This morning's headline in The Times is a complete stunner – NHS abuse of mental patients 'endemic' (£). Already, early on the day of publication, we have various commentators running off down various routes, from Professor Louis Appleby bemoaning a 'harmful media bandwagon', to individual mental health professionals pointing out that the words 'mental patients' are outdated at best and stigmatising at worst. Then we've already seen objections to the implied journalistic conclusions whereby The Times is mistaking every serious untoward incident review for 'abuse', which conflates distinct issues, apparently. I'm sure we'll see more of this as the day goes on – for example, I'm waiting to hear the 'bad apple' theory which we often hear about when it comes to excesses and abuses of police powers. This is the idea the majority of officers are good people who get up every day to put themselves in harm's way in order to protect the public and the stories we hear of abuse are isolated examples by individuals who joined and served for the wrong reasons – just 'bad apples'. I'm sure that's true of the majority of frontline mental health professionals, too – most of them are working hard in a struggling system, doing unpaid overtime amidst under-staffed services and they often do so at great cost to their own health and wellbeing as they routinely plug the holes in the dam. But that's not the point being made, is it?!
And you'll notice what didn't get mentioned in all of that – any abuse of mental health patients. Choose different words to 'abuse' if you prefer, but something that benotes the idea of patient's rights not being respected, physical coercion in the administration of care being excessive or disproportionate and, probably much less often, conduct amounting to wilful neglect or assault. This is a really difficult topic to raise, isn't it? – it makes us ask the most profoundly awkward and sensitive questions and no matter how someone goes about doing that, it will probably give rise to suspicions of there being an underlying agenda. We've seen this in today's coverage: The Times are helping to undermine the NHS so that it helps prepare the way for privatisation, according to just one that I saw; so-called 'anti-psychiatry' views are underlying this according to another … and bear in mind, we're only a few hours beyond the public waking up on this Monday morning to this headline so there is probably to more come.
But you'll notice what didn't get mentioned in all of that – any abuse of mental health patients. I'm acutely aware of the need for effective partnerships between the police and mental health services, so I tread lightly here and, I hope and suspect, with a heightened level of awareness about the difficulties staff face in providing their services. It's also true the police service has a role to play in preventing and investigating crime and abuses and that our first loyalties are to the public we serve and the law of the land. It is with those things in mind that I wonder if we can agree on just a basic set of shared facts and use them in discussions about these most difficult issues? It should be noted: some patients have already responded privately to tweets on this story that they will not engage in this discussion because they anticipate being shut-down in light of the responses they've all ready seen to it. Perhaps that is because we have other journalists, less likely to question? In today's Financial Times, David Tang somwhat solipsistically threatens, he "will howl and hunt down anyone who dares to question the NHS."
WHAT WE KNOW
- Many members of the public have had excellent care from NHS mental health services, who literally saved their lives.
- This is not everyone's experience of NHS mental health care.
- The numbers reported here are very small relative to the overall number of patients receiving care from NHS MH services, albeit they appear to be rising.
- The numbers published by state organisations are not always accurate – history shows some things can go unreported and misreported.
- Police forces do receive criminal allegations of abuse of patients in institutional settings – not all of which are proven.
- Some investigations have led to successful criminal prosecution of NHS staff – see Winterbourne View as just one high-profile example.
- Some of those investigations have been individual crimes, flagged by NHS staff and managers to the police and reflect individual's misconduct, not those of the organisations they were employed and trusted by.
- Coercive activities in NHS data, show more coercion in some trusts than others and answers as to why this is the case are not always obvious.
- If just one patient abused by an individual or amidst any culture that allowed it, that is one too many.
- No discussion is off-limits, as long as it is respectfully conducted and based on everyone's honest perspectives, experiences and a shared set of facts.
My own view, having read the article, was far less animated than some of the things we've seen on Twitter this morning. I wondered why we were surprised that a system under significant pressure to do more with less, is apparently seeing a rise in its reliance upon coercion and is less safe than it was before? If we are going to operate a system of mental health care which, in part and only some of the time, allows and indeed relies upon the exercise of state powers under the Mental Health Act to coerce people, then there will, from time to time, be viewpoints about the exercise of those powers which are unreconcilable, some of which may involve allegations of excess or abuse. This shouldn't be surprising, because we see it in all areas of state activity where coercive powers are used over other human beings. We see police officers, prison officers and mental health professionals have been convicted of individual abuses; we also see certain locations focussed upon: institutions or organisations where the overall levels of coercion sit outside the norms we'd expect and see elsewhere.
My concern here is about whether patients who wish to flag their allegations or their perceptions of abuse can do so freely and in such a way as to mean they are taken seriously and examined, either by health service investigators or by the police? In my own operational experience, I've known situations where patients are alleging their rights have not been respected and upon arrival, you have to conclude they are correct. Voluntary patients being prevented from leaving wards without staff applying legal powers to keep them there, being a common example. What should be noted in response to this article is the number of patients or carers / families on social media pointing out they feel vindicated, because this story reflects something from their own experience. Whether that objectively amounts to any form of assault or neglect is another point altogether but if trust and confidence is important, ensuring reporting mechanisms and scrutiny of coercive practices is crucial but this post was motivated by no-one appearing to focus on the point The Times are making and debating that, directly.
I'll leave this final point here: I recently did a training input for police officers in Lancashire, one of whom asked a question to seek advice about how to handle reports by unwell, detained mental health patients that are 'obviously' associated with that person's paranoid delusions. The officer chose an entirely hypothetical example of something he thought was 'obviously' ridiculous allegation of criminal abuse but very much wanting to know how to professionally respond: he wondered aloud about staff poisoning the patients on the ward. I began to smile as he finished his example because it immediately made me think of an operational job my response team dealt with one Friday night about three years ago. Guess what, a member of staff at a residential care setting for vulnerable and elderly adults was poisoning the residents. One of them was hospitalised in intensive care and nearly died; many more were quite poorly for days. The defendant was not only a care worker, but a special constable with West Midlands Police! But the report made came from other care staff managers and notwithstanding her keenness to volunteer for unpaid policing activities, we arrested her within a couple of hours of the first report. She was charged with three attempted murders and sentenced to life in prison, albeit firstly with detention in a mental health hospital for treatment.
The fact that abuse is rare and highly unlikely, doesn't mean it isn't there, it doesn't mean it shouldn't be discussed and that it doesn't mean it isn't rising in a system under strain. The fact a national newspaper used a bad headline whilst making this point and that this is further pressure on a struggling system, doesn't mean we only get to discuss the headline and politics of mental health funding. No-one can say that abuse doesn't occur and that this is sometimes individual and sometimes about systemic cultures: history simply does not support such an interpretation of the shared and available facts.
Winner of the Mind Digital Media Award.