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The Guardian: Nuwan Dissanayaka: Jamie is psychotic and won’t go outside. Mental health services are failing him

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This article from Nuwan Dissanayaka needs to be read by everybody with an interest in mental health.

Dr. Dissanayaka is really worth following on Twitter. We’re delighted Nuwan’s views are getting wider attention in the national press.

Dr. Dissanayaka is the consultant psychiatrist in the Assertive Outreach team in Leeds. Of course, assertive outreach at Norfolk and Suffolk NHS Foundation Trust (NSFT) was simply ‘airbrushed out‘ without replacement during the ‘radical redesign’. Many people have died or seen their quality of life decline significantly as a consequence of the withdrawal of mental health services for those most in need of support. We consider this withdrawal of services to be immoral.

NSFT dishonestly claimed that the ‘radical redesign’ would improve services and was co-produced but who protected the interests of people like those featured in this article?

When front line clinicians spoke out, managers accused them of ‘shroud waving’. Those same bureaucrats who ignored the concerns of front line clinicians still dominate the middle management at NSFT.

Service user and carer engagement was at best narrow and tokenistic, at worst abusive. The King’s Fund used the radical redesign as the example of how not to implement change.

We have been told frequently by NHS bureaucrats that decent mental health services for those most in need are unaffordable but they always appear able to find money for pay rises and new deputies and managers, like the new Deputy Director of Operations and Deputy Director of Nursing that NSFT is currently planning to recruit. The Care Quality Commission (CQC) has condemned the bloated bureaucracy at NSFT: the layers of unresponsive management between the Board and patients. We need more genuine front line staff and fewer custard cream and chocolate bourbon munchers, if mental health services in Norfolk and Suffolk are to improve. Why is the bureaucrats’ solution always another manager?

Here is an excerpt from the article. Do read it in full by clicking on the image below which will take you to the article on The Guardian website.

I work as a consultant psychiatrist in an assertive outreach team. It was once the next big thing but these teams have been discarded in many areas due to their perceived failure to reduce hospital admissions. Our focus on continuity and therapeutic relationships is often usurped by a short-term approach to long-term mental illness.

Jamie is one of many people I see who have complex issues. A psychotic illness compounded by substance use, a rejection of psychiatric services both statutory and otherwise, all compounded by the serious risks he faces – most significantly – from others. It’s a combination that has led to numerous detained admissions. Other than his friends, we are the only people Jamie regularly sees. We’ve hung in there over the years and he has come to trust us, at least some of the time.

He has been accused of failing to engage by much-changed health and social care systems that have failed to engage with him. Apart from the times that Jamie becomes disturbed in public due to his intense psychotic experiences, he and people like him, remain largely hidden from society.

We work hard to support Jamie’s wish to remain in the community but there are many barriers. Without access to the right health and social support, yet another admission, most likely under the Mental Health Act, feels sadly inevitable. As this vicious circle continues to turn, and the stigmatising perception of him as a danger to society grows, he becomes increasingly likely to join the thousands of people currently in expensive, locked, often out-of-area psychiatric units. Even the support from teams like ours is something that has been myopically stolen from many people like Jamie across the country.

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