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Let’s talk about mental health

Our aim is to halve the number of suicides in men under 45

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Deaths in custody: police urged to stop holding mentally ill in cells

Delayed report recommends broad reforms to police, justice system and health service in England and Wales to cut risk of death

A man in policy custody
 The report says the detention in police cells of those believed to be have mental health issues should be phased out completely. 

Far-reaching reforms to the police, justice system and health service in England and Wales are needed to reduce the risk of people dying in custody, a long-delayed report has concluded.

The report, ordered by Theresa May in 2015 while she was home secretary, contains 110 recommendations for overhauling the way in which the police and health authorities deal with vulnerable people, and how the police complaints watchdog investigates such incidents when they occur.

It is understood special groups have been set up in Whitehall to deal with the fallout of the report, covering police, health, coroners and the Independent Police Complaints Commission (IPCC).

The report by Dame Elish Angiolini QC says police vehicles and cells should not be used to transport or hold those detained under mental health powers, unless in exceptional cases. It also says the detention in police cells of those believed to have mental health issues should be phased out completely.

Responding to another key recommendation, the home secretary, Amber Rudd, said the starting presumption would now be that the bereaved should have legal aid-funded representation at an inquest following a suspicious death or suicide in police custody or in prison.

  • There should be an end to police officers conferring after custody incidents, but before they make their statements.
  • There is evidence of racial disproportionality in police restraint deaths.
  • Video cameras should be used in every police van used to transport a prisoner and on every frontline officer.
  • The police watchdog should robustly challenge discrimination where there is clear evidence.
  • Mental health training should be given of the same standard across all 44 forces in England and Wales for officers and recruits, plus refresher training.
  • The introduction of “drying-out centres” – seen as a potential alternative to police custody or accident and emergency departments for those under the influence of drink and/or drugs and who require specialist supervision – should be reconsidered.

Relatives of Sean Rigg, Thomas Orchard, Olaseni Lewis and James Herbert, who all died in custody, welcomed the report and urged the government to implement its findings.

The report states that every prosecution over a death in custody in the last 15 years has ended in an acquittal. “In fact, there has never been a successful prosecution for manslaughter in this context, despite unlawful killing verdicts in coroner’s inquests,” it says.

“This does not prove that the criminal justice system has failed to deliver justice, but it goes to the heart of why families so often feel let down by the system.”

In its response to the review, the IPCC also said that fewer than 25% of its investigative staff were former police officers.

The National Police Chiefs’ Council lead for custody, Chief Constable Nicholas Ephgrave, said he welcomed the review.

“Police officers across the country strive every day to protect the vulnerable and save life, often in difficult and complex situations,” he said. “Every death is a tragedy for the family and friends of the deceased and each death profoundly affects all those who were in any way involved with that individual during their time in custody.”

He said the police had already been looking at the risks involved in the custody process, but admitted more needed to be done. “We are determined to use this report to further improve and refine our practice.”

The police were working with the NHS, the College of Policing and the Home Office, he said.

“Our aim is to ensure officers are trained to use the right form of restraint in the circumstances based on an assessment of risk, we are able to identify vulnerabilities when someone is brought into custody, and, where appropriate, people are transferred to health services as quickly as possible.”

A video was launched on Monday as part of an internal police awareness campaign about the most critical points in the detention and custody process, aimed at preventing deaths in custody.

Andy Ward, custody lead at the Police Federation, which represents tens of thousands of officers, said the report made many valid recommendations “but stops short of detailing how they are to be achieved against a background of continued austerity and police officer numbers dropping by more than 21,000 since 2010”.

 

Original Guardian article here 

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Mum Amii, 31, opens up about living with ‘nightmare’ anorexia condition

Carnoustie mother-of-two Amii Adams has spoken about living with anorexia nervosa

Link to Evening Telegraph story here

A woman who suffers from anorexia is calling for more support to be given to adults with the condition.

Hairdresser Amii Adams, 31, was diagnosed with anorexia nervosa — described by the NHS as a serious mental health condition — when she was at high school.

The Carnoustie mother-of-two told the Tele of the “nightmare” condition that has plagued half her life.

Amii at a recent hospital visit

Amii’s weight has dropped to just six stone, with a dangerously low body mass index (BMI) of only 14.

She is now calling for more to be done to help adults who suffer from anorexia.

“For me, it was self-punishment. It was like I wanted to get thinner and thinner, but it was never enough,” she said.

“Now, it’s more like my mind is telling me that I don’t deserve to eat.

“I have a busy lifestyle, so it’s easy to just ignore the hunger.

“It doesn’t go away, but you can ignore it, or just drink a coffee or something.

“It is a nightmare — the condition has given me bad anxiety.

“I feel like I am in a room full of people, screaming for help, but no one can hear me.

“A lot of people don’t understand how bad it is.

“It’s so bad that sometimes I don’t even want to be here anymore.

“If it were not for my kids, I would have given up. I wouldn’t be pushing so hard to try to beat it.”

Anorexia nervosa is an eating disorder where a sufferer keeps their body weight as low as possible.

They usually do this by restricting the amount of food they eat, making themselves vomit and exercising excessively.

Amii has spent time in facilities in Aberdeen, Edinburgh and Glasgow, along with various NHS Tayside establishments.

However, she believes that most treatment is centred towards younger sufferers and that more needs to be done to help adults.

She said: “I just don’t think that you are treated as an adult by mental health services when you are suffering from anorexia.

“Adults suffer from it too, but I don’t think people are aware of this.

“You see a lot of campaigns about mental health, but never about adults suffering from eating disorders.

“I was in hospital in Edinburgh and when I got out I didn’t feel like I was any better, so I decided to take matters into my own hands. I got myself a private psychiatrist and spent a whole year attempting to balance everything on my own.

Amii at home

“Then I relapsed and started to lose weight and ended up back in hospital. It has been a rollercoaster the whole time — I have been in hospital for as long as six months.

“As an adult, there’s a lot of pressure, because you have so many responsibilities — and we need more help.”

Amii said her hope is that someone will one day be able to cure her.

She added: “My ultimate goal is to find someone who can make this go away. That is what I hope will happen in the future.

“I love my kids and I do not want to leave them alone because of this.”

‘One size doesn’t fit all’ in treatment

AMii has battled anorexia since she was at school and has been treated at all the major institutions around the country.

She believes that the Priory Hospital in Glasgow offers the best care.

The Eden Unit in Aberdeen

She said: “I think that all the services around the country should be more like the Priory.

“The issue is that unless you are referred there you will need to spend thousands on the treatment, which most people can’t afford.

“The way you are treated in there is a case by case basis.

“I feel like they understand that one size doesn’t fit all when it comes to anorexia.”

A spokeswoman for NHS Tayside said: “As part of the wider NHS Tayside psychological therapies service, NHS Tayside eating disorders service provides specialist, multidisciplinary, outpatient assessment and treatment to adults aged 18 to 64 suffering from clinical eating disorders such as anorexia nervosa and bulimia nervosa.

“Patients aged below 18 and above 64 are managed within the child and adolescent mental health and older people’s services respectively.

“Where a patient’s eating disorder is acutely life-threatening, such that they cannot be safely managed in an outpatient setting, referral will be made to the specialist 10-bed Eden Unit in Aberdeen, which NHS Tayside has access to as part of the NHS’s North of Scotland managed clinical network for eating disorders.

“Should a bed not be available at the Eden Unit, referral will be made to a specialist provider establishment in the private sector such as the Priory Hospital in Glasgow.”

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UK children who need mental health services face ‘postcode lottery’

Survey finds wide regional variation in availability of services, with waiting times as long as 16 months reported

The shadow of a young girl or boy playing on a swing
 Waiting times for family therapy can be even longer than for individual children. Photograph: Alamy

Children needing mental health care are forced to endure waits of up to 18 month for treatment while four in 10 psychiatric services for young people are failing, according to the health service regulator.

The Care Quality Commission (CQC), after surveying mental health care for children in England, said that in one case young people were forced to wait as long as 493 days for treatment and 610 days for family therapy. Elsewhere, services were setting their own targets for how quickly children should be seen, the CQC said, which varied wildly depending on a postcode lottery.

Dr Paul Lelliott, the lead for mental health at the CQC, praised the dedication of NHS mental health care staff but added: “We must also address those times when a child or young person feels let down or not listened to and make sure the same level of support is available to each and every one of them.”

Labour said the report showed an “abject failure of children and young people” who were in urgent need. The Department of Health said it was investing in improving the services, but said it recognised more work was needed.

The research found that crisis care for suicidal young people or those with severe mental health problems was sometimes available only between 9am and 5pm, with night-time care provided by adult psychiatrists who lacked expertise in children’s mental health.

Some children and young people were “waiting an extremely long time to access the specialist care and support they need”, it said. In one part of the country, a child would be seen within 35 days, but could have a wait of 18 weeks in another area.

“The demand for inpatient beds outstrips availability in some parts of the country where fewer beds are available,” the report found. “As a result, some children and young people are being admitted to adult wards as there are no beds available in wards for people their age.”

NHS England’s mental health director, Claire Murdoch, said the health service was now making progress addressing the waiting times, but said there had been “years of underinvestment” in young people’s mental health services.

Murdoch said there had been a 15% increase in funding, far outstripping the overall rise in mental health spending, which meant three-quarters of young people with eating disorders needing urgent care were now provided with that care within a week.

“Without a doubt, after years of drought, the NHS’s mental health funding taps have now been turned on,” she said. “NHS England has also been explicit about the scale of unmet need, which recent improvements have inevitably only been able to begin to tackle.

“It’s going to take years of concerted practical effort to solve these service gaps – even with new money – given the time it inescapably takes to train the extra child psychiatrists, therapists and nurses required.”

The research examined more than 100 CQC reports of specialist child and teenage mental health services, rating 39% as requiring improvement and 2% as inadequate when it came to treating children quickly enough.

Children and young people “are repeatedly referred to different parts of the system after several services tell them they fail to meet the threshold for support”, the report said, although it stressed that when specialist services were eventually accessed, the quality of care was good.

The shadow mental health minister, Barbara Keeley, called the findings “a scandal”, which was the result of government neglect. “Labour will continue to call on the Tory government to invest in and ringfence mental health budgets as Labour pledged at the general election, so that money reaches the underfunded services on the front line,” she said.

Norman Lamb, the Liberal Democrat former care minister in the coalition government, said the report showed “a moral imperative for change”.

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Charities and local authorities said the findings showed the urgency of the need for shake-up of mental health care. The Local Government Association said the report revealed “the fragmentation, complexity and variation of a service that investment alone cannot solve”.

The Children’s Society chief executive, Matthew Reed, said there were too many children suffering as a result of the slow service, with many more not even deemed eligible for treatment. The charity’s own research found 30,000 children being turned away from mental health services every year and not receiving any support or treatment.

A Department of Health spokesperson said: “Our commitment to improving children’s mental healthcare is shown by our additional £1.4bn investment, more trained staff and more children and young people accessing care. But there is more to do, which is why we commissioned this review and will publish a green paper on children and young people’s mental health by the end of the year.”

The department said there would be significant expansion in the service provision by 2021, with at least 70,000 additional children and young people receiving treatment.

Jeremy Hunt, the health secretary, last year admitted child and adolescent mental health services were “possibly the biggest single area of weakness in NHS provision at the moment” and Theresa May has said she is also particularly focused on improving the services, calling it one of the key “burning injustices” in UK society.

 

 

Original Guardian article here

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Mental health services are in crisis and we police struggle to pick up the slack

Link to the original article HERE

Officers handcuff and detain man.

Iam a police officer in an English police force and I’d like to apologise for the lack of support we can offer to people facing mental health problems. Cuts to NHS mental health services in recent years have put mounting pressure on the police force to pick up the slack and we aren’t trained or prepared to deal with it.

Recently I went to the home of a person who had been putting large lacerations across their arm, bad enough to need a couple of stitches, but not bad enough to bleed out. A friend had made the call to 999.

We stood in the living room in some kind of stalemate – my partner and I, the injured person who was self-harming and their friend. We tried to convince the person that things aren’t so bad, and that they can be fixed. Only now I’m not so sure they can be.

What can I do in a situation like that? I don’t have the authority to arrest someone in that situation and I can’t attempt to section them as they do not lack capacity. I would ideally like to call an ambulance or a mental health team but they simply aren’t available.

In the end I just had to sit for an hour or so and talk to them until I convinced them to come with us to A&E. It’s not a perfect solution by any stretch – the local A&E is at breaking point and, because of police cuts, if I commit to transporting someone I leave only one car in the area to respond to callouts. But what choice do I have?

There is also an increasing frequency of callouts that do not need to be attended by the police at all. There is one person, for example, who has mental health problems and calls us regularly about fictitious groups of people with masks, hiding in the bushes.

We still attend to make sure they are OK and that it isn’t a bunch of local teenagers scaring someone with mental health issues. But once again there will be nothing there. They will call again and we will attend – just in case it might be an emergency. The person has been waiting months for an initial mental health assessment and they are getting worse while they wait.

All I can do is attempt to convince them that we’ve checked the bushes and that everything is fine. I’ll have a quick chat about whether they have contacted their doctor and they will tell me they are still waiting on an appointment. They don’t have any friends or family to rely on and even if they did, how much could they do?

I feel sorry for the person I arrested recently who had caused criminal damage because they didn’t have the mental health help they needed. I know it is distressing for them – and their relatives, too.

I tell them that they can shout at me all they want, while two of my colleagues put them in the back of one of our cars and I try to explain what’s going to happen next. I know they have refused to take their medication, it’s been getting worse and nobody at the hospital has done anything.

The NHS is as understaffed as we are, especially in mental health. The control room staff who dispatch ambulances frequently say they are at “surge black” – the second highest level after a major incident.

Paramedics will do their best to get to us, but if someone is contained and being watched by police then they are considered safe and it could be several hours until they arrive to assess them and take them to hospital.

I can’t leave someone alone to wait for an ambulance, so if they are cooperative, calm and haven’t committed a crime then we just have to wait together. Once the ambulance crew is here they are free to go with them. Unfortunately, if someone has committed a crime or is being violent then they are going into custody either way. They can be watched in custody; they will be safe, can get some sleep and be assessed by our in-house mental health team in the morning.

But now the team only has the time to prioritise the most serious cases, so if someone puts on a reasonable show of being all right, they will likely just let them go. They will face charges for what they have done. And if next week they become distressed again and cause criminal damage or assault someone again, we’ll start the cycle all over from the beginning.

I’ll make the same referrals, I’ll take the same steps to try to make sure that person and those around them are safe and I’ll make the same apologies. I hope the situation improves, I really do.

 

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