“We wouldn't accept this in cardiology...why should we accept it in mental health?"

Saturday 20 November 2021

Islanders working closely with mental health services in Jersey have said they're extremely worried about the depth of problems identified in a newly published report.

These include why senior leaders at consultant level should have to be told to work with other disciplines and keep an audit of multiple medications prescribed.

This is the basics of good practice, they argue.

While welcoming the findings of the Health-commissioned review released this week, which identified a lack of senior management leadership within Adult Mental Health and not enough work across disciplines, they have asked why such rudimentary issues were not dealt with earlier.

Independent mental health advocate Patricia Winchester, who leads the advocacy service My Voice, said the review raised serious concerns about the competence of senior clinicians with the adult mental health service.

“We raised serious concerns in November 2019 about poor practice and the inadequate environment on Orchard House,” she said. 

Pictured: Mental health advocate Patricia Winchester: "Issues such as multi-disciplinary working are fundamental and should not need to be pointed out to any psychiatrist".

“There most of the practice issues have been addressed and new wards are being built; however, we continue however to regularly raise concerns about practice and many of these have now been reflected in the report released on Friday.

“What this report says is that there is a lack of senior leadership and direction in adult mental health. In brief, this report calls out the lack of pace and commitment to change at the most senior clinical levels.   

“It is of real concern that basic management practices such as having clear objectives and reviewing outcomes, are having to be pointed out to senior practitioners who are paid to lead this service. 

“We would not accept this in cardiology or orthopaedics, why should we accept it in mental health?

“Clients and their families have a right to expect the highest levels of care and treatment, in line with best practice where the quality of life, and sometimes life itself, is at stake.

“The good news is this is not a resource issue: we have more than enough doctors, and we have experienced substantial recent improvements across the nursing, occupational therapy and social work teams. 

“The crux of the issue here is the significant professional improvements needed from our consultants to deliver treatment and care in line with Nice guidelines and evidence-based practice. 

“Issues such as multi-disciplinary working are fundamental and should not need to be pointed out to any psychiatrist."

She further raised concerns about how medication is prescribed. 

Pictured: The Government is investing in new mental health facilities, which will consolidate at a single site at Overdale in 2026.

“Likewise, it is worrying that we are seeing an increase in polypharmacy [the prescription of multiple medicines, ed.], which should not arise in a modern up-to-date clinical environment without the assurance of robust audit and peer challenge. 

“Can it be acceptable that the culture which is led by senior clinicians is not open, honest, or collaborative and that bullying, whilst reduced, still openly exists?

"Can it be acceptable that service leads need to be instructed to implement a Care Planning approach when this was introduced in England over 30 years ago in 1991? 

“This is a fundamental form of case management to improve community care for people with severe mental illness – without it patients experience the lack of continuity of care which is referenced in the report – it means recovery is jeopardised, patients and their families are being let down. 

“Patients and their families need to feel they can rightly place their trust and dependence on a crucial service at the time of extreme vulnerability – for many patients the care and treatment they receive is of a high standard and a positive experience. 

“Unfortunately, professional processes and practice are not delivered to a consistently acceptable standard by senior clinicians - this places our fellow islanders at risk."

Mrs Winchester added: “We are promised that action will be taken at the highest levels to address what has been identified in this report as real risk to patients – this is a very big opportunity and if we miss it, it will take years for any of the necessary improvements to be implemented. 

“We want urgent, robust and sustained action to challenge the culture of complacency and outdated practice. It is time for those leading our services to be accountable.”

Stephen McCrimmon, who coordinates the charity Focus on Mental Illness, was equally critical.

He sits on an Executive Committee at the Royal College of Psychiatrists, an organisation which the report recommends Jersey should develop closer ties with, including joining its network of specialisms and accreditation programmes.

Focus on Mental Health aims to improve the lives and outcomes of islanders at the more severe end of the mental health spectrum, as well as support their families.

Pictured: "Thank goodness this is now in the public domain and there will be no more hiding," said Focus on Mental Illness's CEO.

While glad that the report had been published, Mr McCrimmon said that senior leaders at Health would now be judged on how its recommendations were implemented.

“Working with the RCP, I know what excellent and good looks like, and I have been pushing for Jersey to have standards fit for purpose for a modern mental health service for many years,” he said. 

“Thank goodness this is now in the public domain and there will be no more hiding - the senior managers will now be judged by their response to this report and not their words.

“This is a shared responsibility; we cannot single out any one person or group to shoulder the blame. It goes from the very top through all the management structures with mental health services. 

“The Government now says it is open, transparent and honest but when we have helped empower families to speak out about failings in the past, we have been criticised for doing so.

“So, why are these failings only coming to light now? We have known about the shortcomings and challenges for a long time, and they should have dealt with a lot earlier.

He added: “We were told that young people would not be sent to Orchard House again so why is it still happening? People are staying in Orchard House for longer, which can suggest that the community care beforehand is not good enough. Again, why has it not improved already?

“As a charity, we take no pleasure in being critical and desperately want to be involved in the solutions but we will not stand by and watch the Government and others tell us things are ok while service users and families suffer from their failures.”

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