Huntercombe Hospital in Maidenhead. "Inspectors found staff “did not use safe systems” to prescribe, administer, record and store medicines on its Severn and Thames wards, which provide psychiatric intensive care" for children and young people https://www.hsj.co.uk/patient-safety/hospital-put-into-special-measures-after-young-patients-appeared-over-sedated/7029514.article#.YC0qZoQaTWU.twitter

I don't think we can get to having a better mental health system without going through this process of what feels like crisis. It's a crisis of holding people's lives and experiences in better regard and treating this stuff as important, not inconvenient

There's a chunk of the Mental Health Act White Paper about improving staff morale in mental health settings within the NHS. There needs to be a similar sympathy with patient morale, too. It isn't there currently. Mental health working conditions are made out of people

We deprive people of their liberty as a result of their mental health need, but we give far too little in return for that fundamental deprivation of their rights. But, conversely, we don't really have any 'right to treatment' in a meaningful, deliverable sense

Unfortunately, it seems from Care Quality Commission inspection, poor care happens both in NHS mental health provision and privately owned provision contracted to the NHS. These judgements aren't a punishment, they're a challenge to the ways people are let down

There's a bit in Mental Health Act White Paper that talks about changing legal criteria for admission, with suggestion that 'being in hospital' not being a sufficient level of 'therapeutic benefit' on its own. That's going to be 'exciting' to see play out in debate and real life

In broad debate we tend to hear a relatively large amount from people who feel they were detained wrongly, or from people who challenge medical, philosophical and legal basis for detention in hospital of mental health. We don't hear so much from people who just got a shit service

Debate about mental health hospital care tends to focus much less on hearing from people who wanted 'something' from mental health inpatient but definitely didn't get anything they either wanted or needed. That set of experiences doesn't get a chance to coalesce into demands

People who know they were let down by mental health hospital care tend to get shunted into making complaints, get charmed into patient involvement or coproduction, get othered into self-blame and self-recrimination. They are given the poisoned gift of cynicism by seeing no change

It's certainly a legitimate project to argue for 'the abolition of the asylum', but as we know, you need to build the alternatives of support, care and being there for people before that's possible. Hospital isn't now meant to be correctional or punitive, but it grew out of that

I think people do need care and support when mental health stuff gets too much. At present 'hospital' is the thing we have that fills the role of 'what we do when people in our community can't sort out their mental health alone. Abstract argument needs a root in practical reality

I think it's very different getting all excited about Foucault and Goffman and your favourite 'closing the asylums' story and having been through an enforced stay in hospital that you know wasn't doing for you what such a stay needed to do to help you get sorted out.

I often get a bit irked by people who have an abstract notion of 'get rid of all mental health detention' who, sometimes accidentally, downplay or ignore the very real and terrifying situations that can be part of severe mental ill-health, distress or trauma.

That we have the 'wrong thing' in place right now to help people does not mean that, actually, those folks don't need help, support and care. Saying 'see, it's all fundamentally terrible' detracts from the recognising the ways things are specifically terrible for specific people

Whether you're abolitionist or pragmatist (or pragmatic abolitionist even) there are people not getting what they need. They're not getting it from our hospitals in mental health now, and they won't be getting it from abstract philosophy, either. People are harmed by no care, too

People are also harmed by not enough care, too much 'care' of the wrong kind, poor care that ends up causing them more problems on top of problems they have. It's not Manichean. We are still terrible at listening when people, in whatever way, state what they need to feel better

I feel like we need to rip the plaster off this wound. There will a be a lot of offended and dismayed professionals, a grim sense of crisis, a horrible period of intensifying distrust, but I feel like only then will we see how many people have been failed and who cares about that

Staff morale is, of course important. So is organisational culture, legal and medical literacy, professional development. But it's also possible to be a very busy, very stressed, very aggrieved person working in mental health services who is still doing the wrong thing for people