PUBLIC MEETING STATEMENT

AND REPORT

Saturday, 10 December 2- 4 pm

60 people attended the public meeting. We heard both inspiring and challenging stories from people with lived experience, family members, workers and concerned citizens.

Our keynote speakers were:

Dainius Puras, psychiatrist, former UN Special Rapporteur on Human Rights and Mental Health speaks about the predominant importance of human rights in shifting the thinking and practice of bio-medical psychiatry across the world and in Manchester. Go to his presentation here

Roberto Mezzina, psychiatrist, Vice President of the World Federation for Mental Health, retired director of Trieste Mental Health Department, proving it is possible to create a mental health system that upholds human rights. A service that has full participation of users and is accessible and rooted in the community. Go to his presentation here

The key message from the meeting is that Greater Manchester Mental Health Trust, Commissioners of services and other responsible bodies need to LISTEN.

Public statement from the meeting: ‘AFTER EDENFIELD – HUMAN RIGHTS NOW’ held on 10 December 2022 at Central Hall, Manchester

This meeting calls for a mental health service that puts compassion and human rights at its centre. We want a service that is accessible and takes a whole person approach.

We have heard stories of systematic and wilful neglect. We have heard evidence of the systematic abuse of power by mental health services in Manchester and beyond. We have heard patients’ concerns and opinions pathologised and dismissed. These failures are both in community and inpatient services.

All forms of violence, aggression, discrimination and prejudice should be illegal in mental health services. This includes restraint, detention, coercion and neglect. We call for a public inquiry that places users and carers at the centre of any investigation

We will build our own evidence base. The meeting calls for people who have used community and inpatient services to tell their story by contributing to the story bank of experiences being collected by CHARM and the Charter Alliance. Anyone wishing to contribute can contact CHARMat Charm.storybank@gmail.com

We have heard accounts proving it is possible to create a mental health system that upholds human rights. To do this we must address the power asymmetry in mental health services. We need a service that has full participation of users and is accessible and rooted in the community.

We must also challenge the dominance of the biomedical model and the iatrogenic harm that it creates. We need recognition of other innovative and creative models of care that use negotiation and dialogue in deciding on care which addresses the power imbalance. This will support the upholding of human rights as well as changing the way people are cared for through creating an alternative system.

CHARM Public Meeting

Supporting organisations: CHARM (Communities for Holistic Accessible Rights-based Mental Health); Greater Manchester Coalition of Disabled People; Manchester User Network; Manchester Hearing Voices Network, GM Mental Health Charter Alliance; Fika Wellie; Unison; Asylum Magazine; GM Keep our NHS Public; Safely Held Spaces; Soteria Network UK; Robert Lizar Solicitors, Talk for Health

Information about the meeting

Presenters

• Citizens with lived experience
• Dainius Pūras, psychiatrist, former UN Special Rapporteur on Human Rights and Mental Health (zoom)
• Roberto Mezzina, psychiatrist, Vice President of the World Federation for Mental Health, retired director of Trieste Mental Health Department (zoom)
• Robert Lizar, Robert Lizar Solicitors, Manchester

Why we called the meeting

The Panorama programme on Edenfield showed an abuse of human rights that are system wide. It wasn’t just the acts of individual workers but a system that relies on restraint, seclusion and socialises workers to lose compassion and humanity.  The internal inquiry and findings by GMMH are not enough. GMMH continues to suggest that what happened at Edenfield is an isolated case, when it is clear from the number of recent scandals that the abuses uncovered take place nationally across private and NHS hospitals. Both in-patient and community services are not safe. We need a root and branch review of services and an inquiry that is open and transparent. This can only be co-produced with the community.

We need to listen to the stories of those with lived experience. We call for anyone who wants to share their stories to join us at the meeting in our fight for justice.  CHARM and Manchester Mental Health Charter Alliance are working together to launch a Story Bank of experiences which we will use to support our campaigns to improve mental health support in Manchester. 

We need to speak out against coercive psychiatry, abusive mental health regimes and forced treatment. As our speaker Dainius Pūras has said, ‘our common goal is to liberate global mental healthcare from coercive practices…. If we do not move in this direction, arguments for coercion will continue to be used and misused.’

The meeting was supported by:

Manchester Users Network Supports users and ex-users of psychiatric services in the Manchester area. The organisation provides a forum for services users to have a bona fide say in planning and provision of mental health services.

Asylum Magazine the radical mental health magazine, has been running for 30 years, acting as a platform to voice and discuss all perspectives on mental health.

Greater Manchester Coalition of Disabled People an organisation of disabled people: run and controlled by disabled people. We campaign to promote the rights of disabled people and our inclusion in society

Fika Welie There is a huge stigma in the Black community in regards to mental health and seeking help. This fear of judgment can deter individuals from getting the help they need. At Fika Welie, we will always recognise the traumatic impact of racism on Mental Health.

Manchester Mental Health Charter Alliance This charter is about what people want from mental health services in Manchester. It has been drawn up from what people who use mental health services have said in consultations over the last few years.

Safely Held Spaces vision is of safe, compassionate, empowering support in local communities in the UK for people experiencing extreme mental and emotional distress and altered states, often called psychosis, and for the people supporting them

Soteria Network UK

Soteria promote humane, non-coercive mental health services. A network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states. Part of an international movement of service users, survivors, activists, carers and professionals fighting for more humane, non-coercive mental health services.

Justice in Care dedicated to promoting justice for and preventing the abuse or exploitation of disabled people or service-users or residents within the care system. This Justice in Care group is co-ordinated by Parasol in co-operation with the Greater Manchester Coalition of Disabled People.

GM Keep Our NHS Public is a non-party-political organisation campaigning against the privatisation and underfunding of the NHS. They support campaigns to reverse the privatisation and commercialisation of social care and to call for health and social care services to be publicly funded, publicly provided and accountable provision.

Roberto Mezzina, psychiatrist, Vice President of the World Federation for Mental Health, retired director of Trieste Mental Health Department.

Dainius Pūras, psychiatrist, former UN Special Rapporteur on Human Rights and Mental Health speaks about the predominant importance of human rights in shifting the thinking and practice of bio-medical psychiatry across the world and in Manchester. The public meeting was held in Manchester on International Human Rights Day to call for a mental health service that puts compassion and human rights at its centre.

A dad who asked for a bed at mental health hospital died hours after being told he would not be admitted, an inquest heard. Darren McHugh, 39, told mental health professionals he was hearing voices, felt paranoid and wanted to be treated on a mental health ward. He thought an inpatient bed was being found – but was then offered mental health treatment at home instead.

The inquest heard that voices became raised and concerned hospital staff pressed a panic alarm, leading to Darren and his family being escorted from the hospital.

Darren’s family accused the mental health staff of being “robotic” in the way they dealt with him.

An inquest at Bolton Coroner’s Court heard Darren was told by staff at Wigan Infirmary on June 11 that he did not have psychosis – which he believed had returned after receiving the diagnosis two years earlier.

He declined home treatment and he and his family were escorted from the hospital by security after expressing “high emotions”.

Darren was found dead at his home in Westleigh on June 12. A post-mortem examination confirmed he died by hanging.

The inquest heard Darren felt anxious and paranoid in the weeks before his death and believed his neighbours were plotting to kill him.

His partner Louise Tither said she tried to reassure him that was not true, but he did not believe her. He stayed awake all night and did not eat.

On June 4 he told her he thought he had psychosis and the next day he went to A&E after taking an overdose of tablets.

He called a mental health helpline after being discharged and described the overdose as a “wake-up call”, saying he would not do it again. He spoke about his supportive family, ways to cope with his feelings and agreed to see his GP.

Darren, a warehouse operative, saw his GP on June 8 – taking a bag packed with his belongings – and asked for help with his mental health, as well as a lump on his chest.

GP Dr Khawaja said Darren demanded to be admitted to hospital and reported not feeling safe at home.

He said: “One thing that was very evident from the outside was that he was scanning the entire room and he couldn’t keep eye contact directly with me. He looked very anxious.”

Dr Khawaja spoke to a senior colleague and then contacted the mental health urgent response team about Darren.

He told the inquest it was agreed Darren would be phoned later that day to arrange a bed for him.

He prescribed diazepam to calm him and an appointment was made at Atherleigh Park on June 11.

But on June 10, Darren went missing and police had to be called. He later phoned his mum to say he was okay and then asked his son to collect him from Manchester, so he could go to the appointment.

Darren and his family went to Atherleigh Park on June 11 and staff referred him to the home-based treatment team so he could be assessed and considered for a hospital admission.

His family believed a bed would be found on a mental health unit.

The inquest heard he was told to go to A&E if he did not feel safe at home in the meantime and that it could lead to a bed being found more quickly, so the family went straight to Wigan Infirmary.

But once there, Darren faced a long wait before he was seen by Rebecca Hill, senior nurse practitioner, and Rita Horken, mental health liaison nurse.

They told the coroner he would not get a bed more quickly by going to A&E and they had processes to follow. They said an appointment had been made with the home-based treatment team for the following day, but his family disputed this.

They said Darren reported hearing voices at home, said he was not feeling suicidal and he wanted a mental health bed.

Ms Horken said he had capacity, risks had not changed since his appointment at Atherleigh and she did not believe he had a condition that needed mental health care at that time.

He was told a bed was not being found for him and instead he should receive treatment at home.

Ms Horken said: “It was discussed about the crisis home treatment team, which Darren didn’t want at that time, he wanted to be admitted to hospital.

“He didn’t present with any enduring mental health issue at that time for us to put him in for a mental health hospital admission.”

She also said that they had to look at the “least restrictive” option for treatment.

Ms Hill said while Darren did not have typical symptoms of psychosis, he did need support with his mental health which could have been given at home.

“There wasn’t enough evidence there to warrant that admission,” she said.

The inquest heard that voices became raised and concerned hospital staff pressed a panic alarm, leading to Darren and his family being escorted from the hospital.

Darren’s family accused the mental health staff of being “robotic” in the way they dealt with him.

His sister Alexandra McHugh told the coroner she sent him messages on the morning of June 12 asking if he was okay and saying she would help him.

She called a mental health team to ask for help and they gave her a number for Darren to call.

She spoke to Darren at lunchtime and he said he could not believe what the hospital staff had said, as they had been his “last hope”.

Miss McHugh tried to call him again later but received no response. When he did send a text message, he said he was going and to not let his child in the house.

She found his body at his home at around 6pm, along with letters and a family photograph.

Tests carried out after his death showed Darren had taken paracetamol, codeine and diazepam, while a cannabis metabolite was also found.

The inquest was adjourned until Friday, December 16.

Full story here

Source: Wigan Today, 8th December 2022

Daniel Kirton tragically died following the collision, which came after he had attempted to take his own life on hospital grounds following his discharge by mental health practitioners. He had attended Manchester Royal Infirmary’s emergency department earlier that afternoon, December 3, 2020, and was assessed by staff from the Greater Manchester Mental Health NHS Foundation Trust but deemed fit to be released. 

A man who ‘rolled’ into the road and was hit by a taxi after being discharged from hospital had said he was suffering from drug withdrawal and wanted an admission to detox from Spice, an inquest heard.

Daniel Kirton tragically died following the collision, which came after he had attempted to take his own life on hospital grounds following his discharge by mental health practitioners. He had attended Manchester Royal Infirmary’s emergency department earlier that afternoon, December 3, 2020, and was assessed by staff from the Greater Manchester Mental Health NHS Foundation Trust but deemed fit to be released. 

At an earlier hearing of the six day inquest at Manchester Coroner’s Court, police coroners’ officer Elizabeth Davies told the court Daniel, 35, who was of no fixed address and was unemployed, went to the hospital to see the mental health team on the afternoon of December 3. He was assessed again a short while later before being ‘escorted’ out of the hospital at around 11.15pm, when security officers based at MRI got a radio call from colleagues telling them there was an ‘aggressive male’ refusing to leave the department.

READ MORE: ‘Not family, but blood’ – Siblings on mission to encourage more black blood donors

During the fifth day of the hearing today (November 23), MRI mental health nurse Godfrey Chiveya described how he had seen Daniel standing on a raised flower bed outside the hospital. The court heard he had made threats to take his own life. Mr Chiveya said: “I spoke to him, he was not very happy to see me.”

Barrister Sam Harmel, representing Mr Kirton’s family, said Mr Kirton had said he wanted an admission to detox from Spice and said he was ‘rattling’ – suffering from symptoms of drug withdrawal.

Daniel then left the hospital grounds and was hit by a taxi nearby, on Upper Brook Street, at around 11.37pm – 22 minutes after first being escorted out of the emergency department.

In court on Wednesday, Mr Harmel questioned Mr Chiveya over whether mental health teams had considered Mr Kirton’s ‘level of suicidality’.

Mr Harmel asked Mr Chiveya: “Did you consider his level of suicidality?”

Mr Chiveya said: “Yes, it was considered.”

When Mr Harmel pointed out Mr Chiveya had said the opposite when he last gave evidence, Mr Chiveya explained he “had been mistaken.”

Mr Harmel again asked: “Did you or did you not explore Daniel’s suicidality?” Mr Chiveya replied: “It was explored.”

Barrister Jonathan Robinshaw asked Mr Chiveya whether he had interpreted Daniel’s behaviour as ‘conditioned threats’ – “a case of ‘you did not help me in A&E, so I am not going to engage with you’.” Mr Chiveya agreed.

He noted Mr Kirton had fluctuated between saying he was going to hurt himself, and then saying he would hurt someone else, if he was not admitted. Mr Robinshaw said: “He suggested he may hang himself, he looked around and saw some railings and said he may impale himself on some railings, he then looked around and saw some cars and said he may jump in front of some cars. A patient presents with an altering plan, does that imply a lack of intent? Mr Chiveya replied: “Yes.”

Giving evidence, mental health nurse Cara Oates, from North Manchester General Hospital, explained that an initial assessment of Mr Kirton would have been carried out in A&E by Mr Chiveya and there would then have been two options – to discharge him or to pass to a gate keeper who could say at that stage whether the patient should be admitted to hospital.

Area Coroner Zak Golombeck asked Ms Oates: “Would it have been possible for Mr Chiveya to have said: ‘We have assessed him outside of the hospital and we think there should have been a gatekeeper assessment’?” Ms Oates replied: “I don’t know.”

Mr Golombeck continued to say it was his understanding that Ms Oates felt Mr Kirton should have been given an offer to come back to A&E for further assessment. Ms Oates agreed, saying: “Yes, that is correct.”

Mr Harmel referred to notes saying Mr Kirton ‘had been told someone would see him tomorrow’, despite no such referral being made. He asked her: “Is it ever appropriate to tell a patient ‘we will see you tomorrow’ if a referral had not been made? Are there ever any circumstances where it is appropriate to tell a patient something that isn’t right?”

Ms Oates said it was not. Mr Harmel continued: “The assessment outside of A&E was not appropriate, would you agree with me?” She replied “Yes.”

Barrister Jonathan Robinshaw asked Ms Oates “Would you say Mr Chiveya had good rapport with Mr Kirton outside A&E?” She replied: “No.”

He then asked: “Is it important for a good rapport between patient and practitioner?” to which Ms Oates agreed it was. Mr Robinsonshaw continued: “He (Mr Kirton) might therefore have been reluctant to have gone with Mr Chiveya as their relationship had seemingly broken down at that point?” Ms Oates answered: “Yes, that is correct.”

The inquest continues.

Full story here

Source: Manchester Evening News, 23rd November 2022

• Figures show steep rise in rates of black people receiving restrictive interventions
• Rates double in six years, but up 30 per cent for white people in same period
• Charities “appalled”, warning that data “reinforces impact of systemic racism” on safety 

The rate of people from black backgrounds being restrained in mental healthcare has more than doubled in the past six years, widening the gap with other racial groups, according to official NHS data.

Standardised rates of black and black British people subject to restrictive interventions – including physical, chemical and mechanical restraints – have leapt from 52.1 per 100,000 people in 2016-17 to 106.2 in 2021-22.

That is compared to a much smaller increase of 30 per cent in the same period for people from white backgrounds, from 15.8 per 100,000 to 20.5.

Data for people in mixed ethnic groups also significantly increased – with rates rising from 39.5 per 100,000 in 2016-17 to 67.1 in 2021-22.

For those from Asian backgrounds, there was an increase from 13 per 100,000 to 25 in the same time frame.

NHS race and health observatory director Habib Naqvi told HSJ he was “very concerned” at the rise.

He said a “range of complex causes are likely to be presented to account for this pattern”, including disparities in care pathways, late presentation and lack of timely diagnosis, and general overuse of restrictive practice on people from minority ethnic backgrounds.

He added: “It is critical we also focus on ‘causes of the causes’ of these disparities, including the impact of discrimination and bias on access, experience and therefore outcomes of mental health services.”

Rates for black people reached their highest since the data began (in 2016) in the year to 31 March 2022. In the same month, the Use of Force Act, known as Seni’s Law – launched following the death of Olaseni Lewis who died as a result of a prolonged restraint by police at Bethlem Royal Hospital in South London in 2010 – came into force.

The act defines use of force as any physical, mechanical or chemical restraint and requires mental health providers to appoint a responsible person accountable for establishing a use of force policy, staff training, and information rights for patients, among other requirements. 

Monthly data on restrictive interventions is not yet showing significant reductions among racialised groups. Detailed national-level data has not yet been produced, although NHS England will be required to report performance annually to the DHSC under the act.

Lucy Schonegevel, of Rethink Mental Illness, added: “We’re appalled to see the staggering number of black or black British people subject to restrictive interventions in mental healthcare.

“These statistics reinforce the impact of systemic racism that risks the safety of mental health patients, damages their experience of treatment and ultimately hampers their recovery.

“Now that Seni’s Law has been enacted it must be comprehensively implemented so that there’s a significant reduction in the use of force on mental health wards and these numbers drastically fall.”

Perceived as ‘dangerous’

Leaders of health organisations representing racialised communities recently gave evidence to the joint committee on the draft mental health bill which is aiming to eliminate racial health inequalities.

It also aims to give people more control over their treatment, particularly those from ethnic minority backgrounds, who are disproportionately detained under the act, with black people over four times as likely to face detention.

Many speakers highlighted disproportionate use of community treatment orders, under which clinicians supervise patients in the community, and called for them to be scrapped. 

Separate NHS data published last month reveals use of community treatment orders for black or black British groups (75.5 uses per 100,000) were over 11 times the rate for white groups (6.8 uses per 100,000).

Lily Huggins, of Manchester-based mental health advocacy service Gaddum, told MPs and Lords: “We can infer from current statistics that minority racialised groups, and black people in particular, are perceived as needing additional restrictive measures by approved mental health professionals.”

She added: “Whether that language is ‘dangerous’ or ‘risk of harm’, that perception is still there and needs additional inquiry.”

Meanwhile, NHS England’s mental health equalities adviser Jacqui Dyer told the committee that reforming the Mental Health Act provided an opportunity to reduce racism in current services.

She added: “[We need to recognise] that the power to abuse is most pertinent in that context, as many of you will have seen with the recent Edenfield [reports of abuse and toxic cultures at a Greater Manchester mental health unit] issue.

“We have to keep that front and centre, because while we were able to see visually, in the same way as we saw George Floyd’s situation, what happened in Edenfield to people at their most vulnerable, and the abuse that took place in that setting, that has been going on for decades in relation to the black experience, particularly in secure mental health settings.”

An NHS England spokesperson said: “Restrictive practices should always be a last resort which is why NHS England has invested in various patient safety programmes and is currently working to improve the reporting of restrictive practices, including protected characteristics.   

“Despite improvements in some areas like talking therapy recovery rates, we want to do more to address inequalities in outcomes for ethnic minorities, and we are developing a race equality framework for mental health trusts which will support them to provide more responsive care in partnership with the communities they serve.” 

A DHSC spokesperson added: “We are committed to preventing the inappropriate use of force in mental health units and to reforming the Mental Health Act to address racial disparities.

“We introduced Seni’s law – also known as the Use of Force Act – to ensure better accountability and transparency over the use of force in mental health units, including on people from ethnic minority groups.

“We are also piloting advocacy services to support the needs of people from ethnic minority groups who are subject to the Mental Health Act, with trained advocates ensuring that cultural differences – such as religious preferences or specific communication requirements – are understood and acted upon.”

Mental Health Bulletin, 2016-22 annual reports

Source: Health Service Journal, 24th November 2022

A recently published report highlights the shortcomings in care provided by the NHS. Peter Walsh, Joanne Hughes and James Titcombe emphasise how millions could be saved if people were empowered early on to have their needs met without the need to turn to litigation

NHS scandal after NHS scandal over decades has sparked outrage and sympathy with the people affected having had to struggle on their own and against all the odds with a system that is in denial. Yet to this day, nothing has been put in place to help people in these situations get the independent, specialist advice and support they need. It is unlikely that some of these gross failures would even have come to light at all without the brave and persistent efforts of heroic patients and families. Take those affected by events in the East Kent maternity scandal – the latest one to hit the headlines with Bill Kirkup’s independent inquiry report.

Before them, the “Cure the NHS” campaigners whose efforts led to the Mid Staffordshire Public Inquiry; and the Morecambe Bay campaigners who also had to move mountain and earth to get the inquiry that was needed. However, in addition to these large-scale and high-profile scandals, smaller scandals are taking place every day, with people who have been harmed or lost loved ones as a result of patient safety failures in the NHS being left to navigate the complex system of NHS investigations; inquests; complaints; health professional regulation and legal issues on their own. Or even worse, like those in the afore-mentioned scandals, people are faced with a wall of denial, deceit and even lies and dirty tricks. The NHS spend millions on expensive consultants and on lawyers to try to avoid coroners criticising them, but do not spend a penny on funding independent advice or advocacy for the patients and families it has caused avoidable harm. The best you can hope for is being “signposted” to a small number of admirable but un-resourced charities in the hope they might be able to help.

A report published by the Harmed Patients Alliance, aptly named “Signpost to Nowhere?” -the case for funded independent advocacy, advice and information for patients and families following patient safety incidents” shines a bright light on this neglected issue and offers a way forward. The report is being considered at a roundtable meeting of key stakeholders also being held, including representatives of NHS England; the Care Quality Commission; the Patient Safety Commissioner; the Parliamentary and Health Service Ombudsman; NHS Resolution; the Healthcare Safety Investigations Branch; and patients’ and advocacy groups. It is hoped that this will result in system-wide acknowledgement of this important and currently unmet need and a commitment to do something about it.

The report points out the irony of the NHS focus on “just” culture when it is prepared to abandon the people it has harmed in this way. It suggests that the NHS owes a “moral duty of care ” to attend to the needs it creates for people affected by avoidable harm in the NHS to support their wellbeing, trust in the NHS and their relationship with it. As the “Harmed Patients Pathway” – a project by the charity Action against Medical Accidents and the Harmed Patients Alliance points out, access to independent advice and advocacy is one of those needs the harm event creates. But it is probably the biggest and most glaring gap.

People are more likely to turn to a lawyer if no other independent, professional, and healthcare harm specialised source of advice and support is available to them

The report points out that (quite rightly) the government aims to ensure that anyone with a complaint about the NHS has access to independent advice or advocacy. That applies as much to complaints about car parking or hospital food as it does complaints about poor treatment which has caused harm. It spends £15.1m a year on independent NHS complaints advocacy which helps people navigate the NHS complaints procedure. But that is all it is funded to do. So, you are guaranteed independent help with a complaint about car parking or if you just want to make a complaint, but absolutely no funding is put in specifically to ensure people who have suffered harm in the NHS get the specialist and wide ranging independent information advice and support they need, to help them have their needs met.

Part of the problem, the report says, is that each part of the healthcare and regulatory system is purely focused on its own specific area. For example, the complaints system; health professional regulation; litigation and inquests; or patient safety investigations. An approach which attends to the holistic needs of the patients and families affected is recommended, rather than different parts of the system striving to “manage” people through their own process. Not only would that be much more helpful to the harmed patients and their families, it would allow for economies of scale. What seems like a momentous challenge to one part of the system is much more manageable when dealt with systematically.

The report also quotes academic and other evidence that shows empowering people via independent advice and advocacy not only reduces their distress, it also leads to massive cost savings. Research commissioned by NHS Resolution for example found that strong motivations for people who chose to take legal action was the poor investigation, poor communication and a lack of honesty with them. Empowering people through independent help is known to reduce these sorts of outcomes. Millions might be saved if people were empowered early on to have their needs met without the need to turn to litigation.

People are more likely to turn to a lawyer if no other independent, professional, and healthcare harm specialised source of advice and support is available to them. People are more likely to refer a health professional to a regulator if they haven’t had independent information and advice about alternatives. People are more likely to be meaningfully involved in a patient safety investigation if they have independent support to help them understand the benefits of involvement and trust the process, and better investigations can help save lives.

It is a scandal that people the NHS has harmed can be abandoned in this way. The lack of attention to addressing the need for independent advice and advocacy that has been stressed by hundreds of patients and families attending countless ‘listening events’, and many major inquiries, is causing resentment and a suspicion that the system does not want harmed families to be well informed and empowered to have their needs met when they are harmed. This all leads to further ‘compounded’ or ‘second harm’ to the very people who have already been harmed. Is this report and summit a catalyst to this being addressed at long last? We certainly hope so.

See full story here

Source: Health Service Journal, 30th November 2022

PRESS RELEASE 

25th November 2022

From CHARM, Communities For Accessible Rights based Mental Health

Concerns raised by CHARM, service users, their families, and staff, some of which have been presented through the media have led to NHS England commissioning an independent review into the services provided by GMMH. The Trust has also been placed in ‘intensive care’ through the NHS Recovery Support Programme. Yesterday the CQC also told Greater Manchester Mental Health NHS Foundation Trust to make significant improvements and have suspended their rating. Given these circumstance we call for roots and branch review of mental health support of people in crisis across Greater Manchester

CHARM identified serious concerns about the crisis in mental health care in Manchester two years ago. In our open letter to Andy Burnham and the Briefing notes and Evidence base we identified many of the failings that are now acknowledged by the CQC and the Trust. 

As we argued at the time

‘Existing practices mean that Greater Manchester already has an unenviable record for: using physical restraint at higher levels than other parts of the UK (Mind, 2018); the worst record in the country for missing patients (625 patients in 2018 – 2019, NHS); too many Black people come into contact with mental health services through the criminal justice system than via a GP referral.”

We were not listened to, in fact the Trust continually denied there were problems and the failures identified have got worse.  In Manchester our experience has been that the Trust has placed its professional reputation before openness and transparency.  

CHARM has been tracking the failure and challenges facing services throughout Greater Manchester through Mental Health Trust Watch where we have recorded information on dozens of incidents.  Our evidence highlights that failings are widespread, with public and private hospitals in the Greater Manchester who treat NHS patients.

As we have stated in previous statements, the failure of GMMH does not just lie in inpatient services. The neglect of vulnerable individuals across the city who were supposed to be served by community teams is widespread. We have been informed that 1000 people in the city of Manchester are waiting for a care coordinator and those who have care coordinators rarely see them because their case loads are unmanageable. The impact on families and carers, mainly women has led to the deterioration of physical and mental health.  

‘Nothing was put in place to help me, apart from a carers assessment and talking to the CMHT carer support worker.   My mental and physical heath was so bad, I had told them I was suicidal and couldn’t see a way out, but they had no power to help me to change the situation.  I knew one of us was going to die in this house, either her or me and I told them this. 

The disintegration of services has gathered pace over the last few years. Senior management have ignored concerns raised by the Union regarding safe staffing. There has been complicity by senior managers who have covered up the failings of community services, ignoring complaints until they have been taken to external authorities or failing to address severe carer breakdowns.

The lack of a functioning community service has meant that often the only available treatment has been hospital admission which as has been revealed is unsafe and has failed to protect people’s basic human rights.  

‘My son was put in isolation for two weeks. It was traumatic and there was no consistent psychiatrist, and each psychiatrist had a different approach. Many of the staff felt it was not appropriate for him to be in isolation and thought I should complain. There were serious breaches of his human rights and his right to privacy (Jan)

‘My daughter ended up in hospital for nearly three years on her second admission. There was no clear plan – they didn’t listen and no psychological intervention and little attempt to engage her in any purposeful activity. She was neglected. She ended up putting on 40kg in weight, became diabetic and at one point had to be admitted to a heart ward. When we finally decided it was best to just get her out of hospital and asked the doctor what his opinion would be if we requested a nearest relative discharge, he threatened us with removing our rights as nearest relative. The system creates this kind of oppressive response.’ (Ana)

The management of the service has not just taken its toll on service users but staff who have been dehumanised by the way in which they have been forced to work creating a lack of humanity due to their need to desensitise themselves in order to survive, creating wide spread Moral injury. 

The failures that have been exposed today are also a result of a wider structural failure to recognise the unique health and social care needs of Manchester. The concerns of families and the workforce were taken to the Manchester Health  scrutiny committee before the Panorama programme but they failed the act and chose to accept the reports from GMMH. Commissioners in the combined authority have also accepted plans for health and social care without considering the impact on the most vulnerable. Joint Strategic Needs Assessments were not adequately carried out.  Most recently the community transformation model adopted in Manchester which has focused on extended provision in primary care, has led to an exodus of staff providing vital services to the most vulnerable in community mental health teams. The service has collapsed. 

We believe Greater Manchester Mental Health Trust through its culture, size and location will remain remote, separated and unaccountable to the communities it serves unless there is a root and branch review of how to meet the mental health needs of its diverse communities. This must be co-produced with the community. 

To begin this process of creating a service fit for purpose we must first listen to the stories of those with lived experience. CHARM  and Mental Health Charter Alliance are working together to launch a Story Bank of experiences which we will use to support our campaign to improve mental health support in Manchester. We call for anyone to share their stories with us by contacting charm.storybank@gmail.com

Join us in our campaign for a mental health service that protects human rights at our public meeting on 10 December 2-4pm, Central Methodist Hall, Manchester. Speakers include Danius Puras, psychiatrist, former UN Special Rapporteur on Human Rights and Mental Health and Roberto Mezzina, psychiatrist, Vice President of the World Federation for Mental Health, retired director of Trieste Mental Health Department to support us to envision a different future.

‘our common goal is to liberate global mental healthcare from coercive practices…. If we do not move in this direction, arguments for coercion will continue to be used and misused.’ Dainius Pūras

For interviews and further information contact:

charm.mentalhealth@gmail.com Tel: 07932 639 757

Warning notices were served after the Care Quality Commission (CQC) inspected the Greater Manchester Mental Health NHS Foundation Trust (GMMH). On Wednesday the trust was told it would face the highest level of intervention from NHS England.

The trust said improvement work was already under way.

A BBC Panorama investigation, broadcast in September, found patients at the Edenfield Centre in Prestwich, near Bury, were being put at risk.

Since that programme, some staff have been sacked or suspended as a result of the trust’s formal disciplinary procedures.

GMMH’s outgoing chairman Rupert Nichols previously said the trust was facing “significant challenges” after “inexcusable behaviour” at the unit.

The trust has also been under scrutiny after the deaths of three young people within nine months.

An inquest in October ruled communication failures “probably caused or contributed to” the death of 18-year-old Rowan Thompson at the trust’s Prestwich site.

The CQC served the trust with two Section 29A warning notices – one relating to ligature and fire risks, the other to staffing and governance, requiring significant improvements within a set timescale.

The report said inspections over the summer found problems with:

suicide risk assessment
the management of medicines
levels of cleanliness
consent to treatment
patients’ safety
Inspectors found there were not enough staff and there was a lack of proper oversight and scrutiny by the trust’s board.

Inadequate fire safety standards and poor levels of maintenance were uncovered, while wards were “dated”.

‘Not enough nurses’

The CQC report concluded: “The trust did not provide safe care. The ward environments were not all safe, clean, maintained or well-presented.

“We had significant concerns about fire safety in the acute wards. Ligature audits were poor because they did not identify all risks or effectively mitigate these.”

The service also did not have enough registered nurses or healthcare assistants to help patients, with staff “frequently” working under the “minimum staffing establishment levels”.

The CQC also raised concerns about mixed-sex wards and the “sexual safety” of patients.

It added: “Services were not always caring, some patients told us that wards were noisy and chaotic, and that they did not always feel safe.”

Full story here

Source: BBC News, 24th November 2022