Yesterday, on World Mental Health Day, at the Royal College of Psychiatrists, leaders from across the Criminal Justice System, clinicians and a health economist spelt out the impact and cost of dismantling Mental Health Services over the last 30 years. Afterwards, Heather Phillips, CEO of Beating Time and the High Sheriff of Greater London and Sir Mark Rowley, Metropolitan Police Commissioner, made awards to Police, Prison and Probation Officers who are left with the responsibility for managing and mitigating the risk posed to our communities by leaving people with acute mental illnesses without the support they need.
The Platform included the Recorder of London and ex-Chief Coroner, HHJ Mark Lucraft; the Governor of Wormwood Scrubs, Amy Frost; the Mental Health Lead for the Association of Police and Crime Commissioners, Lisa Townsend; Head of the London Probation Service, Kilvinder Vigurs; a leading health economist, David McDaid; and Consultant Psychiatrist and Chair of the London Division of the Royal College of Psychiatrists, Dr Suhana Ahmed. The millions of families trying to manage mental illness were also represented. One, Laurian Van Der Hoven, spoke movingly of the death of her husband, a PTSD sufferer and alcoholic in a prison cell. Jim Corrie Hill told the audience about the 38-page report detailing the total failure of community mental health services that led to the death of his son, Ian, by suicide, aged 26. Noel Moran talked about his experience in prison as a Listener for the Samaritans, taking over 2000 sittings a year. The Platform was chaired by Dr Sarah Lewis of Penal Reform Solutions.
Speaker after speaker reinforced the point from very different perspectives, that failing to look after people with a mental illness has far reaching consequences: for our economy, the Exchequer, Police, Courts, Prisons, Coroners, Probation, homeless numbers, suicide rate, levels of addiction, and the demands placed on the hundreds of charities who step in to try and fill the void. There is also a huge hidden cost to families trying to care for family members with a mental illness, who have been left with totally inadequate support. It significantly damages their earning power, mental and physical health, life span and life opportunities. It is costing us far more to go without these services than it would cost to build back an appropriate and proportionate level of care.
Since 1988, the NHS has lost 73% of its psychiatric beds . That compares with 53% of total NHS beds . In roughly the same period the number of transfers from prison to psychiatric hospitals has gone up by 710%. This is against a backdrop of building 20,000 new prison places (at a cost to build and run of £60 billion)   which will take the prison estate to 100,000 beds. That compares with 18,500 psychiatric beds for the entire country. The mental health crisis is not about lack of resources. The panel said it was about policy makers not understanding the magnitude or impact of the problem or the real cost to the economy, taxpayer, families, and communities.
The speakers were clear about what needs doing: build back accessible, effective 24/7 community mental health services to prevent people getting into crisis in the first place; and create more psychiatric beds so people can get the treatment they need when they are in crisis. The Royal College of Psychiatrists is calling for 6 of the new 48 hospitals to be built to be psychiatric hospitals rather than the 2 being proposed currently.
The audience were invited to sign a letter to the Health and Justice Ministries, Home Office, and Treasury, pointing out the benefits that would flow to the Criminal Justice Services, Police, economy, and the Exchequer, from investing in mental health.
David McDaid, a Health Economist from LSE has calculated that the cost to the UK economy of preventable mental health issues, is, conservatively, £118 billion per annum . Most of these costs fall outside of the health system and are due to exclusion from the workforce. These costs would be much greater if reduced work performance, worse physical health, as well as costs associated with addiction, homelessness, self-harm, and suicide were taken into account. Every suicide takes £1.67 million  out of the economy. In 2021 in England and Wales, more than 5,500 deaths were officially registered as suicides . The real figure is likely to be much higher, when “unclassified” deaths (8126) and deaths by accident and misadventure (7696) are taken into account: all up in recent years.
There was unanimity that the criminalisation of mental ill-health has gone too far. Some police forces think they spend as much as 25% of their time standing in for mental health services. Lisa Townsend, the National Mental Health Lead for the Association of Police and Crime Commissioners, and PCC for Surrey said, “I am incredibly frustrated with the increasing number of mental health cases being pushed through to police forces, rather than being dealt with by the NHS. It’s not sustainable. It’s not what the public want police officers to be doing”.
A lack of psychiatric beds and ‘Places of Safety,’ mean that police officers and judges are not able to divert people away from the Criminal Justice System as often as they would like. HHJ Mark Lucraft KC, who spoke about the impact on Courts and Coroners said, “By the time a mentally unwell person reaches me, it’s too late. They have either been charged with murder or terrorism and we are definitely seeing mental health is a factor more often, in around 35-40% of cases”.
Dr Suhana Ahmed, a Consultant Psychiatrist at St. George’s Hospital in London, said, “It has been a rarity to see anyone who has not been statutorily detained, under the Mental Health Act, in a psychiatric unit over the last 10-15 years”. Between 2016 and 2021 the number of referrals to mental health services doubled from 1.8 million to 4.3 million. “People are much more ill when they reach us and, sadly, they are often not as well as they could be when they leave us. The threshold for admission has rocketed whilst the threshold for discharge has plummeted.”
Currently, 18% of people in prison have a psychotic illness and about 70% a mental illness of some description . Prisons are building special units for people with mental illnesses. An award was made to Ruth Hipwell, an officer at HMP Pentonville, who has spearheaded the creation of a 45-person Neurodevelopmental Unit at the prison. The pressures on police, courts and prisons are also filtered through to the Probation Service, which is responsible for managing the risk, and supporting around 250,000 people in the community.
Heather Phillips, the High Sheriff of Greater London is the founder and CEO of Beating Time. She convened the Platform because for the last 50 years she has felt the impact on her family of caring in the community for two family members who have an acute mental illness, with little support. ”My role as High Sheriff is to promote the peace, wellbeing, and prosperity of Greater London. The crisis in mental health care is, I believe, undermining all three. Part of my role is to support the Justice Services. It’s been a privilege to give them a Platform to be heard on this important issue.”
(1) Psychiatric Bed Numbers – 76% https://link.springer.com/article/10.1007/s00127-021-02215-5
(2) Hospital Bed Numbers:- 57% https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/hospital-beds
(3) Size of prison population https://researchbriefings.files.parliament.uk/documents/SN04334/SN04334.pdf
(4) £60Billion in new prison places
(5) £118Billion cost of preventable mental health problems
(6) Cost of a suicide £1.67M
(7) 5,500 recorded suicides – up 8%/ 8126, unclassified – up 24%; 7,696 accident/ misadventure – https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2021registrations
(8) Up to 18% of prison population have psychosis