CHARM, the Community for Holistic, Accessible, Rights Based Mental Health was launched by The Organic Recovery Learning Community in September 2020
We are a campaign calling for radical changes in the way psychiatric services are provided in Manchester.
We’ve teamed up with people with lived experience, trade unions, family groups and citizens to challenge the Greater Manchester Mental Health Trust decisions to build a large psychiatric hospital in Crumpsall.
The campaign was launched after we wrote a letter to Andy Burnham to meeting discuss the future of mental health services in July 2020. We’ve now met with Andy twice and we are seeking his support for a root and branch review and an action plan to transform mental health services.
In our experience Manchester’s mental health services have been constructed around biological understandings of illness for far too long. The best efforts of our mental health workers and services are compromised by the narrow focus on illnesses and medical responses of our crisis services.
This mindset eclipses the significance of social determinants on peoples’ lives. It places the emphasis on disease processes rather than racism; social-economic adversity; people fleeing persecution; homelessness and poor housing; adverse childhood events; trauma; oppression; micro-aggressions; toxic situations and relationships.
These we know are amongst the most significant contributors to undermining our well-being and resilience, leading to poor mental health.
Melanie was admitted to the Moorside Unit at Trafford General Hospital, which is run by the Greater Manchester Mental Health NHS Foundation Trust, on March 9, 2018.
During her admission, a consultant psychiatrist changed her medication to a depot injection for two weeks to ‘improve her symptoms’, the inquest heard.
Her partner Tony said they were ‘concerned’ by the injection because of the side effects she suffered.
By the time Melanie was discharged on June 13, her condition had improved and she was put back on her previous anti-psychotic medication.
She was seen by a psychiatrist on July 12, who recorded that Melanie’s condition was stable.
Melanie was then seen regularly by her care coordinator until August 3.
That care coordinator went off sick before leaving her position, the inquest heard.
But despite being classed as ‘high-priority’ after being sectioned, Melanie wasn’t given a new care coordinator until August 22.
Her new coordinator Wilma Martin-Lawrence told the inquest she was on a two-week holiday at the time Melanie was added to her case load of 28 service users.
The inquest also heard how she was unable to work in her capacity as care coordinator on 21 out of 43 days at that time due to other professional commitments.
Ms Martin-Lawrence was unable to make contact with Melanie until the beginning of October after she had contacted mental health services to ask who her care coordinator was.
She met Melanie during an appointment with psychiatrist Dr William Davis on October 18.
At this appointment, Melanie said she wasn’t feeling paranoid, had no problems with her medication and was not having suicidal thoughts.
Her care coordinator arranged a home visit with her on November 9, but she sadly died before this could take place.
Melanie’s partner Tony told the inquest she ‘gave off the impression that she was doing well’ after being discharged from hospital.
“Melanie did not like being in hospital so obviously the two or three times that they came after she was discharged she would have said that she was doing well because she did not want to go back there,” he said.
A serious incident review was carried out by the Greater Manchester Mental Health NHS Foundation Trust.
It showed that there were ‘significant staffing issues’ at the time of Melanie’s death.
Daniel Cottam, operational manager for mental health services in central Manchester, told the inquest the team ‘was under significant pressure at the time’.
The approach in mental health services, known as ‘stepping down’, has been criticised by service users in a new report published by charity Manchester MIND.
Historically, people with ‘severe and enduring’ mental health needs, including those with conditions such as schizophrenia, have been treated in the long-term by mental health professionals.
But the report says that an increasing number of such patients are being handed over to the care of their GP.
“It has become apparent that this change in service provision is not working either for the individuals who need to access it or the professionals who deliver it,” the MIND report states.
“The perception was that people with complex and chronic disabilities are ‘dumped’ on GPs, many of whom ‘lack the capacity and willingness to understand’ how to manage their care.”
Researchers spoke to around 30 mental health service users about their experience of being discharged, as well as the voluntary and community group workers supporting those who have been ‘stepped down’.
Many people said they were not involved with the decision to be discharged, while some were completely unaware they’d been stepped down.
Researchers said there was ‘obvious confusion’ among patients being discharged, sometimes with a ‘harshness in the delivery’ and a ‘lack of concern’ for the person’s expressed fears.
The report said: “The majority, however, were shocked, puzzled and angry at their treatment, they were not listened to, got little or no information, were not involved in the decision, felt let down and abandoned.”
Many felt they were discharged for non-medical reasons, including missed appointments, using the service for too long and insufficient resources.
Some said a shift in treatment has had a detrimental impact on their lives.
One person said: “There is a rolling back of adult mental health services for those of us with severe enduring diagnoses who need ongoing support.
“The medical model has been superseded by the recovery model which is all about how we live best with our illnesses, but the recovery model is being used in a way that is destroying quality of life for most service users.
“We can’t live full lives because we are terrified of becoming ill as we don’t know what we will do on our own.”
Many complained of losing benefits, housing and community support as a result of being stepped-down.
The report said when people are discharged, there can be an assumption they are ‘recovered’ and are therefore no longer entitled to benfits.
This can be further exacerbated because they no longer have access to supporting medical evidence from a psychiatrist or care co-ordinator.
Paul Reed, mental health campaigner and chair of the Manchester User’s Network, described the report as ‘damning’.
“I’ve never seen so many patients upset,” he said.
“It’s a damning report which shows that something needs to be done.
“These poor people are being stepped down and losing their benefits.
“They are doing it dangerously when they know patients are at risk.
“Nurses are fed up at not being able to do their job.”
The Greater Manchester Mental Health Trust did not wish to respond to the findings of the report.
It described stepping down as a ‘vital part of recovery’.
A spokesperson for the trust said: “Stepping down – the process by which an individual is discharged from specialist mental health services and returns to primary care – is a vital part of recovery.
“Specialist mental health teams are there to offer care for people who are suffering from a range of mental illness and when they respond to the team’s interventions, it is a positive step for them to step-down from our services and return to the care of their GP and primary care services.
“Step-down decisions are based in evidence and what is of most clinical benefit to the individual.”
We have established CHARM, following the concerns that we raised about the lack of meaningful consultation and co production that took place regarding the redevelopment of Park House as a single site psychiatric hospital.
We have analysed the situation in Greater Manchester and reflected on the policy changes that are currently being addressed by the Department of Health (The Community Mental Health Framework for Adults and Older Adults; the new Mental Health Bill 2022; and the Long Term NHS Plan).
Our demands are not new ones. Many of these demands for justice and rights were made in the 1980s, we know because many of us were there. Nearly 30 years later, how much longer must we wait for change?
Our demands are based on our own strong value base that holds human rights and justice as the essential components of any health and social care system.
‘It’s a house of cards and it’s already falling down’ Manchester Evening News, 21/02/2021
“Following her own experience with the service, Anandi Ramamurthy decided to set up CHARM, a support group which works with patients, families and mental health professionals.
She said: “It’s the system – not the people who work in it. We have members of CHARM that work in the service and there was one person who I spoke to and asked if they were going to change something what’s the one thing you would want to change?
“He said I would like to be able to go home at the end of the day and feel that I’ve made somebody’s life better. At the moment I can’t do that.”
Anandi wants to see services in Greater Manchester pursue a different approach to care involving more open dialogue and discussion, as well as focus on the traumatic events which can trigger mental health conditions.
She added: “We want them to rethink the approach and look at other ways of working to try to help those for whom the system they currently have doesn’t work.
“For example the only approach we seem to have when it comes to psychosis is to dole out medication – but now it’s generally recognised that one of the reasons people end up having psychotic breaks is to do with trauma and stress and these are very often related to a whole series of issues.” Read full article here