Subject to its findings, the Essex inquiry could turn out to be one of the worst scandals of NHS treatment in its history
Beth Matthews saved lives with her brutally honest, often shockingly graphic, posts about surviving a suicide attempt. She was an extraordinary young woman, whose blogs and social media threads often reached other unwell people at the darkest moments in their lives. She met the police officer who had held her hand after her own suicide attempt, shared X-rays of her shattered pelvis and told her followers that suicide was not the answer. Yet that was how Beth died in March 2022.
An inquest this week concluded that neglect by the Priory Hospital Cheadle Royal contributed to her suicide. Beth had ordered poison from Russia, which she had opened near staff, but had told them it was something else. Her care plan had stated that they should be aware of the contents of her post and that she had made frequent suicide attempts over a long struggle with what had been diagnosed as a personality disorder. After the inquest, it was revealed that two other women had died after being admitted to the same unit in just two months last year. The Priory say the two further deaths, of Lauren Bridges in February 2022 and Deseree Fitzpatrick a month later, are unconnected.
What does connect these deaths and a number of other big inquiries into NHS mental health services – whether provided by private organisations like the Priory or directly contracted – is that mental health care is looking like the next big, appalling, scandal in the health system. We had Mid Staffs and a slew of maternity scandals including Morecambe, Shrewsbury and Telford and East Kent. These have rightly shocked the public. The scandals in mental health may be bigger.
Today, ministers announced a nationwide ‘rapid review’ into safety in mental health services. Last week, the chair of an inquiry into mental health deaths in NHS trusts across Essex asked the government to upgrade her investigation to a formal public inquiry. Dr Geraldine Strathdee was initially asked to investigate 1,500 deaths over a 21 year period, but in December she was made aware of a further 500. She said only 11 staff out of the 14,000 she had invited to give evidence had agreed, and the inquiry needed stronger powers to compel witnesses.
The Essex Partnership University NHS Foundation Trust has said it continues to ‘support the ongoing inquiry and encourage service users, family, carers and staff to share their experiences with the inquiry team so they have a full picture to draw on to make their recommendations’.
The Essex inquiry is already bigger than Mid Staffs. Subject to its findings, it could turn out to be one of the worst scandals of NHS treatment in its history. Yet, like Mid Staffs, the alleged failings Strathdee and her team are investigating have been highlighted all over the country and not just in Matthews’ untimely death. The Priory has had a number of high-profile incidents, with the Care Quality Commission regulator giving highly critical inspections of four of its units which then closed.
Matthew Caseby was a patient at Priory Woodbourne Hospital in Birmingham in September 2020 when he climbed over a fence and was hit by a train. He was just 23. He had suffered a psychotic episode which had led to his admission to the hospital, where his family had hoped he would make a full recovery. Instead, the inquiry into his death found 32 ‘contributory factors’ in his suicide which the jury at his inquest concluded had been ‘contributed to by neglect’. He was the third patient to have climbed over the fence – and a fourth did so shortly after his death.
It’s not just the Priory. Cygnet is another private provider of mental health services; campaigners have been tracking deaths in this provider’s facilities. Emma Pring was transferred from the Sussex partnership NHS trust to a ward at Cygnet in Maidstone in July 2020. She died in April 2021, and her inquest found an ‘insufficient level of observation and misjudgement of Emma’s actual risk’. Directly-provided NHS services suffer from similar inadequate assessments and procedures – often as a result of short staffing. Earlier this month, the coroner at Luton and Bedfordshire coroner’s court said the death of Desmond Maddix, a patient at an acute psychiatric unit run by East London NHS foundation trust, died as a result of ‘failure of the most serious kind’ when he was injected with heroin by another inpatient.
Mental health has always felt like an optional add-on to the NHS, both in terms of the availability of treatment and the ability of the system to reform at all. It took nearly thirty years between Enoch Powell declaring in 1961 he wanted to close down mental institutions and the first outdated Victorian asylum closing in 1986. By then, the ‘care in the community’ system that Powell had advocated was in serious trouble, in part down to a lack of funding. Even today, the funding for long-term inpatient treatment is thin, to the extent that sufferers, Beth included, are lucky to end up in units 300 miles away from their families and wider support networks. The basic political problem is that while it is now finally fashionable to talk about mental health, it is still not politically expedient to do much about the particularly severe end of the psychiatric spectrum.
Inpatients in mental health services will say they don’t feel the recent global conversation about mental illnesses has made much of a difference to them, not least because the popular discourse tends to focus on three illnesses – anxiety, depression and PTSD. While debilitating, these illnesses are a bit easier for the public to understand.
Beth Matthews had a personality disorder, one of a number of diagnoses that can lead to patients being labelled ‘manipulative’ within the health system. This can lead them therefore to be overlooked by overworked, underpaid and often under-skilled staff in residential units. She was relieved when her specialist multidisciplinary team and consultant agreed that a personality disorder wasn’t her primary diagnosis, changing it to depression/PTSD. Other patients with a personality disorder diagnosis say it instantly leads to hostility from medical professionals, and that they wish they’d never been given that label.
Beth’s family were relieved when the NHS agreed to funding for her placement at the Priory, believing that finally she was in a safe place where she might start to recover. She had written of wanting to ‘grab this opportunity with both hands’, and on arrival was happy that her room felt like a ‘hotel’ compared to her previous ward.
The Priory says it has changed its procedures around care plans and other weaknesses in Beth’s care. Beth, meanwhile, changed other people’s lives. Her life should have been so much longer. But her name could be one that we always remember as a turning point in how seriously society takes the treatment and safety of mental health inpatients, after decades of trying not to think too much about it.
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Source: The Spectator, 24th January 2023