Council member and consultant psychiatrist Dr Helen Read spoke at the TUC Women’s Conference on mental health cuts. She reflects on her speciality and the association’s role
If any single specialism was asked to try to articulate the impact of financially driven care restructuring, managerialism and efficiency drives, those within the mental health system would probably be most able.
Psychological distress among young women is reported to be at an all-time high, while one in five women experiences severe depression, and in some cases psychosis, around the time of childbirth.
Yet thousands have beds have been lost, and specialist women’s wards have closed.
The number of people arriving at A&Es with mental health problems has skyrocketed in the past five years as community-based care is overwhelmed.
This was the stark evidence presented by HCSA Council member Dr Helen Read in a front-line dispatch to TUC Women’s Conference delegates depicting a sector on the ropes.
Despite the bleak content of her speech, Consultant Psychiatrist Dr Read reports a warm reception from delegates “as a senior doctor talking about these things.”
Working with various specialisms within large mental health trusts in south-east London, she has seen first hand the impact of two decades of “progressive cutbacks” which have decimated front-line provision – and are mirrored across specialties elsewhere in hospitals.
“The depressing thing is the creeping privatisation and endless cuts,” she says. “We are always being asked to do more with less.
“There was a mania for closing hospital beds a few years ago, and do all we could do to get people out of inpatient beds.”
A string of cases has since shown the impact of such steps, with tales of patients being forced to travel across the country due to shortages of mental health beds.
“The definition of a manager is someone who changes things around,” she says. “That means endless reorganisations, endless new philosophies.”
By contrast, she says, “Consultants are vulnerable to a special kind of bullying – to feel personally responsible for targets, to change your service in ways you don’t necessarily agree with. It’s not your decision.
“This is responsibility without power – something that is endemic in the NHS as it is.
“There is a barrage of pressure to discharge people. You are the one responsible when things go wrong. You are the one who has to maintain a relationship with an often very damaged person. Very often the system is not there for them.
“Doctors have a special kind of responsibility that other people don’t – caring for but also being responsible.
“It can be very lonely to have to do that. They are there desperately with their fingers in the dyke trying to stop the water coming in. Everyone else has a different agenda – whether it is managing budgets, pushing through the latest initiative or pleasing the CEO.
“You can be pushed into doing things that you personally don’t agree with. If you stand up and consistently refuse to go along with these kind of pressures your life can be made very difficult and ultimately you can be pushed out.”
But Dr Read does detect an increasing reaction among clinicians. “The front line are becoming more vocal. They are fed up with it really,” she says. “The foot in the real world has been missing. Doctors can bring something to the table – better ways to run services, for instance.”
The first step on this journey from psychiatrist with no trade union protection, to HCSA hospital representative, Council member and even conference delegate came as a bolt from the blue.
“For a long time I was not in any kind of organisation,” Dr Read recalls. “Then I faced a small spot of bother, something to do with management being unfair.”
HCSA’s willingness to help, unlike other organisations she approached, has meant that she has been an association member ever since. Years later, facing a grievance that “knocked me sideways,” Dr Read explains how HCSA again offered crucial support psychologically, attending meetings alongside her.
“On the back of that it was explained that HCSA needed more women on the Council” and, wanting to give something back, she stood for the role.
She says in the 12-18 months since the organisation has been “kind and welcoming.”
Asked, though, how the Association can improve and grow she suggests: “We need to be better known – a lot of colleagues don’t realise there’s an alternative. A more friendly, responsive personalised organisation rather than a bland bureaucracy.
“I would like to see HCSA particularly reaching out to women. It also makes intuitive sense to heavily reach out to doctors in training.”
Existing HCSA members have a role too, she adds. “And now we have recognition turning up on Local Negotiating Committees to raise our profile becomes a very important arena.
“As members, we’ve got to continue talking to our colleagues, letting them know that HCSA is a great organisation to be with. It has growing power and influence – it’s on the up and up.”
What’s more, she adds, with the “delicate negotiations” around the new consultants’ contract, “it’s more important than ever that there’s a safe pair of hands at the helm.
“The HCSA is very well positioned to be that safe pair of hands.”