Designated places of safety are not A&E the RCN say

by Ruth F Hunt author of The Single Feather (Pilrig Press) and Rita Binns

In Liverpool on the 16th May at the Royal College of Nurses (RCN) conference, a motion was passed stating emergency departments of hospitals should no longer be ‘designated places of safety’ for when a person who is thought to be unwell by the police and is put on a section 136, for the purposes of assessment under the Mental Health Act 2007.

To justify this motion, the RCN made the case that emergency departments aren’t suitable because they are: “Noisy environments, often with frail elderly and critically ill patients. It is a noisy environment with constant ringing of phones and bleeping of equipment, and therefore not a suitable place (if without access to an amended or adapted room) to wait for a mental health assessment…We believe the emergency department has neither the appropriate environment, nor the appropriate staff to care for these patients’ needs and call on council to lobby to ensure all emergency departments are designated public places and not places of safety.”

Writing the following day, the RCN Forum Chair Ed Freshwater blogged that the wording of the resolution can be interpreted in many ways, and stressed that the debate demonstrated the compassion and concern all nurses have with regard to the mental health crisis and parity of esteem.

No matter how much Freshwater stresses this resolution should be interpreted as a compassionate response, what immediately stands out is the RCN resolution is as far from parity of esteem as it could go. They effectively differentiate between two life-threatening emergencies. For example, a patient who is critically ill and needs a hospital bed due to malnutrition and a patient who is critically ill with malnutrition due to anorexia and needs to be assessed under section 136 for a hospital bed. Under this resolution, one will be allowed through the door, and one shown the door.

Also, they assume it is only those who are at the A&E for a mental health assessment that will find the environment stressful. What about the old or young? Surely, those with mental health needs aren’t the only group?

Unfortunately it also reads as if it isn’t simply section 136 patients who are not welcome at A&E but anyone who is in urgent need of support for mental distress. There is justified concern that with the passing of this resolution the treatment of those in a mental health crisis who attend A&E may deteriorate further.

When the RCN are aware of the crisis in mental health, of the pressures within Local Authority statutory services and the demise of community based resources, then the wording and sentiment behind this resolution appears to be anything but compassionate. Add in the increased pressures placed on those with severe and enduring mental distress at this current time, and it seems there is something else going on.

Rita Binns, of Recovery in the Bin (RITB) is seeing a pattern emerging in that ‘recovery orientated’ mental health services have stressed the need for service users to take ‘personal responsibility’ for their actions and health. “Major cuts to services alongside a neo-recovery ideology has resulted in only people who are experiencing the ‘right’ type of crisis being able to access a service, preferably with a ‘lack of capacity’.

“At the same time, those who are suicidal are reporting that crisis teams are determining that despite the risk to life, they have ‘capacity’ and therefore what follows is ‘their choice’. This is particularly evident in the treatment of people with a personality disorder diagnosis, who are said to have the most capacity (which is just as contentious as the diagnosis) despite the risk being just as high.”

There also seems to be a disturbing trend for nurses to say that an admission ‘rewards behaviour’ such as self-harm, ignoring the evidence that shows self-harm should be taken extremely seriously.

Rita Binns acknowledge that A&E staff are under more pressure now then they have ever been. “They have to deal with devastating cuts to funding and deliberate political sabotage, but sadly, they have taken out their frustration on the patients with the least power – people with mental health problems”.

“Therefore this RCN resolution is a monumental slap in the face to one of the most discriminated- against patient groups. A patient group which already, at times, receives poor treatment in Accident and Emergency departments, especially people who self-harm, who might be dismissed as ‘attention-seeking’.

“Ultimately, the police could be forced to put people into cells, the very last thing they want to do if A&E refuse to take people they pick up. The police are already being treated like an unofficial mental health service and sometimes in their frustration to access a service for people they have made arrests.”

Rita Binns believes the resolution is also a betrayal. “Dedicated disability social justice groups have stood side by side with nurses in support of their pay, conditions and bursaries. It would have been more helpful if the RCN had debated the ethics of their members working as welfare assessors whose processes were found to directly discriminate against mental health claimants”.

With suicides rising for certain demographics, it would’ve been more helpful if the RCN had come up with something constructive, something that would alleviate the pressure on A&E without impacting negatively on mental health service users. However, as Rita says: “Instead they opted to pass a motion with no constructive suggestions or alternatives which gave a devastatingly clear message to every single person with a mental illness diagnosis.”