Patients with mental health problems deserve a therapeutic environment that aids their recovery and not inadequate infrastructure that exacerbates their condition. Writes Paul Farmer.
For most of the public, when they think of mental health treatment, they think of a private therapy session. Perhaps it’s a room with a comfortable armchair, a clock and a strategically placed box of tissues.
But this couldn’t be further from the truth for the tens of thousands of people who access mental health treatment through the NHS every year.
This treatment could be for anything from support for someone experiencing psychosis for the first time, to help for a young person who has developed an eating disorder. And the running theme across all these types of treatment is that they are being delivered in some of the worst buildings that the NHS owns.
Of course, good ward environments are crucial across every part of the NHS but imagine trying to recover from an acute mental health problem while sleeping in a room with other people experiencing symptoms that make yours worse.
Or being a woman admitted for treatment for a trauma-related mental health problem following sexual assault, only to be put on a ward with men.
Or knowing that you are feeling suicidal and are a risk to yourself, then being placed in an environment that is littered with ligature points. These are some of the realities facing people who seek mental health support from the NHS.
So where does the fault lie? According to a report released by NHS Providers last week, it’s certainly not with mental health trusts. According to their survey of trust leaders, two-thirds of trusts will not receive the funding they need this year to invest in urgent repairs or upgrade their buildings.
These leaders are clear about what is needed; the report concluded that between £50m and £150m must be invested over the next five to 10 years to improve the situation. Its findings further underlined the conclusions of countless Care Quality Commission reports, including the need for the 350 dormitory wards still in use across England to be replaced.
Two-thirds of trusts will not receive the funding they need this year to invest in urgent repairs or upgrade their buildings
Despite ongoing political rhetoric from government and NHS leaders about the importance of mental healthcare meeting the same standards as physical healthcare, there has been little evidence that this is a serious commitment – mental health has been completely overlooked in a string of recent capital spending announcements.
Accessing mental health services is hard enough in the first place – we know that the NHS sees only one in three people who require mental health support. And even when people do access help, it is often delivered in facilities that are so poor they limit the quality of care.
Most people who require inpatient treatment for a mental health problem are coming into contact with the health service at one of the most vulnerable times in their lives. They deserve to be supported in a therapeutic environment that aids their recovery.
Instead, long-neglected NHS mental health hospitals and other buildings are undermining people’s recovery and putting them at risk of suicide and sexual assault.
Just 62 per cent of staff within mental health and learning disability trusts are happy with the care offered by their organisation
We cannot expect people with mental health problems to use inadequate and often dangerous infrastructure, nor should we expect NHS mental health staff to work in it. The recent NHS staff survey results showed just 62 per cent of staff within mental health and learning disability trusts are happy with the care offered by their organisation.
Staff, patients and the public know that the continued use of mixed-sex and dormitory wards puts people in danger of sexual assault, while the design of buildings can affect how easily people can take their own lives.
But dealing with these dangers is a bare minimum; it’s time we see investment in creating state of the art, therapeutic mental health wards just as we have seen in other parts of the health service.
For this to happen, trusts must be able to access capital funding in the long-term and current restrictions on trusts spending their income on building projects have to be removed.
If the government is serious about bringing the mental health estate into the 21st century, we need a multiyear capital settlement which roughly doubles the current budget and ensures all parts of the system can access funding based on need.
When people are at their most vulnerable, they deserve the best possible treatment from mental health services – treatment that’s delivered in a therapeutic environment that aids recovery and allows them to safely return to their community at the earliest possible point.
Until this becomes a reality, our mental health services will remain unfit for purpose.