Panorama - Monday 9th September - Care in the Community ?
Over the 15 year during which time our Mental Health Services have been methodically depleted, I have written many times about the inevitable failure of NHS Wales to fulfil their promise to provide 'bed-equivalent' Care in the Community. As seen by anyone with any interest in mental health, hospitals have been closed along with other smaller, dedicated mental health service units in rural areas. The loss of so many mental health beds - along with 'early discharge' policy has increased distress in patients and their families that has not been addressed at all.
The result of all this centralisation and rationalisation of our mental health services has - as predicted - meant that our police services have ended up as the backstop for increasing numbers of mentally ill patients being taken into police custody - many being physically manhandled and bullied into submission, instead of being psychiatrically assessed for the proper care that they need to resume their normal lives in our communities.
The horror of the systemic failure of our NHS to provide this much needed care was shown in video camera footage that showed many mentally ill people being physically manhandled into cells that were built for the common criminal. In the vast majority of cases once the cell door had been slammed, that was the end of any hope of treatment for these seriously ill patients. Most of these were acutely mentally ill with a long history of being given care that enables them to live without fear of being harmed, with their families. Instead, Schizophrenic and Bi-Polar patients were seen going out of control for the simple want of their prescribed medication.
Many of these were seen to be punching the walls with their fists or banging their heads repeatedly against the door and walls, causing inevitable damage to their bodies as well as their minds. The police were not immune to this suffering - they simply were faced with a problem that they have never been trained to confront. Some officers sat with crying, suicidal patients, listening to their experiences in a calm, safe manner. Other patients were seen trying to use their clothing around any ligature point, in order to strangle themselves to death. As soon as these scenes were noticed, officers piled into the cell to physically subdue the patients in order to forcibly remove any potential ligature. The scenes could have come from horror movies, for that was the effect on the viewer.
Under the normal procedure laid down for the police in such circumstances, they detained the patient under Section 136 of the Mental Health Act. This meant that they were taken directly to a mental health unit where they would be subject to forensic examination or assessment by the duty psychiatrist. They would then be given a bed where treatment with the appropriate medication could commence. Unfortunately the police have had patients refused examination because of the serious shortage of beds ( as a result of planned closures in order to save money ). They are then arrested and confined to the custody suite along with regular villains
The procedure laid down for dealing with such obviously mentally disturbed people is that they MUST be assessed by a mental health professional within 3 hours of them being detained. Sadly, this rarely happens as calls to hospitals and Community Mental Health Units can go unanswered for days and the wait for a bed could be two weeks or more. Consequently, the police and the patients are let down by a system meant to facilitate care before any injury or self-harm can occur.
Sadly, care is rarely timely and the already over-worked police end up with becoming the community backstop for the acutely mentally ill. That this is iniquitous is obvious and the blame lays squarely on the government and NHS chiefs who are more concerned with saving money than saving patients lives ! R. W.