Haunting day I came face to face with our mental health crisis
THERE is a street in london that I always avoid walking down. It’s framed by edwardian houses and lined with trees, and on the surface there is no reason to avoid it at all. In fact, it’s the kind of street that well-todo families aspire to live on.
But whenever I find myself near it, I take the long way round, because I hate the idea of walking past one particular house. It brings back haunting memories for me of neglect and abuse that I witnessed while working as a junior doctor in learning disabilities.
That’s because one of the houses on this street is, in fact, a facility for people with severe learning problems. I’d been asked to visit when a GP became concerned after one of the residents developed a bedsore, and I duly went to see what was going on.
The door opened and I was met by someone whom I assumed was a resident. I introduced myself and he said nothing — just gestured towards a door before sitting down in the kitchen to play on a mobile phone.
There didn’t appear to be any staff, so I made my way to the lounge. The curtains were closed but I could make out two residents in the gloom.
ONE sat crunched up on the sofa, screaming constantly, rocking back and forth and biting her hand. There were large calluses where she had bitten deep into the flesh.
She was obviously very distressed, and I couldn’t believe she was just left there without any staff member attempting to help or pacify her.
The truly awful thing, though, was the thudding sound from the other side of the room. I looked over and, to my horror, saw that the other resident was repeatedly banging her head against the wall.
When I looked closer, I could see a large dark-brown patch on the wallpaper where her head was hitting, which I realised was dried blood.
This was clearly routine behaviour for her, and we later discovered that this had been going on for so long that she’d fractured her skull. I looked around for someone in charge, and was stunned to realise that the man who had let me in was not a patient but staff. In fact, he was the only staff member on duty
He clearly couldn’t care less about the people he was supposed to be caring for. His indifference to their plight was astonishing — even when I pointed it out to him.
I discovered a third resident in bed, lying in his own excrement.
Needless to say, I reported the incident and the carer was fired. But I am under no illusion that this was an isolated incident, and it haunts me so much that I still avoid walking past the house.
The problem is endemic because underqualified people are being given tremendous responsibility caring for people who have incredibly complex psychological and physical needs. They are grossly out of their depth.
A report published by the Royal College of Nursing this week found that, despite atrocities like the Winterbourne View scandal, when ‘carers’ were filmed abusing residents of a private hospital in Gloucestershire, people with learning disabilities are still being routinely failed.
One of the main issues is a dearth of adequately trained nursing staff.
In the past six years, there has been a drop of a third in the number of qualified learning disability nurses — a total of 1,700 posts, one third of which were senior nursing posts. Training places have also been slashed by 30 per cent over the past decade.
What this means is that there is an increasing reliance on unqualified staff to provide care. And this is how shameful situations like the one I witnessed can occur.
When the large asylums closed in the 1990s, social workers were left with a dilemma: what to do with the long-term residents.
While there was no doubt that many of those who had been housed in asylums did not need to be there, and — with the right support — could live independent lives in their own homes, there were groups of people for whom this simply wasn’t the case.
These people fell awkwardly between the criteria for NHS care and for personal care.
ULTIMATELY, their welfare was placed in the hands of social services, despite them having complex medical problems. legislation such as the 1990 National Health Service and Community Care Act enabled private agencies to provide specialised housing.
The result is that people with severe and complex needs, who were once looked after by doctors and nurses in institutions, are now at the mercy of unqualified staff, mostly in the private sector.
The issue is not just of abuse in some of these homes, but that the level of care is substandard because staff are not medically qualified or trained to the standard expected on an NHS ward.
It’s purely a quirk of history that these patients find themselves being cared for outside of the NHS, receiving little medical input, when surely they need it more than anyone.
While I wouldn’t advocate returning to the days of large institutions and asylums, the way that those with severe disabilities have had their welfare unceremoniously dumped into the hands of underqualified carers is an untold scandal.