Although the title says it all, the article by the NHS psychiatrist shows the reality of our NHS mental health system where underfunding means lack of beds, inadequate care for many patients, but a whopping profit for the private sector.
As a psychiatrist, I reserve admission to a mental health hospital bed for only the most unwell patients, whose mental health has collapsed. But despite my very best efforts to keep as many patients as I can out of hospital, bed pressures pervade every aspect of my daily work. The decision about whether or not we can admit a patient with a psychotic relapse who is not eating or drinking, for example, must first be agreed by the trust’s bed-management team. The woeful and worsening scarcity of NHS mental health beds forces psychiatrists to make very difficult judgments about a patient’s need for care and the risk they pose.
Acting in the best interests of the patient often seems secondary to the need to manage our hospital’s limited bed capacity. If, after much robust discussion with bed management, I get the green light to admit someone, I immediately become anxious that my patient will be sent to a private sector “overspill” bed, where I can be fairly sure that they will receive much poorer care than they would receive in the NHS.
I am not for one moment suggesting that being an inpatient in one of England’s underfunded NHS mental health hospitals is a pleasant experience. Most of our wards are dilapidated. Between six and eight patients share a single bathroom. Decades of underinvestment in mental health trusts is there for all to see. If the government is serious about mental health, it needs to start rebuilding our wards to provide a proper therapeutic environment and greater dignity in the care of our patients. And yet, the quality of care that we provide in the NHS for our most unwell patients is much better than they would receive in the private sector.
Over the past 20 years, the NHS has come to rely more and more heavily on the private sector, as our own stock of mental health beds has fallen. This is despite the ever-increasing need and demand for inpatient mental health care. It is a hugely shortsighted policy which has left NHS mental health services at the mercy of companies whose purpose is to make a profit.
Many NHS psychiatrists are very concerned about this increasing dependence on the private sector, mainly because the quality of care there is highly variable and also because some private mental health operators use some very questionable practices.
The idea that private provision of mental health care is “better” than NHS care is a myth. Countless Care Quality Commission inspection reports have shown that private mental health hospitals suffer from serious staffing problems. The private mental health sector relies heavily on temporary staff, has few full-time psychiatrists of its own and relies heavily on NHS psychiatrists working there one or two days a week.
The quality of inpatient therapeutic care is often poor, and the follow-up care after discharge can be nonexistent and badly coordinated with NHS community teams. Once private firms have banked the NHS fees from someone’s stay as an inpatient, they often seem to then forget about the patient, whereas we in the NHS continue to support them for as long as they need.
Private beds are sometimes a long way from the patient’s home, family and friends, which is distressing for everyone. I have lost count of the number of families who have complained that their loved ones are in a private hospital far away and that they are therefore unable to visit them. Out-of-area care reduces the support for the patient when they are in hospital, can lead to them staying longer, compromises effective and timely discharge planning and, crucially, reduces their chances of recovery.
Private mental health hospitals often seem to hold on to NHS patients for longer than necessary. They have no incentive to discharge patients and are paid to keep their beds filled, with a guaranteed income from the taxpayer. Longer than needed inpatient stays are bad for patients. When an inpatient stay lasts for many months, the person can become institutionalised and deskilled in everyday tasks.
Some private hospitals also tell patients what they want to hear. They can agree too readily with the patient’s self-diagnosis. A diagnosis of personality disorder in the NHS often becomes bipolar disorder in the private sector. Again, this seems to be all about filling their beds and boosting their profits.
Private care of NHS mental health patients is bad for patients, bad for the NHS and bad for taxpayers. The government needs to face up to this by building more NHS inpatient mental health bed capacity.
The author is a psychiatrist working at a London mental health trust