Mental Health Services Today and Tomorrow

Pt. 1

Charles Kaye, Michael Howlett

• Publisher: CRC Press
• Year: 2018
• eBook ISBN:
  9781315347103
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This work traces and anticipates past, present and future changes in mental health services to assess the impact both of developments in care, and of the implications of new organisational change. It includes contributions and perspectives of those involved in services at all levels, including service users, to draw upon their experience to give a fuller picture of today and help sketch in tomorrow. It balances academic scrutiny with personal involvement, to reflect both national trends and local initiatives. Overall this work is in two volumes, each of which can stand alone: this Part 1 focuses on the realities of offering and receiving care at a practical and local level; it concentrates on personal experiences within mental health services as user, carer, provider and professional.The companion book Part 2 reviews policy and practice from national and international perspectives. Together these books provide essential information and views on mental health services for professionals throughout health and social care, managers, policy planners and policy shapers including those in the third sector and patient groups, academics and the media.

CHAPTER 1

Honesty without discrimination

ALASTAIR CAMPBELL

The following is adapted from Alastair Campbell’s speech to the 2006 Mental Health Media Awards, London. It is a frank discussion by a national figure of his own mental illness and the barrier it could have placed in the path of his career – were it not for an enlightened employer!

I have a fair bit of personal experience of mental illness and I have a fair bit of experience, too, of media misreporting creating fear, prejudice, bigotry and hatred.

You are not the first media awards event to invite me. But you are the first I have accepted. Most media awards are self-serving back-slapping sessions not worth leaving the sofa for.

But this is an awards ceremony that I think can make a difference. The Mental Health Media Awards, now in their 13th year, are successfully used to challenge – challenge stereotypes, challenge complacency, challenge the media to think beneath the easy-to-reach surface.

And for all I might rail at a lot of our media output much of the time, it doesn’t actually make that much difference. If people really believed all the media pundits said about Tony Blair, he would never have survived as long as he has. I remember during the build-up to the Hutton inquiry, when we had a near permanent media camp on our doorstep, one of our neighbours said to me, ‘You do realise if we believed what they were all saying, you would never walk out your front door?’ And she was right.

People find their own perspective.

But I think mental health coverage is different. It is an area where the coverage itself, far from challenging a stigma, can help reinforce it, and in a way that has a direct impact upon the way people with mental health problems feel, are perceived, and the opportunities they are denied for fairness and equality, not least in the workplace but also as they go about their daily lives in their communities. Often met not with understanding but abuse and fear. Three times more likely to be harassed. Four out of 10 employers saying they would employ someone with a mental health history –that leaves six out of 10 who wouldn’t.

I was incredibly lucky. I had a pretty spectacular nervous breakdown in 1986. I was lucky above all because I had a supportive partner, who had seen it all coming but was unable to make me see it, and who stuck with me when many others wouldn’t. I had a small group of close friends, probably smaller after the breakdown than before, because something like that does tend to separate out the real friends from the drinking companions. I remember Alex Ferguson once giving me his definition of a friend – someone who walks through the door as others are preparing to put their coats on. Spot on. I had a brilliant GP and have always been lucky on the medical support front. Unlike many, I have also been lucky in the workplace. At the time I was on Today, but the then editor of my old paper, the Mirror, told me that he would take me back once I had found my feet again. That was an incredible act of support and friendship, all too often not found in worlds as competitive as the national media.

I was lucky, too, because although it was the worst time of my life, certainly the scariest, over time I turned it into one of the best, a life-changing event that made me stronger, fitter, more focused on the things that really mattered.

And I know without that strength I would not have been able to do the job I did from 1994 to 2003. When Tony Blair asked me to work for him, I said, ‘You do know about my breakdown don’t you? You do know I had a drink problem? You do know I still get depression from time to time?’ He said, ‘I’m not worried if you’re not worried.’ I said, ‘What if I’m worried?’ He said, ‘I’m still not worried.’ I think that is quite an important signal for us to take on board – that if the Prime Minister can take that attitude, so should other employers, too. Coincidentally the Government today launched a new programme to improve understanding of these issues among employers.

Part of this is still about basic attitudes. People who suffer from depression are still more likely to call in sick with fake flu than to admit the truth. I know people with schizophrenia who have held down jobs successfully but who are convinced they would never have got them if they had been open. Surely it is better for everyone if we can be honest without being discriminatory? Some people who suffer from schizophrenia will never hold down a job. But many can and could.

And though the media does now cover issues like depression and anxiety reasonably well, one area where I feel little progress is being made is in the constant linking of mental illness and violence. Most mentally ill people are not violent. Yet their issues tend to be in the media only when they are. One in eight of all stories about mental health has an angle related to violence. That is not representative. All the space devoted to virtually every aspect of our lives – people obsessed, it would seem, with their looks, their own physical well-being – conventional health covered extensively, but so little about this area which affects one in four directly, and that means all of us indirectly.

I recently opened an NHS [National Health Service] medium secure unit for severe psychiatric cases, a public–private partnership near Burnley. Amazing building. Great facilities. Fantastic caring and committed staff. Innovative therapies. Really humbling to look at some of the artwork of the patients, for example. But as I said at the opening, the only time the public will ever hear of the place is if one of the patients goes missing or if one of them attacks a member of staff really badly.

I think our mental health services, staff and patients alike, are a fantastic resource of powerful, uplifting emotional stories – the sort of thing I thought the media was meant to be about – but the general impression remains overwhelmingly negative.

And that has a real impact. That’s why so many people will not tell even friends and family about their illness. They frequently report that the barriers they face because of diagnosis have a bigger impact on their lives than the symptoms.

Eighty per cent of journalists say they have personal knowledge – themselves or friends or family – of someone with a mental illness. Yet by a similar margin they admit the reality of mental illness is not reflected, that the picture is way too negative.

So tonight is about celebrating the good and hoping in so doing that we can raise awareness and so challenge the bad. Things do change for the better. ‘Bonkers Bruno locked up.’ Remember that one in the Sun? Of course you do. Changed to ‘Sad Bruno in mental home’ by the later editions because of the immediate furore. Signs of progress. But still day after day we can see the link between illness and violence, and in broadsheets, TV and radio as well as tabloids.

When dealing with stories about cancer, this is all presented sympathetically as a problem for the patients. Particularly if talking about young people. I know this, in the work I do as chairman of fundraising for Leukaemia Research. But when it comes to mental health, it is presented as a problem for society. It is all about risk to others, not help to the patient. It is the same approach taken, say, to asylum seekers, drug abusers, antisocial youths. Problem people, not people with problems. Yet there are three times as many people with serious mental health problems as there are people with cancer. Worth a thought.

Challenging stigma and changing attitudes takes time. But it happens. Black people still don’t get into our mainstream media as much as they should. But it used to be they were hardly there at all, unless as heavyweight boxers, sprinters or convicted criminals. That has changed. Take gay issues. David Cameron standing up and saying he supported the civic partnership laws Labour had brought in. His audience may have looked like they had swallowed a lemon but they will get used to it. And so with issues of mental health coverage, we should pocket the progress but work for more: challenge the media to use sufferers as well as experts, let them know there are stories of hope and recovery as well as stories of violence and despair. And let sufferers know that, too. I know from my own experience how it helps to know there are other people out there who have been to the brink and come back. I benefited from that when I was ill. And I know from the letters I had when I did something for Mind a few years ago, that it is worth putting your head above the parapet on this.

Of course when you do, you will get the odd newspaper go to the usual rent-a-quote political pygmies to generate a fake storm. But that is the stuff that doesn’t matter a damn. What matters is if you can help shape a change in attitudes.

I remember on the day I resigned from the Government and it was wall-to-wall on telly. I didn’t see much of it but my sons were watching at home, and when Fiona and I got home, I asked who had been on. A mix of politicos and journos, but the one that clearly made an impression was Anne Widdecombe. She said I had been a terrible influence on politics – well she had to say that I guess and might even believe it – but what struck the boys most was her saying she admired me for the example I set in recovering from a breakdown and going on to do a job that would itself test most people to breaking point. I was quite proud of that. It is kind of what I feel and why, as I say, I look back on what I call my ‘mad period’ as both the worst and best experience of my life.

My main diatribe against the media is that we have more space than ever but, it seems to me, less ability to handle really complex subjects. The combination of intense competition, negativity, trivialisation, obsession with celebrity, an explosion in outlets, 24-hour news constantly on the lookout for the next whoosh, programmes now only interested in making a splash, rather than genuinely illuminating an issue; it all means there are few places where complexity is dealt with. And then there are the ghastly reality TV shows, modern-day freak shows where for titillation and ratings celebrities, so-called, are created and the nation can gorge on the psychodramas they play out. Not a happy scene generally, which is why it is so important to praise the exceptions as represented here.

Another point, as someone whose background was in newspapers. It is quite something that this is the first time the awards have felt able to make any award to the print media. I hope it helps encourage others to handle the subject more seriously, more sensitively, and with a deeper understanding of the issues.

Mental Health Media does a good job in trying to change attitudes. Its work will only be done, in truth, when there is no longer a need for it to exist. When these awards join the self-serving back-slapping category, we will know that the job is done, and MHM can then be wound up. Sadly, that day is some way off.

So let us honour the good and remember the bad.

CHAPTER 2

Community teams: outreach and intervention

NEIL CARR

The movement to a community-based service has been far from smooth – initial attempts are now seen as failures. This is a description of a ‘new look’ community service – responsive, flexible and measurable.

Introduction

Although the idea and, subsequently, the practice of community mental healthcare has been widely embraced in the United Kingdom since the 1960s, it is now becoming clear that, for it to be effective, much more is required than merely locating services randomly within communities. To deliver services effectively it is essential that those commissioning, providing and evaluating healthcare and health improvement recognise the social, economic and political environments in which they practise and the impact they have on the overall health and well-being of individuals and communities.¹ The driving forces behind the ‘decarceration’ of mental health patients still persist and have supported the psychotropic revolution, the patients’ rights movement, the choice agenda and the closure of crumbling psychiatric hospitals. However, controversy is rife both within and beyond mental health services as to the success or otherwise of community care. Recently there have been calls from both the public and the professions to reinstate places of safety in which people with mental health problems can find refuge and be kept separate from society. While neither politicians, nor the public, nor service users, nor healthcare professionals would wish to see a return to the kind of mental healthcare that prevailed pre-1960, there is a general anxiety about the best way to proceed.

Mental health services have traditionally suffered from a sense of insecurity, more so than other branches of healthcare. This impacts on those who provide the services as well as those who receive them. Reviewing the situation of mental healthcare at the end of the 19th century, Porter² concluded that while medical science had made great advances, knowledge of mental health and of the brain remained weak. This sense of a gap in the professional knowledge base inspired an enthusiastic search for new treatments and interventions, many of which were adopted throughout the 20th century on very little evidence as to their safety or effectiveness. Examples include insulin therapy, psycho-surgery, electro-convulsive therapy, behaviour therapy, cognitive therapy, psycho-social therapies, psycho-pharmacological interventions. Some were found to be useful; others fell out of fashion as speedily as they had come into favour. Reflecting on the 20th century, Wells-Thorpe³ concluded that it was possible that health professionals in all branches of medicine were still doing more harm than good. Concerns a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• List of contributors
• Acknowledgements
• Introduction
• 1 Honesty without discrimination
• 2 Community teams: outreach and intervention
• 3 Homelessness and disorder: the challenge of the antisocial and the societal response
• 4 Moving on from the National Service Framework for Mental Health: the social inclusion agenda
• 5 A GP’s view: interview with Dr Helen Pelendrides
• 6 Dual diagnosis
• 7 Advocacy: does it really work?
• 8 Prejudice and progress
• 9 Clients as colleagues: part of the path to recovery?
• 10 A personal account: from my life
• 11 Working with young people: 24 hours in the life of The Highfield Family and Adolescent Unit, Oxford
• 12 Creating a small community
• 13 A space for creativity and healing: Artists in Mind and the mental health system
• 14 Enhancing the healing environment
• 15 The Retreat: an alternative perspective from the independent sector
• Index