Psychiatric wards are frightening places. They are noisy; there are people out of control; the young are cared for alongside the old, the abused alongside the abusers, and there are not enough staff to cope.
Patients whose first experience of the mental health system is of being forcibly admitted to such a place, where they are drugged up to the eyeballs to enable them to cope, are understandably never likely to use the services again.
The neglect of in-patient wards is one of the biggest scandals of the mental health system. The Government admitted in a report in 2001 (The Journey to Recovery published by the Department of Health) that too many were "shabby and depressing" and would "never have been tolerated in medicine or surgery".
Today's Mind report shows how little has changed. Although billions of pounds are going into the NHS and the service to patients is slowly getting better, mental health is not keeping pace. While it may no longer be the Cinderella of the NHS it still has third-rate status.
Mind is not alone in highlighting the continued neglect. In July the Healthcare Commission, the NHS watchdog, published performance tables showing more than a third of mental health trusts had one star or none, indicating poor performance. The number of those allocated zero stars had risen over the previous year from three to seven. "The performance of mental health trusts remains a cause for concern," the Healthcare Commission said.
Admission to hospital is too often damaging rather than healing. The wards are crowded, unpleasant and dirty; there are many highly disturbed patients; there is drug dealing and violence. Then there is the stigma. A medical record becomes like a criminal record with this difference: the psychiatric patient can never clear his or her name.
The average length of stay in a mental hospital in-patient ward is at least three weeks, compared with two to three days for a physical illness. This is a key difference. As the Mind report notes, a major problem for patients is boredom. There is nothing to do on most wards except watch TV or smoke dope. Little wonder that one manager described the care as "adult babysitting".
Community care for people with mental problems has improved, with new crisis teams and greater efforts to look after people in their own homes. But that has left the hospital wards filled with the most distressed and acutely ill patients, many detained against their will and treated by compulsion, and without the staff or facilities needed for their extreme degree of dependency.
The clearest litmus test of any service is whether the people who run it would use it. Ask any psychiatrist if they would send a member of their own family to be treated on the wards. Ask any manager. Most would not contemplate it.
Sir Ian Kennedy, chairman of the Healthcare Commission, has said that he intends to shine a light into the deepest recesses of the mental health system and has marked it as a priority for remedial action. It cannot come too soon.Reuse content