The ugly truth about psychiatric care

Published by The i paper (15th November, 2021)

It is more than three years since I wrote an angry piece in this publication telling the tale of a teenager called Beth. She was stuck on her own in a cell furnished with just a chair and foam mattress, rarely permitted outside and fed through a hatch like a dangerous animal. Sometimes a television was wheeled outside a glass window for her to watch. When her father Jeremy visited, he had to kneel to speak with his daughter through a metal hatch. He told me how distressing it was to walk down a corridor filled with similar rooms, comparing it to that famous scene in The Silence of the Lambs when an FBI agent goes to see the serial killer Hannibal Lecter.

Beth was not a criminal, let alone a murderer, despite being locked up for more than two years. She was a woman of 17, on the cusp of adulthood, detained in such repressive conditions because she was an autistic human being who struggled with stress in a society that so often seems indifferent to the plight of such people. As I wrote at the time, “like scores of others, she has been left to rot by an inadequate health service while politicians break promises to help and bureaucrats bicker over funding people in dire need.”

The case caused an outcry. Since then, there have been a string of inquiries into the imprisonment of thousands of people with autism and learning disabilities, held in barbaric and often abusive conditions due to a dearth of community support. It is widely recognised that this darkness buried deep in the heart of the National Health Service is shameful; such “treatment” tends to intensify stresses rather than help people. The average length of detention is six years, although one man has been held almost two decades. No wonder MPs on the Health and Social Care Committee concluded that the failure to fix this sordid issue was an affront to civilised society.

Those MPs – shocked by harrowing stories they heard – were right. They called for action to end the “intolerable treatment” at inpatient facilities, with abusive restrictive practices and people held far from family and friends. This scandal casts harsh light on a country that claims to embrace diversity but persistently ignores the plight of this abused minority. It is a saga of pitiful care and political failure, exploited by appalling private providers who pay frontline staff a pittance. Yet it also exposes the harsh truth about a society that talks of mental health and human rights but ignores the ugliness of a psychiatric system reliant on restraint, sedation and segregation.

So why does nothing happen? Perhaps the answer can be seen with St Andrew’s Healthcare, the nation’s biggest provider of specialist mental healthcare. It cares for up to 750 men, women and children with complex conditions in four locations, almost all placed in its care by the NHS. This work is so lucrative it was able to spend £45m building the biggest adolescent unit in Europe. Although a charity, its latest annual accounts show 68 staff on six-figure salaries in 2020 – six more than in 2019 – with two pocketing at least £330,000 a year.

Yet this charity has been accused of “repeated and systemic failings” by the Care Quality Commission. Its specialist provision for adolescents was placed in special measures two years ago, followed by its women’s services last year. Last week the watchdog issued more damning reports into an institution bedevilled by inadequate management, staff shortages and unsafe care. Inspectors found staff at its Northampton headquarters fell asleep on observation duties, food was sometimes mouldy, activities and therapies were cancelled due to lack of staff. Admission of men and women to wards for adults with learning disabilities and female patients to the forensic, long-stay rehabilitation wards was barred without the CQC’s permission.

But this is, sadly, just another slap on the wrist. St Andrews has vowed to improve. Again. Just as it has done so often over the past three years. Northampton, its largest centre, was the place that held Beth. One whistleblower told me of a child held there at the age of 11. Since October 2018, there have been four other CQC reports flagging up safety and staffing concerns on these “inadequate” women’s services. There has been criticism of the leadership, patients left “at risk of continuing harm”, people complaining there was not enough food for them despite taxpayers spending thousands of pounds a week for their supposed treatment.

Bear in mind these are facilities for people in need of profound support. No wonder the latest chief executive has stood down. Yet the complacency of doctors that sanction these services, politicians that do nothing to stop the scandal, local commissioners that send people into hellholes and a watchdog that lacks sufficient bite to shut them down is depressing. Incredibly, St Andrews has even been given extra powers over local services through new “Provider Collaboratives”. “It is like some kind of Orwellian nightmare that these organisations have responsibility for commissioning new mental health services in their area,” said one insider.

The Government is again promising action but offers a pathetic plan that tinkers at the edges, lacks sufficient funding and fails to empower patients, families or staff. Beth, who now lives contentedly in her own flat as she nears her 21st birthday, shows what can be done with the correct community support. Yet perhaps the most disturbing words that keep coming through these wretched reports into St Andrews are the revelations that people are denied dignity, that patients are often not treated with “compassion and kindness”.

Human error is forgivable, but not a lack of respect for fellow human beings in places of supposed sanctuary. And here lies the problem that plagues our society, a glimpse of the prevalent attitudes towards a minority that allows this scandal to drag on as it wrecks thousands more lives each year.

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