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Alia Butt, psychotherapist and Chair of NHS Staff Voices, on the dire state of mental health services

This time last week it was ‘Mental Health Awareness Day’. It irked me to see the usual barrage of self-care suggestions with no admission of the increasingly detrimental impact of irresponsible government policies. I, like many reading this, am concerned about how I will manage to pay my fuel bills, but I am also feeling increasingly worried about the rest of the population’s struggles, and that of the planet itself – and I am surely not alone in this. NHS Confederation chief executive Matthew Taylor among others has made it clear that thousands of people will die this autumn and winter in Britain as a result of fuel poverty. I see the direct and clear impact on young people’s physical and mental health in my clinic, daily; someone I treated for psychosis recently let me know that their main concerns during the time of sectioning were how their family would meet the household bills while they were away in hospital and therefore unable to contribute.

The government on the other hand appear to have different priorities. Years of austerity measures have resulted in huge cuts to public services – cuts that were introduced to offset massive budget deficits that increased to mammoth proportions due to the financial crisis in 2008 at which time we saw an estimated increase of 1000 deaths from 2008 to 2010 due to suicide and an additional 30-40,000 suicide attempts linked to the crisis. Before then the suicide rate had been steadily decreasing for 20 years, apart from a rise in 2007-8 (8% among men and 9% among women).

As a mental health professional who has worked in the NHS for over 10 years, I am unsurprised to find that a report by the BMA shows mental health services are failing disproportionately as compared to physical health services. This is no doubt linked to chronic lack of staff and subsequent overwhelming pressure on those who are prepared to work in an oversubscribed and underfunded system. In fact, since 2009, there has been no increase in staffing levels despite the rise in demand for services.

We hear talk of the importance of championing mental health services – but there is a refusal to acknowledge that they are collapsing.

Mental health workers are not paid enough: many of us are working as hard as we do out of love and passion for the vocation, and the people we treat. I’ve had to leave jobs knowing full well that my position would not be filled and the service I provided will no longer be available to my patients or any others requesting help with their mental health – a number that is increasing daily and has risen to 1.4 million – a 21 percent rise since 2016.

In child and adolescent mental health services, far too many times I’ve seen patients’ health deteriorate while awaiting treatment after acceptance of the referral, yet the wait has been so long that their mental health has deteriorated. This means they have had to be moved to a waiting list for a more intensive service offering care to higher risk (of self-harm and/or suicide) young people.

The type of therapeutic support offered in services is also falling short, and many people find they are returning to services asking for more effective treatment.  In adult services, more often than not people are currently offered short term non-individualised highly structured cognitive behavioural therapy (‘manualised evidence-based CBT’) rather than longer term client needs-led psychotherapy. We are becoming more aware of the shortfalls of such ‘manualised therapies’ that focus on thought processes, cognitions and behaviours of an individual and where mental health is measured using forms and tick boxes. A telling survey taking data from 550 IAPT therapists showed that over 40% reported that they had been asked to manipulate performance data. The idea here may be to reduce costs, but, the reality that many find themselves having to return to their GP despite completing the therapy offered to them implies more in-depth work is needed.

Reading about the government’s commitment to ‘support and expand’ the mental health workforce feels like some kind of cruel joke. Austerity cuts mean cuts to resources and staffing, and fewer staff means fewer patients are provided healthcare in a timely manner, which costs lives. Despite the huge increase in need, staffing numbers across the mental health workforce has dropped from 119,000 in 2009 to 111,000 in 2018.

We constantly raise the issue of staffing shortages within the NHS and how much harder nurses and doctors are working to keep people safe, healthy and alive in relation to these shortages. The RCN has gone to strike ballot over pay, for the first time since its formation in 1916. This is due to the desperation seen by staff, many of whom are struggling to make ends meet despite being in full time employment and working above and beyond their remit. This should be of concern to everyone, especially the Secretary of State for Health and Social Care, Therese Coffey. On the contrary, she recently stated that nurses will not get a higher pay offer after a vote on strike action making it vehemently clear she has no consideration for NHS staff or patients; undoubtedly, it is the public who suffer when staff are stripped of our ability to provide care due to lack of personal and professional resources.

Our physical and mental health go hand in hand – we are becoming increasingly aware of how our mental (emotional and psychological) health impacts our bodies (our physiological and physical health), and vice versa. We constantly speak about the importance of good mental health for our society, but our genuine focus is not on addressing these things. The cost of living crisis is making it more difficult for the majority in society to manage this winter, yet we are seeing no action from the government in mediating the huge profits gained by fuel companies through windfall tax, or indeed nationalisation of energy services. Either of these interventions would mean more responsible and manageable energy sales to the population who are instead being served extortionate price hikes despite company profits. Instead, we are living in a time where access to healthcare is as precarious as access to heating, food, housing and a decent education – and it is killing us.

Reposted from Keep Our NHS Public

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