Why are more people being sectioned by psychiatrists?

Britain is returning to the era of asylums, a top doctor has warned, after figures obtained by The Mail on Sunday show the number of mental health patients locked up in psychiatric hospitals against their will has spiralled over the past four decades.

A person with a mental disorder can be legally detained for treatment in a secure ward under the Mental Health Act – known as being sectioned – if there is a risk they may harm themselves or others.

But psychiatrists claim that thousands of patients are being institutionalised unnecessarily and receiving inappropriate treatment, leaving them at risk of further deterioration and scuppering their chances of recovery.

The warnings come as rates of sectioning in the UK reach the highest level on record. The earliest data dates back to 1984, when detentions stood at 12,130 patients a year. That figure is now an astonishing 53,239 per year, the fastest increase in Europe, costing the NHS more than £400 a day per patient.

And a Government report has forecast that if nothing changes, in the next decade the number will reach 70,000 a year.

Natasha Beauchamp, 31, from Worcester, spent a decade detained under the Mental Health Act at 17 different mental health units

Natasha Beauchamp, 31, from Worcester, spent a decade detained under the Mental Health Act at 17 different mental health units

A Government report has forecast that if nothing changes, in the next decade the number will reach 70,000 a year

A Government report has forecast that if nothing changes, in the next decade the number will reach 70,000 a year

Experts say the situation is at least in part a symptom of a wider problem in the NHS: the practice of defensive medicine. This is when doctors offer treatment or an intervention that may not be warranted, simply in order to avoid the possibility of a complaint or legal action should something go wrong.

The situation has arisen due to the ever-rising tide of clinical negligence claims. In one study, 87.5 per cent of doctors admitted that they’d practised defensive medicine of some kind.

Retired consultant psychiatrist and Care Quality Commission reviewer Dr Duncan Double said: ‘When I started working on an acute psychiatric ward in 1984, we used to pride ourselves on having an open-door policy.

‘In the 1960s and 1970s there was a drive to close old psychiatric institutions in favour of supporting mental health patients in the community, but, if anything, things have become more bureaucratic and more restrictive.

‘Doctors have become more fearful of public safety or being blamed, so may be more likely to section patients inappropriately. We’ve returned to the worst aspects of the asylums era.’

Asylums – large, devoted psychiatric hospitals set up in the late 19th Century – began to be shut down in the 1960s when Britain moved towards a system of treating people with mental health problems outside of the institutions.

Mental health expert and occupational therapist Keir Harding, who wrote of his concerns in The Lancet earlier this month, said: ‘Patients aren’t being detained to offer better quality care, it’s to avoid risk by moving them away.’

About one in six people in the UK have a mental health condition. They are commonly treated with medication, prescribed by a GP, and some receive psychotherapy. Those who need more intensive support will be referred to specialist services. This typically involves a community mental health team, which gives patients access to clinical experts without having to attend hospital. Residential care is also offered in acute cases – ranging from temporary supervised accommodation to a stay in a psychiatric hospital.

Most hospital admissions are voluntary but if, after an assessment, patients are judged to be high-risk, they can be sectioned. This means they can be kept in hospital, stopped from leaving their ward and required to have treatment for up to six months. They may also be restrained, isolated and given medication or other interventions against their will.

When the time is up, patients are reassessed and can be detained for longer if it is believed they have not recovered. NHS data shows that three in five patients are released after one section period, but ten per cent end up being detained for three sections or more.

Despite the number of detentions rising, the number of psychiatric beds in NHS hospitals has fallen by a quarter since 2010 – dropping from 23,447 to 17,610 last year.

Asylums – large, devoted psychiatric hospitals set up in the late 19th Century – began to be shut down in the 1960s when Britain moved towards a system of treating people with mental health problems outside of the institutions

Asylums – large, devoted psychiatric hospitals set up in the late 19th Century – began to be shut down in the 1960s when Britain moved towards a system of treating people with mental health problems outside of the institutions

To meet the demand, there has been an uptick in the number of beds provided by private hospitals – for which the NHS pays £2 billion a year. These are often far from where patients live, and they end up staying longer, say experts.

Research from the Care Quality Commission has shown the average stay on a private psychiatric ward is 359 days, compared with 197 days on NHS wards.

Clinicians have also raised concerns about whether private hospitals are always fit for purpose.

Keir Harding suggests some are more concerned with meeting rising demand for in-patient treatment than offering quality care: ‘I know of private units that claim to be specialists but where treatment for high-risk patients isn’t being delivered by qualified therapists.’

Speaking to this newspaper, patients say they have been robbed of their early adulthood after being locked inside hospitals and forced to undergo inappropriate treatment without any idea of when they would be released.

Natasha Beauchamp, 31, from Worcester, spent a decade detained under the Mental Health Act at 17 different mental health units. She developed problems with anorexia and was sectioned aged just 13 after a suicide attempt the following year. She recalls having her phone taken away, being told she wouldn’t be allowed to see her family for six weeks so that she could ‘settle in’, and was not allowed outside.

Natasha felt isolated and her mental health spiralled out of control. ‘My eating disorder got worse and my self-harming increased to the worst it had ever been. I would get really upset when I couldn’t see my family, and the clinic staff would react by restraining me – it was barbaric. Four huge men would pin me on the floor and go to inject me with a sedative.’

Although there are circumstances in which most psychiatrists agree that detaining a patient for a short period can be beneficial – particularly for those who experience psychotic episodes – this is not true for all mental health conditions. Of particular concern to doctors are people with personality disorders, who make up almost half of mental health patients detained in out-of-area placements.

These include borderline personality disorder and antisocial personality disorder, in which patients are unable to control their emotions and behave impulsively and irrationally. They can also harm themselves or others, meaning doctors might feel sectioning them is the safest option.

But Dr Jorge Zimbron, consultant psychiatrist at Fulbourn Hospital in Cambridge, says this can have disastrous consequences. ‘The majority of patients with a personality disorder have a history of abuse, so restraining them is traumatic and won’t be beneficial.’

Hollie Berrigan, 34, from Worcestershire, had first-hand experience of this after she was diagnosed with a personality disorder and detained under the Mental Health Act aged 19. She says: ‘As someone who has experienced sexual violence, being restrained and injected was horrific. The staff at my facility completely ignored that part of my history and never seemed to consider that my treatment was making things worse.’

One seemingly radical solution is offered by the Springbank Ward at Fulbourn Hospital. It is the only NHS-funded personality disorders unit where treatment is voluntary – and even those who arrive while sectioned are told they are free to leave if they wish. They have a policy never to restrain patients.

Dr Zimbron says: ‘Most people threaten to leave at some point, but if they actually do, they always come back as they recognise they do need treatment.’

The staff offer mindfulness and psychotherapy to manage patients’ distress. Since introducing this policy seven years ago, the ward has not had a single death and has seen incidents – including suicide attempts, violence and self-harm – drop by more than two-thirds.

One patient to benefit from treatment on the ward is Lois McCarthy from St Helens, Merseyside. The 27-year-old was sectioned aged 21 after taking a series of paracetamol overdoses. Although she accepts she was severely unwell at the time, she feels her restrictive treatment – which consisted of being injected with sedative medication and being kept watch over 24 hours a day to stop her self-harming – made her condition worse.

She says: ‘If you are not given a chance to prove yourself, and are not given any responsibility, it disables you.’

Lois was admitted to the Springbank Ward in January and credits it with saving her life. ‘In other places, if you mess up you get told off. Here, the therapists are so supportive, and you learn techniques to help you manage.’

Next month, she’ll have gone a year without a suicide attempt – the longest she has gone since she was 21. ‘I never thought I’d be seeing my 27th birthday, and I’ve got Springbank to thank for that,’ she says.

When asylums began to shut down in the 1960s and treatment moved into the community, it failed to meet demand. Dr Zimbron says: ‘Waiting lists of more than a year for patients needing psychological therapy are not unusual.’

This means patients become progressively more ill, to the point that their families and doctors feel the only option is for them to be sectioned.

High numbers of in-patients requiring care also mean facilities are unable to help those patients who simply need drop-in or day treatment, further compounding problems.

The Mail on Sunday has heard multiple accounts of people in crisis who have been turned away by clinics and told they ‘weren’t sick enough’.

The Mental Health Act is currently being revised, and a first draft of the new Bill was published in June. However, critics worry it will not do enough to prevent over-cautious staff sectioning patients ‘just in case’.

Keir Harding says: ‘The Act needs to explicitly state that as long as clinicians are showing humane and reasonable standards of practice, they shouldn’t be blamed if unpredictable events occur.’

Dr Adrian James, president of the Royal College of Psychiatrists, adds: ‘The increasing number of people detained under the Mental Health Act is highly concerning. Detention should always be a last resort, and people with mental health problems should be able to access support before they reach crisis.’

  • For advice on mental health, visit mind.org.uk.

Fast-acting drug for depression could soon hit the UK

By JONATHAN NEAL 

A fast-acting antidepressant has been approved for use in the US, with the maker indicating that it is now looking to launch the drug in Europe.

The tablets, which take a week to begin working rather than a month with current treatments, contain dextromethorphan, a cough medication that has an effect on parts of the brain, and bupropion, sold under the brand name Zyban as a smoking cessation aid.

The medicine, set to be marketed in America as Auvelity, is the first pill in more than 60 years to treat clinical depression using a new mechanism of action, said maker Axsome Therapeutics.

At present, the most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), paroxetine (Seroxat) and citalopram (Cipramil).

These work by increasing levels of the chemical messenger serotonin in the brain.

A fast-acting antidepressant has been approved for use in the US, with the maker indicating that it is now looking to launch the drug in Europe

A fast-acting antidepressant has been approved for use in the US, with the maker indicating that it is now looking to launch the drug in Europe

In a clinical trial, 163 patients with depression taking Auvelity said their symptoms significantly improved within a week of beginning the drug, compared with 164 patients who took a placebo, according to research published in the Journal of Clinical Psychiatry earlier this year

In a clinical trial, 163 patients with depression taking Auvelity said their symptoms significantly improved within a week of beginning the drug, compared with 164 patients who took a placebo, according to research published in the Journal of Clinical Psychiatry earlier this year

Serotonin is involved in regulating mood, as well as other bodily functions such as appetite. Experts have long believed depression might be caused by low levels of serotonin, and so boosting it could help treat the problem which affects roughly one in 20 adults in the UK. However, more recent research suggests a more complex picture, leading researchers to look at whether other factors are at play.

It takes between two to four weeks for any effect from SSRIs to be seen – a downside when treating patients in a crisis. And while the drugs are effective in many cases, a third of people with depression do not find relief from any current antidepressants.

In a clinical trial, 163 patients with depression taking Auvelity said their symptoms significantly improved within a week of beginning the drug, compared with 164 patients who took a placebo, according to research published in the Journal of Clinical Psychiatry earlier this year.

Dextromethorphan and bupropion are believed to block the NMDA receptor in neurons in the brain, which is known to have a rapid effect on regulating mood.

Side effects include dizziness, headache, diarrhoea, lethargy, dry mouth, sexual function problems and excessive sweating.

Carmine Pariante, Professor of Biological Psychiatry at King’s College London, said: ‘Depression can interfere with work, relationships and make life unbearable. And, of course, in some cases there is the risk of suicide. The sooner you can find something that helps, the better.

‘You can see some improvement within a couple of weeks with SSRIs, but it often takes longer for them to have a noticeable effect and about a third of patients don’t respond at all.

‘A drug that worked in a different way, and faster, would be a welcome addition.’

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