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Alain Catzeflis investigates the impact of an explosion of US corporate money on Britain’s independent mental health sector
Beth is an autistic teenager. Her story is shocking but far from unique. It serves as a parable for a rapidly-growing, for-profit, mental health sector with profound and systemic problems.
Beth spent much of the past three years in solitary confinement in “behavioural health facilities” – private psychiatric clinics. Her father Jeremy says that she was sedated and locked in a cell measuring 10 feet by 16 feet with a mat for a bed. In one facility she was fed through a hatch.
When he visited her, he frequently had to kneel and speak to her through a grille because she was thought too dangerous to have visitors.
“I could only just hold her hand,” he said. “Nearly three years of kneeling down to see her through this six by eight-hole.”
Jeremy says that Beth was regularly stripped naked to stop her using her clothes to harm herself. She was often forcefully restrained.
She was held from the age of 15 at two private, secure units until her release earlier this year. First at the child and adolescent mental health unit in Northampton, owned by St. Andrew Healthcare. Second at the Priory Llanarth Court, Monmouthshire, part of the US-owned Priory Group, the UK’s largest mental healthcare provider.
A serious case review, ordered by Health and Social Care Secretary Matt Hancock into Beth’s confinement at St Andrew’s, found that she was subjected to “profound restrictive practices”.
In its most recent, highly critical, inspection report the Care Quality Commission (CQC) watchdog rated the facility ‘inadequate’, citing increased use of physical restraint, insufficient staff and a top management culture that belittled ‘significant concerns’.
The Welsh Healthcare Inspectorate’s report into Llanarth Court in January 2019 found that ‘physical intervention techniques’ at the time were not appropriate. It identified ‘poor environmental conditions’ that impacted negatively on patient privacy and dignity. A more recent report has found improvements.
Beth and many like her are subjected to treatment reminiscent of Victorian asylums, failed by a state-sponsored system that seems incapable of dealing with complex conditions humanely. Her care workers – paid little more than the minimum wage – were insufficiently skilled to understand what being autistic meant or how to support her with empathy.
Beth is now living independently with the right support after a vigorous political and publicity campaign by her father.
“She was transformed within hours of her release,” he said.
A spokesman for the Priory told Byline Times that at Llanarth Court – the unit in which Beth was held – “staff are attending to patients 24 hours a day, sometimes on a 3:1 or more basis, and no patient is in ‘solitary confinement’. Sometimes a patient is segregated from others or secluded where absolutely necessary to protect them from hurting themselves, other patients or staff.”
“All decisions concerning the care of patients are made by a multidisciplinary team,” the spokesman said “led by a consultant psychiatrist alongside others, including registered mental health nurses, health care assistants and other professionals such as therapists and social workers, with family members consulted and kept informed throughout.”
ASTRONOMICAL COSTS
The cost of care in an assessment and treatment unit (ATU) ranges from expensive to astronomical: it averages £3,000 a week or £150,000 a year. Beth’s care cost around £750,000
Britain’s independent mental health sector is growing fast. Its main client – its paymaster – is the NHS, either through national commissioning or local commissioning groups. This accounts for 90% of its income. The sector would not exist if the NHS had not been cut to the bone.
Three factors have driven the NHS into the arms of private mental health providers: a relentless four-decade of cuts in NHS capacity; the lack of community-based provisions; and the prohibitive costs of building more facilities.
Providers such as the Priory have the bricks and mortar to offer the beds the NHS needs. Because of the acute shortage of alternatives, the NHS has nowhere else to go: it is a captive client.
The CQC has been highly critical of the sector. It says too many people are held in solitary confinement, that many are distressed, wards are not fit for purpose, staff lack necessary skills, too many people are subject to ‘prolonged segregation’, that physical restraint is routine, and management does not listen to concerns.
In its 2020 State of Care report the CQC states: “Since October 2018, we have rated as ‘inadequate’ 14 independent mental health hospitals that admit people with a learning disability and/or autism, and put them into special measures. Our inspectors are seeing too many mental health and learning disability services with people who lack the skills, training, experience or clinical support to care for patients with complex needs. This is an unacceptable situation.”
The Priory trades heavily on the reputation of its £5,000-a-week flagship Roehampton hospital, a high-end addiction and depression clinic known for treating celebrities. Most patients are either rich enough to self-fund or their treatment is paid for by private health insurance.
Individual facilities are vetted by the CQC. While many in the private sector receive a rating of ‘good’ or occasionally ‘outstanding’, those branded ‘inadequate’ or placed in ‘special measures’ remain stubbornly high at between 15 and 20%.
DASH FOR GROWTH
In a few short years, the Priory has gone from being a respected, niche player with just one clinic to become – through an aggressive takeover strategy – Britain’s largest mental healthcare business, heavily dependent on NHS funding.
This coincided, unsurprisingly, with a time when most new contracts to provide NHS services were going to private companies under the ‘Any Qualified Provider’ policy promoted by the then Health Secretary Jeremy Hunt.
The business model groups such as the Priory operate depends on two things to make big profits. ‘High-value’ residents – people with complex needs like Beth whose care, usually state-funded, is expensive; and keeping staff costs down.
The hunt for expansion-led profits at the Priory began in earnest in October 2014 when its then chief executive Tom Riall announced that the group was planning a significant expansion into the ‘mental health community services market’. The group, he said, would be using its “considerable commercial bidding expertise” to become the “overflow provider of choice” for the NHS.
In 2016, a vastly-expanded Priory Group was sold to Tennessee-based Acadia for £1.3 billion – a huge mark-up on previous valuations. The new Priory group made an operating profit of £62 million in 2017, the last year for which results are available. The majority of this came from the NHS and social services.
SCANDALS
Many NHS-funded Priory units receive a ’good’ score from the CQC. But some have been the subject of repeated safety scandals and closures:
- In 2015, the coroner in the inquest into the death of 17-year-old Sara Green, who died in the Priory Royal in Cheadle the previous year, said she would have been safer at home.
- In 2016, the Priory and Solent NHS trust admitted liability for the death of 15-year-old George Werb while on home leave. The coroner said his assessment was “incomplete, inaccurate and did not reflect the actual situation”.
- In 2017, a healthcare assistant at the Priory Highbank in Manchester was jailed for three months for abusing a severely disabled patient. In 2012, two female carers at the same hospital were filmed beating and humiliating a patient.
- In 2018, a coroner criticised the Priory’s north London hospital for “really serious failures” after William Jordan, a 16-year-old schoolboy was found hanged in his room. The inquest was told that staff then falsified logs to appear as if they had checked on him four times an hour.
- An ITV documentary in 2019 exposed further serious safeguarding issues at the Priory Ticehurst clinic in East Sussex. This included a number of cases of unchecked self-harm. It also featured a teenage girl who had spent weeks covered only by a blanket.
- Also in 2019, the group was fined £300,000 for health and safety violations after 14-year-old Amy El-Keria, who had known suicide tendencies, was found dead in her bedroom in 2012 at the Priory Ticehurst with a ligature around her neck.
- In February 2019, the Priory announced that it would be closing its hospital for teenagers in High Wycombe after failing an inspection. Karen Bennett-Wilson, the CQC’s head of hospital inspection, said it had identified a number of serious problems concerning patient safety and the quality of care. “It was a matter of some concern that, at a specialist unit, some of the staff could not demonstrate the knowledge or specialist skills needed to care for teenagers who had learning disabilities or autism,” she said.
A Priory spokesman told Byline Times: “There is no basis whatsoever for any suggestion that we put profit before safety and we strongly refute any allegation that we ‘cut corne