The police can’t continue to pick up the pieces of Britain’s mental health cuts | Ian Blair

In my time as the deputy and then commissioner of the Metropolitan police, my primary concerns were with terrorism and issues around diversity. But a constant problem for my officers was dealing with people exhibiting psychotic behaviour in public, which seemed to be getting worse. A main driver of this was the inadequacy and local unpredictability of mental health services.

Since I left office in 2008 the situation has deteriorated more dramatically than I could have imagined, with the latest report suggesting that police across England and Wales are now using powers under section 136 of the 1983 Mental Health Act 50% more than they did a decade ago – nearly 30,000 times in 2014-15. These numbers are a symptom of a crisis in mental health provision.

Section 136 is the power given to police officers to remove individuals who appear to be exhibiting signs of acute mental distress from public places to what is described as “a place of safety”. This should be a hospital but, in an emergency, can be a police station.

There is a similarity here with the much more widely understood crisis in social care for the elderly, with too many simply frail people staying in hospital when they should be being looked after at home. The closure of many psychiatric hospitals in the 1980s under the policy of “care in the community” has put pressure on mental health provision, while the increased geographical mobility of many families makes care by relatives much more challenging

But the real issue, both in social care and mental health, is that money is being spent on crisis-handling rather than on prevention.

The police and hospital A&E units have, in the past decade, become the only 24-hour public services for people in crisis. The police have had severe funding cuts but are still there at the end of a telephone. Anyone working in the NHS will admit that the government’s vaunted “parity of esteem” between physical and mental health has not been honoured, particularly for young people. Meanwhile local authority budgets, which part-fund child and adolescent mental health service and community health teams, have not been protected at all.

In my early service in the 1970s it was a rare sight to see a cell door open with an officer sitting outside, watching

This means funds for services that would have previously been available are being rationed on the basis of seriousness of need. Adult care provision is being refused by cash-strapped local authorities to hundreds of thousands of people who would have previously received it; now they will only get it when their incapacities worsen to the point where they end up in A&E, then in a ward from which they cannot be released because there is no adult social care service to support their recovery at home.

I have lost count of the number of officers dealing with distressed young people – and of friends and acquaintances whose children are so ill as to be taken by police to local psychiatric institutions only to be assessed as not ill enough to be given a bed. All of these are therefore released into the care of community mental health services, whose budgets have also not been protected. Over 200 people took their own life last year while under the care of such services, which lack sufficient resources to prevent difficulties becoming disasters.

Last year the government announced that police cells should never be used for the housing of mentally ill people. Fine, but announcing that something is forbidden is not the same as providing an alternative, as was highlighted during prime minister’s questions last week.

In my early service in the 1970s it was a rare sight in a police station to see a cell door open with an officer sitting outside, watching over a vulnerable person with mental health problems because there was nowhere more suitable to take him or her. Later, it became less rare. Contrary to the government’s intention, that sight will probably remain commonplace for some time, as will cases on the street where officers end up dealing with psychotic individuals without sufficient backup from mental health professionals. It is interesting that the chief constable of Devon and Cornwall is reported to be threatening to sue his local NHS trusts over a lack of mental health beds.

The social care crisis will affect most of us in the coming years, whether as patients or as relatives. Such experiences can be deeply distressing and long-lasting, but unless more money is put into mental health provision, both in residential care and in the community, significant numbers of people will suffer; and families will face the acute and agonising dilemma of how to look after someone at home whose psychotic state is unpredictable, occasionally violent and sometimes self-harming.

Meanwhile the police will continue working to provide a service for which they were not and are not designed. When Robert Peel, who founded the Metropolitan Police in the 1820s, said the police are “only members of the public who are paid to give full-time attention to duties which are incumbent on every citizen in the interests of community welfare”, I don’t think he envisaged them as community mental health workers.

The Home Office judges the success or failure of individual police services by reductions in crime – not on dealing with mental health crises – but unless NHS and council-run mental health services are adequately funded, too much police time will continue to be taken up with a task they are ill-equipped to perform, and which risks jeopardising their role as protectors of the community from crime and terror.

The police can’t continue to pick up the pieces of Britain’s mental health cuts | Ian Blair

Fanny Burney wrote one of the most courageous pieces of work I’ve ever encountered

As presenter of Woman’s Hour I’m no stranger to the history of women who, over the centuries, have risen above the prejudice imposed on their gender, and whose lives began to be uncovered in the latter part of the 20th century as women’s studies became an acceptable subject for academic research. But nowhere could I find a book which gathered together a group of those who had most excited my interest and admiration.

Then came reports in November 2015 that it was proposed to cut feminism from the politics A-level syllabus. The suffragette movement was to be squeezed into a section on “pressure groups” and only one political thinker, Mary Wollstonecraft, was to be mentioned by name. My son had come home some years earlier with his text book for 20th-century British history and recognised (thank goodness) that something was missing. “Mum,” he said, “I don’t think this is right. I can’t find any women in this book except half a page on the suffragettes.” That’s my boy!

Then I came across Thomas Carlyle’s “The history of the world is but the biography of great men”, written in 1840, and, in Steve Biddulph’s Raising Boys(1997), “It’s important to remember that men built the planes, fought the wars, laid the railroad tracks, invented the cars, built the hospitals, invented the medicines and sailed the ships that made it all happen.”

It became vital to bring together a group of female warriors, poets, playwrights, painters, composers, campaigners, scientists, engineers, doctors and politicians for the benefit of all those young people who need to know that the history of Britain is the biography of great men and women.

Fanny Burney is one such woman. Though certainly not the most accomplished novelist in the canon of English literature, she was successful in her day, often writing in her fiction about the difficulties faced by women in getting an education, taking control of their own lives and surviving the social whirl of the nouveau riche. Virginia Woolf called her “the mother of English fiction”.

Her diaries are phenomenal, giving us the most gossipy and often scandalous details of life in literary and intellectual London in the late 18th and early 19th centuries. She was at the centre of a circle that included Dr Johnson and his biographer, James Boswell. Her diaries give a far more intimate portrait of Dr Johnson than do those of the man she referred to rather scathingly as Bozzy.

She also wrote one of the most courageous pieces of work I’ve ever encountered. I read it around the time I, like so many 21 century women, was diagnosed with breast cancer.

Burney’s is the first example I’ve come across of a woman writing about so intimate an event as a diagnosis of breast cancer and a mastectomy. Even today, when I wrote about my experience, it was regarded as a brave thing to do, though we no longer have any squeamish concerns about speaking the words “breast” and “cancer” out loud. It was generally deemed to be helpful, making it clear that there’s no shame attached to the diagnosis and it can be endured and survived.

Burney was there first. She was diagnosed in Paris in 1810, at the age of 58, when surgery was in its infancy and there was no effective anaesthetic. Her story was written to her sister, Esther, and was headed “Account from Paris of a terrible Operation – 1812”. First she explains that in August of 1810 she had a pain and a heaviness in her breast. She was referred to a surgeon and, at first, dismissed the concerns of her family and friends. Her letter is a cautionary tale. “I relate this false confidence, now, as a warning to my dear Esther, my sisters and nieces, should any similar sensations excite similar alarm.”

She goes on to describe every horrific detail of what she endured: “Monsieur Dubois placed me on the Mattrass, and spread a cambric handkerchief upon my face. It was transparent however, and I saw through it that the Bedstead was instantly surrounded by the seven men and my nurse. I refused to be held; but when, bright through the cambric, I saw the glitter of polished steel – I closed my eyes.”

For now I’ll spare you the remaining horrors and reassure you that the tale has a happy ending. Burney lived for another 29 years after her mastectomy, to the age of almost 88.

I love Burney’s writing, especially her diaries. But most of all I love her for making us aware that, though the diagnosis is awful and the surgery, even with a full anaesthetic, isn’t pleasant, breast cancer can be survived – and a long and productive life lived after it. For this, she deserves her place among the greatest women.

• A History of Britain in 21 Women by Jenni Murray is published by Oneworld. To order a copy for £13.93 (RRP £16.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.

Fanny Burney wrote one of the most courageous pieces of work I’ve ever encountered

Teachers left to select up pieces from cuts to youth psychological well being servicess | Mary O"Hara

As the headteacher of big primary college in the west of England, Joan Cunningham is accustomed to the demanding aspects of managing an intake from a mainly disadvantaged region. Even so, for the past couple of years, she says, one situation has escalated so significantly that it is practically at crisis point. “There is so much much more pressure on colleges and teachers to deal with children’s mental health and behavioural issues,” she says. “We supply as a lot support as we can but, with fewer sources obtainable and a enormous improve in want … the strain has been amazing.”

Cuts to mental health and other services for youthful people indicate teachers are more and more possessing to fill the gap, even however schools do not always have the sources or instruction to offer the extra support pupils with mental or emotional issues may possibly need to have.

“It was presently difficult to access the appropriate providers prior to cuts but its getting worse,” Cunningham says. “Teachers … are not psychological well being experts, and now there is a vacuum in the solutions we have [historically] relied on. Social companies departments are under far more stress due to cuts, Certain Starts … have vanished, [and] in numerous situations the voluntary organisations we utilised to be in a position to turn to are disappearing. Signal-posting households to where they can get help is significantly more difficult because of all of this.” At a time when families are below better fiscal strain and “even quite youthful kids” are underneath stress to achieve academically, she concludes, the require for assistance is “expanding extremely quick”.

Child and adolescent psychological health solutions (Camhs) have been notably tough hit. These professional solutions assess and treat youngsters and younger individuals with mental, emotional or behavioural problems. Usually, when schools can’t offer the help of their personal counsellor, or when a child has specifically serious issues, they will seek out out their local Camhs for help.

In a lot of cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some locations has been extreme. In accordance to study by the charity Youthful Minds, two-thirds of councils in England have lowered their Camhs budget because 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and younger folks, such as youth counselling or distinct providers for colleges, a lot more than half had lower budgets – some by as significantly as thirty%.

The cuts imply neighborhood authorities’ Camhs investing is increasingly redirected towards more serious circumstances of psychological unwell-wellness, at the expense of early intervention solutions. “Draining funds from early intervention services is brief-sighted and just shops up difficulties for the potential,” says Sarah Brennan, chief executive of Younger Minds. “The result is Camhs feels it is getting asked to respond to an huge variety of issues and colleges really feel Camhs has left them higher and dry.”

Chris Harrison, national executive member and former president of the NAHT, says part of the dilemma right up until lately has been that targets in schooling have allowed children’s wellbeing to slip down the agenda. “The concern of psychological well being [in schools] has been coming to the fore over the previous 4 or 5 many years there is a real groundswell of curiosity, but it isn’t yet a priority in schools. We require to accept that planning for lifestyle is about far more than academic results.”

Investigation by the Teacher Assistance Network, a charity focusing on teachers’ wellbeing, exhibits around half of teachers feel pupil behaviour is worsening. Its survey of more than 800 teachers also found virtually two-thirds have been stressed as a consequence.

The cuts to Camhs mean schools are struggling to supply specialist help on site. Some have set aside income from the Pupil Premium to shell out for a normal counsellor. Andy Bell, deputy chief executive at the Centre for Psychological Health, says that an “ad-hoc” method of support relies as well heavily on the initiative of person heads or teachers, and is undermined by unsatisfactory and arbitrary access to funds. “We see raising awareness of this issue as a significant priority,” he says. “When we carried out study on little one behavioural difficulties we identified that three-quarters of mother and father asked teachers for support … Nevertheless, some colleges are greater outfitted than other individuals. A lot of have practically absolutely nothing by way of [specialist] assistance, whilst other people have full-time counsellors.”

Inadequate and underfunded providers mean undue tension is being put on teaching workers, who might feel they are not educated or competent to tackle numerous of the emotional or mental well being issues that come up.

And with anecdotal evidence suggesting the number of youthful men and women experiencing psychological wellness difficulties is increasing, the crisis in Camhs is set to get worse. In 2004, the last year that government statistics were centrally collected on the prevalence of psychological ill-well being between children and youthful folks, 1.3 million youngsters have been deemed to have a diagnosable mental illness. The economic downturn, coupled with government austerity and exam stress, implies this figure is now possibly a lot increased. And with NHS England estimating that only a quarter of youngsters and youthful people with a problem are ever noticed by psychological well being solutions, the figures are just the tip of the iceberg.

Politicians are getting to be far more conscious of the scale of the problem. The health choose committee has begun a parliamentary inquiry into Camhs, which campaigners hope will push psychological overall health in colleges higher up the agenda when it is published this year. “What we need to have is a constant, nationwide method that is accountable. What we need to have is for Camhs to be transformed.” says Bell.

Harrison says more requirements to be accomplished to guarantee heads and colleges have accessibility to effective help solutions. “Colleges and heads are battered at the second. We want the government to search at the proof. It truly is widespread sense. There is mind-boggling evidence that college students understand much better and are far more effective in environments in which they are supported and their teachers are supported.”

For now, charities and campaign groups are possessing to support colleges themselves. Younger Minds offers guidance on its internet site for teachers and is about to pilot a helpline for school staff, whilst the anti-stigma campaign Time to Adjust is working a task advertising pupil wellbeing and supplying practical guidance for educating staff. “Pupils are under a lot far more stress these days and so are employees, however teachers don’t have instruction in mental wellness – or spare time,” says Moira Clewes, lead teacher on health at Sandwich technologies school, Kent, a single of the colleges piloting the task. “We are breaking down misconceptions close to mental sickness. College students are opening up. Teachers are grateful for suggestions. You’d be amazed at the influence this is possessing.”

A Division for Training spokesperson factors to a selection of initiatives, which includes the MindEd site, launched in March, created to support men and women working with children, like teachers, “to recognise when a youngster wants support and how to make sure they get it”. The Division of Overall health says it has a “priority” target on children’s mental health and, among other things, has put additional cash in to “speaking therapies”, incorporating that it is liaising with the DfE to enhance links among colleges and Camhs.

For Cunningham, although any help is welcome, she is adamant that “nothing at all quick of a clear, coherent and correctly funded approach nationally will operate for colleges and for kids”.

• Some names have been modified

Teachers left to select up pieces from cuts to youth psychological well being servicess | Mary O"Hara