Desperate Need for Investment in Community Mental Health Nursing

19 February 2015

Following new figures released today showing a rise in the rates of suicides in the UK, the Royal College of Nursing and Mental Health Foundation are joining forces with the family of a man who took his own life to make a joint call for early intervention and better mental health provision in the community.

Today's figures from the Office of National Statistics show a particular rise in suicides among men during 2013, the most recent year for which statistics are available. This is the highest rate since 2001.

Martin Strain took his own life in 2014 after experiencing severe depression over a period of several years. His family have since been calling for better access to treatment which they believe would save lives.

Martin's father Adrian Strain said:

€œIt is my contention that whilst no-one can say with confidence that Martin's depression would ever have been cured, if a community-based nurse as well as sustained care from a coordinated care plan had been available to Martin through that GP, we would at least be able to satisfy ourselves now that Martin was as well supported as possible.

€œHe might still have taken his own life, but many of us are now left wondering whether or not mental health services left him unnecessarily isolated.”

Mr Strain's family are calling for:

  • better support for GPs, to enable them to work more closely with other mental health services and to recognise warning signs for those at risk of suicide.
  • more community based mental health staff, able to spend more time with those at risk and to triage those who have presented to their GPs with mental health problems.
  • coordinated care plans should be in place for at risk people suffering moderate or severe depression, at a lower threshold than presently. Risk factor would include age, gender, drug use and major trauma. 

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said:

"€œThe death of Martin Strain is a tragedy. Suicide is a complex issue, and it is difficult to say with certainty that individual deaths can be prevented, but we must listen to families like the Strains who have spoken so eloquently about their son's experience and the gaps in the provision of care.

"€œBetter support for people experiencing mental health problems would help to prevent suicides and enable many people to lead full and fulfilling lives with distressing but manageable conditions. Without the expert support of nurses and other staff, many people are growing increasingly desperate while waiting for care.

"We are no longer in the dark ages in terms of understanding or knowing how to treat mental illness – treatments do exist and do work for many people. But for everyone to benefit from these advances, there needs to be a step change in the way in which community services are staffed and resourced."

Jenny Edwards, Chief Executive of the Mental Health Foundation, said:

€œ"The Strain family's dreadful loss has shown how hard it is for families when they see their loved ones in crisis and without support. It has to be clear that there is someone there for them.

€œ"We are really encouraged to see the latest moves to support better mental health crisis care. The Crisis Care Concordat marks a significant step forward in pulling together different services at local level.

"€œThe recent commitment to introduce a named clinician to coordinate care for people with serious mental health problems brings us closer to making this a reality.

"€œUltimately, we need excellent care, but we also need to step back and ask what reasonable steps can be taken to prevent people from having to reach mental health crises. Early intervention is the key."

A brief run-through of Martin Strain's dealings with mental health services has been provided by his family:

"Martin from being a small boy, was adventurous, eager to please, sociable and until his teenage years, certainly, happy. He was outgoing as well as impetuous and left home at 18 to live with a girl in London. Without qualifications he got a job in IT and impressed his employers sufficiently to gain promotion. He had always been interested in computers and whilst self-taught was proud of his achievements.

"When he was made redundant in 2007 he fell into a bout of depression and a few months before he was due to leave Essex made a serious attempt to kill himself - cutting his wrists and preparing a noose with which to hang himself.  He was referred under his employer's private health plan to a psychiatrist at The Priory. This care continued for a few months even after he had moved north, but then funding was withdrawn and the counselling stopped. 

"What ensued were numerous visits to his GP where he was prescribed anti-depressants and a number of referrals to mental health services - both to IAPT and secondary services. His GP, overworked and with little training in mental health, showed scant knowledge of the mental health services to which she referred Martin and at SWYPHT (the local Trust) over a period of seven years, saw over a dozen different counsellors and psychiatrists.

"Throughout this period there is much evidence of his physical and mental health see-sawing as he used drugs and alcohol more or less and as his depression waxed and waned. It is our contention - and it is referenced in the Coroner's ruling - that had he had more consistent coordinated care through this period, his level of disengagement would have been less; or, to put it more simply, he was less likely to have missed so many appointments and perhaps responded better to the treatments that might have been available.

"He was denied access to secondary services because it was felt that his drug and alcohol abuse would have hindered his engagement with those talking therapies, but no alarm bells were rung when he removed himself from the Lifeline course designed to help him reduce drug and alcohol usage. When he failed to attend the course, he was deemed to have disengaged and was duly discharged.

"In the weeks before he died, when he had been off work for three months, was in receipt of no money, was in massive debt to loan sharks and drug dealers, when according to his GP and the staff grade psychiatrist who triaged him in a telephone conversation, Martin spent days curled up and wrapped in a duvet unwilling to answer a telephone, never mind, go out of the house, Martin suffered alone. His wife Lindsey was unable to get him to talk and was often unaware of the extent of his loneliness because he hid it so well, so keen was he to protect Lindsey from his feelings and the effect they would have on her.

"Two weeks before he died he visited his GP with Lindsey for a review and more anti-depressants. His GP failed to ask if he was suicidal. At the inquest she reported that it would have been good practice so to do, but that sometimes "one doesn't want to intrude". When I met her some days after his death I asked her if she felt she would have been better supported had there been a mental health nurse or CPN available to the Practice. Such support could have been used to call on the more acute, more vulnerable, more statistically at risk cases, to check on them daily, or weekly, depending on their personal knowledge and professional judgement."

1. Full details on the suicide figures released today are available on the ONS website.

2. The Mental Health Crisis Care Concordat is a national agreement between local services and agencies involved in the care and support of people in mental health crisis. It sets out how organisations will work together better to make sure people get the help they need when they need it.

3. For further information, please contact the RCN Media Office on 020 7647 3633, press.office@rcn.org.uk or visit  https://www.rcn.org.uk/contact

4. The Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.

5. About the Mental Health Foundation

The Mental Health Foundation is the UK's leading mental health research, policy and service improvement charity. The Mental Health Foundation is committed to both reducing the suffering caused by mental illness and helping us all to lead mentally healthier lives through carrying out research; influencing government policies; developing practical solutions for better mental health services; and campaigning to reduce stigma and discrimination. The Mental Health Foundation has been working to end mental ill health since it was founded 65 years ago.