After Nottingham Is It Time for a MH Database

[WillimNot]

After seeing one of the victims family suggest that huge errors had been made in the Nottingham case that, if they hadn't of occurred the victims would still be alive.

So it makes me wonder whether we need a national database of people with Mental health issues.

Not for minor depression. But for potentially dangerous conditions like schizophrenia.

The guy who killed those people had been flagged before. He had other violent incidents. Yet as soon as he would leave custody or hospital, no checks were done to ensure he took his medication or engaged with his GP or MH team.

Over the years there were 3 other times he behaved in a way to get sectioned.

We know the NHS is struggling. So if we had a national database, it could flag someone who hasn't attended a review, or who hasn't had their medication prescribed. It could also flag someone for a random check, where they'd be expected to attend so a professional can make sure they have been taking their medication and they're feeling well.

There have been so many incidents now of people with severe mental illness who have harmed or killed people. I'm also thinking of the Reading stabbings in 2020. If they'd been flagged before they stopped engaging with medication or doctors, these incidents could've been avoided.

I have bi-polar and would have no issue with being on this database, because I engage with my GP and do what I should. But sadly not everyone does and this would go some way to try and ensure we don't have to see anymore families torn a part.

Re: not involving the police. It's also worth thinking about who had legislative powers

Whilst it's right that the current move is to police not criminalising mental health it's very difficult bot to have police involved.

If I'm concerned about a patient , I don't have powers to for example access cctv to check if they've left their flat, check with their employers if there actually out, enforce a warrant to remove them from the home etc.

I recently called the police I suspected a patient had significantly harmed themselves and couldn't get hold of them. They told me they no longer attended mh incidents and unless I had evidence the person was in the house and on the floor etc.

Realistically 99% of things that involve doing something without consent outside of a hospital setting requires police

Unless you want to give nhs staff the ability to knock down doors, check your phone and bank records, monitor cctv and breach consent more often when they have suspicions you aren't well

The issue with this gentleman is the underfunding of mental health services. If you read the history of him being admitted under MHA and then being discharged to CHMT, on one occasion there was months of medication found that he hadn't taken.

Up until 2010 every mental health service had Assertive Outreach, Early Intervention a proper crisis team (not what they have now), primary care liaison etc. Over the last 10+ years the services are crumbling in front of our eyes. He would have been supported by assertive outreach, sometimes more than daily with skilled staff.

Mental health services are broken. It's an absolute crisis.

OP, there is so much wrong with this I don’t know where to start.

Firstly, we already have compulsory community treatment orders. So if somebody is deemed a danger, they can be forced to have treatment in the community, and if they don’t turn up the police go round.

But there is rightly a very high legal bar to forcing treatment on somebody who doesn’t want it, and if somebody doesn’t meet that threshold you cannot legally treat them against their will, that is battery. And if you are going to change the law so people with mental illnesses with capacity to decline treatment can be treated against their will, what is next? Forcible smears? Locking up pregnant drug users? Enforced insulin for poorly controlled diabetics? Enforced exercise for obese people? In this country, people have autonomy over their own bodies.

Secondly, this man was very well known to MH services, and they were well aware he wasn’t attending, as was his GP. The issue was a lack of resources to do anything about that fact. You could improve this situation overnight by properly resourcing NHS mental health services, which are shockingly understaffed (huge shortages of both psychiatrists and RMNs). Installing an extra layer of bureaucracy over the top won’t fix that fundamental problem.

And yes, a central register of wronguns sounds ripe for abuse, doesn’t it? Like something the Stasi would come up with for political enemies. You may be quite confident that environmental campaigners etc would never end up on there, but sadly given the history of abuses by the police and government in the 1980s that we are only just hearing about now, I am afraid I don’t share your blind confidence in the state not to abuse this.

Someone I am close to has bipolar and at times has gone for years with absolutely no engagement with any mental health professionals, not through any lack of action or desire on his part but because the services literally are not there. At one point a huge percentage of the adult psychiatrists in his trust had either left or retired and they just stopped bothering to engage with long term patients for a while. Eventually his new psychiatrist got in touch after finding a list of patients so overdue for an appointment they had just been shunted to one side and forgotten about. We need to fix the systems already in place, not create extra admin work for overworked staff and a bureaucratic system which anyone who has experience of NHS mental health services would surely know will result in more stress for patients. And that's before you get into the issue of basic civil liberties, holy fucking shit.

Providing them with suitable stable accommodation may help. It's harder to keep track of someone if they are moving around, sofa surfing etc. Many of these people will be unemployable and more at risk of homelessness.

This - database is useless if there is no one to deal with the issues flagged.

All true. And even given all that, and even given the fact that there are about 700,000 people with schizophrenia in the UK, this case is so unusual that it's received heavy news coverage. 1 person, out of 700,000. Or if you broaden it to include people with bipolar disorder, 1 person out of 2 million. Or an even bigger number, if there are other diagnoses OP would like to add.

2 million people with bipolar disorder and schizophrenia, this one man's illness coming together with other factors in a way that resulted in him carrying out these terrible acts — a man who even our diminished, straitened system had identified as being in particular crisis, though it didn't seem able to do anything much about it — and OP thinks this justifies putting all 2 million of us on a national danger list.

Can you imagine the cost? The computer systems and admin alone would be gargantuan. And how would it help? You've surrounded the needle with a haystack the size of the fucking moon.

Definitely not. Lots of people with potentially dangerous conditions do what they need to do to manage them. Where the NHS fails I personally know people who have gone private at great expense because they have no choice.

A lot of government agencies can be incompetent at best so why would you want to open these people up for harassment? I could just imagine the kind of predator who would be attracted to a job involving this database.

Oh but the original poster thinks it is a crime

This is probably the most bat shit thread l have read so far in 2024. I don’t even know where to start with it all. Who would pay for this “scheme”? Who would carry it out? What diagnoses would be involved? What punishments would there be?!

These types of incident are thankfully exceedingly rare which is why they make the headlines. People who have engaged with MH services will already be on their local MH Trust and GP medical records. Unfortunately the data that is already held is not being used to support at risk individuals due to lack of services and huge vacancies even where there are funded services are in place. Mistakes are made even with the existing information available. The Plymouth shooter was granted a shotgun licence by the police despite his record of MH and violence. A database would not have prevented this as the information was already available to police and GP.

As a mental myself (but not a self-hating one who believes I need to be on a national pre-crime danger list), I do enjoy the irony that the only adjective that can fully capture the combined awfulness and ridiculousness of the OP's suggestion is a slang term/euphemism for "insane"

I’d like to see the services and policies we already have properly functioning and utilised before trying to introduce any kind of new register.

The truth is OP, you can have as many registers and policies theoretically laid out on paper as you like but they all mean nothing without the resource to put them into practice. On a fundamental level either using what we already have or introducing something new what we need is more people. Properly trained and paid people. Nothing works without that.

Well said!

(from a fellow bipolar bear)

Unless the law has changed over the last few years there is a part of the mental health act which allows closer monitoring and allows people to be recalled to hospital if the don’t stick to certain conditions (maybe section 25?). I don’t know why it wasn’t used in this case but I’d much rather see that used more effectively than a national database

This and better resources as it actually very hard to access services in may part of the UK.

I'd be very worried about a national database with large amount access not just for discrimination reasons but because these are vulnerable people who do get targeted by criminals - family friend Son schizophrenia and drug addiction and they've had it happen to him.

Who said anything about punishments?

Never let it be said there isn't a contingent of MN that read a thread and immediately add and embellish to suit their narrative.

I would argue that this man should have been on indefinite psychiatric hold before he commited mass murder.

What was the point of allowing him to join a uni flat, where the residents had quite the nickname for him? Why were they at risk? He was sectioned and then, on leaving, could go off and commit more violent crime. No checks.

So please, what is the answer? Because frankly I agree with the parent who said the agencies have blood on their hands, and in the US there would've been repercussions for those who failed to intervene and prevent this incident.

I strongly believe, as a MH sufferer myself, that those who genuinely engage and do what we need to to stay well would not have any issues. We all get busy and a timely reminder would be handy. As I said, just like smear test reminders- do you have an issue with those? Or when the dentist reminds you you're due a check up? Or the opticians?

Those who didn't engage would receive a visit from the MH team. If they're not engaging it is a huge red flag. Because I know I want to be well. Only someone who could be on the verge of crisis would want to keep the teams at arms length.

As for funding, we are currently wasting money on a system which doesn't work. So why not use modern tech systems to automate it.

Let's be honest, every few days there's a post about GPs not working daily, they seem to be universally on part time now. This would mean they were responsible for that patient- not ring and hope you get any GP so there's no continuity of care- and would be required to contact within a set time scale. It makes GPs responsible and helps take pressure off the patient, the community and the police.

As I say, keen to hear what others reckon is the alternative?

As I say, keen to hear what others reckon is the alternative?

Before people wear down their finger-meat indulging you on this one (hint: the answer is money and staff), how about you explain how your proposed national database would've helped at all, in any way, in the absence of any of the additional resourcing and staffing that probably could've prevented this even without such a database, given the fact that it was in fact already known that he was in crisis and not engaging with services?

What do you think the answer is though on what to do with people on the register that don't engage

Currently It works quite similar to a smear test, we write to you twice

No one then forces you to engage in the smear.

If I go to someone's house and they don't answer the door. What then?

How many appointments need to be missed before you think someone should be made to attend? How would you make them?

I have heard a radio programme about an area of the country that has massively improved its care for those mentally ill people who commit crime ,by setting up really close working between the police force and other agencies in the area……whereas other areas have ended up with the police force refusing to intervene because (quite rightly) they feel the mental health services in that area are not stepping up. I think what was flagged up on the news was lack of joint working, cooperation and (for the police)connecting a pattern of violent criminality that was treated as separate incidents rather than 1 person heading down a path that ended in murder……we have to have local policies and initiatives that are a. Joined up b. Funded.

Any point I could make at this point has already been eloquently made by @TipulophobiaIsReal

If they're not engaging, but causing no trouble, what then? Do they continue to be harassed by this automated system? MH problems need meaningful, human support. This will often be instigated/pushed by family or friends, as they are best pkaced to see the differences/problems etc in their loved one's behaviour. An app can't do that.

*I strongly believe, as a MH sufferer myself, that those who genuinely engage and do what we need to to stay well would not have any issues. We all get busy and a timely reminder would be handy. As I said, just like smear test reminders- do you have an issue with those? Or when the dentist reminds you you're due a check up? Or the opticians?

Those who didn't engage would receive a visit from the MH team. If they're not engaging it is a huge red flag. Because I know I want to be well. Only someone who could be on the verge of crisis would want to keep the teams at arms length.*

I have a sister with a bipolar diagnosis. She doesn't engage with services and hasn't for years; because she doesn't seem to have bipolar. She had intense trauma, as we all did, when she was a teenager. The psychiatrist I saw recognised the trauma and eventually CPTSD, hers diagnosed her as bipolar. She tried medication for a while but it didn't help, because it was trauma, not bipolar. She eventually got therapy and it did help; over a long period. She's been symptom-less forever but has a diagnosis that nobody will get rid of. She'd be considered as "not engaging", I presume?

If you were "not engaging" on purpose, you'd probably ignore a timely reminder; which you'll know that you already get. You also get phone calls, if your service hasn't died a death under all the other things they have to do. And the police can get involved and check on you, again, if they're not so underfunded that they basically don't exist anymore.

So really you'd just have a database of people; similar to the one doctors already hold, and you'd... what? There are already reminders. It's already flagged to medical professionals. If it's only being seen by medical professionals, that's all that can happen, and it already does. If you're information sharing with uni, or work, does the person relinquish the right to consent to that just because they've got a diagnosis? Do the police also get to see? Do the police get to review it to see if there's anyone in the area that they think is more likely to commit crimes because of their health? That would pose obvious issues...

Surely you can see the huge flaws in this.

A database is all well and good but the people are still out on the streets. We should go back to the old system where people who had serious mental illness were securely locked up away from the public. The problem now is that the whole process is focused on the rights of the mentally ill person, the number one priority should be public safety.

Some of the old "lunatic asylums" were inhumane in how they treated the inmates, but just because there were horrific abuses during the Victorian era that doesn't mean we have to treat patients cruelly today. The important thing is to get them secured away from society and allow them to live out their lives in acceptable conditions.

The trouble with "care in the community" was that the emphasis was on "in the community" with little regard to actual care.

Out of interest, that wouldn't be anything to do with the High Intensity Network’s Serenity Integrated Mentoring model, would it? That was a scheme introduced in a number of Trusts in the UK, under various names, which involved mental health services working together with the emergency services and police, in a way which resulted in significant problems for some seriously unwell individuals, including the criminalisation of seriously ill and suicidal people, and potentially even human rights and equality law violations. Patient groups came together to campaign against it pretty vigorously, but I haven't been following the story for a couple of years.

Think about it. That would mean 15% of women and 9% of men in the UK would have their medical data uploaded to a likely privately run database.

We don't have functioning mental health support, it's underfunded, understaffed & poorly intergrated. That's what needs to be addressed if we want to lessen the risks for everyone.