The recent inquest into the death of Alan Mann has raised some troubling questions from our campaign’s perspective. So troubling in fact, that we felt the need to take these concerns to the Department of Health and Social Care.
Access to urgent mental health care in the area is regularly raised as a point of the system that requires significant improvement to ensure that those in mental distress are able to get the care they need in the time they need it the most.
However, in this particular inquest, reporting suggested that Alan Mann was denied access to this urgent support from the Norfolk and Suffolk NHS foundation Trust due to the fact he was accessing private treatment that could be seen as ‘gold standard’ and a reason to reject from NHS Care.
The questions we have are relevant and important given the NHS landscape we are faced with, whereby waiting lists are high, staffing and resourcing remains challenged and distress ever increases due to individuals being left to hit crisis despite reaching out before this, so they can reach the thresholds for support that have increased over the years due to the aforementioned issues resulting in forced prioritisation of ‘the most unwell’ for consistent and meaningful mental health support that isn’t just ‘crisis management’ and then discharge.
We feel these questions cannot simply be brushed aside by reassurance and classic comms lines, much like the ones NSFT and the Department of Health and Social Care rolled out in response to our Campaign speaking with Greatest Hits Radio regarding our concerns.
Alan Mann, was a 63 year old company director living with longstanding depression and ME. Unfortunately, he died by suicide in February last year after his mental health deteriorated.
Much like the many other stories we have seen and heard in relation to mental health related deaths within the local area, Mr Mann and his family made repeated attempts to get urgent help in the days leading up to his death. During the inquest, once again, what emerged was a pattern of missed opportunities and systemic failures that again, are not new or shocking.
Most concerning was the evidence that Mr Mann was repeatedly rejected for urgent NHS mental health care. Clinicians indicated that this may have been because he was already receiving private treatment. Both GPs who gave evidence within the inquest suggested that this factor could have played a significant role in the decisions made by the mental health team NOT to accept referrals regarding Mr Mann.
The coroner herself highlighted the seriousness of this issue, particularly noting the:
‘problematic’ reality of someone ‘crying out for help and finding it difficult to access it’.
Expert testimony at the inquest pointed to a systemic gap between services. A consultant psychiatrist stated that Mr Mann appeared to fall between outpatient, psychiatry, crisis care and inpatient admission. Again, this is an observation that reflects longstanding concerns raised by patients, carers, families and bereaved relatives across Norfolk and Suffolk.
This is not an isolated case, and that is what makes this so frustrating. For over a decade, this campaign has documented repeated failures within NSFT, including barriers to crisis care, inconsistent thresholds for support and patients falling through gaps between services.
Once again, Mr Mann’s case illustrates that these systemic issues that seem to persist despite reassurance of improvement journeys, can have devastating consequences that the family of Mr Mann will have to deal with for the rest of their lives.
We feel that all of this raises a fundamental and urgent question: Are mental health patients being penalised for seeking private care when NHS services are unavailable, delayed, or they have already been unable to secure help from them?
We know from our group that many members have felt they have had no choice but to seek out private care in the form of therapy and psychiatry as NSFT have refused to provide them with it for a number of different reasons.
It may be that they are “too complex”, are neurodivergent and the Trust have been unable to effectively meet their needs, the therapy they need isn’t available in the locality they are in, or, they are too traumatised by historic care they cannot bear to continue as a patient under the Trust because they don’t feel safe.
We have family members of those who have died whilst under the care of the Trust who would never entertain seeking help from NSFT, again, because they are too traumatised by their relatives death and now fundamentally do not trust them and never will.
Many of our members who have autism or live with other neurodiverse conditions have also expressed seeking help elsewhere due to the lack of reasonable adjustments NSFT will allow for them to remain in treatment. Many of these people have had to seek private care for them to get treatment that does not cause further distress.
The issue is, Mr Mann was left to get to a point whereby his mental health deteriorated so much that it was felt he needed urgent NHS input. This is input that you cannot get privately and so it is worrying that others could be left in a similar position just because they are accessing other forms of private mental health care.
(Here it is also important to note, many of our members do not seek private care comfortably. These are people who have felt they have no other choice. These are people who don’t have the money to keep it up. In other groups we hear of people using payment plans, credit and family going into debt to provide them or their loved ones with care privately as they haven’t been able to get it from the NHS.)
In response to our concerns raised in the Greatest Hits Radio Report, NSFT stated that:
“Nobody is prevented from accessing urgent or emergency NHS mental health care in Norfolk and Suffolk, regardless of whether they are also receiving private treatment. We have no policy or guidance that restricts access to our crisis services on this basis.”
We feel this totally misses the point.
They went on to say that
“anyone experiencing a mental health crisis can contact NHS 111 and select the mental health option and will be directed to appropriate support.” and that they understood the issue may cause concern and wanted to “reassure patients and families that help is always available and based on clinical need”.
The issue for us is not simply whether a policy exists or not. The evidence that we have seen, heard and that is illustrated in Mr Mann’s case suggests that in practice patients may still be denied or delayed access to urgent care due to their involvement with private providers, should they make this known. The experiences described at inquest and echoed by clinicians themselves present at that inquest, point to some kind of barrier that has existed in this case, and given the track record of failing to learn lessons at the Trust, how can the public be certain this won’t happen again? This barrier may not have been policy driven, but who’s to say it wasn’t culturally driven? Operationally driven? The decision was made to not give Mr Mann urgent support and now he is dead. If decision making like this is still taking place at the Trust and these decisions lead to people being turned away whilst they are in an acute mental health crisis, then the system is failing, regardless of what policies do or don’t exist. Once again, it is this reassurance by language that doesn’t effectively reassure the people who come to us because they have seen failures like this time and time again.
Additionally, the Department of Health and Social Care responded with:
“no one should ever be denied access to emergency care”
Whilst highlighting national investment and workforce expansion. Again, we have heard it all before. Commitments to investment and increasing the workforce are always welcome, if the action actually follows. We feel they also risk obscuring the reality on the ground in Norfolk and Suffolk.
This is an NHS Foundation Trust that has faced persistent regulatory intervention and repeated concerns particularly around patient safety and access to care. Still, people report difficulties accessing timely mental health support, especially in crisis situations. These nationally generalised statements and funding promises do not acknowledge how deep these local service failures are. Without addressing the specific and longstanding issues within NSFT, there is a real risk that cases like Mr Mann’s will continue to occur.
Unfortunately we know that from experience.
This case is worrying and we are disgusted that it was allowed to happen. You’d hope that Mr Mann’s sad and premature death would be a turning point and it must be, but we don’t feel reassured it will. Patients who turn to private care, often out of desperation due to the NHS not showing up for them, must not be excluded from urgent NHS support. Mental health care should not operate a two-tier system whereby seeking help outside of the NHS becomes a barrier to accessing potentially lifesaving support within it. No one seeking help in a crisis, whatever that may look like, should be turned away. The system should respond every time, and there should not be inconsistencies.
An ambulance will always turn up. Why is mental healthcare any different?
See Greatest Hits article here: https://www.hellorayo.co.uk/greatest-hits/norfolk/news/norfolk-and-suffolk-mental-health-campaigners-raise-fears-over-nhs-crisis-care-access
See Diss Mercury coverage of inquest of Alan Mann here: https://www.dissmercury.co.uk/news/26030782.wifes-heartbreak-missed-opportunities-shotgun-death/
