Brookdale) service users experience a mental health crisis from time to time and it is not unusual for the community mental health team to say, “We can’t come out and assess as we don’t have a bed available to admit him.” So, that’s ok we will ask him to hold his mental health crisis off until you have a suitable bed then! Our service users live in our fully staffed services with people around to support them 24 hours a day, so, although not acceptable, they are relatively safe if they can’t immediately be detained under a Section of the Mental Health Act. However, if they were living independently or semi independently they would very likely be arrested and locked up for some public misdemeanour.
People with mental health problems and learning disabilities have always been discriminated against. Whether it be labelling them as the village idiot or banging them up in huge institutions. Well, let’s all pat ourselves on the back that it’s all changed now and we live in a more equal, caring and less patronising society. But that’s just it, this is what we tell ourselves, but this just isn’t true! Discrimination, victimisation and neglect of the vulnerable is real, and happens every day. Mental illness; the clue is in the name, it is an illness. People cannot help having it any more than you can stop yourself getting cancer!
In terms of discrimination, think of it this way, your partner experiences sudden chest pain, you call an ambulance, to be told “sorry we don’t have bed on our cardiac unit at the moment, he can either stay at home or wander the street until one becomes available, or, we can send the police to restrain him and lock him in a cell for 48 hours”. Sounds completely ridiculous eh? Well they are both acute illnesses that can lead to death, so what is the difference? In fact, the heart attack will only kill the person experiencing it; the mental health crisis could result in the death of the individual or innocent third parties!
Interestingly, if someone dies of a heart attack due to inadequate medical attention there would be a major negligence enquiry and possibly even compensation for the family. If a depressed person commits suicide due to inadequate help and support, it is much more likely to be nothing other than a suicide stat! If a mentally ill homeless person dies of hyperthermia on a park bench it’s just an unfortunate death! However, would they have died if they were being properly cared for?
We closed Victorian institutions and rightly so, we replaced them in the 80’s with ‘care in the community’ this offered a range of care choices, from smaller mental health and learning disability hospitals, small residential care and nursing homes, staffed hostels and community outreach teams. It kind of worked as there was a mixed economy of care and people could move from one to the other depending on their mental health rehabilitation.
The current decade has seen a move towards placing and keeping people in their own houses or flats with so called bespoke support packages which are so often poorly resourced, inconsistent and unreliable. Public Sector funding cuts are driving this change under a cloak of “best practice”. This shift in ethos towards independent living for all is a classic example of the values and choice of the majority, being right for everyone. Most of us live in our own homes alone, or with our family and are valued members of society, so that must be right for everyone! But what about those who are not and never will become valued members of society and constantly face persecution and discrimination? Your very own tenancy agreement, the terms of which you don’t really understand and fail to live by, your own payments/benefits/income which you can’t seem to spend appropriately, hostile neighbours because you are not obeying social rules and etiquette, no job because you can’t get or keep one, GP appointments you forget to attend, medication you run out of and don’t replenish and possibly, to put the icing on this great independent living cake, you might just get a gang of kids calling you a nut job and putting doggie do do through your letter box! This is not an exaggeration, it happens. We have admitted people to our services that have spent many years in this situation.
It is an inconvenient truth that there are a small population of people with chronic mental health needs or learning disabilities, who actually want and need to live in a care setting with other people, and staff on hand to support them and give them confidence and some degree of life quality.
Anyway, back to the police locking ill people up, it isn’t the fault of the police. In fact, it puts the police in a very vulnerable and unacceptable position. Equally it’s not the fault of the mental health teams who are struggling to cope with the demands of care in the community which seems to be fast becoming neglect in the community.
If someone has chronic mental health needs they should be properly supported. They shouldn’t be in homeless hostels, sleeping under railway arches or in police cells. If they have acute mental health crisis they must be cared for by suitably trained and qualified staff immediately, with the same urgency as a man having a heart attack.
Ask yourself a question, if you were depressed and homeless with no family or friends, sleeping in snow with only cardboard to keep you warm, and someone offered you a place in a Victorian institution with 3 meals a day, central heating, laundry and catering services, the company of others, a warm clean soft bed with people looking out for you, no financial worries or pressures and good healthcare on hand at all times, what would you choose? Have we really got it right? I think the Panorama program goes some way to answering that question!
Of course I am not suggesting a rebirth of large institutions or workhouses, but we need to get our heads out of the sand and find a common sense solution, not based on idealism but on reality!
The Panorama programme of 2011 exposed shocking, abuse at the Winterbourne View Hospital which was privately owned and operated. Quite rightly this filming had very far reaching consequences and commanded significant government interest and investment. Will this equally shaming exposure of public service neglect become the focus of rapid improvement action? Watch this space!
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