The NHS constitution tells us that care should be available to all based on clinical need. But watching the budget is now the primary concern. Patient care will be sacrificed. NHS services, particularly mental health services, are being viewed as though they are a privilege and not a right.
South London mental health worker
In Southwark, south London, two specialist community services – dual diagnosis (service for substance misuse) and assertive outreach service (for clients who are particularly vulnerable and cannot articulate their needs) have already been closed down.
And with very little advance notice the staff and their patients have been speedily dispatched to other teams.
Support services for the carers and families of the mentally ill in Southwark are also being centralised and cut to the bare minimum.
Families will find that they are having to face very challenging situations alone and unsupported. If community mental health teams are not completely deleted they will be centralised and merged. This will lead directly to frontline medical and nursing posts being permanently lost. Existing staff will have a much larger workload and this will further limit the time they have available to support each patient.
Frontline clinical staff (doctors, occupational therapists, nurses) already find that too much of their time is tied up with form-filling and dealing with ‘over bureaucracy’.
Specialist services, such as occupational therapy, vocational officers, community engagement officers, are also at risk of being axed.
Cuts to funding mean patients will find it even harder to get the support they need from the overstretched community mental health teams.
This will lead to increased stress for the patient and the possibility of more frequent relapses and hospital admissions.
Community mental health teams will end up ‘fire fighting’ and dealing with mental health emergencies.
People with mental health problems will become trapped within the in-patient mental health system as the community options become eroded and many will become ‘revolving door’ patients.
The repeated admission of a patient, apart from being extremely costly, is demoralising for the patient and the in-patient staff who will end up feeling that their efforts make no positive difference to the patient or his/her life.
As mental health services get cut to ribbons, the patient will end up merely being contained, with little else on offer, while they get over the acute stage of their condition.
Ward teams will feel far less confident to take a ‘therapeutic risk’ and discharge their patients in a timely fashion if there is evidence that the patient will not be well supported in the community by well-trained and well-resourced community teams offering a range of specialist services.
Cutting mental health services and community services in particular is a retrograde step for psychiatry.
It is in everyone’s interest that people with mental health problems (one in four of us according to statistics) are adequately supported, preferably within their home environments and integrated into the wider community.
If people shouldering the burden of severe and enduring mental illness, are left isolated and unsupported by mental health services their risk to themselves and others will escalate.
The mainstream media will latch onto and publicise any violent act committed by someone who has mental health problems.
What should be known and acknowledged is that there are many people with diagnoses of schizophrenia and bipolar affective disorder etc who are leading full, happy lives within their communities but who are also receiving consistent, high quality support from community mental health teams.
Lack of financial investment in community mental health services is a false economy and this will only lead to other more personally devastating costs being borne by the patient, their carers and the wider community.
