Let me start by shocking you. I’d like to commend this trust for ordering the recent thematic review into homicides by patients.
The publicity surrounding the killing of Don Lock by Matthew Daley did put pressure on the trust, but many other NHS bodies would have resisted holding a broader inquiry, especially as I suspect the leadership of Sussex Partnership knew the report would not make comfortable reading.
So there you have it, praise from a journalist for the actions of a mental health trust. I doubt many of you thought you'd ever live to see the day. I’ve spoken to many psychiatric staff in recent years who’ve bemoaned the coverage of mental health care, believing we always focus on the failures without understanding the pressures.
From my own perspective, I don’t think that’s fair but I do think that a lot of mental health care needs a fundamental updating. Every story I do starts from the perspective of the patient and their family, rather than the system. Do that, and you’ll realise the problems.
I was at a conference a few weeks ago when the CEO of a trust (not Sussex I hasten to add) announced that they were no longer going to focus on removing ligature points from their inpatient units as it was now subject to the law of diminishing returns. Essentially they could think of cheaper ways to save lives.
Imagine now that your relative is admitted to a hospital in that trust. You are relieved, because you believe they’re safe. And then you receive a call saying they’ve died by hanging. Would you accept the CEO telling you that while they knew the unit had dangers, they decided not to remove them as they could think of better ways of spending the money? Of course you wouldn’t.
And talking of suicides, are they inevitable? Many psychiatric staff unfortunately believe they are. They aren’t. The health authorities in Detroit managed to eradicate all suicides of patients. Some progressive trusts over here, such as Merseycare, are now adopting the same approach.
What about the inquest after a suicide – is that fair? Often not, with the NHS represented by lawyers while the family have to put their own case. And the inquest usually ends with the trust promising to learn lessons and producing an action plan. Invariably, lessons are not learned (as demonstrated by subsequent suicides) and several points in that action plan are merely copy and paste jobs, not an assessment of the failings but a document designed to appease. I know because I’ve read them and when families see the same points being made repeatedly, they are understandably furious.
Ah, the families - too often seen as problematic. Of course they can be, but they are more usually the source of valuable information. Incredibly, “patient confidentiality” is still used as an excuse to prevent professionals from learning more about an individual. That failure to listen to the family is so frequent in psychiatric care that it is, in my opinion, the single biggest challenge facing NHS mental health care. Lack of a risk assessment, no proper care plan, failure to listen the the family – too often, the only thing that changes in an inquiry into a suicide is the name of the victim.
Many of the stories I cover come from a belief that the NHS can do better. Sure, money is tight and demand for mental health services is growing. But many aspects of the system are, I believe, simply broken. The very best trusts, the very best clinicians, are redesigning care to make it much more patient centred, more open and collaborative. That is not just a case of redesigning systems, it's changing the culture within an organisation so that patients and their families are genuinely at the heart of modern mental health care.