‘Good quality treatment has its price’ – mental health worker speaks out on Camden Council’s supported housing cuts
PUBLISHED: 14:36 05 December 2019 | UPDATED: 08:48 09 December 2019
Planned cuts to mental health supported housing services will strip away vital care for some of the most vulnerable people in Camden and Islington, according to a health expert.
Camden Council's decision to cut 10 per cent of its supported housing funding from April means some medium, high and intensive services are being decommissioned.
The decision, which follows a consultation earlier this year, will see the number of units slashed from 231 to 200, including swapping services offering "a couple of hours of support a week" for home visits. Some patients will have to move from their accommodation.
Long-term high support services by St Mungo's and One Housing's intensive support units, both in King's Cross, are being decommissioned, as well as Riverside's medium support in Parliament Hill.
Now a mental health professional, who was worked for various providers, has revealed the impact of such cuts on both patients and staff.
The cash-strapped council's justification for the cuts is research showing patients prefer to live in their communities with maximum independence.
But the worker says that while that's true for many people, it is an "abuse of research" to use it across the board, because it has been proven that many patients have a level of chronic illness that will always require support.
They said the effect of the cuts is that patients who require inpatient treatment are being put in supported housing due to a lack of beds, and then waiting months for an assessment. The lack of accommodation means even when they are given support, they may be placed somewhere that provides a level of care below what they require, and discharged before they are ready.
"This means they will often stop their medication regime and relapse," said the worker. "Beds for inpatient rehabilitation are even more difficult to get, with patients waiting years for a space, while flipping between acute care and supported housing in the so-called 'revolving door syndrome'."
In 2012, Camden and Islington NHS Trust was forced to close the Royal Free psychiatric unit and the whole of St Luke's Hospital in Muswell Hill, resulting in a 30 per cent reduction in psychiatric inpatient bedspaces.
And with forensic inpatient services also being cut further, the worker said patients who should be in such units due to their level of aggression are instead put on community hospital wards, and highlighted incidents where police had to taser patients.
They added: "Now the cuts in supported housing are taking away another layer of high or intensive support for patients who badly need it."
The worker said this can prolong a patient's severe condition as well as depression, anxiety and acute psychosis, and lead to increasing levels of self-harm, suicide attempts and aggressive behaviour.
"An unpredictable environment and being shoved from pillar to post is making these patients' conditions far worse," they said. "It confirms their expectations that they will never be settled, and never be safe."
This can lead to neighbours in the community feeling threatened or scared, which only increases the stigma around mental health.
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"People think the person's behaviour is due to their illness, rather than the fact that their illness is not adequately managed and supported," the worker added.
As for staff, supporting people with mental health problems is already hugely challenging, so to do it with a lack of resources is "near impossible".
"Staff are burnt out, anxious and depressed," the worker added. "This results in a high turnover, adding to destabilising environments for patients and colleagues. And for staff who stay, it can lead to mental and physical health problems."
One of the biggest problems is that outsourcing services to private firms leads to a race to the bottom in terms of underbidding for contracts, they said, adding: "It results in deteriorating standards, unsafe staffing levels and staff working on very low pay, often on zero-hours contracts."
There are also practices such as the "sleep-in" shift, in which a worker, usually in high supported housing, sleeps at work before starting again in the morning. The worker said they are on a low wage and barely get any sleep as they are expect to be woken at any time.
The worker stressed good, cross-agency work is being done in recognising the complexity of people's problems and has called on providers to question the integrity of taking on contracts that don't allow for proper support.
"There needs to be absolute recognition that mental health is as important as physical health, and that good quality treatment has its price," they said.
"This goes for the psychological side of the treatment, as well as the support. Appropriate levels of funding need to be available. The industry as a whole has to stop putting up with this discourse and practice of continuous cuts.
"If contracts are put out with low levels of staffing and pay, don't bid for them. Work together, instead of against each other."
A Camden Council spokesperson said: "We are committed to improving the wellbeing of our residents and supporting them to live as independently as possible.
"We consulted on plans to improve the mental health supported accommodation pathway to provide a service which better suits the needs of our residents.
"The current model has four levels of care, meaning some residents have to transfer more than once when they could be better cared for in their own homes.
"We are reducing this to two levels, ensuring a smoother transition for our residents from hospital to independent living.
"Some residents will need to move from their current accommodation, however we are working very closely with all our partners to ensure these are kept to a minimum."
Camden and Islington NHS Trust, which is involved in the provision of services across the boroughs, has not responded to requests for comment.
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