Wednesday 10 February 2016

Who Cares About Gay Mental Health?

On the 29nd January the charity PACE suddenly closed because of lack of funds. (1)

PACE opened in 1985 to “support LGBT+ people to manage the difficulties they face in their day to day lives; at work, school and home.” (2) To LGBT people in London, PACE provided counselling, advocacy, training, youth work, research and mental health support services.

This wasn't high profile or glamorous work, it certainly wasn't work that made it into the headlines of many newspaper articles, on even online articles, but it was still to many LGBT people PACE was a lifeline. The singer Will Young became a patron of the charity after being involved in some of its workshop (3). But even a celebrity patron wasn't enough to save PACE.

The deep cuts to Local Government funding have deeply afforded many small charities like PACE, charities that relied on grants and funding from Local Authorities. Especially charities, like PACE, that provide services that are not popular or are not seen as “warm” and “cuddly”. Mental health charities always have problems raising money from public donations.

Unfortunately the need for organisations like PACE has not gone away. To be Lesbian or Gay now is very different then it was back in 1985, we have marriage equality, employment protections, equality protections; and yet many things remain the same.

Will Young has talked about the shame he felt over being gay, shame that he internalised growing up with the homophobia around him. “I will keep coming back to shame because it’s such a fundamental thing,” he said. He described a circle of drinking, sex and watching porn until he finally overcame it (4).

Olly Alexander, the 25 year old singer of Years & Years has spoken of the problems he had coming out as gay. He felt repeated pressure to be heterosexual, was bullied for being gay and at 19 he sort counselling for anxiety. But since coming out Olly has added that his anxiety did not automatically go away. “Once you admit to yourself and the world that you’re gay, there’s an expectation that you put on yourself: you’re fine now, you’ve gone through the whole thing of being gay, and now you have to prove to yourself that you can live a happy life and be happy,” he said. (5)

Homophobia doesn't just affect those coming out as gay; it can affect someone at any age. Stephen Fry recently opened up about low and suicidal he felt after coming face to face with a “frothing” homophobic politician. In 2013, while making a documentary, he had a heated interviewed with Simon Lokodo, a Ugandan government minister. Lokodo said gay sex was “worse than child rape”, amongst other homophobia. Stephen Fry stood by his opinions during the interview, but afterwards fell into deep disappear and depression. Lokodo's homophobia tipped him over into a suicide attempt that night (6).

The year 2014-15 Home Office figures saw a 22% rise in homophobic hate crime (7). In England and Wales there were 5,597 homophobic hate crimes were reported, but this figure is probably only a quarter of the actual homophobic hate crimes committed. Only one in four hate crimes are reported to the police (7). That is over 20,000 victims of homophobic hate crimes, over 20,000 people suffering the psychological effects of being the victims of these crimes.

Homophobia hasn't gone away, and neither has its negative effects on LGBT people's lives, but due to this Government's severe slashing of local Government funding there is now one less place were LGBT people can get support and advice. The skills and expertise that PACE built up over thirty years have now been lost, and will be difficult to re-create again. Now is this benefiting anyone?

This Government's policy of austerity has already cut deep into public services, and again the services to LGBT people are the ones that suffer first and deepest. How can the Government talk about equality and supporting working people when their cuts do this?

Drew Payne.

Wednesday 3 February 2016

Sorry is the Easiest Word to Say

On 26th January, Jeremy Hunt apologised in Parliament, over the death of a one year old boy from septicaemia. Hunt said: “Whilst any health system will inevitably suffer some tragedies, the issues in this case have significant implications for the rest of the NHS that I'm determined we should learn from." (1)

But how can he say he is “determined” to learn from it when the changes brought in his government party lead to this boy’s death.

William Mead (The one year old boy) died on 14th December 2014 from septicaemia, secondary to pneumonia. The boy’s parents had repeatedly taken him to his GP and repeatedly called to NHS 111 about William’s deteriorating health. The official NHS England report (Only published in January 2016) stated that if the Call Handler (Non-clinically trained staff who answer NHS 111 calls), who spoke to William’s parents the last time they called, had recognised how seriously ill the child was, William’s death may have been prevented (1). This is very demanding.

NHS 111 has been plagued with problems; poor staff training (3) using untrained temporary staff and poor supervision of staff (3), claims of being “dangerously understaffed” (4) and an uncomfortable lack of clinical staff (5). In January this year; Integrated Care 24, which handles NHS 111 and out-of-hours GP calls in Norfolk and Wisbech, was criticised for not publishing a damning, leaked report into their performance. The report stated that people had to wait 12 hours for a call-back, which caused significant patient safety issues, a lack of GPs employed there and the poor level of staff recruitment (2). This was over a year after William’s death.

To be cynical it always looked like NHS 111 was brought in as a cheap replacement to its predecessor, NHS Direct, but what other conclusion can be drawn. NHS Direct employed experienced nurses to triage all symptomatic callers (Any call about a person with medical symptoms) and gave them appropriate advice, these nurses were employed on the equivalent of Band 6 and above. With NHS 111 all calls are triaged by non clinical call handlers, using computer algorithms (a computerised assessment system), which seems to be a tick-box assessment. These call handlers only have six weeks training (6). They do not have the clinical experience to recognise when something is wrong, when symptoms do not sound “right”, when there are complications that increase the severity of a person’s symptoms. There are nurses available in the call centres but they don’t triage calls, they are there to advice the call handlers. There have also been whistleblower claims that NHS 111 is short of these nurses (5).

I used to work for NHS Direct (Back at the beginning of the millennium) as a Nurse Advisor. Telephone Triage (Assessing patients over the telephone) is a difficult and complicated skill, because you cannot physically examine the person so you have to carefully talk to them to get a “picture” of their symptoms. I couldn’t have safely done that without the years of nursing experience I had built up before starting that job to call on. Many of the people I spoke to had a poor basic knowledge of their bodies, what is normal and what are symptoms of illness. I do not know how we can expect non-clinical call handlers to do this complicated assessment, it is more than just reading questions off a screen.

I have repeatedly turned down offers of jobs at NHS 111 in the last four years and always for the same reason, I do not feel it is clinically safe and I don’t want to work for a clinically unsafe organisation. It may sound selfish, but I want to keep my registration as a nurse.

Unfortunately I do not see NHS 111 improving any time too soon. Jeremy Hunt has proved very deaf to the concerns of healthcare professionals and this Government has reduced their spending on the NHS (7). Are they willing to spend the money it will take to make NHS 111 a safe service?

Drew Payne