What happens when a healthcare policy disconnects from sound ethics? As a healthcare ethics keynote speaker, healthcare ethics consultant and book author, I am asked to wrestle with this issue. And, of all phases of healthcare, mental health is usually the dumping ground for flawed policy.
While the following healthcare scandal takes place in the U.K., it can – and does, take place in the U.S.
Children in crisis
In a recent study conducted by Rebecca Thomas, writing for the Independent (May 2, 2023), it has been shown that close to 2,400 children with mental health issues were essentially dumped in non-psychiatric hospitals, in general, pediatric wards, with untrained staff. The range of patients is troubling, from eating disorders to serious mental health psychosis.
Not only are patients being admitted to the wrong wards, they may be held (often with restraints) for up to three months. Sometimes children may be held up to a year.
Dr. Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, said:
“We now find ourselves in a situation where children and young people who have an eating disorder or mental ill health, and who may be on long waiting lists for treatment, are increasingly ending up in emergency settings and then being treated on general pediatric wards. This simply isn’t good enough.”
Of course, it’s not. There are numerous stories of entire wards being shut down as children with eating disorders must be restrained and force-fed. This creates systemic distress and trauma for everyone involved. It has often been described as being like a horror movie where even staff members must undergo counseling.
There aren’t enough beds, enough hospitals, and enough trained personnel. So, in addition to the initial complaint that forced the children into the wrong hospitals, they often add PTSD to the list of problems. Frequently, it increases staff turnover. No rational adult wants to intentionally hurt a child.
It is widely recognized that the pandemic helped to make the problems far worse. As a healthcare ethics keynote speaker, healthcare ethics consultant and book author, I acknowledge the impact of the pandemic on all of us; however, it is difficult to agree that the problem seems to have come out of nowhere.
The British National Health Service (NHS) stated:
“(They are) now treating more young people than ever before and the mental health workforce continues to grow in line with this demand – more than 2,000 trained mental health practitioners have been introduced into schools for additional and earlier support so as ever, do come forward if you need help.”
Nice words, but…
The encouraging words spoken by the NHS imply that all children who need help should come forward and get help. It isn’t true in the U.K., and it surely isn’t true in the U.S., where mental illness, homelessness and drug abuse are epidemic.
Bias against children with mental health is still very much alive and well. The American Psychiatric Association point to three factors in our society they identify:
- Public stigma involves the negative or discriminatory attitudes that others have about mental illness.
- Self-stigma refers to the negative attitudes, including internalized shame, that people with mental illness have about their own condition.
- Institutional stigma, is more systemic, involving policies of government and private organizations that intentionally or unintentionally limit opportunities for people with mental illness. Examples include lower funding for mental illness research or fewer mental health services relative to other health care.
Of the stigmas, I fear the most serious challenge is the institutional. Some attitudes have shifted, with about 84-percent of Americans believing mental illness is not the fault of those who suffer. Nevertheless, and this is as true today as decades ago, the healthcare system and those who insure, are still inadequate and judgmental of those who suffer.
Nice words are “nice,” but we still come down to ethics. Recognition and treatment of those with mental illness is still based and locked-in to bias. A child with a serious disease is seen as tragic, while a child with mental illness is somehow broken and easily “fixed.”
Until the healthcare system takes mental health seriously, the same outcomes should be expected. In a government system filled with wasteful spending, perhaps the ethical thing to do is to help our most vulnerable.
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