Mental health services for society's most vulnerable people are unfit for purpose, according to the findings of a damning independent inquiry published today.
Seriously ill patients are subjected to assaults, taunts and overcrowding in over-stretched hospital wards where containment rather than recovery is the priority. Meanwhile, others on the verge of suicide or a manic breakdown cannot access help because crisis teams are too busy or closed outside office hours. A combination of rising demand and government cuts is leaving the services at breaking point in some areas.
The year-long inquiry by the charity Mind found huge variations in the quality and availability of hospital and community crisis services across England and Wales. Evidence from 400 patients and staff found that innovative, humane and responsive services do exist, but only for a lucky minority.
Some people endure a lack of kindness and compassion at a time when they are deeply distressed and vulnerable. Such traumatic experiences in hospital mean many people "would do anything not to return", the inquiry found.
More than 1.25 million people used specialist mental health services in 2009-10 in England; out of those, 107,765 were admitted to a psychiatric hospital. Just over half of all inpatients felt unsafe at some point during their stay and one in eight had been physically restrained by staff, according to the latest figures from the Care Quality Commission.
The Mind report calls for an outright ban on face-down restraint after the inquiry heard evidence about the use of potentially fatal techniques. The Government said last night it would now be considering the use of restraint.
Vicki Nash, head of Policy and Campaigns at Mind, said the inquiry had heard a great deal of evidence of inhumane treatment and violence. "It is totally unacceptable that people trying to prevent themselves from getting worse cannot get help when they need it," she said.
The Labour government made a record investment in mental health services, rolling out crisis and home-treatment teams, an alternative to hospital, across England and Wales. In some areas, they have been a huge success, offering patients and their families round-the-clock access to professionals, reducing hospital admissions by up to 40 per cent. In other areas, the teams are poorly staffed, inadequately trained and slow to respond.
There has also been a rise in voluntary-sector crisis houses which offer a non-medical, therapeutic alternative, cutting NHS costs.
But, despite these changes, the inquiry heard compelling stories which demonstrate the absence of choice for many mentally ill people, who are unable to access the right services when and where they need them.
The Care Services minister, Paul Burstow, said last night: "We are committed to increasing patient choice and will publish much more data on mental health services so that the public can challenge commissioners who commission services that do not fit best practice."
He added: "Mental health consumes the biggest chunk of NHS spend but do we always get the best value for money? The answer to that has to be 'No', with consequences for individuals using those services."
Success story: A care service that works
The Leeds Survivor Led Crisis Service was set up in 1999 by a group of mental health services users, fed up with the lack of out-of-hours support. The service provides an evening helpline 365 days a year and a crisis house, open Friday to Monday, 6pm to 2am, for anyone in crisis. It is run by people who have experienced mental health problems.
The manager, Fiona Venner, says: "Mental health services that open Monday to Friday, 9am to 5pm, are set up to suit the needs of staff, not the people who use them. Night-times and weekends are the worst times for people, which is why we are open when no one else is."
Case study: 'I'm vulnerable at night, but the crisis team is shut'
Hannah Walker, 55, from Dorchester in Dorset, was diagnosed with bipolar affective disorder by a psychiatrist while serving as an RAF officer. She left after 16 years in service in 1991 because of her mental illness.
"I have had more than 20 hospital admissions, when I've been manic and depressed, though thankfully I've never been sectioned. My early experiences were not that good, but hospitals are better now than they used to be, mainly because there are single-sex wards which make me feel much safer. I live alone so it's the nights that I am most vulnerable but our crisis and home treatment team isn't open at night, though the trust has promised this will change. Going into hospital disrupts my life. I have three cats and have to look after them, which is why we need a 24/7 team. People should have access to local services when they need them."