Mental health crisis services in Norfolk are ‘uncaring, unwelcoming, unsafe and ineffective’ says new report
PUBLISHED: 10:32 08 August 2017 | UPDATED: 10:54 08 August 2017
“Tell them you are suicidal and they do nothing”.
This is one of the shocking comments made by people in desperate need about Norfolk’s mental health crisis care.
They are revealed today in a damning report by Healthwatch Norfolk, which spoke to 680 crisis care users - and concluded services were “consistently unsatisfactory”.
The report said: “The views and experiences of patients, service users, carers and families of their experiences of mental health services provided by the NSFT are at best mixed and at worst poor, unresponsive and unsafe.”
Healthwatch Norfolk gathered the views to paint a picture of urgent and emergency services available at times of mental health crisis.
It found “a consistently unsatisfactory picture of mental health service provision – in particular at times of mental health crisis – in our county”.
Interviews and surveys found there was genuine sympathy for front-line mental health professionals who were felt to be doing the best they could.
However, the group concluded mental health crisis services were “under-resourced and over-stretched and this issue required urgent attention”.
The piece of work did not set out to look at Norfolk and Suffolk NHS Foundation Trust (NSFT) - the region’s mental health trust - but many interviewees spoke about these services.
It comes at a time when mental health is under the spotlight both nationally and regionally.
In Norfolk and Waveney, the region’s healthcare overhaul - known as the Sustainability and Transformation Plan (STP) - looks to put more focus on preventative methods across healthcare, including in mental health.
Nationally, a BBC investigation found crisis services were facing unprecedented demand, with some teams reporting a workload increase of 70pc without a comparable rise in funding.
NHS England has pledged an extra £400m would be spent on crisis resolution teams. However, in Norfolk three themes which caused issues for people in crisis emerged.
Some patients complained about long waiting times - one said they waited for 20 months to get a consultation at Chatterton House, in King’s Lynn.
Another reported an eight-month wait to be seen at Hellesdon Hospital.
Others felt left alone at their greatest time of need, with one service user saying: “There is no help. I have made detailed plans for suicide. I have no help, no family, nothing. I have been left to sink or swim. It is like there is no NHS at all.”
Another person added: “They have failed so many, I wouldn’t have believed the stories if I had not experienced them.”
The amount of money available for mental health services was an issue particularly raised by family members and carers, who felt funding cuts put services under pressure which led to a lack of staff, longer waiting times and the ability to deal with only the worst of emergencies.
One said: “I feel NSFT are under a lot of pressure and this shows through the care they are able to provide, this is not to the fault of each individual but as a whole organisation. Because of cut backs, NSFT are not able to provide the quality support to each individual they care for, but instead have to prioritise their time to those who have already reached crisis point instead of preventing and supporting those who are reaching crisis point.”
Another said: “Statutory crisis provision currently suffers from a lack of adequate funding and preventative reach, meaning safety suffers.”
Where to go
Another issue highlighted by service users was that they did not know where to go when they were in crisis. Dr Deborah Holman from West Norfolk Mind told Healthwatch: “At crisis point, when individuals are very ill and vulnerable, our interviewees felt that the onus is on them to search for the care they need.”
And there were mixed messages about whether service users should go to A&E or not when in need.
The report concluded: “It is quite clear that whilst people and services can come together to provide a person with the right care at the right time, many people’s experiences of trying to getting help and support are unsatisfactory and at times, uncaring, unwelcoming, unsafe and ineffective.”
Praise for GPs
Patients were asked about what services they had used in a crisis which had worked well, and GPs and community, voluntary sector and charitable organisations came out on top.
These were ahead of services which focussed purely on mental health, such as community mental health teams and professionals, the Wellbeing Service and crisis teams.
There was also some indication that whilst a GP could be supportive and attempt to make an appropriate referral, often other services were slow to respond or the response was disappointing.
One service user said: “My GP was the only person to help because the mental health teams are so backed up it took 8 months before I saw anyone!”
Another added: “My GP [...] has been nothing short of spectacular. He has done more for me than the so-called specialists at the Wellbeing Service, who have, and I’m being kind here, been dire.”
‘Nothing available for older people’
A often overlooked area of mental health provision in our region is the care of people with dementia.
In the Healthwatch report, the Queen Elizabeth Hospital in King’s Lynn raised concern that there was “nothing available for older people in crisis (e.g. people with dementia)”.
And Zena Aldridge, a mental health nurse, said many of the situations were connected to “increased confusional states”, which often resulted in the person being admitted to hospital. The majority of carers felt that admission to hospital for the person with dementia had not been beneficial and in fact many felt it had been detrimental. Many also said they had not been contacted by mental health services, especially if the dementia diagnosis was made in hospital. One carer said: “without having a dementia nurse as a friend we would not have known anything as mum wasn’t seen by mental health services, it shouldn’t be like that.”
‘We welcome feedback’
Michael Scott, NSFT chief executive, said: “We welcome organisations, such as Healthwatch Norfolk, inviting people to share their experiences of our services.
“All feedback is important as this helps us develop and continue to improve the quality of our services. We are taking steps to ensure that learning from the experiences of our service users and carers is shared across the trust and embedded into clinical practice.
“Demand for local mental health services, as with all NHS services, continues to increase year on year and it remains a priority for NSFT to provide good quality care for people in crisis. However, pressures continue to increase and one of the themes of the report was that mental health crisis services are under-resourced.
“To help manage this for example, one of our overarching aims, is to focus on extending and improving community services which help keep people well for longer and help to avoid them going into crisis.
“The design of a non-medical crisis café service is now underway. This will support people experiencing heightened emotional distress and escalating towards crisis. It will focus on offering appropriate interventions, ensuring the individual has a short-term support plan and will engage the individual with appropriate community resources.
“NSFT is also working to design a community personality disorder service. We know people with personality disorder can go into crisis and so this service will provide care to support them in their own homes and reduce that risk.
“We have already introduced the Flexible Assertive Community Treatment (FACT) model which has enabled our community teams to increase support to a patient within hours, if they appear to be heading into crisis, making our community teams more responsive.
“We agree with how the report highlights the importance of care plans. All over our service users have their needs assessed and, if they require it, will be managed under the Care Programme Approach (CPA). This is designed to support them to maintain and increase their independence and manage their own care as far as possible.
“We have also put in place a single-point-of-contact crisis care helpline to make it clearer and more consistent for people about who to contact if they find themselves in a crisis.
“To help mothers we will be developing a new mother and baby unit and our community perinatal service has already started seeing mothers, providing them with the most appropriate urgent care.
“As part of major investment and redevelopment in West Norfolk, we have based all adult acute mental health services in West Norfolk one site (apart from those provide in people’s home and places of residence) in order to provide urgent and emergency care.
“We aim to provide the highest quality of care to our local people and will to looking at the feedback provided by this report in detail to make further improvements.”