Mental Health Deaths

Unexpected deaths among mental health patients under NHS care have soared by more than a fifth over the last three years. Data, obtained by the Liberal Democrats under Freedom of Information laws, has revealed that the number of mental health patients attempting or committing suicide has risen by 26% since 2012-13 to 751 last year. The number of serious incidents – cases requiring an investigation – climbed by 34 % to 8,139 in 2014-15.

These findings raise really serious concerns. I believe they should trigger a full investigation by the government and by NHS England. On the face of it, they show a dramatic rise in unexpected deaths and suicides – at a time when real terms funding provided by commissioning groups has gone down – Norman Lamb, a former health minister in the coalition government

Since the 2010 general election the Conservative/Liberal Democrat  coalition presided over cuts to spending on mental health. There was a  real term cut over five years of the parliament. The budget was £11.71bn in 2009/10 falling to £11.66bn in 2014/15 – cuts in effect of approximately £460 million across 5 years of coalition government.

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An investigation by ITV News revealed that in 2014 alone £35m was been cut from children and adolescent mental health services, £80m in since 2010.  Freedom of Information requests to 165 clinical commissioning groups, 97 local authorities and 37 mental health trusts. The investigation revealed that although NHS spending as a whole was ‘ring fenced’ (apparently) – three quarters of mental health trusts had been forced to freeze or cut their budgets between 2013/14 and 2014/15.

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 A disturbing picture of disinvestment at a local level –  Sarah Brennan,  chief executive of YoungMinds

Statistics from the Health and Social Care Information Centre show a clear reduction in spending by local councils on ‘adults with mental health needs‘. There was a real terms the peak in Gross Current Expenditure (GCE) on adult social care expenditure for 2009-10, followed by a reduction each year for the period 2010-11 to 2013-14.

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Over the five year period of the coalition government, expenditure on adults with mental health needs aged 18 to 64 was reduced from £1.2 billion to £1.1 billion (a decrease of four per cent); with other adult services reduced from £380 million to £260 million (a decrease of 31 per cent).

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The impact of these cuts falls squarely on patient care. Bed shortages, cuts to frontline nursing posts and long waiting times for therapy have been well-documented in the last couple of years and, at the same time, demand has been increasing as more and more people come forward and seek help. The treatment gap for mental health is huge – 75 per cent of people with mental health problems get no help at all. Meanwhile, many more are being turned away from services when they need them the most, left to cope alone with self-harm and suicidal thoughts. – Paul Farmer, Chief-Executive, Mind 

An investigation in 2014 by the Health Service Journal (HSJ) revealed there were 3,640 fewer nurses and 213 fewer doctors working in mental health WHEN compared to staffing levels IN 2012. Freedom of information requests relating to workforce data revealed that the 57 NHS mental health trusts had lost 2.3 per cent of their funding, equivalent to £253 million.

Cuts to mental heath services are expensive cuts to make. The short-termism inherent in the cuts implemented by the coalition government have had externalities which reverberate beyond simply savings for the exchequer. Cuts in quality care for people with mental health problems cost the NHS (those in need of care and society) long-term. For example, Early Intervention services (a holistic approach to treating young people swiftly when they first experience psychosis) create savings for the NHS of £15 for every £1 spent. It  costs £350 a day to support someone in hospital, compared to just £13 a day in the community.

…people who get Early Intervention are far less likely to deteriorate to the point where they need expensive hospital care.

It is difficult to correlate any direct link between the cuts to mental health services and the utterly terrible figures on deaths related to mental health. However it can be safely said that adequate & appropriate funding for mental health services, despite the short-term costs, reaps future dividends and protects the vulnerable. Underfunding mental health tacitly has terrible consequences. Long-term patients experience long waiting times, lack of psychiatrists, over-reliance on pills as an easy solution and a sense of limbo. The number of qualified nurses working in psychiatry dropped by 10.8% from 41,320 in 2010 to 36,870 in 2015. While the number working in community psychiatry services has fallen only slightly from 15,986 to 15,826, those listed as working in “other psychiatry” – mainly hospital units – went down from 25,334 to 21,044.

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These shocking figures raise serious concerns about the future of our mental health services …. At a time when there is growing demand and staff are being asked to do more for less, cuts to the number of nurses working in mental health are completely unacceptable – Luciana Berger, shadow minister for mental health. 

This comes at a time when numbers of individuals seeking mental health treatment from the NHS has increased by 40% since 2010. Without funding the NHS cannot deliver the necessary care or adequate staffing levels.

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I do not want (or intend) to make political capital from such human tragedies.  I will not (and cannot) claim that funding at the level prior to the coalition would have prevented any tragic increase in deaths (related to mental health). However it is important to consider the context in which this unacceptable increase in mental health related deaths developed.  1 in 4 people in the UK will experience a mental health issue each year, services in the NHS should be properly funded. Mental health care, its perception and potential stigma surrounding mental health issues needs to be dealt with objectively.

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For mental health to be treated with the same priority as physical health – ‘parity of esteem‘ – it must be given the money necessary to do so. If the government funds mental health in the same way as physical health, investing in NHS services, this may prevent many vulnerable individuals from getting to a point where their life may be in danger. A reactive, holistic approach, suited to the needs of those seeking support and help with mental health problems needs to be funded in order to exist. Early intervention is always key. Providing care for mental health on the cheap is not good enough, and will cause greater problems in the long run.

By Frederick Antonio Gallucci | International Law LLM | @gibblegbble

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