The Systemic Failures of UK Independent Mental Health Care

By Kaden Pradhan

London, England

Three horrific incidents were surrounded by failing independent institutions (Photo Credit: The Independent)

It was the 31st of May, 2011, just before 9:00 pm, and families across the United Kingdom were settling down for an evening of primetime television. Unusually, a special program was just beginning on BBC One. What was broadcast in the next hour would shock, sicken, and anger millions of people. It was the night that the Winterbourne View scandal began.

What happened at Winterbourne View, an independent, residential mental-health institution for adults with severe learning disabilities, sounds like it has been pulled from a horror story. The program showed patients who were restrained under chairs, repeatedly slapped, and dragged across the floor. They were held down on the ground as medication was forced down their throats. They were shown screaming and shaking as their hair was pulled by staff. As punishment for resisting, they were showered in cold water fully-clothed and had mouthwash poured into their eyes. Sometimes they would be locked outside in a yard in temperatures near freezing. One ‘senior’ care worker was shown shouting at a patient that he would get “a cheese grater and grate [their] face off.”

Patients constantly attempted to either commit suicide or escape the building: there was no distinction for them, as long as it would end the years of abuse they had suffered. One victim tried to jump out of a second-floor window, and after failing to, was mocked and laughed at by staff. A parent of a victim said the abuse was simply for the staff’s “fun and amusement.”

All this is just the tip of the iceberg. In total, police arrested eleven staff members, all of whom pleaded guilty. Six of them were placed in prison. Soon afterward, the independent care watchdog published a Serious Case Review, which revealed hundreds more of these incidents at the very same institution. Winterbourne View was shut down. The watchdog then conducted a large-scale investigation into Castlebeck Care, the private company that owned and operated Winterbourne View. Three more of Castlebeck’s care homes were forcibly closed for similar reasons.

The public reaction to these revelations was a national sense of outrage and mourning. Letters were sent to Parliament, and the Prime Minister, at that time David Cameron, demanding serious change. The powers-that-be promised that there would be a radical overhaul of inspection and qualification procedures. Debates were held in special committees, papers were published, and life slowly settled back into rhythm. The scandal was thought to be over.

At Winterbourne View, police arrested eleven staff members, all of whom pleaded guilty (Photo Credit: The Guardian)

Unfortunately, the real scandal had only just begun. In 2011, David Cameron promised that the mistreatment of patients would never happen again. In May 2019, an investigation by the BBC exposed serious abuse at a very similar independent mental-health institution in County Durham, Northern Ireland. Staff at Whorlton Hall were shown to have frequently intimidated, mocked, and used violence against patients. One victim was held down on the ground for ten minutes while the restraining member of staff handed out chewing-gum to his colleagues. This care worker later said of a patient: “... as soon as she starts screaming, I just want to f****** kill her”. Another replied that he “ f****** clotheslined her once. She f****** hit the deck like a bag of s*** ”. Care workers called the patients “mongs” and told them their families were “poison.” They told one patient, known to be terrified of males, that her room would be “inundated with men,” which they later described as “pressing the man button.” Experts have called this a form of psychological torture.

The parallels between the abuse at Whorlton Hall and at Winterbourne View are striking. The response also took a similar path: a police inquiry was launched, and sixteen members of the staff were suspended. The care watchdog, which in 2011 David Cameron promised would be improved, chose to “apologize deeply” as they “did not pick up the abuse that was happening.” Whorlton Hall had been given a ‘Good’ rating by them in 2017. Although the Whorlton Hall scandal did not achieve as much public attention as at Winterbourne View, it still spread across social media and was condemned by public figures. Once again, change was promised, useless reports and debates were held, and life went on. People slowly forgot about Whorlton Hall, forgot about the vulnerable victims of systematic abuse whose lives would be scarred forever.

That is, until recently. On the 23rd of September of this year, a fresh scandal emerged at yet another independent mental-health hospital, this time in Essex. Ten members of staff at Yew Trees hospital have been suspended, and two referred to police after an unannounced inspection of the facility by the care watchdog. The officials in charge have revealed to the media that they saw CCTV footage showing episodes of “physical and emotional abuse” and that patients were “dragged, slapped and kicked.” They concluded that they “witnessed abusive, disrespectful, intimidating, aggressive, and inappropriate behavior.” The private corporation that operates Yew Trees, Cygnet Health Care, also operated Whorlton Hall. Another hospital run by Cygnet, Thors Park in Brightlingsea, was shut down by inspectors in June, who later said that “patients and others were placed at risk of harm” there. It is the 34th time one of these profit-driven mental-health hospitals has been rated ‘Inadequate,’ and the ninth time it has involved Cygnet Health Care.

Patients were restrained under chairs, repeatedly slapped, and dragged across the floor (Photo Credit: Daily Mail)

Three separate incidents, each horrific in their own right, were surrounded by a network of failing independent institutions. The culture of abuse and mistreatment that is prevalent throughout this sector should have been thoroughly extinguished nine years ago after Winterbourne View. Instead, it exists even up to this moment. The UK is a wealthy, developed country, with an efficient political system, well-established legislation, and a world-class health system, the National Health Service. It is extraordinary that such a shocking systemic failure with such a straightforward solution has not been addressed. The most present question, therefore, is why.

In the past few months, the NHS has been given emergency funds due to the ongoing COVID-19 pandemic. In the last decade, however, the NHS has been constantly and substantially underfunded, to the extent that, for example, our doctors have always feared winter and that the influx of common cold, cough, and flu cases it brings could overwhelm the system. Historically the NHS has had to alleviate pressure from its stretched resources, and they usually do this by subcontracting lifelong specialist care to private corporations, who then set up facilities to receive patients.

The responsibility for scrutinizing the staff and procedures of these private companies before they are awarded the contract is, in fact, spread across multiple government departments: the regional NHS Trust, the Department for Health and Social Care, the Care Quality Commission, and many more. Each of these completes the job half-heartedly, falsely believing that the other departments will make up for their shortcomings. In the end, this means corporations such as Castlebeck and Cygnet can achieve the contract without having sufficient personnel or assets to provide proper care. In the worst cases, these corporations will hire untrained staff with no knowledge of how to help vulnerable patients and so often resort to the abuse and mishandling we have seen at Winterbourne View, Whorlton Hall, and Yew Trees. 

The root of the problem is clear, and so is the solution: a radical reassessment of how the NHS is funded to ensure trained NHS staff can provide the proper care that is desperately needed by this community. This is the only way such incidents can be prevented in the future.

Joe Casey, the reporter who investigated at Winterbourne View, says:

“I could not save Simone [a victim of abuse] on that day. I had to resist my instinct to step in. I was there to gather information that could help save others from a similar fate⁠—and Simone herself from future abuse. The way we treat Simone and Simon [another victim] is a measure of a common humanity. By that measure, we have failed.” 

It is now our responsibility to ensure such failures never happen again.