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.

My mum was "locked up" in a mental hospital for a lot my childhood. She was often in a restrictive jacket when we saw her, and definitely if we were allowed out to the tiny, very secure garden area. I was not born in the Victorian era, I was born in the 90s. It was pretty dire, but not abusive. No way to live, though. Almost all of my memories of my mum are there, or in an ambulance on the way there.

What are "acceptable conditions"? We rarely jail criminals for their whole lives. Most people would consider being locked away as unacceptable.

Who is providing the care? There are massive abuses in the elder care industry, and those people aren't unwell. Who are you going to recruit who wants an inevitably low paid, hard career?

Who is funding the care? Realistically the poorly person, if they're unwell enough, won't be. Their family probably can't either, in most cases. Tax payer? So it'll be bottom dollar, again, and just like care homes? And there will be pressure to release people as quickly as possible to save money.

Who gets locked up? Is it enough to just be diagnosed? Do you need to be spiralling? Have committed a crime? Who is building the scale of what illnesses are bad enough to deserve you being locked up? PTSD? Bipolar? Post-partum psychosis?

Once the people you've deemed as not deserving society or freedom are locked up, how will secure public safety from all the people who commit crimes who are not mentally ill? There's a lot of those. The news may sometimes appear to suggest otherwise, but that's what sells papers...

Yep let’s put more stigma onto mental health issues. Who else do we know who made a list of people with mental heath illness hmmmm
or we could spend the millions that would cost on actually treating mental health like the illness it is and help the people who are suffering with it

Well aren't you rude?

I've not been rude to you. You asked a question, I answered it from my experience. It's not smug.

In fact, I would hate that of I did enter a period of crisis, I would find it very hard in my area to access help. It would be all on me, someone who was struggling to function, to sort it out. And if you have had periods of MH crisis, however big or small, that can be impossible to achieve. In my experience, I found it hard to get out of bed I put my phone in a drawer, and I detached from everything.

Your suggesting that the person with MH can be capable of dealing with their illness. That's far from true.

They then have to run the exhausting gauntlet of calling the GP at 8am. If on the slim chance they get through, it can hard to be understood, especially by the type of person on a GP surgery phone line. So will they get an appointment? Probably not.

If they do, it will potentially be a phone call, which they probably won't answer. If the GP even bothers. It will also be a triage GP, or practice nurse, who the patient probably doesn't have as their named practitioner. So they won't know to look out for queues, or previous illness. They will have a whole list of people to call so you're lucky if you get 5 minutes, if not 2. So the person calling is hardly going to go through years of notes, are they?

Every time this individual was forced to engage with authorities, it was after a violent incident or a potentially violent incident, such as him following a woman home and entering her property. At that point, it becomes a crime, a Police incident. But where was his GP? His MH consult?

Yes, if they don't engage, and the home visit doesn't receive an answer, would that not cause concern? That they could be very unwell? A danger to their own health? They may not be able to leave the house to get shopping, they may be at risk of losing their home or job.

We don't do enough for people with MH issues. We really don't. Too much is put at the door of the police and the patient.

You mightn't have an issue of being in such a database. I would if I was in that position.

I get where you're coming from but think that it would be end up being abused in some way, not least because things change as time moves in.

Abhorrent suggestion with potentially devastating consequences . YABU

As do females

Also post natal depression

No, I think it's time to bring back the death penalty.

And how will.that help?

There aren't enough MH resources to do any bloody work so not sure how a database would help.

My understanding was that people with severe mental illness are far more likely to be victims of crime than perpetrators so no, let's not go there.

That's true, but it is also true that a person with schizophrenia is still several times more likely to commit a violent crime, than a person who does not have schizophrenia. The data is extremely clear on this.

For male persons with schizophrenia, it looks like the lifetime risk of committing a violent crime is around 10-25%, which is extremely high compared with men in general. (Of course, this also means that the majority of men with schizophrenia do not ever commit a violent crime - I am not trying to scaremonger here).

These facts are relevant when discussing risks and countermeasures.

The drugs used to manage this condition are mostly very effective if taken correctly. The trouble is that a very high % of people with schizophrenia have episodes of not taking their medications.

Association of Schizophrenia Spectrum Disorders and Violence Perpetration in Adults and Adolescents From 15 Countries: A Systematic Review and Meta-analysis | Adolescent Medicine | JAMA Psychiatry | JAMA Network

For a start as a deterrent. Secondly, this evil specimen, who will never be able to contribute to society in any way, will not be a burden on the taxpayer by keeping him alive in a secure hospital for the rest of his pointless life.

Oh thirdly, appropriate justice for the families.

Please explain how it is a deterrent to someone who is acutely psychotic and quite literally not in reality ,you clearly know absolutely nothing about severe mental illness, s such as schizophrenia.

Good luck. In 2022, there were fewer than 25,000 psychiatric care beds in the UK, for a population of 67 million, or one bed for every 2680 people.

https://www.statista.com/statistics/473278/number-of-psychiatric-care-beds-in-the-united-kingdom-uk/

Just prior to the big "care in the community" push in the early 1980s, there were about 85,000 beds, for a population of 56 million, or one bed for every 659 people.

https://hansard.parliament.uk/Commons/1997-11-27/debates/62d0a01a-2264-482f-a042-1b9f72bdb210/PsychiatricBeds

In other words, we've got a quarter of the psychiatric hospital places, per person, that we had in 1980.

Doctors and other mental health workers want people who are desperately ill to be able to stay in hospital until they're truly well enough to go home, or, say, to be able to have a gradual return with nights at home but keeping their hospital place. But they have to kick desperately unwell people out of hospital because someone even worse off needs their place. And running at less than full capacity is unthinkable, when so many people need a bed but can't get one — even though you need spare spaces for emergency admissions.

When someone is so seriously unwell that they need to be admitted to a psychiatric hospital right now, their doctors and their families would usually like to be able to admit them straight away to the local psychiatric ward. Instead, patients wait, often with only their family to try and keep them safe if they're lucky, while staff call around the country to see if there's a bed anywhere. If they're lucky enough to find one, the patient is locked up potentially hundreds of miles from home — no family support, no visits. If not — well, the person might still be sectioned, but with nowhere to go.

Doctors would like to be able to do planned admissions like they used to, to prevent deterioration or to monitor trying a new medication. No go.

People used to be voluntarily admitted sometimes, and the wards they were admitted to were places with patients with various levels of severity. Now, wards are temporary holding pens crammed full of only the most severely and dangerously unwell people, a place for chemical stabilisation at best, not a place to start getting well.

Psychiatric patients are crying out for more beds, mental health services are crying out for more beds, for people who are so severely, acutely mentally unwell that the average person would be agog that they weren't in hospital weeks ago, long before they reached this point. Just being psychotic or suicidal isn't high enough severity.

Families live on suicide watch, retrieve psychotic family members from abroad, watch loved ones sink into squalor or homelessness or chaos, and none of these things are necessarily severe enough to qualify for one of the very few beds left. Psychiatric patients kill themselves, ones who might've been kept alive and recovered, if inpatient treatment had been available.

None of these things is enough to convince our government to fund adequate inpatient care for mental illness. God only knows how many avoidable deaths and how many ruined lives that adds up to.

I suppose it's entirely possible that our governments will change their minds and decide it is worth spending the money on, when it's the deaths and ruined lives of a tiny number of people who don't have a mental illness, or a mentally ill family member, themselves (rather than the much larger number of deaths and ruined lives they're happy to accept for the mentally ill and their families). But they'll have to find at least four times as many staff, at least four times as many adequate physical facilities, and spending all that money on mentals when there's Hardworking Families out there will be a hard sell.

By the way, how are you intending to distinguish the hundreds of thousands of people with schizophrenia who will never harm anyone in their lives from the ones who are so dangerous they should be secured away from society? I'm sure you're not advocating for life sentences for people who've committed no crime beyond having a mental illness that's beyond their control, who have never harmed anyone and never will?

Well you could argue that most people who commit heinous crimes are mentally unwell. It's not a get out if jail free card if one has some sort of mental illness. Look at many serial killers or mass murderers. Many reported hearing voices etc.

I don’t think that’s the right approach to be honest. I think only people with dangerous hallucinations would be more of a risk than the general population.

Plus, ‘Mental Health’ diagnoses are notoriously unreliable and don’t actually stand up to scientific rigour. They are just a description of thoughts, feelings and behaviours that tend to come together. It’s nit like you can get a blood test. Research has shown (carried out as part of the DSm-V work) that even for seemingly clear diagnoses like major mood disorders, psychiatrists don’t provide reliable diagnoses.

Would we have a register for someone caught drink driving? Someone who is ordinarily gentle, but punches the bloke who is sleeping with his wife whilst he is drunk?

Schizophrenia isn’t actually a diagnosis. It’s an umbrella term for various psychotic illnesses.

What about a woman with puerperal psychosis after giving birth? Would she go on the register? A young man with drug induced psychosis? A woman with PTSD following a brutal sexual assault who declares murderous thoughts towards her aggressor?

Where would you draw the line? How would you draw the line in an area of medicine with such dubious reliability and accuracy?

Better outreach and pro active mental health services is what we need. Mental
health services are always underfunded. A decent and regularly reviewed risk assessment and proactive engagement is what would help but still, you can’t predict and prevent all risks.

Is this post aimed at me?

Personally, I find it quite rude when someone argues that they'd like to put me on a national pre-crime nutter database, but there you go.

And please stop pretending your nasty little authoritarian post was anything to do with removing barriers for people with mental illness needing help and support.

Most people who commit Henious crimes are not mentally unwell.and those are will have had full asesemens ,yes some people may claim to.hear voices but its usually very obvious to mental.health staff ,if they are not genuine ,i used to be a mental.health nurse
I don't know if you have ever been inside a secure hospital but they are not somewhere you would wish to be I had a placement in a medium secure unit when I wax a student nurse and that was bad enough ,a high secure area would be a lot worse
.

I've lost someone to a violent horrific crime. You don't speak for me in your call for state-sanctioned murder.

@TipulophobiaIsReal DFOD

Very sorry to hear that.

I don't claim to. But these families are not happy with the sentence handed to this individual. Not to say that they would welcome the death penalty either. But speaking for myself, if someone killed my daughter, I would be more than willing to carry out the execution myself.

This is a horrifying idea that would open the door to unthinkable abuse and surveillance. I wouldn't trust anyone enough to handle such a database appropriately, but I would definitely not trust the health system which is owned by the state and vulnerable to political manipulation.

Cases like the Nottingham one become exploited and sensationalised by the media precisely because they are unusual. It's horrific for the victims but it's a very rare event and you are not, statistically, in any real danger of being stabbed by a random person with schizophrenia tomorrow, any more than you are in danger of winning the lottery. However, you are probably in significant danger of dying before you get medical care if you have a medical emergency, for example. A surveillance database for mentally ill people is not a priority for 2024 Britain.

What we need is a better society: a better health system overall where everyone gets help when they need it, a better social safety net, less poverty, better housing, better working conditions in all jobs, etc. I guarantee that overall mental health would improve if these things improved. Britain is sliding back to Victorian standards in many ways.

No it was totally different,this was much more recent…I believe that the SIM scheme has been investigated both by the police and the nhs and withdrawn within the last couple of years ( nhs statement in 2023 that it was no longer to be used). I think that scheme effectively resulted in police using coercive measures . I wish I could remember more about the programme but it was more to do with mental health professionals being more available at the assessment end rather than people being responded to solely by police / held in police premises. I haven’t worked in MH for a good many years but had a number of patients who’d had traumatic experiences from being arrested by police during psychotic episodes .(edited for spelling !)

You're pushing dangerous ideas in the wake of some truly horrible events when passions are running high.

If you want to advocate for better access to mental health services, go ahead! I'll be right by you cheering you on.

If you advocate for worrying overreach, increasing stigmatisation and state harassment, then try to twist it round when you get backlash, don't expect nicey nicey.

Ah I'm really glad to hear that @Thisisnottheend — I've been out of the loop with things like StopSIM and other patient/survivor/whatever action groups for a little while. I'm glad to come across sometimes who's worked in MH and is familiar with the patient-group opposition to SIM, though — I was never sure how far the message was getting, but they did amazing work campaigning. I did vaguely hear that the NHS had said they would stop using SIM and derived programmes, but hadn't looked into what was actually happening on the ground, IYSWIM. I know sometimes things do keep going in another form, or are intended to be discontinued but a replacement isn't found, etc. — but glad to hear from you that it hasn't.

The programme you're describing sounds (tentatively) better, and from what you say seems to be getting positive results.

It sounds like this "Right Care, Right Person" thing might not get rolled out in Norfolk after the stabbing there, though… seems to an outsider like it's the police desperately trying to protect its resources because they're the one service that everything eventually devolves onto and they're overwhelmed, which is understandable, but then where is the need going to be met? We've just whittled down all our public services so far that the services of last resort are either falling over or putting up boundaries, and it's terrifying.