The Commission on Acute Adult Psychiatric Care has published its final report! – and the publication was headline news on BBC Breakfast this morning with a range of people welcoming its findings. I have been very interested to be a Commissioner in this inquiry, not least because I’ve never done anything like that before but also because the subject matter is something that many would imagine is not immediately linked to policing or criminal justice. And yet at every stage of the Commission’s work, I found myself with things to think about and say, relevant to policing, mental health and criminal justice. I have learned a lot, quite honestly!
So here are the resources –
- The full CAAPC report – 126 pages long!
- The summary report and recommendations – 2 pages.
- The Royal College of Psychiatrists press release.
- The interim report – published in July 2015.
- The RCPsych Background Briefing Paper.
This has been a major piece of work and I know the staff within the RCPsych policy unit who did a lot of research and running about at the whim of the various Commissioners have worked tirelessly to produce it. The risk with any such thing is that it becomes ‘yet another report’ that can be filed away – in my case, I print them off and put them on a shelf in my house.
DO WE HAVE ENOUGH BEDS?
The Commission’s essential task was to address the question of whether England has sufficient inpatient psychiatric beds for adults. It was obvious to everybody at the first meeting of the Commissioners that the answer could not be a ‘Yes’ or ‘No’ and that is reflected in the final report. You can get talking if you want to about whether mental health care should be more balanced towards inpatient care or community models of care: it was really interesting for me listening to very senior and experienced people as well as service users all over the country talking about their views. But ultimately any local health economy is going to be a balance of inpatient and community provision – the issue is whether local areas have got their balance correct. The report concludes that there are enough examples of imbalance to suggest urgent action is necessary – not least on the long journeys some patients undertake when first admitted (see the recommendations, above)
Policing seemed throughout the inquiry to be connected to the issue of sufficiently minimising imbalance to prevent instability becoming too great, although even there we came across examples of where it could not do so (see example one on page seventeen of the full report) and therefore the final report highlights the need for a ‘systems’ approach to our mental health care – this means seeing various public functions as directly connected to achieving a balance. If 16% of patients don’t need inpatient care but do need community care that doesn’t exist, some will become hospitalised, some will become criminalised, others may develop informal coping strategies like drugs, alcohol or self-harm. If 16% of patients are in hospital having required admission but are now medically fit for discharge and have no housing or other vital social supports, it prevents discharge occuring and forces the system to rely on the most expensive resource of all: an acute inpatient bed.
So my concluding thought about all this, having spent a year working on the Commission is that you can have as many or as few alternatives to admission as you like, you can plan properly for that by understanding demand, or not – as you prefer. Either way, we will end up paying for it anyway with out of area and private sector admissions costs; with criminal justice interventions and imprisonment; or with a cost in human suffering from unnecessary institutionalisation, predictable self-harm or avoidable suicide.
So we may as well just do this properly and accept it needs planning and paying for.
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