New Research Findings: Tapering Antipsychotic Treatment May Minimise Risk of Relapse: An historic breakthrough?

See article in the The Metro, 23rd March 2021 below:

We already knew this from our Taking Care of Medication Expert Group but it’s great to see that the renown psychiatrist Professor Robin Murray and colleagues now agree with us. We hope the leaders of our psychiatric services in Greater Manchester will read this and will act on the recommendations. We would be very happy to help the services make this happen in Manchester.

The report says:

“The process of stopping antipsychotics may be causally related to relapse, potentially linked to neuro-adaptations that persist after cessation, including dopaminergic hypersensitivity (check below for what this means) Therefore, the risk of relapse on cessation of antipsychotics may be minimized by more gradual tapering. There is converging evidence that suggests that adaptations to antipsychotic exposure can persist for months or years after stopping the medication”

(Note we think this is the same as dopamine super-sensitivity psychosis, a term used in psychiatry to explain the phenomenon in which psychosis (e.g. hearing voices and seeing things that other people do not see or hear) occurs despite treatment with escalating doses of antipsychotics.)

See full research article: Mark Abie Horowitz, Sameer Jauhar, Sridhar Natesan, Robin M Murray, David Taylor, A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of RelapseSchizophrenia Bulletin, 2021 here.

End the Crisis in Greater Manchester Mental Health services

Members of Unison have launched a petition to demand change in Mental Health Services in Manchester. Please share with friends, colleagues and family.  

Read and sign the petition here

All too frequent headline deaths of people waiting for or under mental health care in Greater Manchester reveal the same story of inadequate underfunded services:
 

  • People with serious problems on long waiting lists for care
  • Staff with caseloads so high people are often not seen for months
  • High staff turnover and sickness absence due to stress.
  • The majority of people in services don’t recover as there is little or often no access to therapy
  • Devastated families often unsupported
  • An over reliance on medications with dangerous side effects
  • Institutional racism leading to excessive custodial detention and restraint of black  and ethnic service users
  • Discharge of vulnerable people to unsafe or homeless conditions
  • Unaccountable services 
     

Now staff organizations, service users, families and  friends have come together to  speak out, support all staff action for better services  and demand that, Matt Hancock, Minister for Health  (matt.hancock.mp@parliament.uk) Andy Burnham Mayor of Greater Manchester (the.mayor@greatermanchester-ca.gov.uk) Neil Thwaite CEO of Greater Manchester Mental  Health  NHs Trust  (neil.thwaite@gmmh.Nhs.uk), Claire Malloy CEO Pennine Care NHS Trust (ceo-penninecare@nhs.net), take action:
 

  • Double the funding to mental health services for people with serious conditions to ensure parity with physical health services
  • Ensure caseload sizes are always within guidelines from national institute for health and care excellence 25 and 12 for early intervention and assertive outreach
  • Guarantee access to psychology, occupational, art and other therapies
  • Guarantee that discharge from community services only occurs with adequate housing and a package for full social inclusion.
  • Create humane and local therapeutic environments that promote healing when needed
  • Guarantee the human right to a home, education and employment for all service-users.
  • Establish clinics to safely support people who wish change, reduce or withdraw from psychiatric medication.
  • Establish a public inquiry into the practices of mental health services, including institutional racism, informed by independent experts, service users and their families.

Greater Manchester Community Mental Health Transformation

February 2021, The NHS Community Mental Health Framework for Adults and Older Adults Plan for Greater Manchest

The first draft of the prospectus for the Mental Health Framework transformation has been completed by the Greater Manchester Health & Social Care Partnership and Innovation Unit, and you can read it by clicking below:

Across Greater Manchester Mental Health services claim they will be taking a “place based approach” that enables them to:

● Better understand and respond to local demographics

● Address health inequalities and the social determinants of mental ill health at an earlier stage

● Prevent and delay the need for crisis care or risk support

● Engage in meaningful co-production and co-design.

They hope to improve the quality of person centred care by developing their multi-agency team working: with a shared practice model that is strengths based, trauma informed and solutions focused; increased access to evidence based psychological therapies, social support and community connections; and ensuring the of our wellbeing of their staff, processes and systems.

They say the service model is designed to meet the dynamically changing needs of adults and older adults with serious mental illness, and those with very complex needs but who may not currently meet the thresholds for secondary care services.

They further claim that this programme provides a unique opportunity to invest in primary care, social care and VCSE provision as areas where there has been historic under-development.

See the plans here:

GMMHT publishes proposed Clinical Model for Inpatient Care in the New Park House Psychiatric Hospital

This describes the care a patient can expect during an admission to the in-patient unit.

We will be responding to the proposed plan and would appreciate your views.

It is written in technical, professional language and that can make it off putting to read.

It describes the values underpinning the service, and claims to provide clarity about who the service is for, as well as confirming the place of in-patient services within the whole clinical pathway.

The model also describes the service “offer”, the key care principles beneath it, and the interventions which are available.

This is a more accessible description of the project by Greater Manchester Mental Health Trust published last year. Go here

Should you have any questions about New Park House, you can email them to nmredevelopment@mft.nhs.uk.

You can also contact them on 0161 276 1234.

Or you can write to them at North Manchester General Hospital Redevelopment Project, Estates Office, Manchester University NHS Foundation Trust, Cobbett House, Oxford Road, Manchester M13 9WL.

CHARM Meeting Tuesday 16th March

We are a campaign calling for transformative changes in the way psychiatric services are provided in Greater Manchester. 

We are a campaign calling for transformative changes in the way psychiatric services are provided in Greater Manchester. 

We’ve teamed up with people with lived experience, family groups, trade unions and citizens calling for a root and branch review and an action plan to transform mental health services in Greater Manchester.

Can you help?

Find out more at our next CHARM meeting on Tuesday 16 March at 6.30. Zoom Meet

Agenda will include:

6.30-7pm Tom Reynard from the Independent mental Health Network will introduce us to what IMHN do and answer questions
7pm onwards

1. response to the circulation of information regarding the clinical care model for Park house.  Clinical model document attached and draft response (to be presented)

2. Planning our own public meeting to debate Park house clinical model with emphasis on co-creation, trauma informed care and thee continuation of the medical model (Eg ECT and the emphasis on medication).

3. update on Unison campaign

4. Our fledgling website

Any other agenda items – please let me know.
Join Zoom Meeting 
https://shu.zoom.us/j/4232242863
Meeting ID: 423 224 2863 

See Recent MEN Coverage

Desperate families, staff shortages and surging lockdown demand – inside Greater Manchester’s mental health care crisis

Anandi

Pennine Care NHS Foundation Trust slammed after popular young artist survived jump from car park but killed himself in hospital

Inquest finds that a lack of communication between mental health teams, particularly after Ashley’s most recent admission, had partly contributed to his death.

The jury found that the process of discharging him from the Rochdale hospital had been ‘wholly insufficient’ and that there had been a lack of documentation relating to his condition for medics to use.

They also concluded that the ‘communication and handover documentation was fundamentally flawed’, and that this needed to be improved.

A jury has found mental services were ‘fundamentally flawed’ in their handling of a beloved son and brother who killed himself in a hospital ward.

Ashworth had been admitted to hospital and underwent months of treatment after he jumped from the Arndale Shopping Centre car park and survived, an inquest at Rochdale Coroners Court has heard.

The 34-year-old spent eight years battling his ‘plummeting’ mental health – which came on ‘without any signs’ while in his mid-20s, his family said.

Ashley was diagnosed with paranoid schizophrenia.

Ashley was admitted to Stepping Hill before being transferred to Birch Hill and placed on a psychiatric intensive care unit on January 8, 2018.

He was released on February 1 – in a move that ‘surprised’ his family.

“They need the bed, can you pick me up,” Ashley texted his dad, heard the court.

The family say they never heard from the hospital about his discharge.

After spending a few weeks with his parents and brother, on February 18, 2018, Ashley was rushed to hospital with ‘catastrophic injuries’ after ‘jumping from the Arndale shopping centre car park.

He was found with serious wounds but miraculously survived and, after multiple operations, was beginning to regain his physical health.

However, while he was being treated at Salford Royal Hospital, he made an attempt at hanging himself, the inquest heard.

Later, he was moved to a psychiatric unit at Fairfield Hospital but sadly on February 10, 2019 – less than a year after falling from the car park – he was found dead in his room.

Ashley’s medical cause of death was found to be hanging, according to the pathologist that conducted a post mortem examination.

Ashley’s family has criticised the mental health care their loved one received, saying that health care teams were ‘reactive instead of proactive’ and had a habit of ‘only intervening at the point they have to’

Brother Christopher also raised concerns that Ashley’s care ‘was too clinical’, adding that he felt medics ‘did not take the time to get to know’ their patient.

Nicola Kidd, manager of the North Ward at Fairfield General, refuted the claim. She said that staff at the unit in Fairfield attempted to get to know Ashley by ‘engaging with his musical interests’, watching videos of him playing guitar which he had uploaded to YouTube.

Trying to develop a relationship with Ashley was difficult, however, as he remained detached from other people due to his mental health condition, said the manager.

But, following jury deliberations, the inquest found that a lack of communication between mental health teams, particularly after Ashley’s most recent admission to Birch Hill, had partly contributed to his death.

The jury found that the process of discharging him from the Rochdale hospital had been ‘wholly insufficient’ and that there had been a lack of documentation relating to his condition for medics to use.

They also concluded that the ‘communication and handover documentation was fundamentally flawed’, and that this needed to be improved.

After hearing the evidence, the jury concluded that Ashley’s death was the result of suicide.

Coroner Lisa Judge said that she would likely have issued recommendations for change within the mental health services that cared for the young artist, but staff within the hospital had already undertaken a review and made changes.

“What is apparent is that, as a result of the root cause investigation, a formal document was prepared with recommendations that the authors had and all of those recommendations have been taken forward by the trust,” the coroner said.

See full article here

Source: Manchester Evening News, 11th March 2021

Welcome to CHARM

CHARM, the Community for Holistic, Accessible, Rights Based Mental Health was launched by The Organic Recovery Learning Community in September 2020  

We are a campaign calling for radical changes in the way psychiatric services are provided in Manchester.

We’ve teamed up with people with lived experience, trade unions, family groups and citizens to challenge the Greater Manchester Mental Health Trust decisions to build a large psychiatric hospital in Crumpsall. 

The campaign was launched after we wrote a letter to Andy Burnham to meeting discuss the future of mental health services in July 2020. We’ve now met with Andy twice and we are seeking his support for a root and branch review and an action plan to transform mental health services.

 In our experience Manchester’s mental health services have been constructed around biological understandings of illness for far too long. The best efforts of our mental health workers and services are compromised by the narrow focus on illnesses and medical responses of our crisis services. 

This mindset eclipses the significance of social determinants on peoples’ lives. It places the emphasis on disease processes rather than racism; social-economic adversity; people fleeing persecution; homelessness and poor housing; adverse childhood events; trauma; oppression; micro-aggressions; toxic situations and relationships. 

These we know are amongst the most significant contributors to undermining our well-being and resilience, leading to poor mental health. 

This is what needs to be addressed.

Melanie Hogben fell to her death from Arndale car park after battling mental health issues, inquest hears

Melanie, who leaves behind a son and a daughter, had been struggling with mental health issues for several years.

She was sectioned under the Mental Health Act just months before her death after battling Schizoaffective disorder.

An inquest into her death at Manchester Coroners’ Court heard she was discharged from a mental health unit in June 2018.

She had regular visits from a care coordinator until the beginning of August, but wasn’t then seen or contacted by any mental health professionals until October 18.

Melanie took her life just over two weeks later.

Melanie was admitted to the Moorside Unit at Trafford General Hospital, which is run by the Greater Manchester Mental Health NHS Foundation Trust, on March 9, 2018.

During her admission, a consultant psychiatrist changed her medication to a depot injection for two weeks to ‘improve her symptoms’, the inquest heard.

Her partner Tony said they were ‘concerned’ by the injection because of the side effects she suffered.

By the time Melanie was discharged on June 13, her condition had improved and she was put back on her previous anti-psychotic medication.

She was seen by a psychiatrist on July 12, who recorded that Melanie’s condition was stable.

Melanie was then seen regularly by her care coordinator until August 3.

That care coordinator went off sick before leaving her position, the inquest heard.

But despite being classed as ‘high-priority’ after being sectioned, Melanie wasn’t given a new care coordinator until August 22.

Her new coordinator Wilma Martin-Lawrence told the inquest she was on a two-week holiday at the time Melanie was added to her case load of 28 service users.

The inquest also heard how she was unable to work in her capacity as care coordinator on 21 out of 43 days at that time due to other professional commitments.

Ms Martin-Lawrence was unable to make contact with Melanie until the beginning of October after she had contacted mental health services to ask who her care coordinator was.

She met Melanie during an appointment with psychiatrist Dr William Davis on October 18.

At this appointment, Melanie said she wasn’t feeling paranoid, had no problems with her medication and was not having suicidal thoughts.

Her care coordinator arranged a home visit with her on November 9, but she sadly died before this could take place.

Melanie’s partner Tony told the inquest she ‘gave off the impression that she was doing well’ after being discharged from hospital.

“Melanie did not like being in hospital so obviously the two or three times that they came after she was discharged she would have said that she was doing well because she did not want to go back there,” he said.

A serious incident review was carried out by the Greater Manchester Mental Health NHS Foundation Trust.

It showed that there were ‘significant staffing issues’ at the time of Melanie’s death.

Daniel Cottam, operational manager for mental health services in central Manchester, told the inquest the team ‘was under significant pressure at the time’.

Full story here

Source: Manchester Evening News, 3rd February 2021

Increasing numbers of mental health patients are being ‘dumped’ on their GP and discharged from psychiatric care, damning report says

People with severe mental health conditions are being discharged by psychiatrists and ‘dumped’ on their local GP in Manchester, report has revealed.

One person said: “There is a rolling back of adult mental health services for those of us with severe enduring diagnoses who need ongoing support.

“The medical model has been superseded by the recovery model which is all about how we live best with our illnesses, but the recovery model is being used in a way that is destroying quality of life for most service users.

The Greater Manchester Mental Health Trust did not wish to respond to the findings of the report.

The approach in mental health services, known as ‘stepping down’, has been criticised by service users in a new report published by charity Manchester MIND.

Historically, people with ‘severe and enduring’ mental health needs, including those with conditions such as schizophrenia, have been treated in the long-term by mental health professionals.

But the report says that an increasing number of such patients are being handed over to the care of their GP.

“It has become apparent that this change in service provision is not working either for the individuals who need to access it or the professionals who deliver it,” the MIND report states.

“The perception was that people with complex and chronic disabilities are ‘dumped’ on GPs, many of whom ‘lack the capacity and willingness to understand’ how to manage their care.”

Researchers spoke to around 30 mental health service users about their experience of being discharged, as well as the voluntary and community group workers supporting those who have been ‘stepped down’.

Many people said they were not involved with the decision to be discharged, while some were completely unaware they’d been stepped down.

Researchers said there was ‘obvious confusion’ among patients being discharged, sometimes with a ‘harshness in the delivery’ and a ‘lack of concern’ for the person’s expressed fears.

The report said: “The majority, however, were shocked, puzzled and angry at their treatment, they were not listened to, got little or no information, were not involved in the decision, felt let down and abandoned.”  

Many felt they were discharged for non-medical reasons, including missed appointments, using the service for too long and insufficient resources.

Some said a shift in treatment has had a detrimental impact on their lives.

One person said: “There is a rolling back of adult mental health services for those of us with severe enduring diagnoses who need ongoing support.

“The medical model has been superseded by the recovery model which is all about how we live best with our illnesses, but the recovery model is being used in a way that is destroying quality of life for most service users.

“We can’t live full lives because we are terrified of becoming ill as we don’t know what we will do on our own.”

Many complained of losing benefits, housing and community support as a result of being stepped-down.

The report said when people are discharged, there can be an assumption they are ‘recovered’ and are therefore no longer entitled to benfits.

This can be further exacerbated because they no longer have access to supporting medical evidence from a psychiatrist or care co-ordinator.

Paul Reed, mental health campaigner and chair of the Manchester User’s Network, described the report as ‘damning’.

“I’ve never seen so many patients upset,” he said.

“It’s a damning report which shows that something needs to be done.

“These poor people are being stepped down and losing their benefits.

“They are doing it dangerously when they know patients are at risk.

“Nurses are fed up at not being able to do their job.”

The Greater Manchester Mental Health Trust did not wish to respond to the findings of the report.

It described stepping down as a ‘vital part of recovery’.

A spokesperson for the trust said: “Stepping down – the process by which an individual is discharged from specialist mental health services and returns to primary care  – is a vital part of recovery.  

“Specialist mental health teams are there to offer care for people who are suffering from a range of mental illness and when they respond to the team’s interventions, it is a positive step for them to step-down from our services and return to the care of their GP and primary care services.

“Step-down decisions are based in evidence and what is of most clinical benefit to the individual.”

The trust was recently rated as ‘good’ by the Care Quality Commission (CQC) but told it must make safety improvements.

See full article here

Source: Manchester Evening News, 18th February 2020

CHARM Demands

We have established CHARM, following the concerns that we raised about the lack of meaningful consultation and co production that took place regarding the redevelopment of Park House as a single site psychiatric hospital.

We have analysed the situation in Greater Manchester and reflected on the policy changes that are currently being addressed by the Department of Health (The Community Mental Health Framework for Adults and Older Adults; the new Mental Health Bill 2022; and the Long Term NHS Plan).

Our demands are not new ones. Many of these demands for justice and rights were made in the 1980s, we know because many of us were there. Nearly 30 years later, how much longer must we wait for change?

Our demands are based on our own strong value base that holds human rights and justice as the essential components of any health and social care system.

Read our demands here.