For the past few months my regular Care Co-ordinator/CPN has been absent, they have been off sick since the very beginning of March. I usually saw this person every few weeks and had been trying to work with them in a more open and mutually respectful way.
Now psychiatric services within the NHS are stretched at the best of times, but I have over recent weeks realised that there is no longer any give in the system. Staff are working to maximum capacity and every last morsel of energy and work time is being squeezed out of every single one of the staff who make up the Community Mental Health Team (CMHT).
Once my CPN was off sick I quickly realised that there were no contingency provisions available for those people who like me were on the client workload of the now absent member of staff. I also understand that each one of those people who no longer had a service, were most probably vulnerable and in need of support from the Community team. The reality sadly is that I can only assume that like me, many of them were failed for a period of time and like me struggled on without that support until they could no longer cope.
A few weeks ago I had to call the Crisis Team in the middle of the night, they in turn flagged me up to the CMHT and as a result one week after my crisis I was called back. Now I don’t know what the services expected me to do in that week long gap between the crisis call and them making contact, but I know it wasn’t easy. Yet I had the benefit of my Psychologist appointments and my support workers and family, imagine if I had no one would I have survived that week?
After I eventually spoke to the CMHT on a couple of occasions I asked if someone could visit me at home, to offer some kind of mental health support in the interim. I had realised I benefited from seeing my now absent CPN and that I needed that kind of provision again. They allocated me a person who would visit on a temporary basis and so far we have had two meetings, which I have found helpful. I don’t know if these visits are going to continue throughout my regular CPN’s absence, yet I feel that I need them too.
The truth being my CPN still has no return date as far as I know and they have been off now for some months. Yet the reality is also very clear that the service hasn’t got the ability to provide cover from existing staffing resources. The services have in recent years seemingly been stripped to the bone, staffing levels reduced and workloads increased.
It’s no wonder there are staff absences within CMHT’s, that they don’t have the ability to operate a contingency plan to cover for such absences. It’s no wonder that service users/clients are left a week between being flagged up by Crisis and any contact from the community team.
When I first began working with community mental health team the services were very different, my first CPN became a part of my life when I was just 16 years old. Child Adolescent Mental Health Services (CAMHS) didn’t exist back in those days, once you left school and the remit of the school psychiatry team you came under adult services. Now I am not advocating that was better far from it, but CMHT’s were just different back then. They saw a wider age range of clients and yet there staffing numbers seemed much larger, I could easily get an appointment with a CPN every week. The CPN was far more relaxed and easily accessible, they’d meet me for coffee during my lunch break. We use to have my appointments away from my home and the stresses of a dominating mum, my meetings were secret the family never knew. As a result sometimes I would need to cancel last minute and I always spoke to my CPN when I called, she seemed to have a smaller case load.
In fact even 5 years ago, the community teams looked much better equipped and that’s my concern. We seem to be rationalising Mental Health services both in the number of inpatient beds available and the community provision too. But at some point, will we not cut too thinly, will we not end up squeezing the system at both ends and end up causing more harm and in turn more demand for services?
In my area a few years back the CMHT’s were rationalised, some services were amalgamated and that has meant less Doctors and less CPN’s. I no longer see my psychiatrist unless I’m deemed to need an appointment, so when I am particularly unwell the person I meet feels like a stranger instead of a familiar face. If I was to go to hospital I would now have a different psychiatrist to my not so regular one in the community, even more confusion and disruption for clients.
The lack of CMHT staff mean they have bigger workloads and less time to go around, thus appointments are less frequent and often shorter. It’s impossible usually to call the CMHT and speak to your own CPN unless of course they are on duty. But then they are too busy to talk or help, instead they are probably running around trying to do the impossible for ever growing numbers of people. I can’t imagine the strain these staff are under, but I can see that it’s intense and it’s not good for them or the clients they are desperately trying to help.
It feels like it has all gone too far, the services are being placed under constant attack and overwhelming pressure. In Shropshire the number of beds has been cut just like in many areas and so searching for a bed is a mammoth task these days, you are no longer admitted to hospital until you are more unwell. Now I’m not so sure that this is a good thing especially given community provision is also under attack.
If CMHT’s are stretched to breaking point, how can they help the growing numbers of people needing services. It’s simple maths really, less beds with the same, if not growing numbers of clients means more clients needing to be picked up by community services. Less staff in those community teams means a lesser ability to deal with the increasing demands being placed upon them.
Of course we all know who suffers, yes the staff do clearly but the main losers in all of this are the clients, people like me who suddenly find themselves adrift from community provision and support. In my case staff sickness meant no CPN visits for over 3 months, now that cannot be right.
I don’t blame the staff, in fact I feel sorry for them if I’m honest, I’d hate to face the intolerable strains of increasing demand amidst less resources. But I do blame the people at the next tier and above, managers and trust executives who seem to be allowing the situation to go on unchallenged and who undertake these restructuring exercises. But most of all I blame the Government who clearly cannot comprehend that they have a duty of care to those with Mental Health problems, who talk about parity of care, but don’t deliver.
My CMHT couldn’t meet my needs when faced with a sickness absence, but I don’t blame them it’s not their fault, it’s the fault of those who squeeze the NHS time and time again.
Copyright DID Dispatches 2014