'We need a revolution in mental health'

Mental health is finally at the top of the political agenda. The Liberal Democrats yesterday launched a "manifesto for the mind" which included a pledge for a £3.5bn investment, and there is cross party consensus on the need to improve services. Over 25 years ago when I founded SANE, a mental health charity, recognition on this scale seemed impossible.

Despite this, parity of esteem between mental and physical healthcare will not become a reality until there is a revolution in the way mental health services are delivered. People going to A&E with suicidal thoughts are not treated like someone with a physical injury, such as a broken leg, and can often find themselves turned away and left at risk. We must bridge the growing gap between these high aspirations and the reality of frontline services.

The fundamentals of care and treatment for people with mental illness remain in the Dark Ages, far behind most other areas of health. Over 40,000 psychiatric beds have disappeared since the late 1980s and more are lost every day. Dinesh Bhugra, the former president of the Royal College of Psychiatrists, reported that there were times during late 2013 when there were no beds available anywhere in England, while a BBC investigation revealed that more than half of mental health trusts were running average bed occupancy rates of 100 per cent or more for acute adult and psychiatric wards.

This has had a predictable knock-on effect on other areas of the mental healthcare system. We believe that it is significant that the numbers of people who take their own lives while being treated at home by crisis resolution teams doubled between 2003-4 and 2010-11.

The poor state of care experienced by patients and families affected by schizophrenia was revealed in a recent survey by SANE. More than half (58 per cent) of patients told us they received no information at all at the time of diagnosis. Eighty six per cent said they felt only partly involved or completely uninvolved in their choice of treatment and, importantly, only one in four family members stated that they were always involved in the treatment choice of the person they cared for.

In our experience families often feel positively excluded, sometimes blamed, and left to shoulder the main burden of care for someone who may be depressed, desperate and often suicidal. Additionally, under-resourced community mental health teams struggle to manage major increases in caseloads and extra responsibilities, for example for dementia care, while cuts to services have resulted in closures and mergers of day centres. As a result few patients are given any choice over where they are treated, or by whom, or what medication or therapy is available.

This leaves people needing to get sectioned under the Mental Health Act in order to get the treatment they need. Often this means patients can be turned away when they request help and left to deteriorate to the point when they "qualify" for a hospital bed. Others may be shunted hundreds of miles across the country, leaving them isolated from their homes and families. Some may even find themselves held in a police cell following a crisis, like the mentally ill girl, 16, from Devon who spent two days in a police cell last year when she should have been receiving treatment. Her mother said her daughter was left sleeping on a mattress on the floor in such a vulnerable state that it was "heartbreaking." But there are often no other places of safety for people with mental illness to stay before they are assessed.

This desperate situation is the result of a longstanding agenda to reduce expensive psychiatric beds and treat all mental health patients, however unwell, in the community. Yet we have also lost 4,000 mental health nurses over the last five years and in many areas community mental health teams have unworkable caseloads and are unable to provide any psychological therapies essential for recovery.

Any new funds released should first be used to ensure every mental health trust has available psychiatric beds; that crisis care teams are better funded and trained; that it should be mandatory to regularly monitor the physical health of people with mental illness; and that they should not be deprived by cuts to services such as day centres, lunch clubs and structured social activities. It is these relatively modest services and projects which can make daily life less isolated and more bearable.

There remains a jarring conflict between the high aspiration of raising mental health to the same level of importance as physical health, and the daily realities of life on the frontline for patients, their families and staff. Without concrete measures to restore the balance between inpatient and community care, it will remain a political pipedream and we risk condemning future generations to isolation, misery and despair.