The NHS is set to take another major step towards improving patient access to mental health services with the introduction of five new waiting time guarantees.
The proposals could ensure that patients requiring urgent care will be seen by community mental health crisis teams within 24 hours of referral, with the most urgent getting help within four hours. Mental health liaison services for those who end up in A&E departments would also be rolled out to remaining sites across the country.
The NHS is consulting on the new standards, which have been piloted by mental health providers in collaboration with acute NHS trusts, and are backed by clinical and patient representatives.
Tracey Higgins & Elisabeth Svanholmer reflect on their own journeys and how they found roads to autonomy and fulfilment
Two lived experience perspectives on the challenges of hearing voices and other extreme states.
Our speakers will reflect on their own journeys and how they found roads to autonomy and fulfilment. They will consider their experience of ‘schizophrenia’, medication, hospitalisation and the ways they found to recover their lives.
Tracey Higgins, is the author of The Girl on the Bridge: A Memoir. (2021) ‘….an exquisite, sensitive, and painful rendition of a struggle against almost impossible odds’. Her experience shows us that ‘schizophrenia’ doesn’t have to be a life sentence. While some mental health professionals called her hopeless, she went to college, worked in Government, and owned and operated a popular restaurant. “
Elisabeth Svanholmer lives with experiences of hearing voices and identifies as highly sensitive. She is on an ongoing journey to figure out how to be human in a world that seems increasingly fragmented and dehumanising. She is based in West Yorkshire, UK and is a self-taught facilitator and organiser of training, supervision and other ways of people coming together to learn and connect. She is passionate about creating space for things that may be considered uncomfortable, strange, inconvenient, confusing and distressing. She finds inspiration and solace in nature, movement and relationships. See more about Elisabeth here
Organiser of Journeys of Hope And Freedom: A lived experience perspective CHARM Communities for Holistic Accessible Rights based Mental Health We are a campaign calling for changes in the way psychiatric services are provided in Greater Manchester. We’ve teamed up with people with lived experience, trade unions, family groups and citizens We are calling for a root and branch review and an action plan to transform mental health services in our communities.
The number of students registered with the Disability Advisory Support Service (DASS) for mental health issues has increased steadily from 2333 in 2018/19, but the number of students receiving at least one private counselling session with the University’s service has dropped by 10 per cent from 3266 to 2910, an FOI request reveals.
Students have reported struggling to access the service, with one* saying: “I called them multiple times, only to not get any answer or be told the week was already full and to try the week after”.
In response the University of Manchester spokesperson said, “For a period of time during lockdown and remote operation access to the appointment line became more difficult. In recognition of this … we have recruited 4 triage and support workers offering the first point of contact to all callers and introduced a new caller management system. This allows the appointment line to be available throughout the day and routine next day appointments are offered. Urgent and crisis queries will be offered same day support. In addition the duty counsellor responds to all email queries.”
But the University’s claims of a same-day booking service have reportedly led GPs and Community Mental Health Teams (CMHT) to rely on the University’s system, rather than offering external support to student patients.
The 25 workers, who are members of the public service union Unison, are campaigning against the proposals, warning that “seven days is not safe.”
Unison North West regional organiser Lyndsey Marchant said: “This group of dedicated mental health workers are determined to provide high-quality care to those who need it most.
“This is exactly why they have voiced their opposition to the trust’s flawed proposals, which would stretch an already overloaded service to breaking point.
“This group of NHS workers’ overwhelming vote in favour of strike action shows the strength of feeling on this issue.
“We call on the trust to listen to its front-line workers and return to the negotiating table with proposals that provide its hard-working staff with the resources to deliver excellent care.”
The workers said in a statement: “We work with extremely vulnerable people who have experienced a first episode of psychosis.
“We are telling the trust that the service is so overstretched that asking us to spread across seven days is not safe without additional staffing and resources.”
No dates have been set for strike action and Unison said that, following the vote, more talks with management are planned.
Juliette Tait, associate director of HR at the Trust, said: “Throughout the pandemic, we have been supporting the delivery of seven-day community services in Manchester to ensure that the right support is available at the right time for all who need it. We have received great support from our staff to enable this to be delivered safely and effectively.
“Patient safety is our number one priority. A seven-day community mental health service offer for Manchester is key to this, and directly responds to the dynamic needs of our service users, which occur on every day of the week. This is already successfully in place across our other localities and follows national guidance.
“Following implementation of seven-day working in our Manchester services, we have supported all our staff who were originally contracted to work over five days to remain doing so.
‘We have no intention of forcing any member of staff to change their working pattern unless they wish to do so on a voluntary basis to support their own personal flexible working needs.
“We continue to engage with our staff and their representatives in relation to this matter, and remain immensely proud of the service our staff provide.”
At a preliminary hearing today, senior coroner Joanne Kearsley revealed that the inquest would look at the treatment Zakari’s dad received from various agencies after his release from being sectioned.
Zak Bennett-Eko was sectioned in 2014 after suffering from cannabis-induced psychosis. He was discharged in 2016 and put on a community treatment order for six months.
That then ceased and the hearing was told that a number of services had involvement with Zak.
Among the agencies represented at today’s hearing were Pennine Care NHS Foundation Trust, Greater Manchester Mental Health Trust, Manchester City Council, North Manchester General Hospital, Manchester Clinical Commissioning Group and Bury Council.
Ms Kearsley said the inquest would look into Zak Bennett Eko’s care plan after the community treatment order ended and how agencies responded to his ‘medical and social needs’ following his release.
The inquest will also focus on the prescribing and monitoring of Bennett-Eko’s medication in the two years prior to his son’s death.
He was signed up to a GP practice in Fallowfield until 2018, although it is not yet clear who his GP was following that or which pharmacy he collected his prescription from.
The hearing was also told that Zak attended North Manchester General Hospital’s A&E department on six occasions in the five months prior to throwing his son in the river.
Four of the visits came in the fortnight prior to Zakari’s death – the last of which was three days beforehand.
Ms Kearsley requested statements from the healthcare staff who interacted with Mr Bennett-Eko while he was at hospital as well as from Greater Manchester Police, summarising their involvement with him.
She said the facility where Zak was confined had been contacted, but he was ‘not well enough and does not wish to engage’ with the inquest proceedings.
A further preliminary hearing will take place next month.
Sanm was discovered in a critical condition shortly later on Bank Farm Lane, about a mile-and-a-half from the hospital. Ambulance crews arrived quickly and started CPR and he was taken to the Royal Oldham Hospital but died three days later, on May 20.
Senior coroner for Manchester North Joanne Kearsley says Pennine Care NHS Foundation Trust, which runs Birch Hill Hospital, had already accepted a series of failures in the lead up to Sam’s death.
There was an absence of a risk management plan, and instead of just one member staff escorting him on a walk out of the hospital there should’ve been two.
There was a failure to liaise with his mother, Helen McHale, despite concerns raised by her at the risk to his safety following the death in the previous January of his younger brother Matthew.
When Sam left the facility, the carer should’ve had either a phone or radio to maintain contact with the hospital in case of an abscondment.
Although earlier complaints in 2018 by Helen over the care Sam was receiving were investigated and recommendations for improvements were made, they were not put into effect, Ms Kearsely was told by Clare Parker, the trust’s executive director of quality, nursing and healthcare professionals and deputy chief executive.
Ms Parker opened her evidence by saying: “I want to apologise to Sam’s family for the failings we have found in the investigation by Pennine Care. We have accepted six areas that at the time where there were failures and as a result of Sam’s case we’ve made amendments to our policies.”
Ms Parker said the quality of the nursing reports about Sam’s care – a key component informing how his nursing needs would be met – were ‘not of the standard the trust expected’.
Helen complained about a lack of communication between herself and the team caring for staff, and although it was recommended this would improve, it was not acted upon.
She also objected to the withdrawal of a ‘named nurse’ – a designated nurse who the family could liaise with. A named nurse is now part of the provision, Ms Parker said.
Helen earlier told the inquest Sam had been seriously injured in 2016 when he threw himself in front of a train and, as a result, had been detained in a psychiatric intensive care unit before being transferred to Prospect Place. He was diagnosed with paranoid schizophrenia in 2017.
She said she believed medical staff were consistently ‘under-estimating the risk’ to her son.
“I was worried about how distressed he was, but I was also worried about him going out and the safety of the public,” she said.
“We agreed to weekly calls from the medical team, but they weren’t calling me. He didn’t take a shower in 2019, and his carers weren’t communicating with me. It was like talking to someone who doesn’t want to listen.”
The court heard that Mr Rice’s family believed he may have had ADHD, and he was tested for it last year, but never had the result before his death.
A statement from his GP confirmed that Mr Rice had been referred to mental health services in November 2018 and reported the same issue again in May 2019.
He was prescribed medication last year, and this was believed to be working until earlier this year, when Mr Rice attended A&E on February 24.
Mr Rice was seen by Florence Makurira, who works in the mental health liaison team at Fairfield Hospital.
She told court that he had walked out on her during his assessment, before returning with his partner and talking about resolving ‘anger management issues’.
Mr Rice complained to his GP about his medication not working in April, and the dosage was increased, before raising the issue a month later when the prescription was switched.
He attended A&E twice in three days in May for injuries, before returning on May 17 after attempting an overdose.
Mr Rice’s father took him to hospital and told both the receptionist and a triage nurse that he believed his son should be sectioned under the Mental Health Act, the court heard.
His dad stayed with him for five hours before leaving Mr Rice at the hospital, where he was again assessed by Ms Makurira.
She told court he was displaying a ‘fleeting suicidal ideation’ but had no signs of psychosis or acute depression, and was able to make his own decisions.
Ms Makurira said Mr Rice was deemed low risk to himself or others, and claimed he appeared ‘tranquil’.
He was referred to a remote mental health service set up during the pandemic and told to expect a call within 24 hours – which was an assessment Mr Rice agreed with, Ms Makurira said.
Gordon Rice, alongside Mr Rice’s mother and grandmother who were also in attendance, shook their heads at Ms Makurira’s testimony and expressed their disbelief that he had been allowed to leave hospital so soon.
He said: “I told both of them – the receptionist and triage – that he wanted to die.
“And then within 30 minutes of me leaving hospital, he was sent home.”
Ms Makurira added: “There were no grounds to keep him in hospital. He did not meet the criteria of being in hospital.”
Margaret O’Neil, head of quality for mental health services in Bury at Pennine Care, conducted a review of Mr Rice’s case at Fairfield Hospital and found the trust’s response to have been ‘appropriate’.
She told the court that in February, Mr Rice had denied he had been self-harming and said his main issue was anger management, and said that on May 17 there were ‘no concerns with Jim’s capacity’.
She added: “There were no identified concerns [with the hospital’s actions]. The actions taken were in line with the expected standards.”
The Bolton inquest was told Alex had been diagnosed with an emotionally unstable personality disorder shortly after being admitted as a voluntary inpatient to North Manchester General Hospital’s Safire unit on November 24 following multiple suicide attempts.
The warehouse worker had been a cannabis and cocaine user over a period of five years.
Alex told staff that he heard a voice in his head telling him to kill himself, and his father raised concerns of a similar nature if he was discharged.
Alex had repeatedly told staff that he would kill himself, the hearing was told.
Despite this, assistant coroner Catherine Cundy heard that Alex was discharged without his family being told on November 28.
Within hours, Alex was admitted to the Eagleton Ward after council staff called an ambulance due to concerns that Alex would take his own life.
At the beginning of the two-week inquest at Bolton Coroner’s Court, Ms Cundy read out a series of failings admitted by Greater Manchester Mental Health NHS Foundation Trust (GMMH), including that there had been ‘a failure to formulate a comprehensive discharge care plan for Mr Turner’s discharge from SAFIRE Unit’ and ‘a failure to fully involve and engage Mr Turner’s father in the discharge’.
During his time on Eagleton Ward, Alex reported suicidal thoughts. On December 2, he told a consultant psychiatrist that he was hearing a voice in his head telling him ‘to go to the bridge’ and that ‘he was going to throw himself into a train but his girlfriend asked him not to’. Later that day, he told a nurse that he had ‘tried to jump off a bridge’ but had been stopped by his girlfriend.
According to medical records read out at the inquest, during a two-hour appointment with a student nurse on December 5 Alex ‘reported that he had suicidal ideation and he wanted to be put on a section as he was unable to keep himself safe in the community’. The court heard he became distressed and shouted that the devil was telling him to kill himself.
The inquest heard that GMMH telephoned Greater Manchester Police (GMP) shortly after midnight on December 6 when Alex failed to return to the ward.
Despite staff telling GMP that Alex, of Cross Kings Drive, Whittle le Woods, had previously attempted to climb over the Stott Lane railway bridge, it was not until 3.45am that GMP contacted British Transport Police (BTP).
A GMP search coordinator told the court that he expected that his colleagues would ask BTP to search the tracks within a 300 metre radius of the ward, which included the tracks under the Stott Lane bridge, but no such request was made.
The court heard that the BTP control room breached its own procedures by failing to ask what GMP wanted them to do, before grading the call as low risk requiring no further action. Shortly after 5am Alex’s body was found on train tracks under the Stott Lane bridge.
The inquest was told Mr Schofield suffered from a recurrent depressive order and had been taking anti-depressant medication for many years.
He had been trying to reduce his dosage, but was experiencing discontinuation syndrome and had a mental health crisis on August 6, 2019.
Mr Schofield was admitted to Safire Ward at at North Manchester General Hospital on August 8, having been to A&E two days expressing suicidal thoughts.
There was also a family history of suicide, the court heard.
While at Park House, Mr Schofield expressed suicidal thoughts on several occasions, but ‘disclosed no current plan or intent’.
The inquest was told that before he was discharged a comprehensive suicide and self-harm risk assessment was not completed by a member of inpatient staff who had ‘full knowledge of his condition and future care plan’.
On August 22, Mr Schofield attended A&E and reported that he had attempted to end his life the night before.
He said he bought drugs with the intention of killing himself.
Mr Schofield subsequently had several contacts with the HBTT, the last of which was on August 26.
When asked about the drugs, he said he had received them, but thrown them away.
He was found dead on August 27 at home having taken an overdose.
Mr Meadows raised concerns, including:
That there was no thorough comprehensive risk review undertaken by a member of staff who had detailed knowledge of the deceased prior to Mr Schofield being discharge from the inpatient unit. This was not identified before he left the ward and it was not discovered by the HBTT when they took over his care.
That the transfer and communication process from inpatient care to the HBTT appeared inadequate.
That there was no clear plan to deal with the risk of Mr Schofield’s condition deteriorating and him experiencing significantly more suicidal thoughts as well as obtaining the means by which to kill himself. Mr Meadows says in his report: “It is well known that a history of suicidal thoughts and actions increases the risk when they are repeated.”
That when Mr Schofield said that he bought drugs, there was no risk review planning involving a senior HBTT clinician, which was then monitored even when he indicated he had received them.
That on several occasions before he died, Mr Schofield saw members of the HBTT, but they failed to demonstrate professional curiosity and enquire about his suicidal thoughts and plans.
That there were a number of missed opportunities for the HBTT to assess changes in his presentation and risk profile.
That there was no robust audit system for checking compliance with the trust’s own policies and protocols, in particular with regard to medical record keeping, risk assessments and reviews.
That the trust’s own investigation report contained several factual errors and misinterpretations and it was only discovered at the inquest hearing that one of the last members of HBBT staff to see the deceased had given an account that was not the same as given to their line manager. There was inadequate overview of the report before it was signed off, Mr Meadows said.
The report, published on October 25, found that emergency medications were out of date, prescription charts were not completed correctly and staff gave patients medication without waiting the required time between doses.
It also found bugs in light fittings in the corridors, a ripped mattress being used as a crash mat and a pair of garden shears that had been left in a box that patients could easily access.
But the hospital was still rated ‘Good’ in the effectiveness, caring, and responsive aspects of its care
The independent hospital, managed by Making Space, had also been visited by inspectors from the CQC in February and was urged to take immediate action following their findings.
The service, which cared for 16 patients at the time of inspection, was placed under special measures and kept under review.
It was found to have a poor ‘track record on safety’ and failed to address various environmental risks.
This included finding broken door handles, holes in bedroom walls and potential ligature anchor points that had not been recognised.
Following its most recent inspection, chiefs told the home it must remain under special measures and make urgent changes or it could risk being closed down.
nspectors said: “An external audit completed in March 2021 had recognised many of the issues we found at our inspection in August however, these had not been acted upon sufficiently.
“We found emergency medicines which were out of date, prescription charts not completed correctly and staff giving patients medication without waiting the required time between doses as instructed on the prescription charts.
“Despite an improvement in the environment from our last inspection, we found that new environmental issues had not always been picked up on or acted on following identification in internal audits.
“These included bugs in the light fittings on the corridors, a ripped mattress being used as a crash mat and garden shears in a box in the garden that patients could easily access.
“Our findings from the safe key questions demonstrated that governance processes did not operate effectively at team level.
“Audits did not identify all new issues and managers did not make all the necessary improvements to keep patients safe.”
The home will now remain under review and has been given changes that must be made before the next inspection – including ensuring that qualified staff are competent to carry out their roles, especially in relation to dispensing medicines.