After the government announced a five-year suicide prevention strategy and prepares to launch a national investigation in mental health services next month, one patient explains why NHS care is failing her.
“Each time I go into hospital I lose hope,” says Nicola Brokenshire.
The 28-year-old, peers out from under the brim of her cap. She is eloquent and thoughtful.
She cares deeply about her family, but her arms and legs are patterned with scars from self-harm, and she admits she doesn’t want to live.
Nicola has been in and out of inpatient care with autism and resulting mental health problems for around 10 years.
She says the experience has taught her more destructive ways to hurt herself and she has become more motivated to do so when she doesn’t get the support she needs.
She also seems to spend a great deal of time not inside her hospital but on it, perched on its roof top.
‘NHS has done more damage than repair’
Of the service provided by her Gloucestershire hospital, Wotton Lawn, she says simply: “They want to get you in, make it look like they’ve helped you, and then get you discharged.”
Suicide and self-harm are on the rise among young people and the government is looking to combat this in a prevention strategy announced last week, while also launching an investigation into mental health services next month.
There are lessons from Nicola’s story, not least the old doctors’ mantra “First Do No Harm”. She says, in some ways, her experience on the NHS has done more damage than repair.
In May we reported a series of failings at Wotton Lawn in Gloucestershire.
Staff were photographed asleep on the job, patients were going missing, one was discharged while saying he was suicidal, then jumped off a bridge and broke multiple bones.
We interviewed a patient who was able to jump off the roof during a psychotic episode and we learned about a young woman who regularly scaled the building to spend time on the roof – this was Nicola.
Deciding to speak out about her experience in the hospital, she says: “In the last 10 years I have been up and down off that roof using the same route to climb hundreds of times. That route is still there.”
Nicola knows it is dangerous and has injured herself falling. She has suicidal thoughts and once attempted to take her life on the roof.
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On balance she thinks her route should be blocked off. Indeed, a psychiatric unit in Winchester was previously fined by magistrates for failing to provide safe care, after not blocking off its patients’ route to the roof.
But, Nicola says, climbing up there is also a form of therapy, a way of compensating for what she feels is lacking inside the hospital walls.
It is also an autistic response to escape over stimulation, like the cap she wears – it’s a way of blocking certain things out.
Nicola says there are some amazing staff who care for her, but the hospital has failed to get to grips with the complex issues which lead her to self-harm.
‘Staff sleeping on the job’
“They are more reactive than proactive. They are not very good at picking up the pieces after, but they are even worse at preventing it from happening.”
“They haven’t taught me a different way of coping. They haven’t taught me ‘how do I ask for help?'”
One thing that really aggravates her is staff sleeping on the job.
She says: “Staff falling asleep is one of the most frustrating things about being in the hospital, it happens way too much. And when it does happen there is a significant risk.”
In May Sky News showed several photos of sleeping staff in the hospital who should be looking after patients.
Nicola says it means sometimes they don’t notice when patients self-harm or abscond. She also says it can happen at all times of the day not just at night.
A whistleblower who has recently left the Gloucestershire Health and Care Services Trust told Sky News a key problem is the growing use of agency staff.
The individual we won’t name says: “Working across different hospitals sometimes they can get away with booking double shifts in different places within 24 hours.
“The managers don’t seem to have a way of checking this and there is a culture within the healthcare system that facilitates this.”
‘Big increase in use of agency staff’
Nicola agrees this is a problem. “In the last 12 months I’ve been there, I’ve seen a big increase in the use of agency staff; agency staff that are travelling from further away.
“They are travelling from other jobs straight to the hospital to do another shift. Then there are just the staff that do long days.”
She believes this is a cultural leadership problem and that the trust tends to blame individual staff rather than addressing the real problems.
She says she self-harms because she has autism, so copies what other people do and was influenced by her twin sister Laura.
She lost Laura to suicide after she was also a patient at Wotton Lawn. An inquest found the hospital had failed to pass on crucial information about Laura, regarding a suicide attempt, to another hospital leading to a fatal mistake.
A mixture of grief and dealing with autism has led Nicola on a downward spiral. Her stepfather, Darren Watts, says there is “a remarkable lack of understanding when it comes to autism.
In my view young women in particular sometimes get misdiagnosed with personality disorder – and if they actually have autism, the misdiagnosis can trigger the mental health problems they are being labelled with.”
As the government launched its suicide prevention strategy, it stated: “Evidence suggests autistic people, including autistic children and young people may be at a higher risk of dying by suicide compared with those who are not autistic.
“It is essential that health, mental health, and local authority services and education providers consider the needs of autistic people in suicide prevention activity.”
Nicola’s family feel she needs better autism-informed care. An independent review of her care last year found her suicide risk increased after she’d been admitted to hospital.
Nicola says: “Since being in hospital through other patients directly telling me also just from over hearing stuff, I’ve learned new methods of self-harming that are more severe, and if I hadn’t been in hospital, I wouldn’t have known about that.
“Each time I go into that hospital my admission is a little bit longer, or there is a new method of self-harm that I’ve learnt or there is a new patient whose given me some information that I wouldn’t know out in the real world.
“So, each admission gets harder – it gets more physically difficult on my body and its mentally draining.”
Nicola was discharged from the hospital not long after our first interview and a few weeks later, in late August, attempted to take her life by taking an overdose of her medication.
She was saved by doctors in intensive care and speaking from her hospital bed a few days later, she says: “It was kind of obvious things were getting worse and worse.”
She’d hoped there would have been more support for her in those early days after discharge, but says: “It just seems like they got further and further away.”
Indeed, concerns about her care had been raised by an independent review panel both before and after her discharge from Wotton Lawn.
One review stated they were “not at all confident” with Nicola’s care plan and had “great concerns” with regards to risk and safety. This was mostly around how Nicola would be helped with the transition out of hospital.
Her stepfather Mr Watts, told Sky News: “All these things were predictable. Nikki even said she felt she was at risk; risk to ending her life, prior to discharge. We asked time and again for a transition plan – none was provided. They did the minimum.”
‘All these things were predictable’
Nicola says: “You come out of hospital thinking ‘there’s no hope. If this is going to be my life for the next 20 years, if I’m going to be in and out of hospital and this is how they are going to treat me and they are not going to fix the cause of my issues – then what’s the point?
“And you go back to thinking ‘what’s the point in anything – what is the point in living?’
“Being in Wotton Lawn has taken away a lot of the hope that I had.”
It’s a damning assessment, while also demonstrating the human complexities institutions like Wotton Lawn are trying to deal with.
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And yet, perhaps most remarkable is Nicola’s courage in speaking frankly about her experiences, while she is still in the care of mental health services, and still struggling day-by-day with her illness.
Gloucestershire Health and Care NHS Foundation Trust said in a statement: “We regret that our patient and their family are not satisfied with the services we provide.
“The hospital is a therapeutic environment, not a secure unit,
“Without going into details which would breach patient confidentiality, we can assure you that we constantly review our policies and procedures.
“For example, we have a range of anti-climb measures in place, and these have been reviewed and strengthened in recent months.
“The hospital is a therapeutic environment, not a secure unit, so we need to strike a balance while maintaining safety and security.
“Reports of sleeping on duty at Wotton Lawn Hospital are very rare indeed, but when these have arisen, we have taken robust action.
“Recruitment has been a particular focus this year for us and Trusts nationally. Positively, following success in this area we will soon be close to our full establishment for Mental Health Nurses.
“This will greatly reduce our use of agency colleagues, which has already been reducing for some time.
“We will continue our dialogue with our patients to bring about any appropriate changes with a view to supporting them in their continued recovery.”
Responding to concerns raised about Nicola’s inadequate care plan the Trust said: “We cannot comment in any detail on individual care and treatment plans due to patient confidentiality.
“Our focus is always on maintaining the safety and wellbeing of the people using our services – both within our hospitals and when they are discharged.
“Our teams work with thousands of patients every day to create care plans that best support them and promote their recovery. We are always happy to discuss any concerns when these arise but would not do this in a public forum.”
Nicola returned to Wotton Lawn direct from her suicide attempt where she was classed as a “moderate” risk of self-harm, suicide and vulnerability.
She was also back up on the roof. The anti-climb measures don’t seem to have affected her route.
:: Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email email@example.com in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.