Latest report on Mental Health services in Nottingham

Wyllow3

Iam64

Thanks Wyllow3 for summarising the real problems. I’m surprised anyone is unaware of the impact of austerity in the care of people with mh problems.
Suggesting ‘experts’ know less than the rest of us is a growing sport, as is insisting they be named and shamed.

Iam64 I think people are unaware of the scale of cutting back. Thats why I wanted to give a detailed and factual picture of the realities. The big changes begun to really hit 2016/7.

I noticed really big changes around 2006 when a big hospital was closed in my area to be replaced by a small 4 ward hospital.

When I started working at my very large MH hospital in 1989 on an acute ward, patients could turn up at the hospital and ask for help ie asylum and we would admit them.. We had wonderful hospital grounds, many group therapies, our own dentist and hairdresser.. plus much more..

Later I joined the Day Hospital and at that time clients could just walk in and have lunch and lots of facilities like groups and individual counselling were open to them.. We had an open door and a wonderful team of nurses, psychiatrists, psychologists, art therapists, and a big community team which included Social Workers We could therefore keep an eye on medication and their wellness.. Then in about 2009 the criteria for illness changed and our front door was locked.. we could only treat clients for 6 weeks and then they were discharged.. obviously suicide rates increased. We no longer had continuity of care and the safety of all services working together.. Then they closed the two day Hospitals..

My last work was doing assessments for clients as part of the triage service between GP's and the MH service.. it became increasingly difficult to find the services clients needed..
If clients were in crisis they needed to present at A&E and either the on-call psychiatrist or the Crisis Team would assess them. They would maybe get a home visit..

When I left in 2012 it was practically impossible to find a bed anywhere in the whole country for someone needing to be sectioned. Absolutely impossible for someone presenting with MH problems.. the most they could be offered would not be enough.. I had a MH social worker friend who left the service when she organised a family care plan meeting and then realised she could offer them nothing..

I have watched with absolute dismay the way the services have been cut back and severely underfunded for many years..

I just don't know how MH workers manage now..

Iam64

Thanks Wyllow3 for summarising the real problems. I’m surprised anyone is unaware of the impact of austerity in the care of people with mh problems.
Suggesting ‘experts’ know less than the rest of us is a growing sport, as is insisting they be named and shamed.

Iam64 I think people are unaware of the scale of cutting back. Thats why I wanted to give a detailed and factual picture of the realities. The big changes begun to really hit 2016/7.

Apparently he is Ashworth High security Hospital in Liverpool.

Thanks Wyllow3 for summarising the real problems. I’m surprised anyone is unaware of the impact of austerity in the care of people with mh problems.
Suggesting ‘experts’ know less than the rest of us is a growing sport, as is insisting they be named and shamed.

Allira

. unless they commit something like this tragic crime and then they'll go to a Forensic Hospital I imagine

Would he not be in a high security hospital rather than a Forensic Hospital which would be a lower category?

I don't know what the court will decide Allira but I would think that he'll have a full forensic assessment prior to the case.. when I was working we had a Forensic Hospital with locked wards but maybe that has changed now..

. unless they commit something like this tragic crime and then they'll go to a Forensic Hospital I imagine

Would he not be in a high security hospital rather than a Forensic Hospital which would be a lower category?

Thank you for these insights into MH services and lack of resources.
Personally I think it would be inappropriate to blame individual staff, who are attempting to work in almost impossible situations.

LauraNorderr

It has long been my opinion that psychologists and psychiatrists should be held accountable for the release of dangerous criminals in to society.
Too often people are released back to the community on the say so of a whole mental team only to commit another heinous crime.
Police officers, teachers, social workers, the judiciary, etc., are often accused of failing us but none of them have the necessary psychiatric training to make the decisions that would prevent the return to the community of deranged people.
Those who are qualified to make these decisions should be held accountable. Perhaps then they would be less hung ho with releases.

Locally in 2006 there were 4 Mental Heath inpatient wards, for adult patients (thats either 16 or 18 years to 65 years old). Cutbacks were on the horizon already.

These had which had a mixture of voluntary and sectioned patients, and one higher level (resources and security) facility. They did of course have regular contact with police.

Two psychiatrists covered those wards.

There was time, although time was tight, to keep patients in for longer stretches of time and get the treatment right before a proper handing over to community Mental Health Teams.

Psychiatrists were available as needed in those teams, not always easy to access, but nevertheless there.

In the community health teams patients were generally seen once a week and therefore could be monitored better. There was often good relationships between GP's and local Community Health Teams as they had the time.

In 2025 we have just one ward for the whole city although there are considerably more referrals plus a high security holding unit, there is always a constant bed shortage meaning patients are sent up to hundreds of miles if sectioned. People are discharged early.

They are handed over to Community Mental Health Teams stretched to breaking point, which can offer close supervision to less people for shorter periods of time and cannot offer weekly visits anymore to nearly everyone. It is very hard to get to see a psychiatrist.

This is the reality

Most workers are good people doing their very best under circumstances that mean outcomes are less than adequate in some circumstances.

People who desperately need hospital for help cant get in as its now only when there is immediate danger to self or others.

*I'm appalled the shout

"Perhaps then they would be less gung ho with releases*
or "
It has long been my opinion that psychologists and psychiatrists should be held accountable for the release of dangerous criminals in to society"

It shows little knowledge of the realities, instead of shouting "blame"
shout "give people the resources to do the job"

Casdon

My gut instinct, with no knowledge of this case, but some knowledge of how mental health crisis services operate, is that fundamentally this will be down to a lack of resources leading to unmanageable caseloads, which leads to inadequate care and supervision of vulnerable and high risk people. I completely understand the families’ grief and wish for individuals to be challenged, but ultimately that is not going to prevent a similar situation in future.

I tend to agree with this overall view but there may be other factors such as non communication between relevant parties.
Mental Health has long been the poor relation when it comes to resources.

We had an incident in my neck of the woods in 2016 where a Matthew Daley stabbed Donald Lock, in a fit of road rage and killed him. Donald Lock had accidentally run into the back of Matthew Daley's car.

Matthew Daley's mother said she had pleaded with mental health experts to have him sectioned as she felt that his mental condition was out of control. His mother described the situation as the day that "all your nightmares come true." Help appeared to be unavailable until it was too late.

There was the usual bleat from an NHS representative about hindsight and stressing the nobody deliberately withheld care etc. etc.

This was all nearly nine years ago and mental health services are now even worse.

This man had paranoid schizophrenia.. it is difficult to keep someone in hospital unless they are on a section order.. it is also not possible to force someone to accept a depot injection .which is what he needed.

We don't know if he was discharged with a Community Treatment Order or not, but as a retired CPN I can say that if a patient does not want medication it is almost impossible to give it short of re-sectioning the person.. and to do that you need 3 MH professionals each time you do it..

It's a very tricky situation to deal with as you can't keep someone in hospital indefinitely.. unless they commit something like this tragic crime and then they'll go to a Forensic Hospital I imagine..

Lathyrus - I retired 12 years ago. I was ex-directory and my name wasn’t on the electoral role. My children had their father’s last name so I felt reasonably secure. A colleague was abducted and though located, didn’t return to work.

I’d be very anxious now as it’s so much easier to locate people. I share the views expressed by you and Casdon. I do believe sw/cpn/probation etc could help prevent future difficulties if they were allowed to be open and honest about the complexity of their work, the need for manageable workloads and effective supervision, that might help

I worked with children in difficult circumstances and accepted the level of threat that parents and relatives sometimes directed at me. I left when my children also became the subject of their threats.

I lived at a distance from my work, worked under a different name from my family. On the whole I felt safe when away from work.

Now with the internet and social media I would not do that job again. I would be so easily traceable to my home and would be threatened, not just by those directly involved, but by numbers of people who felt that I had made a poor decision, whilst they would not have access to the facts.

Mistakes are made when posts cannot be filled and inexperienced staff cannot be supervised and mentored. Public exposure will not improve that. Who would want the job?

It has long been my opinion that psychologists and psychiatrists should be held accountable for the release of dangerous criminals in to society.
Too often people are released back to the community on the say so of a whole mental team only to commit another heinous crime.
Police officers, teachers, social workers, the judiciary, etc., are often accused of failing us but none of them have the necessary psychiatric training to make the decisions that would prevent the return to the community of deranged people.
Those who are qualified to make these decisions should be held accountable. Perhaps then they would be less hung ho with releases.

My gut instinct, with no knowledge of this case, but some knowledge of how mental health crisis services operate, is that fundamentally this will be down to a lack of resources leading to unmanageable caseloads, which leads to inadequate care and supervision of vulnerable and high risk people. I completely understand the families’ grief and wish for individuals to be challenged, but ultimately that is not going to prevent a similar situation in future.

I’m waiting to read the detail but, I heard the radio news summary, along with the families call for a public inquiry. The families want individual staff members questioned on their decision making.
I’m not advocating a ‘witch hunt’ but increasingly, I feel public servants in situations where things go so badly wrong, could help future situations by being honest about what drives their decision making in high risk situations.
I’m sadly well aware of the pressures in high risk employment sectors given austerity. I’m not suggesting this excuses poor practice. I’d be very interested in what front line staff and their managers say

Thank you.

Although the Police were involved with him on a number of occasions it was mostly escorting him to mental health facilities.

I suppose they should have tried to arrest him when he failed to turn up to court, but would they have been able to hold him for that? And for how long? Or would he have had to be taken to the mental health facility that had already released him several times before?

I confess I’m ignorant of the law in this regard but I don’t think there were multiple failures by the Police in this case.

www.nottinghamshire.police.uk/news/nottinghamshire/news/news/2024/january/timeline-of-our-contact-with-valdo-calocane/

Sorry no time to reply just now as I need to check the facts re the police. It has just been on the news.

When you say he had come to the attention of the police, offences had he actually committed before Cabbie ? Where they incidences of violence against other people?