Latest report on Mental Health services in Nottingham

Casdon

Thank you for sharing your son’s story with us Agapanthus72, it a very sad indictment on governments over the years that he has received so little input or support for so long.
I’ve always felt that huge psychiatric hospitals where they are away from the rest of society are not the right solution for most people, but there needs to be an alternative model with enough beds and community resources in the system to enable people who need help to receive it quickly, intensively when necessary, and for as long as they need it.

The big hospital where I worked was a couple of miles outside a city and it had extensive beautiful grounds with vegetable gardens, it's own church, chaplain. art therapy rooms, OT department, Physiotherapist, loads of therapists, it's own kitchens, dentist, hairdresser, lots of social activities and a plenty of nurses and psychiatrists.. It was also on a bus route.. There was a real feeling of community and most importantly continuity of care..
So once patients left the locked ward (if they needed it) they would transfer to an open ward where they were observed and given care plan meetings. The most important thing IMO was that the various MH teams in each part of the city generally knew each other AND their patients and would ring each team if they saw someone deteriorating so they could be picked up quickly.. and we didn't need to send people in crisis off to different parts of the country.. to be nursed by teams they didn't know or trust..

They would obviously have been expensive to run as each villa had 48 beds and there was a villa for each part of the city.. so patients could stay as long as they needed to..

Care in the community and the closure of these hospitals was a big mistake I think.. and in terms of the deterioration it has caused to MH services certainly not worth the savings..

Your son's experience Agapanthus is a national disgrace.. I am very sad that he and you have had to suffer because successive Governments have not had the foresight to properly fund MH services.. It should absolutely be a priority..

Thank you for sharing your son’s story with us Agapanthus72, it a very sad indictment on governments over the years that he has received so little input or support for so long.
I’ve always felt that huge psychiatric hospitals where they are away from the rest of society are not the right solution for most people, but there needs to be an alternative model with enough beds and community resources in the system to enable people who need help to receive it quickly, intensively when necessary, and for as long as they need it.

My son has a Paranoid Schizophrenia diagnosis from 2009. I recall that year before his diagnosis, writing to his psychiatrists and getting no reply, and attending an appointment with him where the Psych declared that he definitely did not have BiPolar or Schizophrenia after I voiced the concerns of my other son and myself about his deteriorating condition. He was sectioned eventually and diagnosed, but without my intervention, I am not sure how long it would have taken and what might have happened in the meantime. I lived at the other end of the country by then, and he lived alone.

I suspect that the people who are most at risk from someone with this condition are the person themselves, as even if they take the medication as my son does, their lives are often miserable, due to the effects of the meds on how they feel.
Suicide risk is very high, and effects of self medication with alcohol and cigarettes also common, does more damage physically, as well as long term side effects from the medication. It is known that quality of life is poor and that many of those with this condition can die years before an average age of death. I am not trying to underestimate the effect on the families affected if the person's mental health spirals out of control - it's devastating if it's ignored as the case highlighted at the start of this thread.

He used to have depot injections but about 5 years ago he stopped going for them and no one noticed for some months, until he finally rang them and let them know, and then they turned up on his doorstep. Surely a basic recording system would have told them this? Unbelievably inept.

Just over 2 years ago he was discharged from the Community Mental Health Team by letter with no discussion into the so-called care of his GP (who he has never met in person and very few phone appointments and until now no mental health input). He appealed and it was rejected. A 2nd time he appealed and was seen in person for assessment, (I went to that with him), after a neuropsychiatrist wrote to his GP on his behalf (he also has Tourette Syndrome). This too was rejected - the letter arriving a week after his overdose (see below). No one from the CMHT contacted him despite this happening.

So re the above, last May he took an overdose of his medications and was rushed to hospital, only because he informed Facebook and it got picked up by someone who informed my other son and me and we called the police. The NHS were brilliant with his physical needs, but he was discharged rapidly and had NIL aftercare other than a phone call from his GP was due for 6 weeks later - changed to 4 weeks after my protest by letter. Since then another overdose, and no care. I have written to his GP 3 times raising my concerns.

He is difficult to treat for sure as he has lost faith in the system and is almost housebound so going to appointments is agonisingly difficult for him to manage. He is still very depressed and missed the one appointment offered to him back in November, for January but then postponed to February, just last week.

Yes, I believe it was the closure of the mental hospitals that triggered this. I remember at the time under the Tories that the Care in the Community wasn't happening. It improved under the Labour Govt, but then cut again under the Tories in 2010. I remember that very clearly as my son had things available that disappeared in 2010 as everything got cut away, and then continued in many areas. I have been my son's advocate from afar enabling as best I can, with benefits and getting a carer on board. Now there are so many with mental health issues the system is completely overwhelmed.

Who would possibly have expected so many mental health issues after years of austerity??? (other reasons too of course but people who are on the breadline and no decent housing will likely founder). Mental health is still not on a par with physical health but that too is foundering for lack of money. Unless the finances are on an even keel again then things will go downhill further it seems. Different Governments have their own priorities but if they don't get to grips with the physical and mental health of their citizens, (and housing is intrinsic to that and food and warmth, as well as jobs to make money of course), then it feels we are doomed.

I would like to believe that Nottingham is the only area where this happened or could happen. cuts in services and the growth in the population means that this scenario will happen time and time again. I know people will not like me repeating the truth but this all started when Margaret thatcher cut mental health hospitals and wanted "care in the community". those that needed specialist care were put into general society and there are few health carers around to ensure that medicaiton is taken

There are quite a number of very attractive, larger former “asylums” as they used to be called - but basically, mental health institutions - around the country which have now been converted into attractive flats. Due to Care in Community, there has been a 75% reduction in Mental Health beds in the last 30 years. And yet the population has grown massively.
You cannot be forced to have medication unless you are sectioned under one of the MH acts. When you are “sectioned”, you will be given a “bed” in a MH hospital and will have no choice but to receive medication. Depot (injectable) medications are often ideal, but due to the patients suffering a complete lack of understanding that they are ill, it will often be necessary to restrain the patient to administer it.
If you can imagine one of the worst nightmares you have ever had, where people in your dream were frightening and threatening towards you, perhaps chasing you and wanting to attack you. Their voices are very real, and threatening and possibly advancing towards you. They manage to implant a “chip” inside you so now they can see you wherever you are - in the bathroom, looking at your bank statements, altering your Birth Certificate, accusing you perhaps of murdering someone close to you (maybe a relative who’s recently died of natural causes), saying they are going to contact the Police about you. Someone says “oh you need to take this medication” - but of course, you don’t understand at all why it should be YOU that takes this medication, when someone should be dealing with these people who are harassing and deeply upsetting you….. imagine this nightmare continues in this vein during the day? This is broadly the experience of a schizophrenic. The themes of persecution and paranoia seem to be very similar in these individuals.
We MUST take mental illness more seriously and build far more mental health hospitals so that people requiring help get it straightaway, not be left for weeks languishing with Mental Health crisis teams attempting to visit them every day trying to persuade the individual that they should take their medication.
The individuals themselves don’t understand why those helping them are not trying to put the [non-existent] perpetrators behind bars, rather than ask them to take medication they don’t (feel they) need. Many anti-psychotic meds make patients feel very drowsy, unable to wake up until the afternoon and unable to function normally. They also don’t work in 20-30% of patients although there is one, which works usually when other meds have failed (clozapine) but it is very dangerous long-term in terms of its side effects profile.
To whoever is reading this - if I were to say to you:- “you’re not yourself, you need to go a Mental Health hospital and take this medication”, you would automatically reply - “well, obviously not - I’m fine” - well - - that’s exactly what a schizophrenic thinks (although deep down, they know something is deeply wrong and feel very frightened).

Wyllow3 Have to agree with you. MH services have over the years had the same cutbacks as other NHS services yet demand has increased.

No doubt he should have been detained.

I suppose the question is who should have been discharged in order to admit him.

And if they then committed a violent act should individuals be named and shamed for discharging them?

The people already admitted are there for a reason. Choose A or B. We know what B did. We don’t know what A might have done if back in the community.

Not as easy as “clearly should have done…..”

Yes, and there probably always will be people who are a danger to others but escape adequate notice,

except for a major difference - if the beds were there, many more people would be able to be sectioned when there were concerns, risk levels right down.

I also think that if more beds and related resources were put in place, more MH workers would return to the sector.

Naming and blaming is not the answer, the services are.

Wyllow3

"Despite training more staff, the number of vacancies in NHS mental health services remains high. In September 2023, there were 28,600 vacancies (19% of the total workforce), including 1,700 medical and 13,300 nursing vacancies."

Lots more details in Kings fund report
www.kingsfund.org.uk/insight-and-analysis/long-reads/mental-health-360-workforce#:~:text=Despite%20training%20more%20staff%2C%20the,medical%20and%2013%2C300%20nursing%20vacancies.

I don't think anyone is arguing with that.

However, this man was known and known to be a dangerous individual who was refusing to take his medication.
Wrong decisions were made.

A review published by the Care Quality Commission (CQC) on Tuesday found "a series of errors, omissions and misjudgements" by mental health services.

Mistakes were made.

It was not unique.

"Despite training more staff, the number of vacancies in NHS mental health services remains high. In September 2023, there were 28,600 vacancies (19% of the total workforce), including 1,700 medical and 13,300 nursing vacancies."

Lots more details in Kings fund report
www.kingsfund.org.uk/insight-and-analysis/long-reads/mental-health-360-workforce#:~:text=Despite%20training%20more%20staff%2C%20the,medical%20and%2013%2C300%20nursing%20vacancies.

This case wasn't exceptional sadly Allira. This one sticks in my mind because it was quite local, but there are similar cases every year in the UK.
www.walesonline.co.uk/news/wales-news/woman-who-bludgeoned-man-death-29503616

The first thing I’d do would be to involve the professionals working in the service to identify their top priorities to reduce risk. I’d would guess that in the first instance a recruitment drive to open more crisis and rehabilitation beds in existing hospitals and to enhance CMHTs and crisis teams would be needed. Attracting people back into mental health won’t be easy, but there are many people who have left the professions. Increasing training capacity for psychiatric support so that more people are available over the next five years. A review of the current model and agreement on better mitigation of risk is already happening, but it will cost a lot and take time to implement real change - the number of beds, for example has dropped by over 70% since the early eighties.

We know.
I don't know how a poster on GN can change that though.

Actually, this case was so exceptional, a known danger to others, and, as he showed no inclination to take his medication, this man should have been followed up as a priority.

How many times does one need to say it?

There aren't the specialist beds, there aren't enough staff.

So - what would you do?

I wasn’t goading Allira. I genuinely want to know what solution eazybee thinks there is as she is saying people are making excuses. The bed crisis isn’t fabricated, it is a genuine crisis, and I don’t see what can be done to alleviate it in the short term. There are thousands of people with diagnoses that make them potentially dangerous to themselves and others in the community, that’s the reality.

Well said, eazybee

Hindsight is a wonderful thing. This man showed every indication that he would carry on offending yet was considered fit to be free in the community.

Goady replies to your post are not helpful in the slightest.

I meant to ask eazybee the same question

eazybee

Excuse after excuse after excuse.
Calocane assaulted 4 flatmates (that is people living in the same building as him) at different tines since 2019, by breaking down doors to their rooms .
Police officers had to be present when he was engaging with NHS staff.
He assaulted a police officer when taken to hospital.
He assaulted three work colleagues at different times and places.
There was a warrant out for his arrest when he committed the three murders.
He admitted to not taking essential psychotic medicines yet deemed fit to be released into community care and evaded contact.
All these professionals who saw him yet no-one thought it fit to keep him confined. They knew he was refusing to take his medication. NHS staff had protection provided for their safety, yet considered him safe to be released into community care.
Until people are identified and justify their decisions this will continue happening. There are seven people who are lucky to have escaped with their lives,plus the three he injured after committing the murders.
Now he is confined he is apparently accepting treatment and responding well. His brother said on Panorama with an excruciating lack of tact; 'it is good to have my brother back'.

As Mrs. Webber, with remarkable self-control commented: Pity the brothers of Barnaby and Grace cannot say the same.

So what would you suggest eazybee, in the absence of available beds to enable people who pose a risk to others to all remain detained? It’s all very well sounding off, but what would you actually do?

“Until people are identified and justify their decisions this will continue happening”

I posted earlier that I believe it might help if staff involved in various agencies could be honest in reviews.
There are several helpful posts here that demonstrate the devastating impact of the cuts on mh provision. That can’t be ignored any more than poor practice should be

The police chronology shows how often they were called and took appropriate action. Over recent years our police have become the only 999 service that responds in decent time.

We need to accept it isn’t all down to poor practice - there are structural problems and a culture of overworked over stressed staff in our public services

Excuse after excuse after excuse.
Calocane assaulted 4 flatmates (that is people living in the same building as him) at different tines since 2019, by breaking down doors to their rooms .
Police officers had to be present when he was engaging with NHS staff.
He assaulted a police officer when taken to hospital.
He assaulted three work colleagues at different times and places.
There was a warrant out for his arrest when he committed the three murders.
He admitted to not taking essential psychotic medicines yet deemed fit to be released into community care and evaded contact.
All these professionals who saw him yet no-one thought it fit to keep him confined. They knew he was refusing to take his medication. NHS staff had protection provided for their safety, yet considered him safe to be released into community care.
Until people are identified and justify their decisions this will continue happening. There are seven people who are lucky to have escaped with their lives,plus the three he injured after committing the murders.
Now he is confined he is apparently accepting treatment and responding well. His brother said on Panorama with an excruciating lack of tact; 'it is good to have my brother back'.

As Mrs. Webber, with remarkable self-control commented: Pity the brothers of Barnaby and Grace cannot say the same.

It will be the same when they announce the failures for the Southport killer. This country needs to get a grip and get them off the streets into secure units where their medication is strictly administered thereby keeping our streets safe. They won't though, will they and this tragic events will happen again. I would be blazing angry if I lost someone I love in these circumstances.

Wyllow3

Thank you for that big picture that really goes back to when real care was offered Pascal. And the cuts in the range of services, and staff pressures.

and thankyou Wyllow for your comprehensive post.. It's heartbreaking isn't it?

Thank you for that big picture that really goes back to when real care was offered Pascal. And the cuts in the range of services, and staff pressures.