Last summer, a young man – let’s call him Daniel – walked into a hospital A&E department in England and told doctors that he had schizophrenia. He had struggled with his mental health for years, and now he wanted help. But after he was briefly seen by an early intervention team, he was discharged. A few days later, he stabbed a stranger whom he deemed to be a threat to his life, and now he’s locked away in a prison cell. “I’m devastated for him,” his mother tells me, “and concerned for others in similar situations.”
It’s worth pointing out that the vast majority of people with schizophrenia are not violent. And this is not about the NHS’s overworked and underpaid army of staff, who overwhelmingly do their best in unnecessarily challenging circumstances. It is instead a plea for attention to solve one of the great under-discussed crises of modern Britain: the mental distress that blights the lives of millions of citizens, and the lack of provision to tackle it.
According to the charity Mind, there are not just 1.6 million people languishing on mental health waiting lists, there are another 8 million who would benefit from treatment, but can’t make it on to those oversubscribed waiting lists because of high eligibility thresholds. The Guardian recently revealed that the NHS in England is paying £2bn a year to private hospitals to care for mental health patients because of the lack of its own beds – another striking example of lights flashing red on the dashboard. For those who shrug their shoulders, believing the use of the private sector is just a pragmatic solution to help those in need, consider the fact that one in four non-NHS psychiatric facilities have been judged “inadequate” by Care Quality Commission inspections. “If taxpayers’ money is being spent on poor-quality care in some cases,” says Mind’s head of policy, Vicki Nash, referring to recent deaths in private mental health services, “we need to ask ourselves: is that money better spent elsewhere?”
Our rulers will undoubtedly rebut these criticisms. After all, the Tory-led coalition government announced that mental health would be granted parity of esteem with physical healthcare more than a decade ago, and more investment has been ploughed into the sector, including £500m last year in response to the pandemic. As the King’s Fund thinktank has argued, while demanding parity of esteem is useful – not least in a country in which suicide is the biggest killer of men under 50 – it needs to be matched with adequate funding and better joined-up working between different NHS services.
What we do know is increased investment has been offset by surging need. Calls to the helpline of anti-suicide charity Campaign Against Living Miserably, for instance, surged by 40% when the pandemic began, while there has been a 100% increase in the number of 16- to-24-year-olds accessing its website. The trauma unleashed by the pandemic and the drastic measures needed to contain it cannot be understated: according to the World Health Organization, cases of anxiety and depression jumped by a quarter across the globe in the first year alone.
The testimonies of those working in crisis-ridden mental health services tell their own story. One mental health professional with decades of experience tells me: “It is now at the worst point I can remember due to a staffing crisis that has been a problem for well over five years now, and probably closer to 10 years.” Staffing issues had led them to start locking up patients at night, they tell me, and while a new unit being built should be a cause for celebration, it causes them dread, since staff are leaving in droves.
Another worker tells me of a child patient with a history of being abused who fell off a waiting list because their working mother had missed a call from mental health services. One of their female patients who suffered abuse from her parents and then partners has suicidal tendencies, they say, but waiting lists mean having to wait months to get an assessment, and then another 18 months before getting help. One mother of a suicidal teenage boy was made to put in a referral to child and adolescent mental health services in writing, told there would be two weeks until an urgent appointment was possible, and felt there was no choice but to take him to a chaotically busy A&E department. “My son feels his life isn’t worth bothering with, and feels even more hopeless,” she tells me. If you speak to anyone who has been through our struggling mental health system, you’ll hear the term “waiting lists” comes up again and again.
Why do we put up with such chronic and systemic failures, many of which undoubtedly lead not just to unnecessarily prolonged misery, but in all too many cases loss of life? Perhaps the sheer number of crises afflicting modern Britain is crowding out the space to talk about it. Whatever the answer, avoidable misery is imposed on the lives of millions because of a recurring failure to match need with provision – and the human cost is incalculable.
In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is at 800-273-8255 or chat for support. You can also text HOME to 741741 to connect with a crisis text line counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org
This article was amended on 26 April 2022 to provide more context about schizophrenia.
Owen Jones is a Guardian columnist
