Two major reorganisations and ongoing budget cuts have left many NHS mental health units running at or beyond full capacity – here, staff under pressure explain why they fear patients will suffer as a result
Overnight there have been seven admissions to this mental health crisis unit in west London, which means that 68 out of the 71 beds are full. There are almost no beds elsewhere in west London, and the senior management team use their 8.30am meeting to discuss who might reasonably be discharged to make room for incoming patients.
Operating with just three free beds in the unit is either a mark of commendable efficiency, or a sign of the terrifying pressure the system is under, and even the consultants are not sure which it is. A senior manager concedes: “We are sailing very close to the wind.”
Ward managers are asked to assess if anyone on their lists could be sent home. “We’ve already sent home everyone we could,” one says, scanning his list. “There’s a remote chance we could discharge Maria,” a ward nurse, says doubtfully. “Have there been any improvements in Mikhail?” the senior manager wonders, but there haven’t. “Is there no one else?”
Occupancy levels for acute adult psychiatric beds elsewhere are often running at 100%, and this level of intense demand is not considered particularly extreme. But the pressure on beds is not the only sign of strain the team faces. One senior nurse complains that the trust’s mental health teams have been so radically and repeatedly restructured over the past two years that it is her view that “people will die”. A psychologist describes feeling “despairing” and “heartbroken” at the eight-month waiting list for his services. Some patients are angry at being discharged from hospital and given what they feel is inadequate follow-up care.
Three days with the teams working with patients experiencing a mental health crisis in west London reveal some of the profound pressures the NHS’s service is operating under. But it also reveals how overworked staff are managing to look after a challenging group of patients with immense care and dedication, despite the combined pressures of those restructurings and ongoing funding cuts (which are still officially supposed to be referred to as “efficiency savings”)…
To read the rest of this article from The Guardian’s Amelia Gentleman, follow this link