It is Friday night, and A&E staff are trying to work out what to do for a 14 year-old boy found wandering the streets of a London borough, naked from the waist down, not making sense. It is clear he is having unusual ideas and hearing things that other people can’t. He needs to be somewhere safe. A&E is busy and chaotic. There are specialist psychiatric wards designed for under-18s, where professionals help young people and their families understand what is going on and offer treatment. None of the London adolescent wards have a bed free, though. The only option is a bed on an adult ward, inappropriate and illegal, or a bed three hours away, far from family or friends.
Earlier the same day the senior nurse of a gastroenterology ward in another major UK city calls around trying to find a bed for a 15-year-old girl with anorexia. She has been on the gastro ward for over a week, eating just enough to stabilise, still extremely underweight and likely to deteriorate without specialist support. The girl is not in the right place to get the psychiatric treatment she needs, and is in a bed which a gastro patient needs. Eventually, the nurse finds a psychiatric bed—a five hour journey away.
Searches for adolescent inpatient beds are routine. Mental healthcare and social care have suffered chronic, debilitating cuts, and money promised to child and adolescent mental health has been spent on other things. Psychiatric beds for adolescents are continually over-subscribed, leading to teenagers being cared for miles from their families. When there are not enough NHS beds, costly private hospitals are used.
It is a mess, and political parties are absolutely right to be talking about it in their manifestos.
Comparing the manifestos
The Labour manifesto pledges to use tax from higher earners to finance higher spending on the NHS and social care. It highlights child and adolescent mental health as areas of need and pledges to give NHS staff “the support they need” and “the pay they deserve.” It promises to lift the NHS salary cap and spend £30bn in extra funding.This figure is the most realistic of all the manifestos. It is nearest to the independent estimate of what the NHS actually needs, made by the King’s Fund, a health charity. It promises to ring-fence funding so it is spent on mental health.
The Conservative manifesto promises similar things, but without the follow-through of anything near the same level of funding, or of ring-fencing. It highlights stigma around mental health, and pressures on children and adolescents, but says little about how to tackle these beyond promising a green paper and doing more in schools.
It promises more places for training doctors and nurses, but doesn’t recognise that there is a shortfall in medical training places that are taken up, probably because of the stress and difficulty of working in an underfunded NHS.
It pledges to reform the mental health act, with no rationale for why beyond a few controversial criticisms. It promises £8bn in funding. Chris Ham, from the King’s Fund, commented that this sum “will not be enough to meet rising demand for services and maintain current standards of care. The Conservatives need to be honest with the public about the consequences for patients and their care.”
The Liberal Democrat manifesto promises to add a penny per pound on taxes, ring-fenced for the NHS and social care (approximately £6bn), and it seeks to prioritise mental health as one of four areas for this funding to be spent on.
The Liberal Democrats have a good track record on this issue and will ring-fence money for mental health, although not child and adolescent mental healthcare in particular. Their manifesto also highlights how NHS staff are “embattled and undervalued” and sets out specific ideas about how to retain clinical staff, including ending the pay freeze.
Looking ahead
The NHS was created to provide free healthcare at the point of access for all. For years the health secretary was responsible for this. Legislative changes under the Conservatives have meant that the secretary of state—since 2012 Jeremy Hunt—no longer has this responsibility, instead devolving it to clinical commissioning groups nationwide. The more that responsibility is devolved the less it lands in the lap of the government, and the more likely it is that private healthcare will be resorted to for “help,” despite a disastrous and costly track record in several areas.The NHS is at huge risk, as are the most vulnerable people in our society. Those vulnerable people can be any one of us: one in four of us experience mental health problems each year. Approximately half of people with a mental health problem will have developed difficulties by the age of 14. Good quality intervention at an early age is crucial. The boy wandering the streets at night in London; the girl stuck in a gastro bed when her difficulties need a different sort of treatment: these patients are failed by current NHS underfunding, as are the hardworking stressed-out staff trying their best to care for them.
Lucy Maddox is a consultant clinical psychologist. These views are her own, not of any organisation she works for.
The examples of psychiatric illness described here are amalgams of real world cases.
