'You cannot expect a nurse to handle 50 staff and a £1.5m budget without training'
A conscientious friend of mine in TV always bangs on about what a disgrace the House of Lords is, how people are becoming ashamed to be associated with it. I protest that it does good work and we agree to differ.
Perhaps it is because he lives in what I call 'the red belt' of north London: Camden, through Islington into progressive Hackney.
I thought of my chum when surveying a crisp 78-minute debate in the Lords on the state of mental health wards, staged one evening during the June heatwave. Since so many of the mentally ill are in prison, the debate had a topical resonance at a time when we are all suffering a tabloid-led 'crisis' over the need to lock more people up.
Its instigator was the tireless Baroness Julia Neuberger, former head of the King's Fund. But a cross-section of experts joined in, as they do in the Lords, to stage a debate barely possible in the Commons, which is more ignorant and more partisan.
Take Baroness Murphy. You may know her as Elaine Murphy, professor of old age psychiatry at Guy's and St Thomas' or chair of assorted NHS bodies, not least North East London strategic health authority and former vice-chair of the Mental Health Act Commission. Here's someone who has earned her stripes.
Where Baronesses Murphy and Neuberger and others like Lord Carlile of Berriew QC and Lord Ramsbottom, former chief inspector of prisons, seemed to agree was that the mental health cup is more half empty than half full - despite the very proper insistence of the duty minister, Stormin' Norman Warner, that mental health spending is up sharply: 3 per cent this year, 25 per cent in real terms since 1999. Lady Murphy conceded a 'slight improvement in recent years'.
Not forgetting capital spend of£1.6bn over four years to improve accommodation - a big concern of the peers who cited a succession of recent reports on the need to do more for both patients and staff. Indeed they agreed that boredom and violence - growing problems on overcrowded wards - would be eased if more and better-trained staff have the chance to engage better with their clients, the majority of whom nowadays are 'dual diagnosis' - ie mental illness plus drink or drugs.
Baroness Neuberger called it 'protected engagement time' (a new one on me) in which phones were diverted and paperwork stopped: 'It has become very popular with patients' she said. Baroness Murphy stressed that many acute wards remain 'unsafe and quite frightening'. She was ashamed to confess that when asked by friends to recommend a 'decent place' to admit someone in London, she 'can never think of anywhere'.
Her remedies are fourfold:
- the creation of more integrated community and ward teams to provide joint management of patients;
- more training for ward leadership, therapeutic skills and management:
you cannot expect a nurse to handle 50 staff and a£1.5m budget without training;
- better still, hand over ward management to non-nurses, as happens in learning disabilities;
- keep patients linked to education, training and jobs in the outside world.
Amen to that. Likewise to Lord Carlile for saying that too much effort in the aborted Mental Health Bill was focused on the few dangerous people who might kill on release - 'the Michael Stone question' - and to Lord Ramsbottom for some scary statistics.
Thus, in the general population 5 per cent of men and 2 per cent of women may have two or more mental disorders, but in prison the figures are 72 and 70 per cent respectively. For neurotic disorders, anxiety etc, the figures are almost as grim, for psychotic disorders alarming: 0.5 per cent and 0.7 per cent in the general population, 7 per cent for men, 14 per cent for women in the slammer. Needless to add, the figures are worse for Afro-Caribbeans.
As Lord Ramsbottom pointed out, all but 30 of the 80,000 prison population will one day be released to the community and the NHS. By the way, that often means London where the above problems are worst.
I think it an obvious conclusion that a marketised society produces winners and losers, most dramatically in the capital. 'Efficiency' excludes the semi-competent from jobs, a tipping point for some.
Michael White is assistant editor (politics) of The Guardian.