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On the fifth day of Christmas, the cuts took away… access to the only available treatment

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muppet christmas chickens

This is the story ‘Sally’ wanted us to tell:

There has been a lot of press coverage about the lack of beds, but this usually refers to beds needed in a crisis or following a Mental Health Act assessment.

My colleagues and I in community teams have been dealing with another, almost hidden, consequence of there not being enough beds.

Clozapine is the NICE guideline recommended treatment for persistent “treatment resistant” psychotic symptoms. Treatment can only be started in hospital, as the side effects can be dangerous and careful monitoring of bloods and physical health is needed. Hospital admission to start clozapine is usually planned, rather than an emergency. Consequently I’ve been trying to arrange a planned admission for a couple of people under the care of our team. Each time I think we’ve got a bed it gets cancelled, as emergencies and detained patients are understandably always given priority. This goes on for weeks and weeks.  What this means though is that people are either having treatment delayed or denied, and ethically this feels wrong. I feel like I’m not living up to my professional code of conduct. We did manage to get one person admitted, but they were discharged so rapidly clozapine treatment wasn’t even started. It feels like people will only get treatment if they end up being sectioned but that goes against all the principles of the Mental Health Act.

‘Sally’ is far from the only person to raise their concerns about this disgraceful situation which is preventing some of those in greatest need from accessing the last resort treatment available to them. Yet the NSFT Board continues to claim it has enough beds and has plans to cut still more. How much longer can this be allowed to continue? The chickens are coming home to roost for the bed closure programme.

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5 thoughts on “On the fifth day of Christmas, the cuts took away… access to the only available treatment

  1. Susan says:

    This is yet another disgraceful story that is all too familiar to those of us who work for NSFT.

    The questions I would really like answering are: Who is Scrooge and who are the Muppets in this fiasco?

    Reply
  2. Barry says:

    This is inaccurate. Clozapine can be started outside of hospital with adequate community support, which perhaps the current difficulty in accessing may have been a better point for this story. While using real stories from staff and patients is the best way to highlight the campaign’s points, using an emotive title such as this article has when the basic facts are incorrect weakens the overall argument.

    Reply
    • admin says:

      Barry,

      Thanks for your valuable contribution and support. Technically, you are absolutely right – Clozapine can be started outside of hospital given adequate and guaranteed community support. However, at NSFT, chaotic with cuts and change, this level of community resourcing is far from the case, so the only safe way to start Clozapine here is in hospital and there are no beds. An earlier contributor wrote on our forums:

      “It [the bed crisis] is also making it almost impossible for service users to be commenced, or recommenced, on Clozapine, the only recognised drug available for treatment resistant schizophrenia, as this requires admission to hospital, or very frequent physical monitoring in the community, which the understaffed community teams are completely unable to provide.

      Is a mental health service that is unable to provide timely appropriate treatment for those with the most severe mental illness fit for purpose?”

      The combination of the lack of beds and inadequate community resources, coupled with the frequency with which this situation is arising, means that, in our opinion at least, the headline is justified. The final question that ‘Susan’ asks is the important one: whether caused by the lack of beds or inadequate community resources, treatment is being denied or delayed to some of those with severe mental illness. We are campaigning against both causes.

      Thank you for your comments and your support for our campaign.

      Reply
    • Emily says:

      Yes it has been possible to start Clozapine in the community, I did 10 years ago but the massive risk involved means that there has to be more than just ‘adequate community support’. Even with an amazing care team totally committed to keeping me out of hospital it was a huge task to ensure all the physical health checks were carried out. EI staff often came by after finishing their normal working day to make sure this happened and then came the battle to ensure this continued over the weekends with the crises team/home treatment…. My house mates had a list of people to call if I became unwell, at the time reassuring. As anyone who has tried to phone for support in the last year, particularly out of hours knows, it is not  guarantee that there is anyone one free to take the call. Given the current state of services it would be totally unrealistic to even consider hoping to achieve this safely now.

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  3. Barry says:

    By adequate community support, I meant support which was of an adequate level to allow someone to start Clozapine, which I wholeheartedly agree is, in reality, high level. I did not mean to suggest a basic support package was enough, but rather meant “adequate” in its literal sense i.e. good enough. Apologies for the lack of clarity.

     

    The first two paragraphs of this article clearly set out its stall as one focussed on a “consequence of there not being enough beds.” I think that this article would much better serve the cause if its point was to highlight the decimation of community services, instead of saying, without your later qualification, “Treatment can only be started in hospital…” This is a misrepresentation of the facts, and a missed opportunity to highlight a key flaw in the trust strategy, namely that a reduction in beds can be compensated for by improvement in community services while these same services are also cut to the bone. The focus on beds gets headlines, but what is happening in NSFT runs far deeper, and I wish more was being heard about that. I am glad we agree that both issues are of equal importance, and hope that Emily’s positive account of her previous experience is one we can fight to hear more of in the future.

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