RSA Norwich: The Road to Hell is Paved with Good Intentions

Terry Skyrme reflects on the recent RSA mental health event in Norwich:

“Campaign supporters held a protest outside an event organized by the RSA at St Michael’s church in Norwich. Speakers at the event represented the “Third sector” and other mainstream services such as Norfolk and Suffolk NHS Foundation Trust (NSFT), the main provider of secondary mental health services. No service-users, carers or front-line professionals were invited to speak. We had offered to provide speakers but were refused.

The theme of the discussion was meant to be how we can prevent mental illness without spending any public money. We decided to protest against this dangerous premise and many of those attending agreed with our view and were pleased about our protest. We were belatedly allowed to attend the meeting (but as audience members and at the back) and made several contributions.

The theme being pushed by the panel was that no more funding for mental health can be expected from the public purse and that the way forward was to seek charitable funds, to persuade employers to pay for mental health treatment for their employees, and, most insidiously of all, for the third sector or private health services to take the place of the NHS.

The meeting had a distinctly Victorian flavour or as one of us said:

“It’s just Dickensian!”

For us, the third sector should be the cream on top of a comprehensive, safe, publicly-funded mental health service. We already have the knowledge and the research to know what such a service consists of. We are constantly told we have the fifth biggest economy in the world and yet we cannot fund an essential mental health service. No comment was made about the Health and Social Care Bill which promotes competition between third sector organizations, not partnership. It creates uncertain short term services employing, exploiting poorly paid and unqualified staff and fails to train the professionals of the future.

Another speaker promoted the idea of peer support-workers and quoted research to show how they improve outcomes. Again, peer support-workers are valuable and have a unique perspective but they should not be misused to compensate for a shortage of psychiatrists and qualified community mental health nurses. As one of our supporters said, the shortage of school nurses means that many children in schools are not having serious mental health problems addressed. Many voluntary organizations who deal with young people are finding themselves out of their depth with the severity of the mental health problems they encounter and discover they have nowhere to refer these young people to.

Political action to fight for mental health funding should not be counter-posed to voluntary work; we need the third sector to speak out strongly against cuts to government funding and not be cowed because they are dependent upon funding from commissioners or the Department of Health for their existence. Similarly, NSFT should stop pretending they can provide a safe service on the present level of funding. If we all unite we may get somewhere.”

Although The Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA)’s interest is welcome, it is hard to understand why the RSA has decided it can solve the mental health crisis. Would it display the same arrogant self-confidence about oncology, cardiology or particle physics? We suspect not.

The so-called expert from the RSA on the panel was a young politics graduate and former intern, without relevant qualifications or experience of working in mental health, who quoted research results about Care Programme Approach (CPA) and naively stated that more such research would lead to better services. As if we don’t know already what makes good evidence-based services. In the 90s, when CPA was set up, the Clunis Inquiry and all the other inquiries into what’s gone wrong over the years, the Richard King inquiry, Garnet Hooper, all the research from the Sainsbury Centre, from National Institute for Mental Health in England (NIMHE), all went out of the window with the disastrous radical redesign and the loss of experienced qualified staff, the collapse of CPA, the unallocated cases, the abolishing of Assertive Outreach, etc.

Then again, the same RSA ‘expert’ has written:

“Norfolk and Waveney is a trailblazer in the delivery of mental health services”

We thought NSFT was the first mental health trust to be rated inadequate and put into special measures, where the number of unexpected deaths has doubled and continues to increase? Obviously, the Care Quality Commission (CQC) and NHS Improvement consider NSFT to be a different type of trailblazer to the RSA.

The charity employees on the panel stereotyped the public sector as bureaucratic and the third sector as ‘sensitive and empathic’, one stating that service users prefer to be helped by a worker from the voluntary rather than the statutory sector. This is a common theme. However, the reality is that people want to be helped by good, competent, qualified workers, no matter where they come from. Given the current and expanding commissioning practices, the third sector is even more bureaucratic than the public sector. People don’t want constant change, which is what they are getting at present.

Opportunistic charity employees on the platform claimed to be non-political but then said things like ‘New Labour spent all the money’ or ‘The public sector is not the answer’. Norfolk Community Foundation said it is hoping to raise £500,000 for mental health. How is that going to solve the mental health crisis when NSFT’s annual budget would be £70 million higher if it had enjoyed the same increases in funding as the largest physical health trust in Norfolk? Furthermore, why should treatment be subject to the arbitrary whims and prejudices of rich donors and charity bureaucrats rather than co-produced by service users and professionals based upon research evidence and clinical judgement?

It is very worrying that Gary Page, the Chair of NSFT and Alex Stewart, Chief Executive of Healthwatch Norfolk, shared a platform with these people when they are supposed to be champions of the NHS.

Accepting the massive cuts to mental health budgets is accepting stigma and discarding ‘parity of esteem’. The mental health equivalents of soup kitchens and food banks are not the way forward and proposing them as the solution to the mental health crisis is not apolitical: it is deeply offensive. This isn’t ’21st century enlightenment’ but ’19th century Dickensianism’.