The Crisis in Manchester’s Mental Health Services: How do we do it better?

18.30 12th May 2021 Zoom Meeting

A Conversation and Discussion

Mental Health Services in Manchester are being overwhelmed by the level of need.

Can’t get the support you need? It’s time for us to get together and say what’s needed.

As the crisis in community care has increased so have hospital admissions. This is a consequence of a lack of resources combined with resistance to thinking beyond the outmoded medical model of care based around the psychiatric hospital.

The discussion is always about the lack of “beds”. We say we don’t need more beds, we need better community support and care for people in crisis.

Panel

Dr Gail Coleman Oluwabusola (Chair)

Paul Baker, CHARM

Anandi Ramamurthy, CHARM

Claire Miller, Unison Representative

Amy Wells, National Survivor User Network

Mary Patel, Family member

Jeff Evans, Mental Health Campaigner

Simon Smith, family member

Come and listen to our speakers and take part in a discussion to identify ways forward.

Let us know you will be attending here

Manchester Crisis in Mental Health Zoom Meeting or join us directly on the night
here (Meeting ID: 876 2857 9841)

There will be plenty of time for questions and points of view. 

We will also be launching our  CHARM Demands (click on link) that you can find on our new website.

This event has been organised by CHARM (Communities For Holistic, Accessible, Rights based Mental Health).  We’ve teamed up with people with lived experience, trade unions, family groups and citizens calling for changes in the way psychiatric services are provided in Manchester. 

See more about us here.

We hope the meeting will be a great opportunity to develop our ideas and approaches.

See you there!




Mental health crisis: How a new approach to care could help the NHS

“In Home Group, working in a psychologically informed way is one of the fundamental principles of our LIFE support practice model. It is central to how we support our customers in that we seek to understand what has happened in their lives up to that point in order to develop how we support them most effectively.

“Mental health services have historically been based on a medical model where diagnosis is the focal point. Working psychologically helps avoid the stigmatisation and labelling that can arise from a diagnosis driven approach and looks at what has happened rather than what is wrong with individuals.

“Our customers have often experienced trauma and many other difficulties in their lives. Having support teams that understand the impact of trauma, are empathic and supportive of customers regarding such experiences, helps prevents re-traumatisation and leads to much better outcomes for all.”

Interesting article from the National Health Executive website from November 2020 about Home Group who run Beech Range, a mental health step down service providing homes and care for up to eight people over a 12-week period, and is being piloted by Greater Manchester Mental Health Trust (GMMH) to help reduce the need for out of area placements (OAPs).

Beech Range is a Mental Health Step Downservice delivered by Home Group in partnership with Greater Manchester Mental Health Foundation Trust (GMMH). The service was introduced in July 2018 to provide a community based short stay of up to 12-weeks. giving an alternative and less restrictive environment for customers who are medically optimised but not yet able to go home.

The service description says it is a “CQC registered service forms a critical part of the acute care pathway whilst increasing capacity and flow within Manchester’s acute wards and reducing the need for an out of area placement.”

The article claims that as well as improving bed flow and patient outcomes, figures produced by GMMH show that Beech Range has the potential to achieve an annual saving of £1.27m for the NHS in Greater Manchester, compared to the independent sector’s average nightly bed rates, and £738,000 compared to GMMH’s own nightly average.

They say with this pioneering service is proving its value to both commissioners and customers, Home Group are now expanding the model further, both in Greater Manchester and across England, in order to support bed flow in the NHS and reduce the reliance on out of area placements.

See article from the National Health Executive Website here

Any feedback about Beech Range you’d like to share?

Greater Manchester Mental Health Trust uses Electro-convulsive Therapy at one of highest levels in country: We call for review

We call on Greater Manchester Mental Health Commissioners to urgently review this treatment and provide alternative support for people previously administered ECT.

We call on GMMHT to suspend the treatment and to explain the huge difference in usage compared with our neighbouring Trust, Mersey Care.

We call on on the Mayor of Greater Manchester to call a halt to this practice and to support the national campaign for a review of ECT

CHARM Communities for Holistic Accessible Rights based Mental Health

Findings from an audit published last week shows that Manchester has the 4th highest rate per capita for administering electroconvulsive shocks in the country.

This shocking statistic means Manchester’s rate of administering ECT is 8.7 per 100,000. This is way above the national average of 5.4.

This is 43 times greater than the lowest Trust, our neighbouring Trust, MerseyCare.

Or to put it another way, for every one person receiving ECT in Liverpool, 43 people receive it in Greater Manchester.

ECT involves an electrical current being passed through the brain under anaesthetic to trigger seizures. Mostly administered to older women. The Greater Manchester Mental Health Trust claims Electroconvulsive Therapy is an effective and essential treatment and they plan to further develop this service in the new Park House Psychiatric Hospital in North Manchester.

The audit throws considerable doubt on the wisdom of this decision. In 2019 the authors of the ECT audit contacted 56 Mental Health trusts in England (using Freedom of Information Act requests) and asked whether they were following NICE guidelines about ECT being a treatment of last resort. They were also asked about other things such as how they were monitoring for signs of progress, brain damage and cognitive dysfunction. 57% of NHS Trusts replied.

The audit discovered ECT is a dwindling treatment. However, it also found that there is a 47-fold difference between the Trusts with the highest and lowest usage rates per capita and the highest rates of usage are in the North West of England.

The research has also revealed that there is no regulatory authority responsible for ECT safety and monitoring its appropriate use.

We know GMMHT responded to this Freedom of Information request, even though their answers were incomplete. What we have subsequently found out about this practice in Greater Manchester has increased our concern. (you can see their position in the notes below). We’ve also discovered there is no information about ECT services on their website.

In our view ECT is a controversial psychiatric treatment for depression and other conditions because it can cause side effects such as memory loss and is ineffective for many patients.

Further, a range of respected organisations are calling for a review because of safety concerns, asking for national audits to be reinstated and for independent, objective monitoring of adverse effects to be put in place, including: National Mind, Headway, Association of Clinical Psychologists, PsychSoc, Change Wales, Platfform (formerly Gofal, Wales), the National Counselling Society, the National Hearing Voices Network in England, and the Royal College of Nursing.

We have been calling for the adoption of new approaches in line with the GMMHT’s philosophy of care, based on recovery, psychologically informed environments, and a trauma-informed approach.

ECT does not fit within this approach. It should be dropped now and the funding and staffing used for more compassionate and appropriate evidence based support.

In conclusion we demand:

  • the Mental Health Commissioners urgently review this treatment in light of the anomalies re. over use of ECT by GMMHT
  • that GMMHT, explain the huge difference in usage compared with our neighbouring Trust, Mersey Care
  • the provision of alternative support for people previously treated using ECT and ultimately to suspend the use of this treatment
  • the Mayor of Greater Manchester calls a halt to this practice and supports the national campaign for a review of ECT
Notes:

Campaign News

Questions have been asked about the apparent  failures in ECT practice in Parliament by Dr Rosena Allin-Khan, Shadow Minister for Mental Health and more than 20 MPs have also expressed support for the campaign in various ways including asking Matt Hancock to set up an independent review. In Greater Manchester, Jim McMahon, MP for Oldham West, has agreed to request a Westminster Hall debate on ECT and we have written to Jeff Smith MP asking him to support this request.

We would encourage you to write to your MP (see link to the letter to Matt Hancock here or use the template which can be found here)

See more from the ECT Campaign Blog here

Practitioner points: 

  • Psychologists and other mental health staff should ensure that people are offered evidence-based psychological treatments before being offered E.C.T.
  • All staff should ensure that patients are fully informed of the high risk of memory loss and the smaller risk of cardiovascular failure and mortality.
  • Individuals receiving ECT should be closely monitored for adverse cognitive effects, and treatment immediately terminated if these become apparent.
  • Because of increased risk of memory loss for women and older people, the use of ECT should be kept to a minimum and avoided where possible, with these two groups.

GMMHT’s Freedom of Information response from February 2020 to questions about use of ECT here.

They do not answer any of the questions, instead refer to the answers contained within GMMHT’s Freedom of Information response from September 2018 to questions about use of ECT here.

However they only partially answered the questions put to them, for example claiming they could not provide information about the cost of the ECT service as this is commercially protected information. However we’ve discovered that in 2009 six treatment sessions of ECT were estimated to cost £2475. This does not include inpatient costs, estimated as £171 per day. (Nice ECT Operational Guidance 2009.) If the 104 patients treated with ECT had 6 sessions, the annual cost would be about £250,000.

In the most recent audit GMMH said they had treated 104 patients in 2019 and answered two other questions:

What measures of clinical outcome were used for patients who received ECT and what were the results?

They answered: Patient self-report, MADRAS, CGI, other tailored outcome measures as appropriate.

What measures of adverse effects for patients who received ECT were used, and whatwere the results?

They answered: Patients have a structured assessment of physical and cognitive side effects (including self-report and observed symptoms) which includes appropriately tailored standardised cognitive assessments. The results of these tests/assessments are used to guide treatment decisions with patients.

They said they could not answer any other questions, not even gender or how many patients were under 18 / over 60, or how many without treated without consent.

The reason they gave was ‘This data is not centrally collected’ and it would take too long to go through all the files.

That is probably true but the fact that they don’t collect data (including whether it works and whether it causes memory loss etc) speaks volumes about what the Trust thinks is important.

See GMMHT’s Electro Convulsive Therapy Policy here. It was due to be reviewed in 2020, there is no sign that it has been, we have asked for information about this from the Trust.

In GMMHT’s Description of ECT service taken from GMMHT Clinical Model for Inpatient Care document for the proposed new Park House Psychiatric Hospital (pages 26/27) they make claims for the treatment that we would challenge:

Description of ECT service taken from GMMHT Clinical Model for Inpatient Care for Park House Hospital here (pages 26/27)

Extracts

They say: “Electroconvulsive Therapy (ECT) is an essential intervention for some service users who attend treatment from both the inpatient wards and community settings. ECT can be a life-saving treatment for some and is the definitive treatment for catatonia of any cause and life-threatening depression.”

We say:

  • The use of ECT in is dwindling in England and has levelled off at about 2,500 people per year.
  • There was a 47-fold difference between the Trusts with the highest and lowest usage rates per capita.
  • 27% of the people who were given ECT in 2015 were not offered any psychological therapy before getting ECT.
  • People administered ECT are mostly women (66%) and people over 60 (56%) (a Department of Health study in 2003 found that 70% of those receiving ECT are female).

They say: “The possibility of receiving ECT can be frightening, and service users should receive information on the pros and cons of this treatment, and have the opportunity to discuss these in full with the clinical team.”

We say:

  • More than a third of ECT was given without consent, and 18% of Trusts were non-compliant with legislation concerning second opinions.
  • Only one Trust could report how many people received psychological therapy prior to ECT, as required by government guidelines.
  • Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment
  • In 2018, a class action case was settled in the US after a federal court ruled that a reasonable jury could find against manufacturers of ECT equipment if they failed to warn of the dangers of brain damage.
  • One ECT manufacturer, Somatics, immediately added “permanent brain damage” to the list of risks from the treatment”.
  • Thymatron ECT manufacturers are required to note that ‘the long term safety and effectiveness of ECT treatment has not been demonstrated’ and to warn of ‘permanent brain damage’ as a possible consequence.
  • GMMH has been using the Thymatron System IV, from 1st January 2017

Articles

The audit summarised findings here: https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202103/report-finds-monitoring-electroshock-treatment

Summary of ECT practice in Aeon online journal: https://aeon.co/essays/why-is-electroshock-therapy-still-a-mainstay-of-psychiatry

Lack of evidence for ECT in Psychology Today: https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202008/80-years-do-we-know-if-electroconvulsive-therapy

Article about the debate in Medscape:  https://www.medscape.com/viewarticle/934536

‘ECT – from research to action’ Psychology Today https://www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202008/electroshock-therapy-research-action

Psychology Today: Comparing the evidence for ECT to that for homeopathy: https://www.psychologytoday.com/gb/blog/our-turbulent-minds/202009/should-ect-be-judged-the-standards-homeopathy

JohnRead Interview interviewed about the campaign by Lucy Johnston: https://www.youtube.com/watch?v=_gFQ3p2dVRw&t=855s

COMING SHORTLY

AN overview of the information in patient ECT leaflets, demonstrating that informed consent is virtually non-existent, since very few are warned about longterm damage, but are instead are told about re-setting the brain mechanisms that cause depression.

The campaign has also attracted interest from a European Mental Health group with links to the European Parliament. 

Opinions: Park House Psychiatric Hospital – A new hospital for the 2020’s or the 1920’s

Tony Baldwinson asks “Are we building new hospitals for the 2020s or the 1920s?

As many mental health activists and campaigners have pointed out, building a new centralised mental health hospital flies in the face of all modern best practice in dispersed, community-based mental health services. “

Leave a reply

Park House will be a new-build mental health hospital in north Manchester, opening in 2024 for 150 people. Every person will have a single room en-suite with a locking door, and there will be treatment areas for therapies such as ECT – high voltage electric shocks to the brain – which is outlawed in some countries such as Slovenia. As many mental health activists and campaigners have pointed out, building a new centralised mental health hospital flies in the face of all modern best practice in dispersed, community-based mental health services. The only aspect of this hospital design that is missing from the 1920s is a library room for books on eugenics. To be replaced with daytime TV screens dressed up as therapy.

New Park House (M25 3BL) gained planning permission in January 2021 and with £72m of government money from the national programme for election-promised new hospitals towards its £105m total cost, it is politically very likely to be built despite its antiquated nature in terms of international modern mental health practices.

So what happens next?

There are already talks of the new building being better suited for use as general medical wards, or maybe as routine surgical wards for elective items like hip replacements. More of these wards are desperately needed after the austerity reductions in the NHS in the 2010s.

But maybe the single room design could also be used to flex its future use into a regional biosafety hospital. Covid-19 has taught the UK what other countries with experience of SARS-1 already knew, that epidemics and pandemics are increasingly likely and need to be robustly prepared for.

Biosafety levels internationally, known as the Containment Level in the UK, have the following examples:
CL-2 – campylobacter, Dengue
CL-3 – rabies, bird flu
CL-4 – Ebola, Lassa.

So a regional hospital with biosafety or containment level 4 facilities would be a great regional asset in the early-days management of an outbreak of any novel unknown pathogen.

It would be perfectly possible today to “future proof” the construction design of New Park House, for example with including a ventilation system that is cellular and not mixed, with ducting for oxygen to each room, and with safe waste water treatment before its discharge into public sewers and waterways.

But, sadly, the silo thinking of being a Mental Health Trust Board will not allow even the thought of “future proofing” for a wider benefit – one NHS, one public health.

So we will probably have to pay another construction company more millions of pounds in a few years time to rip out much of the pipework that is only suited to a 1920s design to make the hospital fit for purpose for the world we live in today.

Tony Baldwinson, 4th April 2020. See Tony Baldwinson’s website here

About Tony: Tony is a CHARM supporter, he believes in a good future based on sustainable cities, urban regeneration and building inclusive communities. His work has varied across the voluntary, public and private sectors and universities, always with a partnership approach to solving big problems.

What if we said Mental Wealth instead of Mental Health?

Our Mental Wealth is a valuable resource that can be diminished and replenished

Olatunde Spence, 2021

I wanted to think about mental health in a way that acknowledges and recognises our capacity and resilience to deal with life’s challenges. Our internal world is rich and diverse and at different times in our lives we find ourselves having to adjust and adapt to new situations that can undermine our sense of who we are e.g illness, homelessness trauma, birth, death, unemployment, migration, etc.

When we use or hear the term mental health, it is used, in the main, negatively to describe ‘illness’ or deficit of. I began thinking about mental wealth after mis-hearing what someone had said in conversation. This misunderstanding led me to think about what is evoked in my mind by using the term Mental Wealth.

So today I searched for a dictionary definition of “Wealth” meaning – an abundance of valuable material possessions or resources.

I want to challenge this term and replace ‘mental health’ with Mental Wealth.

Mental Wealth recognises an abundance of valuable materials, wisdom and resources that can help us to navigate change, loss and at times unbearable pain that might leave us depleted of our inherent resources.

Unfortunately within mental health services the pathologising of one’s experiences robs us of our inherent strengths, culture, resources, habits and identity, replacing these ‘valuables’ with a ‘diagnosis’ that rarely identifies, strengths and assets that have supported us in the past to overcome adversity.

I hope by recognising people’s Mental Wealth we can begin to unpack and identify the resources, the skills, the strengths and the richness of a person’s experience and think about what recovery from adverse events might look like for each unique individual with a unique set of skills and circumstances.

Copyright: Olatunde Spence, 4th April 2021. See Olatundes website here

Olatunde has extensive experience of working with people from diverse and marginalised communities to include Black and Minority Ethnic Communities, LGBTQ Communities and autistic adults and young people. She works within a framework that recognises the impact of oppression and discrimination on well-being and identity. 

Olatunde has experience of working with people who hear voices and have been involved in the International Hearing Voices movement for over 30 years.

Olatunde is HCPC registered, a member of the British Association of Art Therapist (BAAT) and Member of the British Association of Counsellors and Psychotherapists. (MBACP) She has a trauma informed approach and use both Children’s Accelerated Trauma Treatment (CATT) and EMDR in her practice. 

Supporting someone experiencing altered states of mind (psychosis)? Complete the Survey

The survey is about what it is like to give this support to someone experiencing altered states of mind, what we often call “psychosis”.

The survey which forms the first part of a study about what it is like to give this support to someone and is now live here, and is open until the end of April 2021

Safely Held Spaces help people experiencing mental and emotional distress, and those who support them, to make informed and empowered choices about the kinds of support they want, by exploring various ways of understanding mental and emotional distress, and by helping to influence the types of support and information that are available.”

Safely Held Spaces

They are looking to gather up to 100 survey responses from holders/carers/friends and family of people experiencing mental and emotional distress and the altered states of mind we often refer to as psychosis.

If you’re a holder yourself and then circulate the survey link to those in your network who are in contact with carers/friends and families? They are keen to reach friends and family who are new to services, or perhaps not in contact with services, as well as those who have been connected to services for longer periods of time.

This survey is part of a research study about friends and family who support someone experiencing altered states of mind, what we often call psychosis. The study is about what it is like to give this support to someone. If you are a friend or family member of someone who experiences altered states of mind and the person you support is based in the UK, then you can take part in this study.

“Even though we know that the support of friends and family is really important to the person experiencing altered states of mind, we don’t know very much about what it is like to give that support. We also don’t know how the experience of giving support changes over time, especially when support is given over many years. This study aims to help fill these gaps.”

The study has two stages.

This survey is the first stage where they will find out what is most important to you and about the experiences that people who support others may have in common.

In the second stage they will explore the experience of giving support to another person through in depth-interviews with a smaller number of people. At the end of the survey, you will be asked if you would like to take part in a depth-interview for the second stage. 

The findings from this study will be submitted for publication in a peer reviewed journal and presented at meetings and conferences. We will also share the findings with influencers, mental health services and other organisations supporting family and friends.

Building Back Better Mental Health in Greater Manchester

Tuesday , 20 April 2021: 18:30 – 20:00 BST

(Zoom or Teams – link to be sent one week before event)

EventBrite registration here

BACP Mayoral Hustings: Government and media attention during the pandemic has largely focussed on acute NHS services and, to a lesser extent, social care. The massive impacts on mental health have received less attention. Now the vaccination roll-out is well underway and Covid-19 infections and deaths decrease, it is time for the ‘mental health pandemic’ – and the vital importance of counselling and psychotherapy services play – to be recognised and addressed.

Please join us at our major hustings event on building back better mental health in Greater Manchester.

We are delighted that the Greater Manchester Mayoral candidates will set out their plans to tackle mental health issues and their views on why our future mental health and wellbeing is so critical to Greater Manchester’s Covid-19 recovery. 

  • Rt Hon Andy Burnham (Labour) CONFIRMED
  • Michael Elston (Independent) CONFIRMED
  • Laura Evans (Conservative)
  • Melanie Horrocks (Green)
  • Simon Lepori (Liberal Democrat) CONFIRMED
  • Stephen Morris (English Democrats) CONFIRMED

Each candidate will set out their party’s position on the long-term impact on the mental health of people in Greater Manchester and their ambitions to improve mental health and wellbeing. 

We very much hope that you will want to attend and be represented at these important hustings on mental health.

BACP – British Association For Counselling And Psychotherapy

Over 600 adults in the City of Manchester waiting for an Autism Assessment

A Freedom Of Information Request to Greater Manchester Mental Heath Trust (GMMHT) about the current waiting times for adults who have requested an Autism Assessment has revealed that in the City of Manchester over 600 people are currently on the waiting list, yet only 30 assessments are carried out a year.

Potentially then there are 1000’s of adults are waiting for an assessment across Greater Manchester.

Under current arrangements you could wait for 20 years before being assessed. NHS guidelines say waiting lists should be no longer than 12 weeks.

The Trust says it is going reduce the “longest waits” by 31st March 2022. Although this is conditional, as their ability to do so will be dependent on “procuring capacity” from the independent sector.

A CHARM supporter from Manchester told us:

“I live in Manchester and I have been on the waiting list for an autism assessment for over two years. I rang the service , they were very kind, but they could not tell when I might get my assessment, only that it could be another year or more. That would mean at least three years.

I felt very let down and confused. I know NHS waiting lists should be no longer than 12 weeks for physical health care issues, and this seemed ridiculous. Faced with this impasse I wrote to my MP.

Shortly after I was contacted by the service who offered to put me at the top of the list as an urgent case (if there were safeguarding issues), I refused as I thought this was like jumping the queue. I also received another phone call from the service asking if I wanted to remain on the list. Why would they even ask this? Was this a way to try for GMMH to bring the waiting list numbers down?

I read the MAKING GREATER MANCHESTER AUTISM FRIENDLY (2019-2022) strategy introduced by Andy Burnham. It says Greater Manchester will be a place

“where you can get a timely diagnosis with support, meet professionals with a good understanding of autism, find services, organisations and employers that make reasonable adjustments when required, where people can feel safe, have aspirations and fulfil their potential, and become a full member of the local community

Making people wait so long for an assessment doesn’t feel very friendly to me.

Here are some of the information they provided:

Note: We have been told that some Manchester GP’s have stopped making referrals for assessments because the waiting list is so long. Further we heard that to bring down the numbers on the waiting list GMMHT contacted people on the list asking them of they wanted to stay on it. We wonder waht the figure was before this exercise took place?
Do the maths: if there are over 600 people on the waiting list how can the average waiting time be 1266 days?
Why can Bolton do so much better than Manchester? – is this a question for the commissioners? Is this post code discrimination?
Why no MANCHESTER City based service? Services are supposed to be place based and as local as possible. How much investment hAve they made?
THIS IS NOT A REASSURING ANSWER – IT DEPENDS ON THE CAPACITY OF THE PURCHASED SERVICE – AN ASPIRATION IS NOT ENOUGH
AND THEN …. IF YOU ARE LUCKY AND YOU HAVE ASSESSMENT THERE ARE NO SUPPORT SERVICES FOR ADULTS IN MANCHESTER SUCH AS THEY HAVE IN BOLTON AND WE CANT ACCESS THIS SERVICE

See the full response below:

RE: FREEDOM OF INFORMATION ACT 2000 – INFORMATION REQUEST  Regarding significant backlog in accessing autism assessments for adults from Manchester