Youth deaths highlight growth of UK private mental health services
22 July 2016
The recent inquest into the death of 14-year-old Amy El-Keria has highlighted concerns about the safety of young people being treated in private mental health units operated by the Priory Group across the UK.
The Priory Group is Britain’s largest private mental healthcare provider and receives millions of pounds a year in public money to look after some of the most vulnerable young people. Nearly half of all child mental health patients are now cared for in the private sector.
El-Keria died in November 2012, while a resident at Priory Ticehurst House hospital in East Sussex, one of Britain’s most expensive private hospitals. Her treatment was paid for by the National Health Service (NHS).
Her tragic death was the culmination of numerous failings at the hospital over a period of months whereby staff had missed the opportunity to pass on information regarding threats that El-Keria had made indicating she wanted to end her life.
At the time of her death, El-Keria was found unconscious with a football scarf tied round her neck. Panic ensued, leading to staff delaying calling the emergency services and failing to summon a doctor immediately. It emerged that the staff had not been trained in resuscitation, though they had requested training. When paramedics arrived on the scene, the lift would not fit a stretcher as it was too small.
El-Keria had a history of using ligatures, and opportunities to remove the scarf had been missed. Her risk of self-harm had been mistakenly downgraded from high to medium.
The jury at Horsham coroners’ court found that the young girl had not intended to take her life and may have lived had she received proper care.
The Priory Group has received severe criticism following the deaths of a number of young people in their care.
Earlier this year the case of Sara Green, who died in the Priory Royal hospital in Cheadle, Greater Manchester in 2014, led to the coroner describing some of the evidence from staff at the hospital as staggering. The coroner went on to say that Green would have been safer at home.
The Priory hospitals are often associated in the public mind, with the treatment of rich celebrities, requiring rehab, yet this can disguise the role they play in treating NHS patients, with 85 percent of the Priory’s income coming from the public sector.
Recent figures show that the increasing demand on child and adolescent mental health beds within the NHS, has led to an increasing dependency on the private sector for bed spaces. This has led to people being placed out of area, often a long distance from where they and their families live.
Green was placed 100 miles away from her home, and at the time of her admission to hospital was expected to stay in hospital for six to eight weeks. She remained in hospital for nine months due to a combination of failures in managing her discharge and a lack of an NHS bed nearer to her home.
The NHS now sends 47 percent of this group of patients to private hospitals, with the Priory Group being the main recipient of all its child adolescent mental health beds, with all being taken by the NHS. The average cost of each private bed is £800 a week.
Deborah Coles, director of the deaths in custody charity, Inquest, who have been working with Green’s family, said there was now an irresistible case for an inquiry into how private companies are operating within the NHS.
Coles noted that Priory was allowed to conduct its own internal investigation into Green’s death and it has taken the family four years to get an inquest with a jury to expose the truth.
Nine young people have died since 2009, while being treated in mental health units across the UK. Inquest fears that the numbers of young people who have actually died could be higher because their own research suggests that the Department for Health have no idea of the true figure.
The government has consistently denied the deaths of young people in care. But in an investigation into the death of Green, “I’m Broken Inside: Sara’s Story”, carried out by the BBC Panorama programme in April this year, the minister for Community and Social Care, Alistair Burt, admitted that he didn’t know how many children and adolescents had died in the care of psychiatric units in recent years.
The Priory Group was sold by the private equity firm Advent in January this year to the US firm Acadia Healthcare, based in Franklin, Tennessee, for £1.3 billion. Acadia has 587 behavioural facilities that include 17,400 beds across 39 US states, the UK and Puerto Rico.
A damning report by the Children’s Commissioner has shown that mental health services are failing children. The report showed that 28 percent of children who had been referred for specialist mental treatment in 2015 did not receive a service, with 14 percent of children with life threatening conditions being turned away, including those who had attempted suicide, serious self-harm, and/or suffered from psychosis and anorexia nervosa.
Since 2010, spending for young people with mental health problems has been cut by 6 percent in real terms, with the numbers of specialist mental health nurses in England falling by 10 percent in the last five years.
Official NHS figures show these nurses have been lost in the main to mental health units treating some of the sickest patients. The number of qualified nurses working in psychiatry has dropped by 10.8 percent, from 41,320 in 2010 to 36,870 in 2015. At the same time, the number of people seeking help has increased by as much as 40 percent.
Many psychiatric hospitals now have a growing number of vacant posts. Earlier this year the Royal College of Nursing research showed that London had 10,000 nursing posts vacant with many NHS mental health trusts amongst the worst affected by staff shortages.
The government is abolishing education bursaries for nurses, forcing those wishing to train to take out student loans, which will inevitably increase the shortage of nurses.
The dire state of mental health services for young and old alike is a product of decades of underfunding and cuts that have been implemented by successive Labour and Conservative governments.
At the same time there has been a growing market in private sector health care provision, with lucrative contracts to be won as sections of the NHS are being broken up. In 2015, the campaign group NHS Support Federation showed that private firms had won £3.54 billion of £9.62 billion worth of deals that had been awarded in England in 2014.
Clinical Commissioning Groups (CCGs), responding to a Labour Party freedom of information request, revealed that private firms have been winning 40 percent of contracts put out to tender by CCGs.
It is unacceptable in a society awash with wealth for anyone with mental health problems to be left to the mercy of the market when they are in need of fully funded specialist services where they live.