Young people admitted to adult MH wards:
This was all over bits of the media (Guardian, Nursing Times, Community Care, BBC that I saw) and the twittersphere yesterday.
It clearly isn't a good thing to happen and around 5 years ago was declared to be a “never event” in the official jargon. So why do I bring it up?
Mostly because of the bee in my capacious bonnet about media coverage of MH issues...
In all the reporting and tweeting did I see any looking behind the headline, anything other than report by press release, any consideration of how such situations arise? Not really, mebbe a tip of the hat but nothing of any depth or substance.
OK, so here are the relevant issues and the questions our esteemed journos never get round to asking...
Why would a young person need admitting to a MH bed? Because their condition is severe enough that community staff can't manage them or because there aren't enough community staff to manage them. My caseload usually had a large chunk of young people who back in the day, before we had more community services, would have been admitted. Or that there aren't such things as day units to fill that gap between community and in-patient work.
Why admit to an adult MH bed? Because there are not enough CAMHS in-patient units and beds.
Why are there not enough CAMHS beds? Because not enough have been commissioned, some of those which were commissioned have been de-commissioned (that is closed in English).
Why are there not enough community staff? Because budgets have been cut and staff lost, assuming that adequate services previously existed in any given area, which wasn't always the case.
How did this happen? Well, one would have to ask senior NHS management, commissioners and their political masters why they took particular decisions, as it is their responsibility.
What about CAMHS clinicians in all this? Let me tell you (as per other posts on this blog) that clinicians have, for 30 years to my certain knowledge, raised issues of staff shortages, inadequate skill mix, lack of beds generally, lack of urgent care or emergency beds in particular, inadequate training, excessively high caseloads and levels of clinical risk, under-funding, poor commissioning, poor decision-making by management and all the rest.
What happened to staff who raised those issues? If you were only ignored you were one of the lucky ones! For others, including me, it was bullying, harassment, victimisation. This gives you a flavour of what can happen, even to consultant psychiatrists (note that in that link 3 of the 12 staff work for a MH trust), so what chance does a nurse stand? Hint – I left one job as a result of trying to get anyone to listen about poor staffing; I had another job “re-structured” away after years of arguing over inadequate staffing levels; I have seen many people moved out of their jobs, sidelined, bullied and the like. Essentially it is pretty much anything goes in order to shut people up and protect those on high, with ranks being closed, wagons circled, if anyone makes a complaint...And I did...
Did anyone in the media ever want to know about those things? No! They most certainly didn't, as per other posts here.
To cut a long story short, this sort of issue is very old. Clinicians have been pointing them out to management (and commissioners when ever we were actually allowed to talk to them) for donkey's years. They didn't want to know, politicians didn't want to know, the media didn't want to know.
I feel somewhat sick...