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Inadequate mental-health care is putting vulnerable women in danger

A new report from the Care Quality Commission shows the grave impact of a failing mental-health care system. Katharine Sacks-Jones, director of Agenda, says it’s imperative the government acts now

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Barely a day goes by without a reminder of the fragile state our country’s mental health is in. A 68 per cent rise in hospital admissions due to self harm over the last decade says one report. Millennials are experiencing higher levels of anxiety, depression and suicidal thoughts than previous generations, warns another. Especially among women and girls mounting evidence points towards mental health problems continuing to rise and rise and rise – yet, says a new report, our system is seriously struggling to cope.

Latest findings from the health regulator, the Care Quality Commission (CQC), released yesterday, have highlighted growing pressure on mental health services, specifically for people detained under the Mental Health Act. The Act, which was debated in parliament yesterday, provides a legal sanction for authorities to admit, or detain a person in order to treat them in hospital, even against their wishes. Not only is the process of being detained still shrouded in hard and fast stigma, it can be a distressing experience, for both the person admitted into care and for their friends and family.

Quite obviously, it should only be a last resort, when all other care options have been exhausted, especially for women who have experienced abuse – the physical manhandling of their bodies in detention care, and the lack of control, can easily re-traumatise them. Yet, a flailing and inadequate system means that the number of people being detained – or “sectioned”, as it is often called – is, worryingly, growing.

And, so says the CQC report, women are facing particular difficulties in accessing appropriate care. Even if they manage to navigate the system (increasingly, a person needs to be in an acute crisis to be offered help; sometimes even a suicide attempt is “not enough”) yesterday’s findings show that the quality of care is getting worse. What’s more, a sizeable minority of mental health units in the UK are failing even in their basic duties to patients.

Specifically, nearly one fifth (17 per cent) of patient care plans do not appear to be taking a patient’s particular needs into account. And this is especially alarming for women, because of the close links between women’s mental health and abuse. More than half of women who have a mental health problem have experienced abuse – and this figure is likely to be considerably higher among women with the most serious mental health conditions who are being detained. For detained women’s particular needs, including experiences of sexual and physical abuse, to be ignored means they are unlikely to be getting the therapeutic support they need and also that they may be being restrained in ways that could be re-traumatising, a practice which is sadly all too common in secure units.

The thought that someone could be held in these conditions for more than a year because of a lack of suitable care is shocking. How is someone supposed to recover in those conditions?

That’s not all – the CQC report highlights additional concerns around women’s care. Many women are being admitted to or trapped in higher levels of physical security than is necessary because there is nowhere else for them to go – high secure units are full, medium secure units are full and other hospital beds and community support are desperately stretched. As a result, many women are being held inappropriately in high secure settings, meaning they’re not getting the right care for a start, and that they are rendered isolated and unprepared for life in the outside world when they’re released. Many become institutionalised – a real risk in this scenario. The report outlined one woman’s case, who had been held in long term segregation for over a year, simply because no one could provide her with the bed she desperately needed.

Earlier this month, I visited a secure mental health ward, which had a segregation room – a small empty room, with nothing but a plastic covered bed where you are kept under constant watch for 24 hours a day. The thought that someone could be held in these conditions for more than a year because of a lack of suitable care is shocking. How is someone supposed to recover in those conditions?

The report highlights how absolutely imperative it is that we do better, and push for a system that provides proper and effective care, especially for vulnerable women. Some positive steps have been taken – a recently formed women’s mental health taskforce, which I co-chair, is a big step in the right direction, and we have welcomed an independent review into the Mental Health Act recently commissioned by the government – its interim report is due to be published in the Spring. But I’m anxious to see that it is not just an analysis of the Act itself. We must also push the government to address how we reduce the number of detentions, and instead provide care that is appropriate and effective.

Simply put, now it’s time for the government to turn words into action. We continue with a situation that leaves some of the UK’s most vulnerable women, many of whom have experienced extensive violence and abuse, without the care they need. Instead, we urgently need investment in mental health services – services that take into account women and girls’ particular needs and experiences, especially of abuse and trauma. Right now, the evidence shows that just isn’t happening.

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Mental Health

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