Mental health services in Sheffield are failing. The cost is measured in human lives

Poor mental health services in Sheffield are failing some of the most vulnerable people in our city. That is the view of two senior Sheffield GPs who have spoken to The Tribune for today’s report. They work with people with serious mental illnesses in the city on a daily basis and say it is “virtually impossible” to get them the help they need. One described mental health services in the city as “dire and failing people”. Another, speaking to us off the record, told us the mental health system wasn’t “patchy or a bit bad, but appalling”.

The doctors are raising concerns about a critical part of Sheffield's healthcare system that they say isn’t working as it should. They describe a system that is overly bureaucratic and slow to respond to patients and their families. As a result, both of the doctors we spoke to told us that they now often don’t refer patients to mental health services as they know that nothing will come of their requests.

An inquest into the death of a young Sheffield man that took place last year illustrated the problems many patients and their families face. Josh Adey-Rennard was just 33 when he took his own life in 2021. When his family pleaded with mental health services for help they were told no one was available and that they should call the police. At the inquest, Josh’s mental health nurse was asked if she thought the system had failed him. “A little bit, yes,” she replied.

Insiders say that much of the pressure on the system comes from funding and staffing issues that have affected every part of the NHS over the last decade. But we have been told Sheffield’s problems with mental health provision go well beyond that; and that there is a “siege mentality” at the Sheffield Health and Social Care Trust that illustrates wider cultural problems at the organisation.

The trust chose not to comment on our story. In today’s newsletter, we dig into a story that healthcare professionals speak about all the time privately, but that hasn’t received the public profile it needs to.

Stories like this take us days and sometimes weeks to report on, and the only way we can do them is by having lots of paying subscribers who fund this kind of work. If you want local journalists in Sheffield to spend their time speaking to sources, putting questions to institutions and going searching for documents, the best way to make sure that happens is to be a member of The Tribune. Huge thanks to our 1,457 paying members who have got us this far and whose subscription revenue means we have just been able to add our second staff reporter. It’s remarkable what we’ve been able to achieve in our first two years, but in the coming months, we need hundreds more readers to get on board. Usually this edition is only available in full for our members, but today we’ve made it free to read for everyone because of the story’s clear public interest. If you want to support high-quality independent journalism in Sheffield, and get all of our members-only journalism in your inbox every month, please join up now.

Mini-briefing

💦 Severn Trent Water say that plans to build a new reservoir in the Upper Derwent Valley are “just one” of a number of options being considered to increase capacity and replace water lost to leaks. The firm say they have “a duty” to explore all possibilities, two of which are either creating a brand new reservoir above Howden or submerging both Ladybower and Howden dams beneath one much larger reservoir. The plans, which could see the loss of homes, roads and ancient woodland, are opposed by local groups, some of whom were interviewed on BBC Radio Sheffield this week (fast forward to 2 hours 15 minutes).

🥪 An brilliant piece in The Guardian about the true north-south divide: whether Greggs or Pret a Manger outlets dominate the high street. The piece is based on a study led by Sheffield Hallam University physicist Dr Robin Smith, who adapted an algorithm normally used to study nuclear reactions. His research shows that Greggs begin to take over from Pret close to Watford Gap services, placing the previously disputed midlands region firmly in the northern side of the divide. Sheffield city centre’s only Pret a Manger disappeared in the first Covid lockdown in March 2020, leaving only the one at Meadowhall left. We have 14 Greggs.

🥁 Ahead of Arctic Monkeys two huge shows at Hillsborough Park this weekend, drummer Matt Helders appeared on on Toby Foster’s programme on Radio Sheffield this week. In the 10-minute interview, Helders talked about the fact the gigs are taking place almost 20 years to the day since the band played their first ever gig at The Grapes on Trippet Lane. He also confirmed the long-standing story that he only took up the drums as no one else in the band wanted to. 

Things to do

🎭 On at the Lyceum for two performances only this Friday and Saturday is the Olivier Award-winning Showstopper! The Improvised Musical. A brand new musical is created from scratch at each performance as audience suggestions are turned on the spot into all-singing, all dancing productions with hilarious results. So, whether you fancy Hamilton in a hospital or Sondheim in the Sahara, you suggest it and The Showstoppers will sing it. Tickets are priced £15-£28.

🍻 Returning to Victoria Quays this Saturday, 10 June is Quayside Market, nine hours of music, beer, street food, independent shops and crafts in one of Sheffield city centre’s most beautiful locations. This month Indian street food vendor Koolkata will be there for the first time while music, as ever, will come from the fabulous Cirque du Funk. The market has been going for about a year now and on a hot summer’s day there is nowhere better to be than down by the quays.

🏹 On Sunday, 11 June, Sheffield’s Manor Lodge will return to its mediaeval roots with a visit from the Ferrers Household, a “15th century living history re-enactment society”. On the day (10.30am-4.00pm) you’ll be able to see knights, lords and ladies, archery demonstrations, a working forge and pole lathe, calligraphy, a weaponry display and more. There will also be a chance to tour the lodge’s turret house, apothecary garden and lavender labyrinth. Tickets are £2.

Mental health services in Sheffield are failing. The cost is measured in human lives

On 29 September, 2021, Josh Adey-Rennard was found dead at his parents house on Psalter Lane in Sheffield. He had taken his own life.

Just 33 years old, it appeared Josh has everything to live for. He enjoyed his work with the charity Shelter helping homeless people off the streets in Sheffield. He was a devoted uncle to his nieces and nephews. And he loved his border collie Babs, who went everywhere with him.

But Josh also suffered from depression, and the Covid lockdowns only seemed to exacerbate his condition. Working from home all the time led to a deterioration in his mental state, which culminated in him having two psychotic episodes. But on both occasions, Josh’s mum and dad Gillian Adey and Malcolm Rennard were told there was no one who could help him and that they should call the police.

The first time he experienced an episode, no critical mental health beds were available in Sheffield, so he was sent to Darlington and from there to Colchester, a three and four hour drive away from his family. The second time, he was wrestled into the back of a police van and taken to A&E in Sheffield, where he was handcuffed to an officer for 12 hours. “It was like he had committed a burglary and was being arrested,” says Gillian.

After the second incident, Gillian and Malcolm both say the help offered to Josh did improve, but they believe that the damage had already been done. “By the time he was getting something that I would describe as good care, it felt like it was too late,” says Malcolm. “He had these two pretty bad psychotic episodes where we felt he was a danger to himself, and our only recourse seemed to be to the police.”

“It just seems woefully inadequate,” adds Gillian. “Josh used to say how do people get on who don’t have somebody to look after them. We’re articulate and know our way around the system and we struggled. I don’t know how ill you have to get to be a priority.”

After an inquest into Josh’s death last year, assistant coroner Stephen Eccleston wrote to Sheffield Health and Social Care Trust to say he was worried that delays like Josh experienced could lead to future deaths. At the inquest Josh’s mental health nurse was asked directly whether she thought the system had failed him. “A little bit, yes,” she replied.

That may well be an understatement; according to a recent council report, approximately 90,000 people are living with depression or anxiety in Sheffield, yet three quarters of these receive no treatment. There are also 5,191 people in Sheffield currently recorded by their GP as living with a severe mental illness (NHS England defines this as anyone diagnosed with schizophrenia, bipolar disorder or other psychosis or who is receiving lithium therapy). In the two decades from 2001 to 2021, there were 895 suicides in the city.

The latest figures show that across South Yorkshire and Bassetlaw’s Integrated Care Board (which includes Sheffield), there were over 10,000 children and more than 39,000 adults on waiting lists in December 2022. Figures show that South Yorkshire and Bassetlaw has a higher suicide rate than the England average.

While Josh and his parents’ experiences may have been extreme, The Tribune has been told that they are by no means unique. The way mental health services operate in Sheffield is through something called the Single Point of Access (SPA), which was created back in 2018. This is essentially the “front door” for the mental health trust through which anyone from GPs, nurses, police officers or even third sector organisations can refer patients for treatment.

However, a Sheffield GP who spoke to The Tribune on condition of anonymity said that as well as being hugely bureaucratic and short-staffed, the SPA system was characterised by poor communication and delay. “In terms of accessibility and responsiveness, mental health services in this city are appalling,” they told us. “They’re not patchy, they’re not a bit bad, they are appalling.”

At any one time, the single point of access system will have literally hundreds of people on its waiting list. And if these patients are deemed to be non-urgent, they will stay there for months, waiting for a diagnosis. “The trust has got various targets where they say we'll respond to your referral within X period of time and they're nowhere near there,” the GP told us. “They've got a reputation for not responding at all, so literally nothing happens. You send a referral and there's just silence.”

A spokesperson for the Sheffield Health and Social Care Trust said that after consulting with their teams and executive colleagues, they had decided not to comment on the concerns of an anonymous GP. They added they would follow up on the points The Tribune had raised through partnership working with local GPs and that their objective was to work together as “one NHS” in the city.

According to the trust, when referrals come in, screening is meant to take place within the first hour. In crisis situations, referrals are meant to go straight to the crisis resolution and home treatment team, while for priority cases a full triage is meant to take place within the first day. In more routine cases, a full triage is meant to take place in a maximum of four to six weeks. However, the GP we spoke to said these targets are “far from the reality” of the SPA system and that 50-60% of all referrals are actually rejected by the service.

While delays must be difficult for all patients with mental health problems, they must be even more traumatic for those in crisis. The SHSC trust does operate a crisis service but it too is part of the single point of access system, with serious requests logged alongside more routine referrals, meaning that even if a GP is so concerned about a patient’s risk of self-harm or suicide that they don’t want them to leave the surgery, that referral still goes in to the SPA in the same way, with no guarantee of a timely response.

And even when patients are contacted, it’s not always good news. Sometimes the trust says they don’t think a given patient is suitable for their therapists, and that patient can get “bumped back down” to general practice. Some of these patients are told to contact the IAPT service (Improving Access to Psychological Therapies, recently renamed NHS Sheffield Talking Therapies, for anxiety and depression, in line with a national rebrand), but there is nothing to say the service has to take them on. If the team deem them to have “risk elements” in their history like thoughts of deliberate self-harm or alcohol use, they dismiss them as “too complicated”. The GP we spoke to said it felt like some of their patients were being bounced around in a kind of “pinball machine”.

After its latest Care Quality Commission inspection in 2021, the trust was rated as ‘requires improvement’. This was an improvement on the ‘inadequate’ rating it received in 2020, when the trust was placed in special measures. However community-based mental health services for adults of working age were last inspected in March 2020, when they too were rated as requiring improvement. This inspection found that the service did not always provide safe care and that not all patients were able to access a Mental Health Act assessment in a timely manner. The average waiting time for psychological treatments in the Mental Health Recovery Service South team was also longer than the Royal College of Psychiatrists’ recommended 18 weeks.

Since 2020, South Yorkshire and Bassetlaw Integrated Care Board (of which Sheffield is part) has received money from the CMHT — NHS England’s Community Mental Health Transformation programme to inject an extra £2.3bn into local mental health services with the aim of delivering care closer to communities and in a more joined up way. The doctor we spoke to said that this model is working, but that mental health care in Sheffield was still being held back by the trust.

“It seems to me that you'll find lots and lots of people who are the manager of this and the director or assistant director of this,” they told us. “But actually where are the doctors or the nurses that actually deliver the care?”

Jo Maher, a GP with 21 years of experience in Sheffield, agreed that mental services in the city were “dire and failing people”. However, she blamed this on the system being “paralysed” by a lack of funding. Of all the services in the city that were struggling, she said the community team was currently the weakest. “Community mental health services have always been underfunded but they have been cut and cut and cut,” she said. “The most vulnerable people with serious mental illnesses are being massively let down.”

She acknowledged that the single point of access system was a difficult service to deal with, but said the sheer number of people being referred to them meant they were having to make decisions based on what is feasible and then only dealing with the most urgent cases. “I very rarely put a referral into SPA because I know I’m not going to get anywhere with it,” she says. “I have some background of mental health work so I feel I can hold some of those patients myself, but many GPs don’t have that experience.”

Asked to what extent this could be considered a national problem as opposed to one specific to Sheffield, the GP we spoke to accepted that mental health was seen as a “Cinderella service” in many parts of the country, with problems around recruitment, failing services and poor care evident in many mental health trusts around the UK. However, they added that they felt that there was a “siege mentality” at the Sheffield Health and Social Care Trust that illustrated a wider cultural problem at the organisation.

“I have lots of conversations with GPs in different practices across the city,” they said. “I've yet to find one that says it's working. From most you’ll get a fairly consistent response which is; it’s really poor.” They said it was “virtually impossible” for them to have a conversation with a mental health worker within the trust — whether that’s psychiatrist or a nurse — on a day-to-day basis. “When you create a situation like that, where you don’t allow professionals to communicate, it makes it very bureaucratic. Delay becomes inherent to the process.”

And delays can be deadly. The GP told us they believed that the reasons why the UK doesn’t perform as well as other European countries in cancer could equally apply to mental health treatment in Sheffield. “We know when cancer patients present late or when they have to wait longer for investigations, they have poorer outcomes and are more likely to die,” they said. “The same applies with mental health.”

When I went to see Josh’s parents at their home this week, I met his border collie Babs, who still lives with them. It felt impossibly sad stroking Josh’s dog while talking about him with Gillian and Malcolm. “It’s broken,” says Gillian as I leave, summing up her experience of Sheffield’s mental health services. “And until it is fixed, people are just going to continue dying unnecessarily.”