[CN: discussion of suicide, hospital, benefits, political bollocks]
It is with a heavy heart that I have to tell you that the Tories have been talking about mental health again. Theresa May made some proposals yesterday, which broadly covered three areas:
1) Changes to the Mental Health Act to reduce the numbers of people being detained for treatment.
2) Putting mental health first aiders into schools and other large organisations.
3) An additional 10 000 “mental health staff”.
Let’s take these one by one.
1) May says that people are being sectioned “inappropriately”, using the same rhetoric as Jeremy Hunt’s claims that the A&E crisis is down to people “inappropriately” attending A&E with the sniffles. But, like A&E waiting times, detentions under the Mental Health Act are a barometer of the health of the system as a whole. Detentions were up 36% in the 12 months to April 2016 compared to five years earlier. Does it really seem likely that mental health professionals are using the Mental Health Act 36% less appropriately than they were in 2011? Or does it seem more plausible that cumulative cuts to welfare benefits, community services, and inpatient units have left more people in crisis, with less chance of finding a bed while they are still in the frame of mind to consent to an admission?
During my current crisis, I had consented to go into hospital voluntarily but there were no beds on a women’s ward for four days. I couldn’t cope at home and ended up being sectioned by the police, at which point a bed was found overnight. With the NHS in its current state, May’s proposal – shifting the focus of the Act to mental capacity and effectively raising the threshold for sectioning someone – will just mean that even fewer desperate people will get help in time. It will also block more people from entitlement to aftercare: currently, Section 117 of the Mental Health Act guarantees free aftercare to anyone who has been held under Section 3 for as long as they need it.* They can’t be asked to pay even if they need a package of social care, which many people are being charged more and more for as council budgets shrink.
This is a tried-and-tested political move for May: announce new legislation on the issue of the day, because it is cheaper than providing the funding needed to tackle the actual problem. Check back to her detail-free announcement of a new Domestic Violence and Abuse Act from February this year. Compare her rhetoric to the stats on how many refuges have closed under Conservative rule because local councils’ budgets have been slashed and slashed again, hitting the poorest areas hardest (34 at last count).
2) Putting mental health first aid on a par with physical health first aid is fine. But it’s not a substitute for long-term professional help. If I break my leg at work, first aid might stop me going into shock, but I’d need there to be a surgeon and a bed available to fix my bone, and a physiotherapist to help me get back on my feet afterwards. I have had my life saved by interventions from non-professionals, but all they could do was keep me alive until I was taken to hospital, and I only got out of hospital because I had long-term therapy. If you’ll forgive the slightly inappropriate metaphor: at some point you have to stop pulling people out of the river, head upstream, and tackle the reasons they’re falling in in the first place.
3) There is no information about what grade these staff will be (Do the new mental health first aiders count in the total? Will they be nurses? Low-paid healthcare assistants? Doctors?) and it has been made clear that there will be no new money. 6 700 mental health staff have been lost since 2010. This year, the government rewrote the rules for claiming disability benefits to specifically discount “psychological distress” when travelling, blocking 160 000 people with mental health problems from getting Personal Independence Payments; this in turn will affect their entitlement to Housing Benefit, Working Tax Credits, and (if they’re a student) Employment Support Allowance.
So when it comes to putting their money where there mouth is, I trust the Tories’ track record on mental health more than I trust their rhetoric.
That is a video of my cat playing fetch. I needed cheering up after brooding on May’s hypocrisy all day, so I thought you might too.
*For a fun, penguin-filled guide to the sections of the Mental Health Act, see Katie’s blog here.