Crisis over city mental care

NICHOLAS TIMMINS

Public Policy Editor

Further urgent action to improve services for the mentally ill is needed - over and above the Government's announcement last week of new forms of "asylum" for new "long stay" schizophrenics and others, NHS Trusts said yesterday.

In a rare assault on Government policy from the NHS Trust Federation - the direct providers of the service - psychiatrists and managers said the Government's existing plans are not sufficient to address a "crisis" in inner city mental health care.

Beds are running at up to 140 per cent occupancy, serious assaults on staff are increasing to the point where some wards are "battle zones", patients are being discharged too early, private beds are having to be used, producing poor after care, and virtually half of patients on acute wards in London are now forcibly detained under the Mental Health Act.

Services are so pressured that there is a "major problem" in recruiting psychiatrists and other staff. Even in well-regarded services, posts are providing impossible to fill, despite being re-advertised. Such issues now affect not just London but inner city services across Britain, the federation argues.

Existing plans for allocating NHS cash imply a transfer of resources from inner cities to outer areas - a move which "will cause a significant worsening of the crisis", a fact the Department of Health has failed to recognise, the federation's report says. The report backs the move towards 24-hour nursed homes for the new "long-stay" patients, but says other action, including the provision of out-of-hours crisis services, is needed.

In London, an emergency bed service is needed to identify empty beds for emergency admissions, along with an agreed mechanism to fund the use of private beds whose use in one Trust has quadrupled in little over a year.