Following up the issue in my earlier post, I met with the Chief Exec and the Chair of Haringey Mental Health Trust this morning to discuss some of the issues raised from my advice surgeries, from my meetings with service users and organisations, from colleagues and from local people’s responses to my request for personal experiences of mental health services in Haringey.

The Trust closes its consultation next Monday on keeping permanently closed an acute ward that was flooded – permanently reducing inpatient bed capacity. The plan is to move people appropriately out of inpatient care into the community, supported by appropriate support to maintain patient safely in a stable and home setting.

An early question on the survey asks people whether they agree with the principle of looking after people in their own home as opposed to being kept in not the nicest of environments in an inpatient mental health ward. I would think that the majority of people will agree with this in principle – but it is the practicalities that are crucial and can sink the idea.

So of course we would all like to be fluffy, cuddly, let people live in their own homes – but there are a lot of buts. Buts such as …

But only if we never hear that someone couldn’t be admitted in an emergency or just prior to a crisis incident because there were no beds available. I can’t see how this can be the case if beds are reduced. The Chair and CEO said that Haringey had a high bed capacity compared to other boroughs. Users of the service tell me otherwise, talking of occasions where a patient would be sent home early because there was no capacity or where a crisis admission did not take place for between four days and four weeks because of shortage of space. Surely that does not suggest that capacity is adequate?

But only if we can be assured that care in the community is not just code for abandonment or poor support. Again, people who use the service have given me lots of instances where the home treatment team fell short. For example – the team will come once a day to ensure proper medication is taken. However, my service user describes the team as coming and when the door isn’t answered – going away without even contacting the housing manager to be let in and check what’s happened to the person. The Trust says that this is serious and shouldn’t happen – but the problem is the gap between what should happen and what does happen.

But what about the possible costs and fallout for neighbours, the police and the council if things go wrong? When the Trust says that it is cheaper to keep people in the community rather than the high costs of inpatient care – doubt whether they are counting in the cost to everyone else who is left to deal with the fall out when the care in the community fails. And the fallout isn’t just about finances when things go wrong.

There are many tales of gaps fallen through in the community care net as it is now. So how can the Trust guarantee that the care will be good enough to support even more people than before? The Chair says that the money not spent on inpatients will mean that the expenditure in the community will be enough to ensure good care. Easy promise to make, but will it stack up in reality?

There is also a belief gap in Haringey. In Haringey we do not have confidence in inspection regimes, tick-box procedures and management speak. We had all that only too recently with Baby P. How on earth can we get to a point of trust with the Trust?

There are loads more issues (lack of communication, lack of planning on transfer, 24 hour emergency line not working properly and on and on) and so will post my official response to the consultation when have finished it as it will contain more detail.

Both the Chair and the CEO wanted me to know that whilst some areas definitely need improving – they are very good at some things and have just won the commission for cognitive therapy for London. Indeed, I visited their Star Wards project when they won one of those. And given the dreadful years the Mental Health Trust had under the previous chair and management, these two have an awful lot to achieve and I am sure are trying very hard to bring about change in what is quite a stuck environment – not easy.

So – my consultation response will still focus heavily on the problems currently being experienced in terms of crisis admission with current bed capacity – and on the already stretched and reportedly unreliable care in the community. Without addressing these issues – I don’t see how the Trust can proceed.