In this article, I want to contribute to the conversation and momentum our government is building to improve our mental health services. Or to phrase it differently, to improve our ability to help our family, friends or neighbours when they need us most. My advocacy seeks to move this issue up the agenda and secure increased or reprioritised funding. I will illuminate the issues and organisations that demonstrate exceptional practice, and solutions. I will also present the economic argument. My assessment of psychiatric wards is informed by my work in the sector before working for a Labour MP, as well as the perspectives of colleagues and patients.
While I was working in homelessness, I worked with a client who was sexually assaulted by his neighbour when he was a boy. He experienced voices that terrified him and suffered from severe, complex post-traumatic stress disorder related to childhood sexual assault and other traumas. During a Friday meeting - an assessment to determine whether he would be admitted to the psychiatric ward - he sat with me, the psychiatrist, and the head nurse. He told us he was unable to prevent the voices from telling him to harm himself or others, and he revealed homicidal thoughts. Just a week earlier, he had attacked someone on the street whom he believed was trying to attack him. The week before that, he had left my office smiling, only to go to his room and slash his arms because the voices told him to. He was admitted to the psychiatric ward that Friday. The next day, still a threat to himself and others, he returned to our hostel. He had been deemed ready for discharge.
I worked with a father who experienced an episodic psychotic break linked to many complex stresses and traumas. He had never previously had mental health issues beyond anxiety. During his period of acute unwellness, he tried to jump out of a top floor window in his family home. His child was lucky enough to be able to grab him before he came to harm. The family called an ambulance, which brought him to a psychiatric ward that his family could only describe as a living nightmare; an old Victorian clinically-lit hospital with patients experiencing acute distress scattered through the ward and overwhelmed staff. The family told me that, even though their father was a risk to himself, they carefully considered returning him home and staying on 24/7 watch over him instead of leaving him in such conditions.
In my first week as a manager at the Southwark Mental Wellbeing Hub, my colleague was sectioned due to experiencing extreme paranoia. Her psychosis began when she tried to save the life of a man who had been attacked by a stranger, who was experiencing extreme paranoia. The man sadly passed away, my staff member was left with lifelong trauma, and the perpetrator will require lifelong intensive support.
These are just three stories of many, but they exemplify how inadequate preventive mental health care can perpetuate a domino effect of suffering. Case studies like this are prevalent across Britain, and austerity has hugely exacerbated them. Involuntary psychiatric inpatient admissions in England rose by 38%, and the use of Section 136 spiked by 617%, following the implementation of austerity measures after 20121. The prison population shows similar trends during the same period.
It is important to say at the outset that experiences such as hearing voices or psychosis should not be equated with violence. Two of the case studies above come from my experience in the sector, the ones that stood out to me most just happened to involve violence. The overwhelming majority of people experiencing severe mental distress are not violent, and people with mental health difficulties are themselves disproportionately likely to experience violence, abuse and victimisation. The cases described here concern failures of support around individuals, they should not be read as representative of people experiencing psychosis more generally.
Psychiatric wards in the United Kingdom are a national disgrace and should account for a collective shame. We place people in these settings during some of the most frightening and overwhelming periods of their lives. This includes people hearing distressing voices, experiencing unusual beliefs, paranoia, extreme states, suicidal distress, and other experiences that may profoundly disrupt their sense of safety and connection with the world. Many people who are mentally ‘well’ find their thoughts and minds uncomfortable. Consider how you would feel if you had to deal with constant bullying voices, hallucinations, and paranoia. Now, imagine being at your most severely unwell and being forced to remain in the environment I will go on to describe, sometimes for a 28-day or far longer sectioning process.
This is the story of poor reactive measures, exacerbated by our under resourced preventative model. It is a story of a model that does not effectively comprehend that experiences described as severe mental illness can become more understandable when we consider what has happened in a person's life and the social, relational and material conditions in which their distress has developed — human responses to human experiences.
Progress requires more than improving psychiatric wards or providing more therapy. It requires us to rethink how we understand severe distress. A relational trauma-informed approach does not ask only, ‘What is wrong with this person?’ but ‘What has happened to them, what are they facing now, and how have they adapted to survive?’ It recognises the impact of trauma alongside poverty, discrimination, violence, isolation and other forms of adversity, and pays attention to power and relationships. Crucially, services themselves can either compound distress — through coercion, disconnection and loss of control — or help to create safety, agency, trust and connection. This changes not only how we treat people, but how we understand what we are responding to in the first place.
The Prime Minister has demonstrated outstanding values and courage in his commitment to advancing social care, taking on an issue that has left political bodies in its wake for decades. The PM’s lived experience of his father’s Alzheimer's is clearly helping to inform him and us. I know he holds similarly strong views on mental health provision, which is heavily interlinked with social care. The government under Keir Starmer made a positive start on this issue, attempting to reverse the implications of the previous government's indifference to the sector, which Burnham will now look to build on.
The conclusions I have come to regarding psychiatric wards are:
- The environment can seem punitive, like we are criminalising mental health issues. The TV in many wards plays the news on repeat; patients are allowed out twice a day; screams echo in the corridor day and night. Locked doors, restrictions, restraint, coercion and having very little meaningful choice can intensify people's experiences of powerlessness and, for people who have experienced trauma, can sometimes reproduce dynamics of threat and control.
- Resources are so scarce that staff must apply strict admission criteria, meaning only the most severely ill patients receive support. Others are turned away with no options for respite, which often leads to worsening symptoms in the community. These symptoms then escalate to the point that services must intervene, usually through sectioning, because good preventive care was not provided beforehand.
- There is little psychological support, even though staff try to stretch their limited time. The support provided often lacks genuine psychoanalytic ambition. It is too medicalised and can overprescribe medication. Psychological, social and relational support, peer support, meaningful relationships, people's material circumstances and the whole culture in which care takes place should be the priority of our model but isn’t.
- The hospital staff are not to blame; they are among the heroes and heroines of our society. They are underfunded, understaffed, undertrained, and underpaid. They receive vicarious trauma daily, and we put them at high risk of burnout.
- The lack of pay, at times, has led to the recruitment of under-skilled staff. Agency staff are used far too often. Health care assistants and trainee mental health nurses are often treated like nursing staff due to low staffing capacity on wards, placing patients and staff at risk.
- Poor pay leads to hospital staff dealing with pay insecurity, anxiety about bills, and no financial room to breathe. If I were religious, I would say this is not how we should be treating those who are doing God's work.
So what key statistics support this diagnosis and what are the economics behind it?
The economic benefits of getting this right are clear. Mental health issues are the single largest cause of disability in the UK; they cost an estimated £119 billion per year, factoring in lost productivity, social costs and NHS spending2. The OECD found that poor mental health costs the UK about 4% of GDP3.
- Mental ill health is the single largest cause of disability in the UK, accounting for 23% of the total burden of disease4. LSE research commissioned by the Mental Health Foundation estimates that every £1 invested in mental health promotion and prevention yields an average return of £5, due to reduced long-term health and social care costs.
- Between 2010 and 2020, the number of NHS adult acute mental health beds fell by 30%. Insufficient psychiatric bed capacity leads to “out-of-area” placements, which are more expensive and result in poorer outcomes. Improved bed capacity and better ward conditions lead to shorter average lengths of stay, fewer readmissions, and lower use of emergency services, all contributing to cost savings.
- The opening of a new 18-bed psychiatric intensive care unit at South London and Maudsley NHS Trust was associated with a 20% reduction in out-of-area placements within the first year, saving over £2 million in placement costs and improving patient and family outcomes5.
- Only 38% of inpatients in the 2022 CQC survey said they had received enough help for their mental health problems during their stay6.
- 42% of NHS staff working in mental health reported feeling unwell due to work-related stress in the previous 12 months7. Increased use of agency staff significantly increases NHS staffing costs.
Greater investment in mental health provision - including prevention, community support, crisis alternatives and safe, therapeutic inpatient care when it is needed —-will benefit the whole country. Investment should not simply mean increasing psychiatric bed capacity. It should also reduce the number of people reaching the point where hospital admission becomes necessary and ensure that meaningful alternatives are available when people are in crisis.
This article attempts to get the Chancellor's ear to prioritise mental health services in the next budget, and for the Government to go harder and faster on improving provisions. A good start has been made on this since the government was elected in July 2024. John Healey, Yvette Cooper, and Alison McGovern have a good start to build on.
Positive steps the Government has started to take
- Annual funding boost by an additional £2.5 billion annually, ring-fenced specifically for mental health services, including inpatient care.
- 59 dedicated mental health emergency departments, allowing people to access support without a GP referral and receive specialist care closer to home. 100 new community mental health centres for those with severe mental health needs to prevent clients from deteriorating into acute unwellness and hospital admission.
- £1 billion ward refurbishment programme has been allocated for the refurbishment, modernisation, and expansion of psychiatric wards, targeting outdated and unsafe facilities.
- The Government's Mental Health Workforce Plan is recruiting 8,000 new mental health professionals (nurses, doctors, therapists, support workers) by 2028, with a focus on inpatient staffing.
- Introduction of dedicated mental health support teams for NHS staff, improved pay packages, and guaranteed access to psychological support for those working in psychiatric care.
- The government is scaling up alternatives to hospital admission, such as crisis houses and intensive home treatment teams, aiming to reduce admissions and provide more humane care options.
- The Mental Health Reform Act 2025 has been largely welcomed across the sector.
These initiatives have begun to pave the way towards progress. Below, I put the spotlight on great practice, plus demystify some of the negative connotations about the sector and patients.
Solutions and exemplary practise
Dr. Jacqui Dillon, former Chair of Hearing Voices Network England and currently Chair of ISPS UK
Jacqui Dillon is an activist, writer and trainer and a longstanding figure in the Hearing Voices Movement. Drawing on her own experiences of childhood trauma and psychiatry, alongside decades of activism and work in the mental health field, she has challenged the assumption that voices and other extreme experiences should automatically be understood as symptoms of disorder. Her work explores how such experiences can become more understandable in the context of trauma and adversity, relationships, social circumstances, power and meaning. The Hearing Voices Network provides peer-support spaces where people can talk openly about voices and other unusual experiences without those experiences being interpreted as symptoms of illness. People share experiential knowledge, explore what their experiences mean to them, learn from each other and develop their own ways of understanding and responding to voices. We should expand and promote this model, providing additional funding or reprioritising funds toward it.
Dorothée Bonnigal-Katz, the Psychosis Therapy Project (PTP)
The crux of why the service produces such brilliant outcomes, beyond its clearly conscientious and attentive culture, is that the therapists at the service actively engage with clients’ unusual beliefs, paranoia, or voices. PTP does this through 1-1 and group therapy, creative therapies, and non-verbal techniques. The service is the opposite of the all too common thought process in Community Mental Health teams, which holds that clients who for example, hear voices are too difficult to manage or too complex to make progress with, so medicate and contain them. PTP works on acute wards and in the community; they also have a racial trauma clinic, Usemi, which tackles the overrepresentation of racialised communities with ‘severe mental illness’. We should expand this model, provide additional funding for it, or reprioritise funds towards it.
Jacqui and Dorothée should have the ear of every Minister for Mental Health, and hopefully Alison McGovern. Of course, there are other exceptional trailblazers in the sector, but for this article, I have focused on Jacqui and Dorothée.
Drayton Park Crisis House
Crisis houses provide people with acute alternatives to an inpatient admission, which can sometimes be perceived as punitive and counterproductive to becoming well. Drayton Park is a fantastic example, providing an acute alternative to hospital for women.
One of five crisis houses run by North London NHS Foundation Trust across its five boroughs in north central London, Drayton Park is a homely big house with a garden, a place where you can take two/three weeks off from the world and genuinely become better. It has astute trauma informed staff who connect with the residents. Its importance is not simply that it provides additional capacity. It demonstrates that people experiencing acute distress can sometimes be supported through relationship, safety, respite and choice rather than automatically through containment and hospitalisation. Expansion of good mental
health wards is one option, but I know most patients would prefer to see this provision expanded.
The Nightingale Marylebone, a private mental health clinic
If you want to know what a "money is no object" private mental health ward is like, this is the best model in the private sector I know of. Most famously, the amazing Amy Winehouse attended the clinic. Nightingale points the way to what public sector wards could look like in many respects, but it is, of course, funding intensive. The solutions it points to include improving staff wages to reduce turnover; increasing the number of staff in the ward, which also boosts morale; improving staff quality; reducing agency staff; and returning to more permanent in house staffing, which is also more cost-effective. Further, the model shows the benefit of increasing the number of intensive psychodynamic treatments patients have access to, improving the trauma informed interior design of mental health wards, and making them a more therapeutic physical environment. The staff told me that if a patient has three good nights' sleep after admission, they’ll see drastic progress in a patient's wellbeing, and they were right. Largely, we don’t give that respite to those in NHS psychiatric wards. Rest, safety, human attention and a tolerable environment are therapeutic conditions in themselves, and they shouldn't depend on somebody's ability to pay for private care.
The Power Threat Meaning Framework 8
The framework offers an alternative to traditional psychiatric diagnoses by shifting the central question from "What is wrong with you?" to "What has happened to you?" Diagnostic categories and constant pathologisation can lead to over-medicalisation and a sense of hopelessness among patients. This framework reframes distressing emotions and behaviours not as biological "symptoms" or individual pathologies, but as understandable, resourceful, and protective responses to external threats and the harmful effects of power — such as trauma, social inequality, and discrimination.
Other services and approaches worth noting
I don't have direct experience with the services below, but Jacqui Dillon highly recommended them in our discussions. Open Dialogue / Dialogue First – NELFT. NELFT currently runs Dialogue First, a non-crisis Open Dialogue-informed community mental health service. It works with people alongside their families and wider social networks and emphasises dialogue, relationships, continuity and collaborative care. The service accepts referrals from across the UK.
Leeds Survivor-Led Crisis Service / Dial House. LSLCS was founded by people with lived experience of mental health crisis and provides survivor-led, person-centred and trauma informed crisis support. Dial House is a long-established sanctuary offering an alternative to hospital admission and statutory crisis services for people experiencing acute distress.
CHARM – Community for Holistic, Accessible and Rights-Based Mental Health, Manchester. CHARM campaigns for fundamental change in mental health services in Manchester, with an emphasis on human rights, social determinants and alternative community-based approaches. They have met with Andy Burnham on multiple occasions and have sought his support for a root-and-branch review and action plan to transform mental health services.
To conclude, I will paraphrase Tina Jones, MNZM, the Co-Founder of the Youth in Transition Suicide Prevention charity in New Zealand. She told me that the key ingredient in mental, emotional and physical wellbeing is human connection. Across her organisation’s clients, the therapeutic relationship is consistently identified as the single most impactful part of their experience, more than any particular technique, group or physical space. That is why sometimes a friend can give you a better therapy session than any top psychologist could ever do. Simply put, the question is not simply how many sessions we provide or which intervention we deliver, but whether we are creating the conditions for genuine human connection. Genuine human connection cannot be separated from the conditions in which relationships take place. It is difficult to create trust where people feel powerless, safety where people experience coercion, or collaboration where one person's understanding of another automatically carries greater authority. The path forward therefore requires more than reforming psychiatric wards. It requires a broader shift in how we understand and respond to distress: away from asking only what disorder a person has and towards understanding what has happened to them, what they are facing now, the social and relational conditions of their lives, the meanings of their experiences, and what they have done to survive.
Mental health services can be a place where light can be seen from the darkest depths of human experience; we must reach out to lift people rather than dismissing them in their time of need. In return, our society and economy will benefit.
References
1 https://www.sciencedirect.com/science/article/abs/pii/S0160252719300494
2 Centre for Mental Health, 2022
3 OECD, 2018
4 Chief Medical Officer’s Report, 2013
5South London and Maudsley NHS Trust 2019
6 Care Quality Commission, 2022
7 NHS Staff Survey, 2023
8 The Power Threat Meaning. British Psychological Society. 2018
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All blog posts represent the views of the author alone and not necessarily those of Mainstream.
Cianán Whelan is the Chief of Staff to a Labour MP. Cianán previously worked in mental health and homelessness, including as Project Manager for the Southwark Mental Wellbeing Hub and at Arlington House homeless hostel in Camden.
