When you think “safety”, what comes to mind? Seeing someone on top of a rickety ladder reaching out to wash a window perhaps. Or putting a guard rail along a high pathway or using an oven mitt to pull out a hot grill pan. Protections from physical harm. But what does “safety” mean in the context of mental health care?
Caring for people with mental health problems should naturally – since the pain and suffering is mental – involve alleviating mental distress. So often, however, the terms in which mental health is spoken and the means by which people are assessed and treated in psychiatric care appear to be almost entirely physical: assessing someone from their demeanor; treating them with drugs; locking them on a psychiatric ward. I’ve speculated about that before (here). Sadly, I haven’t heard any contradiction to that suggestion yet.
Today, it was announced by psychiatrist Professor Louis Appleby that this year’s annual “safety in mental health care” report was being launched. There would also be a tweet chat, on the hashtag #ncish14. What could the report be about and would it deal purely in physical aspects of mental health care?
The report, it turned out, was about death: suicide, homicide and sudden deaths in mental health patients. It was a serious and sobering report about tragic deaths which also dispelled myths about “dangerous mental patients” (a tiny proportion of homicides are by people with mental health problems; but a far higher proportion of suicides) and offered concrete recommendations to reduce the rates of all three. Mental health charities Rethink Mental Illness and Mind released a statement about the report.
What struck me in addition, however, were two things: first that, in mental health, the word “safety” seemed to be a euphemism for “preventing deaths” rather than, say, patients feeling safe and cared for in their distress or alleviating distress; and that the only thing measured and reported nationally on an annual basis in relation to mental health was a physical outcome, namely death.
I joined in the tweet chat and exchanged some tweets with the NCISH (National Confidential Inquiry into Suicide and Homicide by People with Mental Illness in the Centre for Mental Health and Risk at the University of Manchester) and with Professor Appleby. I’m still pondering this and may add to this blog post later. But, in the meantime, I’m left with the impression that – hundreds of years since practices such as mechanical restraint, confinement in madhouses and cold baths began to be condemned – mental health care is still viewed, treated and measured in largely physical terms.
The report and related documents:
- Press release about the report
- The report – National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Annual Report 2014 – England, Northern Ireland, Scotland and Wales (pdf) (by the National Confidential Inquiry, based at the Centre for Mental Health and Risk at the University of Manchester)
- Comment by mental health charities Rethink Mental Illness and Mind about the report
- My earlier post – Mental health? Physical treatment (May 2014)
- Madness to Mental Illness – A History of the Royal College of Psychiatrists (sample chapter) – A snippet of psychiatric history, full of references to”the insane” and “the mentally ill”, despite being only 6 years old.
- Men Without Hats – The Safety Dance (Music Video) (1982)