The world is supplying an awful lot of material on the topics covered on this website and I’m genuinely struggling to keep up! There are a few burning stories at the moment which I’ve decided to just ignore for now because I don’t have the time to cover them or do the reading or research that would be needed to do the story justice.
But this one needs covering, so here we go –
The Edenfield Centre, in Greater Manchester is a medium secure unit. You may remember a Panorama programme broadcast in 2022 called “Patients at Risk”. Unfortunately, the BBC iPlayer link shows the programme is no longer available, but I’ve provided it in case the BBC decide to review that in light of a report published today. The BBC had journalists sought employment with Greater Manchester Mental Health Trust (GMMH) which runs Edenfield and those staff undertook covert filming of what occurred whilst they were on shift. You can read a longer BBC piecce from one of the men who went undercover, it’s quite illuminating and it all included absolutely disgraceful abuse which was widely condemned by many mental health professionals. The trust Chief Executive resigned six months after the programme was broadcast.
In response to it all, a review was ordered and Professor Oliver Shanley OBE and that review has today been published and the BBC are providing extensive coverage, as you’d expect given it flows from their exposure of the abuse. The major emphasis in the report is on how the abusive actions themselves and the lack of adequate response from the trust to concerns raised were a breach of human rights.
BIG READ
The full 157 page report is available on the NHS England website. It is perhaps summed up by one comment given to the review by a family member of someone who had been detained there. They had tried to raise concerns and were ignored: “The trust seem like they are firefighting and walking from room to room with fire, and petrol already in the room, smoking a cigarette”.
The opening of the report is worth reading –
“As with many organisations nationally, we found a Trust that was facing significant workforce challenges; however, many staff described feeling exasperated, tired of not being listened to and disconnected from the Trust leadership. We were told that these concerns started long before the scope of this review. We heard that staff have felt fearful to speak up for many years, and that the full extent of Edenfield’s nursing shortages and their consequences have been masked and ignored. Over time, this culture and way of working have led to many staff from across various disciplines leaving the organisation. Nursing levels had become unsafe; the ability to deliver safe and timely care was severely compromised. The inadequate governance systems and the wider Trust culture contributed to the purported ‘invisibility’ of these deteriorations. We found it was difficult to discern how this workforce crisis was acknowledged in GMMH: there was an absence of an effective response to these concerns. We also observed that some of the concerns identified within Edenfield existed across other parts of GMMH inpatient services.”
WOW!
At the risk of being accused of skirting over the abuse detailed within the report, the short-tempered lack of compassion and empathy, etc., I couldn’t help but keep thinking as I read this report last night about the points Professor Shanley makes about staffing, recruitment and cultures which result from under-staffing and management struggles. None of this excuses abuse, of course, and criminal investigations are ongoing in to what Panorama uncovered but we’ve been hearing for years – OK, for decades – about mental health services being under-funded and under-staffed. I once had an awkward discussion at a social event with someone I’d not previous met who worked for the NHS, albeit not within the mental health sector. We’d been introduced with our common link deciding without asking me to tell this stranger that I was a police officer. She asked what I did and I was at the College of Policing at the time, working on mental health policy and practice as a full-time job and when I’d said that, I was told without discussion that “all the problems in the mental health system were down to underfunding” and when I said I disagreed and it was much more complicated than that, it promptly brought things to quite a hostile end. I regret that it became hostile, I was thoroughly relieved that it ended the discussion.
UNDERFUNDED
But there it is: some people in the NHS do believe things are just due to funding but Professor Shanley doesn’t reach that finding, but he rightly highlights the impact on care which is the result of not having enough staff, or enough nurses. It impacts on care that managers, for whatever reason, do not hear or see the things which should be prompting thought about how to correct the conditions giving rise to concern. Of course, what managers can actually do with those concerns will vary by place and by issue. We know that 20% of all mental health nurse positions in England are vacant – that we’ve lost over 5,000 mental health nurses since 2016 and that recruitment is difficult in that context. It’s all very well the Chief Executive of a mental health trust knowing and wanting to react to seeing that wards or units don’t have enough nurses, but where do you get the nurses from, in this context? It takes three years to train a new one, after all. The report states, “There was not a clear strategy to address either the recruitment or retention of staff.” Maybe that’s because there is a genuine sense of little that can be done, given all mental health trusts are competing with each other to recruit or retain a pool of staff who have liberty to move as they wish, given employers are struggling and vacancies abound?
The report makes clear there are also recruitment problems at Board level in this mental health trust. We noted above, the Chief Executive at the time of the filming had resigned, by publication of the report almost 18-months later, a new Chief Executive had not yet been appointed. In addition, the Chief Nurse had retired and not yet been replaced, the medical director retired and a new appointment has now been in place for only six months, there are others acting as ‘interim’ leaders in key positions, pending recruitment and of course, many people who might be qualified to undertake these roles might be cautious about applying, given what has become known about the trust more widely. Remember, this report published today looked under the rocks not only at the Edenfield Centre, but at other care locations in the same Trust and, perhaps unsurprisingly, found similar issues elsewhere, even if not necessarily on the same scale.
I remember many years ago hearing a senior figure in policing talking about “empathy fatigue” – the idea there is, that if you continually expose human beings to stressful work which has emotional impact amidst relentless demand and under-staffing or other problems, people start to find adverse coping mechanisms to survive contact with that environment. People learn how to survive within a system. We saw earlier this week, the Catch a Copper programme on Channel Four and if you read my post on it, you’ll see an extensive quote from a young officer who treated a vulnerable woman appallingly and during a filmed conversation with his supervisor, went on at length about the relentless impact of mental health jobs which he clearly sees as the responsibility of other agencies. Now, I had happen to disagree with him in respect of the incident which led to a complaint and his discussion without coffee with his sergeant, but I had some sympathy with the general proposition that officers feel adversely impacted by frequent handling of incidents which they see as the responsibility of others or preventable by others.
NOT AN EXCUSE
But none of this means you can treat people the way we saw on Panorama or Catch a Copper – the risk with these things is you list all of the above as if it’s an explanation of these things and it’s not. It never is. There are plenty of staff within the Edenfield Centre who did not abuse patients and who were flagging problems to line managers, about staffing, culture and so on. The report makes that very clear. And just like poverty and discrimination don’t explain crime because individuals always have choiced and most of us choose not to offend, pressures within systems do not explain abuse – but just as poverty and discrimination is correlated to some extent with types of crime, organisational factors are correlated with pressures on staff and the ability of non-professional or abusive practices to occur or thrive without being flagged or challenged increases.
Ultimately, we do need to resource and staff our mental health system accordingly and the fact we’ve chosen not to do so is reflected not just in this report and this appalling mess at the Edenfield Centre, but in the prison population and in how our police service spend their time. I’ve not said this for a number of years on blog posts, but I used to frequently write that you can have as little criminalisation of mental illness as you’re prepared to pay for and if you you’re not prepared to pay for very much, you’ll pay anyway in consequential criminal justice costs. it’s costs about £350,000 a year to keep one patient in high secure mental health care, for example – imagine how much community mental health care provision you could have for that, which might well prevent patients deteriorating to the point where they need secure care.
And equally, you can have as little abuse in mental health units as you’re prepared to pay for, and if you’re not, you’ll pay at least as much, if not more, because of the legal consequences, criminal justice investigation and other processes which follow. It’s cheaper to do things properly, in the long run and I’ve never understood why that’s not understood except to say too much is about short-term thinking.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 