Top nurse hopes book will ‘jolt’ politicians to act on mental health

Dr Peter Carter, mental health nurse and former general secretary of the Royal College of Nursing (RCN), is the author of My Asylum Days: How Mental Health Policy Has Changed.

“These are just not good times if you’re suffering from mental illness”

Peter Carter

The book, his first, focuses on the challenges facing mental health nursing, and mental health care overall, Dr Carter told Nursing Times.

He hoped that his perspective as a veteran of the ‘old’ system – one which focused on residential care – could shed light on possible solutions to the problems, as well as highlighting the negatives he saw back in his days as a practising ‘shop floor’ nurse.

My Asylum Days, the book’s description said, aims to “jolt” leaders and policymakers into realising that the current system is broken and in dire need of reform.

“These are just not good times if you’re suffering from mental illness,” Dr Carter said. “There are major issues.

“When I talk to psychiatrists… people are talking about the pressure in the service – how difficult it is to get people in, and then the delayed discharges,” he said. “I thought it was timely to bring it all together.”

Dr Carter said a slew of inquiries into poor care, missed care, neglect and abuse in mental health and learning disability care settings over the last decade were a motivator to write about the topic at length.

“One thing which really sparked me off was when I saw the scandals – Winterbourne View, a whole series of inquiries into failures in the system.

“There’s a major inquiry going on in Northern Ireland at Muckamore, there’s problems in Norfolk and Suffolk, and a major inquiry into Essex where they are looking at thousands of deaths.

Dr Carter said, however, that he does not want to “damn the whole system” with his book and that the issues facing mental health nursing are largely systemic ones, which need policy-level intervention.

“There are some excellent services, and some wonderful people,” he said.

“But the reality is that because of the years and years of underfunding, we now have a mental health service, which, frankly, is not as good as it could have been, had there not been the cutbacks.

“Claire Murdoch [the NHS national mental health director], my colleague and friend, is doing a great job trying to address those issues but it’s on the back of decades… of underfunding,” he noted.

Dr Carter said the inquiries that sparked him to write the book – alongside individual incidents of violent crime linked to mental health, including a murder in Nottingham – showed the current way care was arranged must be wrong and that promises to “learn lessons” were not coming to fruition.

“It’s a recurring pattern of very serious events, inquiries, promises to learn lessons. But the problem is, what usually happens is, the only recommendations that are implemented are the ones which don’t have any resource implications,” he said.

Dr Carter spoke about the calls he makes in his book to revisit the way mental health care was organised in the past, though warned about valorising inpatient systems, which had their own share of problems and abuse scandals.

He said that, in his view, cost saving – reducing the number of beds and live-in settings – has been done “for cost saving, dressed up as clinical progression”.

“Something I wanted to get across was that there is this kind of view that everything in the old mental hospitals was uniformly bad – and it wasn’t,” he said.

“There were very bad things that happened – which I’ve said in the book – but also, there were countless examples of really kind, caring staff doing a very good job, often under very trying circumstances.

“I just wanted to say: ‘Hey, hang on a minute. Not everybody was a Nurse Ratched from One Flew Over the Cuckoo’s Nest, the cruel sadistic nurse. There were lots and lots of really kind, caring people doing a very good job.”

Dr Carter pointed to mental health and psychiatric services in other countries, such as France, Germany, Spain and Canada, which have “far more resources” in the form of inpatient facilities and beds compared to the UK.

He added: “Some of these countries have accepted that there’s nothing wrong with coming to terms with the fact that some people do need long term care…”

Referring to a discussion he puts forward in the book, Dr Carter said: “It is not a call to reopen all the old mental hospitals, definitely not – because they had their issues as well, but we do need to come to terms with the fact that there are people that need long term residential care.

“And we shouldn’t be afraid of that… if that kind of model was replicated throughout the country, I’m not saying for one moment it would cure all the ills, but it would certainly help,” he said.

He added: “[Many] of the people that are sleeping rough in central London, have a severe and enduring mental health problem and a lot of them would be much better off if they could be in some kind of residential care.”

Dr Carter was chief executive and general secretary of the Royal College of Nursing from January 2007 to August 2015, and is now a fellow of the college.

Prior to that Dr Carter was chief executive of Central and North West London NHS Foundation Trust for 12 years. He was awarded an OBE in 2006.

In 2020, he received the prestigious Chief Nursing Officers’ Award for Lifetime Achievement at the 30th Nursing Times Awards and in 2023 was included on the Nursing Times NHS 75 list of influential nurses.

My Asylum Days: How Mental Health Policy Has Changed