Imagine something terrible happens to you, like you get hit by a car. You're bleeding, disorientated, confused. Maybe you need major surgery. You get rushed to A&E, operated on, you get looked after.
Imagine, then, that you are a teenager with severe mental health problems. You try to kill yourself. The police pick you up, you get taken to hospital. But there is no bed for you. They're all full. Because the government says there isn't enough money for any more.
Mental health problems account for 23 percent of ill health in the UK, but spending on mental health services accounts for only 11 percent of the NHS budget. It's because of this disparity that 200 or so famous names – including Danny Boyle, Louis Theroux and Ade Adepitan – have signed an open letter calling for equality in the way mental and physical health is treated and funded in the UK.
Despite the number of patients being referred to community mental health teams rising by 20 percent from 2010 to 2015, mental health trusts in England saw their budgets fall by more than 8 percent over the same time.
Doctors have responded with an unprecedented attack on the government. The outgoing president of the Royal College of Psychiatrists called the current state of mental health services a "car crash", while other doctors have warned that these cuts to mental health services are leading to preventable deaths and suicides. Take that – as well as the proposed new contracts that would monumentally fuck over younger doctors – and it's not hard to see why medical professionals are becoming more politically outspoken than ever.
So what is life currently like for doctors on the frontline of NHS mental health services? I spoke to psychiatrist David McLaughlan at Bethlem Royal Hospital in London to find out. Below are his thoughts, edited for length and clarity.
I see things on a daily basis that would never happen on wards where people were being treated for physical health conditions. I was working on a night shift recently and we had a 14-year-old boy who had tried to kill himself by jumping onto a train track. The police had found him, pulled him off and brought him into us. He's had a tough life. He'd been in foster care since he was a baby; it was likely he'd been abused. He was a very vulnerable child who couldn't see any other way out.
When he got to us he was put in what we call a 136 suite, which is a bare, white and windowless room with no door handles, sharp corners or ligature points. We use it for adults temporarily waiting to be assessed by a psychiatrist. It's not suitable for adults for long periods of time, let alone frightened children. But this boy ended up stuck there, in isolation, for 48 hours, because there was not one single adolescent bed in the entire country. That is how we are treating frightened and vulnerable children with mental health problems. Can you imagine treating a child with an asthma attack like that?
Every time I'm on call there's always someone in a desperate situation who has been waiting in A&E for at least eight hours. It's just cruel.
It's not uncommon for us to send people around the country because of the beds crisis – and it is a crisis. A few weeks ago, a young woman came in who had attempted to kill herself. She was at high risk of causing more harm to herself. The only available bed for her was in Liverpool, 200 miles away from her friends, family and support network. One of the most frustrating things for us is that when you have to send patients that far away, that obviously influences their decision about whether they're willing to go to hospital or not. This woman was very worried, anxious and scared. She was having hallucinations, hearing voices. She was willing to be treated in a local hospital, but when she found out the nearest bed for her was so far away, she refused to go. So we were then forced to use the Mental Health Act to detain her. We're having to do this more and more because of the bed crisis, which is appalling. It's just not acceptable.
The psychiatric intensive care unit in our hospital was closed a few years ago. We are cutting beds – because the NHS is supposed to be saving £22 billion – but the clinical need for them is not disappearing. Every time I'm on call in south London – in Lewisham, Southwark, Croydon – there is always someone in a desperate situation who has been waiting in A&E for at least eight hours, because there are no beds. It's just cruel. If that was someone who'd come in having a heart attack, they wouldn't be sitting in a trolley with no idea where they're going. And then we're shoving them in a taxi up to Liverpool at 5AM. Often, because we're not willing to discharge seriously unwell people, we are forced to admit people to private beds. So we are essentially cutting public beds to give to the private sector.
The government can smile to the newspapers and say they are ring-fencing funding for the NHS, but they've just taken it away from social care and housing. If you're someone already living in poverty – relying on food banks, and now your tax credits are being cut – for someone already vulnerable to mental illness, this is the kind of stress that will tip you over the edge. And it's putting huge pressure on mental health services. A few months ago, I treated a young man with bipolar disorder. He'd been sleeping in train toilets and had been admitted to A&E with bilateral pneumonia. He was well enough to go home, but where was I supposed to discharge him to? Back on the streets? Sometimes we have people who are well enough to leave stuck on the ward for months. It costs the NHS £600 a night to keep someone on the ward overnight; it would actually be cheaper to put them all up in the Ritz.
This new campaign with the celebrity signatories is making the economic case for mental health services. And there are others, like a recent report published by LSE that says for every £1 you spend on maternal mental health, the overall cost to the state in terms of education, social services and the lower likelihood of a child ending up in prison, for example, is £10. But as doctors, the fact that we are having to break down the value of somebody's life into pounds is outrageous. But that's the only way we can translate this to the politicians.
Historically, doctors like me would have been really nervous talking about these things. We like to follow hierarchy, we respect our seniors and we are quite stoic – we do our best and work hard. But I think we are so under-resourced that doctors are having to become politicised. In the past, I would never have criticised my hospital and my consultants and my trust. But I'm not criticising any of those people – I'm criticising our lack of resources. And that comes straight from the government.
Mental health has always been underfunded, but the situation is now desperate. We have to speak up for our patients because many of them can't speak for themselves. It's not like they're – for example – part of a society for arthritis sufferers who can send beautifully written letters to their MPs like people with physical health problems often do. Our patients don't have power or influence. And they are the ones being ignored.
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