Archive | August, 2014

Selling stigma: Ridiculing and demonising people with mental health problems for fun and profit

26 Aug

Stigma spoiled identity Goffman

Every now and then, they’ll crop up. For fun and profit, a business will offer for sale a product – whether that’s a teeshirt, mug, fancy dress costume, tickets to a theme park ride or other product – that’s based on ridiculing and demonising a vulnerable and marginalised group, namely people with mental health problems. Where racist and homophobic products would bring swift condemnation and be pulled before the production stage, in some corners people with mental health problems are still seen as being very much fair game. But that is starting to change.

In the past, people affected by mental health stigma and discrimination – people with mental health problems and their friends, family and supporters – may have kept quiet out of shame or fear of exposing themselves. There is still a huge amount of shame and fear, stigma and discrimination, even though some (such as Observer journalist Elizabeth Day in her recent comment piece) doubt it exists. That’s like saying that, because someone doesn’t experience racism personally then it just doesn’t exist, which is misguided and misinformed. Nowadays, profiteering from the suffering of people with mental health problems is being challenged more often. And, sometimes it makes a difference. Two examples from last Halloween:

  • Asda (and other retailers) marketed “mental patient” fancy dress costumes. When this was challenged, Asda quickly withdrew the products from sale, apologised and donated £25,000 to mental health charities.
  • In contrast, Thorpe Park only agreed to rename its “scary mental patient” live action horror maze, Asylum (part of its annual Fright Nights season), after heavy prompting. In fact, Thorpe Park only agreed to rename Asylum it had been closed for the season and whilst it was being investigated by Surrey police for hate crimes. Fright Nights begins in only a few weeks’ time. It remains to be seen what theme it’s live action horror maze will appear under this year.Daily Mail mug

The offering that’s come to my attention today – and promped me to set up a new “selling stigma” page to collate such incidents – is More T Vicar and The Daily Mash’s “mental hospital” teeshirt and mug (pictured right) (£17.99 and £10 each respectively, plus post and packing). Someone at The Daily Mash thought these products were just right for its customers. Someone at More T Vicar embraced the opportunity to sell them on their behalf. Bad decision. And, quite frankly, a bad design.

So far, both companies have been contacted – by me and others – via email, via online contact forms, via product reviews and, of course, via twitter. The only response at this point is that More T Vicar has changed the blurb beside the teeshirt from, “The lunatics have taken over the asylum and are printing their own teeshirts” to, “A thought-provoking T shirt design from The Daily Mash emporium.” But both products are still very much for sale. Let’s see whether these companies will follow in the footsteps of Asda (swift withdrawal, apology and donation) or the Thorpe Park (dragging it out till they’re reported to the police and have made plenty of money from sales) – or will simply carry on ridiculing and demonising people with mental health problems fo fun and profit.. 

In the meantime, I now have a website page on which to collate what will hopefully be an ever-decreasing incidence of such offensive and harmful products.

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Here’s what I wrote to More T Vicar earlier today:

Open quotesYour “lunatics have taken over the asylum” teeshirt and mug demonise and ridicule a vulnerable and marginalised group, namely people with mental health problems.

Your products may also be in breach of Daily Mail copyright, apparently using their namestyle and logo. I have written to the Daily Mail to let them know that, despite their recent excellent coverage of mental health topics, their namestyle and logo is being used on offensive products which perpetuate negative stereotypes about people with mental health problems and contribute to discrimination.

You should be aware that, last year, after a public outcry, Asda, Tesco and Amazon withdrew from sale offensive “mental patient” fancy dress costumes. Asda’s response was welcomed: it acted swiftly, apologised sincerenly and donated £25,000 to mental health charities Mind and Rethink.

I strongly recommend that you withdraw these two products from sale immediately, apologise and consider making a donation to mental health charities, and involve your staff with mental health awareness campaign Time to Change, who will be happy to help. You can contact them here.

Bear in mind that 1 in 4 people will experience a mental health problem in any one year. Workers at your company, friends and family and, perhaps most important to your business, customers will all have experience of mental illness. Ridiculing and demonising people with mental health problems isolates people, stops them coming forward to ask for health, prolongs unnecessary suffering and contributes to a climate where cuts to mental health services are 20% deeper than other acute hospitals. The very insitutions you are ridiculing are being cut back even as we speak.

Looking forward to hearing from you that these actions have been taken.Close quotes

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  • 26 August – More T Vicar revised their promotional text to “A thought provoking product” (from “The lunatics have taken over the asylum and printed their own teeshirts”). Both products remain on sale.
  • 26 August – More T Vicar deleted 3 negative reviews of their “mental hospital” products.
  • 27 August – More T Vicar revised their promotional text to “The Daily Mail is insane”. Both products remain on sale.
  • 27 August – More T Vicar deleted all negative reviews of their “mental hospital” products and disabled the function which had enabled people to leave reviews on their website.
  • 27 August – More T Vicar began sending out a standard reply to people who contacted them complaining about the “mental hospital” products with points remarkably similar to those made by Thorpe Park. Are they taking tips from Thorpe Park’s car crash PR handling of Asylum? Here are their arguments for continuing to sell their “mental hospital” product range:
    • ” … we have also also received positive comments from people who claim to have mental health issues and find the design amusing.” That’s like saying, “We found a black man who doesn’t find our golliwog offensive, so that’s okay then.” And I wonder whether the people who have “mental health issues” have been sectioned in a psychiatric hospital.
    • “We do not believe that the design makes fun of people with mental health issues …” That’s their belief, but does it stand up to logic? No, for the reasons set out above.
    • “… and it is certainly not intended that it should.” First, it’s about harm, not offence: stigma and discrimination cause real harm to real people’s lives every day. I live with their effects as do many others. It’s about harm, not offence. Secondly, whether or not something is intended to cause offence doesn’t mean harm isn’t caused: the little girl who accidentally shot her machine gun teacher today no doubt didn’t intend to do so, but her teacher is still dead. Third, once you know about the harm and still continue to do so, that is intentional harm. Once you know about the harm, ignorance is no defence.
    • “We have noted your complaint [and w]e will continue [to] keep our policy under review.” Yadda yadda yadda. Blah blah blah. Fancy words for “Go away now”.

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Mental health moocs – Free online courses

25 Aug

FutureLearn The Mind is Flat.Update small

Scroll to the foot of the post for updates on newer courses

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One day about a month ago, I introduced two people at the day centre to the concept of the “mooc” – the massive open online course. They were so thrilled that I thought I’d do a little blog about them, to share them with others who might not know that there’s a wealth of online courses from some of the world’s top universities available free of charge.

If you’re looking for courses, a good place to start is FutureLearn from the Open University (@futurelearn, @OpenUniversity) and Coursera (@coursera). FutureLearn only went live this year. Coursera has been running for longer and offers courses from mainly US universities (bear in mind that, in the field of mental health, US thinking and teaching can be very different to that elsewhere). There are many different courses, at all levels, from improving your writing skills through to niche high level academic courses.

Please note:

  • All courses and course material are free of charge. There is no charge to participate in the course. All you’ll need is online access to be able to read or watch course material and to take online progress quizzes and so on. If there’s material to read, it will be available online or to download (for instance, selected book chapters).
  • Typically courses are composed of lots of bite size chunks, including videos, material to read, progress quizzes and end of section reviews.
  • One of the really helpful aspects of moocs is the way they’ve been developed to facilitate online interaction between the (sometimes) thousands of online participants. For instance, courses may have online discussion forums where people can post questions and receive answers from fellow participants. There may also be online groups you can join if, say, you want to take the course in a hurry, at a more leisurely pace or if you’re from a particular country. And, if there isn’t one to suit your needs, why not set one up yourself?
  • Some providers offer optional extras for a small fee, including:
    • Certificate of completion (if you want to have evidence you’ve competed the course, for instance for a CV or job application)
    • Recommended course textbook (there may be a discount rate for course participants buying a recommended book)
  • All courses are complete and beneficial in themselves. However, some may also whet your appetite to take a longer fee-paying course with the same institution. The stand-alone course is worthwhile, but afterwards you may receive online marketing for a related fee-paying course. It’s easy to opt out if you’re not interested.
  • Many moocs will be re-run periodically so, if it’s too much the first time round (I couldn’t join the dots the first time I tried a mooc, which was a bit frustrating), you can always try again later. Or go for a different course.

If you’ve got a particular area of interest, have some spare time on your hands, or want to take your mind out for a little walk to see how it does, why not sign up for a free course? Give it a go. Here are some courses I’ve come across related to mental health. Let me know if you come across others so I can share them here.

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Courses that started recently (you can still join) or are currently open:
  • The Clinical Psychology of Children and Young People“The course will cover the basic guiding principles of the Clinical Psychology of Children and Young People and illustrate how theories of psychological development can be applied in understanding children and young people’s mental health and well being within a wider societal and cultural context. We will also discuss current psychological models of prevention and treatment for Children and Young People. University of Edinburgh (@UniofEdinburgh) (Coursera) – 5 weeks of study, 1-3 hours of work per week – Started 28th July, runs to 7th September
  • Introduction to Psychology“This course is all about you … your mind, your behavior, and what underlies them both. It will be a fast paced tour of the most important experiments in psychology, one that is intended to fascinate, inform, and provoke deep thought. Come learn about yourself with us!”University of Toronto (Coursera) – 8 weeks of study, 4-6 hours of work per week
  • Social Psychology – “Ever wonder why people do what they do? This course offers some answers based on the latest research from social psychology.” – Weslyan University (US) (Coursera) – 7 weeks of study – 4-8 hours of work / week – Started 14th July, runs to 15th September

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Upcoming courses:
  • Major Depression in the Population: A (US) Public Health Approach“Illustrates the principles of public health applied to depressive disorder, including principles of epidemiology, transcultural psychiatry, health services research, and prevention.” – Johns Hopkins University (US) (@JohnsHopkinsSPH) (Coursera) – 7 weeks of study, 2-4 hours of work per week, starts 3rd November
  • The Mind is Flat: the Shocking Shallowness of Human Psychology – “Make better personal and professional decisions and consider the psychological dimension to key ethical and political choices.”University of Warwick (FutureLearn ) – Duration 6 weeks, 5 hours study per week – Starts on 13 October – #FLmindisflat
  • Psychology and Mental Health: Beyond Nature and Nurture“How a psychological understanding of our emotions and behaviour can give us new ways to improve mental health and well-being.”University of Liverpool (FutureLearn ) – With professor of clinical psychology Peter Kinderman (@peterkinderman) – 6 weeks of study, 3 hours per week – Starts 8th September

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Courses that may run again if enough people sign up:
  • Drugs and the Brain“The neuroscience of drugs for therapy, for prevention, and for recreation.  Drug addiction and drug abuse. You’ll learn the prospects for new generations of medications in neurology, psychiatry, aging, and treatment of substance abuse.”Caltech (US) (Coursera) – 7 weeks of study, 4-6 hours of work per week
  • The Social Context of Mental Health and Illness“Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated.”Toronto University (Coursera)
  • Why We Need Psychology“For adults with an interest in the study of human behaviour – especially those who have often considered studying psychology but who have yet to begin.”University of London (Coursera) – 6 weeks of study – 8-10 hours of work per week

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Others:
  • Medicines Adherence: Supporting Patients with their Treatment “How can healthcare professionals help patients to improve their health through medicines adherence?”Kings College London (FutureLearn) – Duration 2 weeks, 2 hours per week, started 25th August – A course to teach doctors, nurses and other healthcare professionals how to get patients to adhere to treatment. Wouldn’t it be nice if medics were taught to work in partnership with patients?

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Secrets from the modern day asylum

20 Aug
Actor Ray Winstone in episode 1 of ITV's new series Secrets from the Asylum

Actor Ray Winstone in episode 1 of ITV’s new series Secrets from the Asylum

 

This evening, episode 1 of ITV’s new family history series Secrets from the Asylum aired. It delves into the murky world of dreaded Victorian lunatic asylums through the eyes of celebrities who make emotional discoveries about relatives incarcerated in the distant past. With a doom-laden commentory and spooky music, viewers were invited to be shocked that people with senile dementia were condemned as lunatics, to gasp at disturbing treatments like chaining or hosing with cold water (“treatments which now seem crazy themselves”) and to shake their heads at “sickening attitudes towards the mentally ill”.

I’ve often said that one of life’s cruel ironies is that, whilst nowadays we condemn with obvious horror what was done in the name of mental health care in the past, we don’t recognise the horror of some of what is being done now, today, in modern psychiatric hospitals. What is going on now – behind locked doors, out of sight, to the country’s most vulnerable people, sometimes by the most brutal of “carers” – goes unremarked. I’ve said before that, in the future, we will look back at some of today’s practice of mental health care with horror, just as we now look back  in horror on the lunatic asylum. How long will it be before we do that? And why can’t the general public see it now?

Because it is happening now. This minute, as I write this piece, as you read it, horrors of commission and omission, of things done and not done, are taking place in the name of mental health care. And yet the damage they cause – the lack of job satisfaction of good staff, the lives half-lived through inadequate treatment and support and even the lives cut short – go largely unremarked. It’s a secret from the modern day asylum, because no one is looking.

Only this morning, government minister Norman Lamb announced he was establishing a new mental health task force to look at the state of children and young people’s mental health care. Some of the papers ran the story. There was an excellent feature on the morning news. But, by lunchtime, it seems it had all been forgotten. What – if not hundreds of sick children detained in police cells for want of treatment of hospital beds, of sick children bussed from hospital to hospital, hundreds of miles from their parents – what could make the wider public see the utter inhumanity of the way in which people with mental health problems are treated today? If even sick children won’t make the public – and hence politicians – sit up and reach into their back pockes for some serious money and some serious thought how those in need of help can best be supported, then what hope is there, really for things to improve in mental health services in this country?

So today, the day that Norman Lamb announced that children’s mental health services were “in the dark ages”, ITV launches a new two-part series, Secrets from the Asylum. We gawp at the outdated practices of the old lunatic asylums. We gasp at the people locked away without proper treatment. We shake our heads in judgment at the barbaric treatments in days gone by.

And yet, it wasn’t until very recently that there were any effective treatments for mental distress and mental illness. Those running the old Victorian asylums had, in a way, an excuse. They did the best they could. In the words of the title to episode 1 , those trying to help people with mental health problems in the past had the “best intentions”. Nowadays, we don’t have that excuse.

Nowadays, there are treatments, help and support that can make a real difference to people’s lives. And yet … they are not employed. And, worst still, sometimes – in fact, far too often – practices that we know – through logic, humanity and research studies – are actively harmful to people are employed instead.

Why is that? It’s hard to explain. In large part it will be down to the resources allocated to NHS mental health care: with few staff on wards and paperwork to complete, there isn’t enough time to spend building therapeutic alliances with patients. There isn’t enough time to show the care and compassion, kindness and support so vital to helping people in mental health crisis. With wards that are badly designed and ill-equipped (as was the one on which I was detained), staff will be struggling from the outset.

But, also, it seems that there is something to do with the training of mental health professionals that creates a barrier, preventing staff from recognising human suffering. On ward, it seemed to me that the priority of even well-meaning staff was ward management. “Order and control took precedence over care,” said the commetator in episode 1: it seems that nothing has changed.

I speak as someone who was so traumatised by my experience of inpatient psychiatric care that I came out with the gift of PTSD (post-traumatic stress injury). Tonight’s episode refers to people in the past – before the advent of Victorian asylums – being chained, caged and beaten: I have been “chained” by means of the chemical cosh, a cocktail of drugs intended to quell me; I have been “caged” by being held in seclusion; I have been “beaten” by staff who assaulted me (in the criminal sense) and many more who physically restrained me, six at a time, for forced treatment and by patients from whom the staff did not protect me. Based on my experience of modern day inpatient psychiatric care, it doesn’t seem to me that there’s any obvious reason for us to pick over the bones of history and gloat about how far we’ve come.

And how is it such practices are allowed to continue, without a public outcry? Several powerful reasons. One is that there is still an enormous stigma to mental health problems. There is a shame to having been treated in a psychiatric hospital. It’s not something people speak out about readily. Another reason is that psychiatric patients lack almost any credibility. In an NHS system which we know is hard for even staff to raise concerns about and which has, it seems, a culture of closing ranks and covering up, what hope for patients’ complaints to be dealt with? And of course these things go on behind closed doors, out of sight. No one sees apart from those incarcerated in the strange world of the psychiatric ward, whether they are staff or patients.

It isn’t just me who thinks that some of what goes on on inpatient psychiatric wards is wrong. Here are a couple of examples from this week:

  • Here is a conversation that took place a couple of days ago when a psychiatrist, a psychiatric nurse and I discussed our experiences of physical restraint and bullying on mental health wards. The strong impression is that what I experienced is the norm, rather than the exception, which is heartbreaking.
  • Here is a post by Skye, the Secret Schizophrenic, about an upsetting incident that happened to her on ward recently. It illustrates how what happens on wards now can confound humanity and logic.
  • Here are some tweets on the hashtag #secretsfromtheasylum comparing modern day practices with those in Victorian asylums and questioning whether it really all is in the past.

I do know people who have had excellent experiences of psychiatric inpatient care that has transformed their lives for the better. It gives me hope. It should be the norm. Especially now that we there are effective treatments available to help people recover from  or manage mental health problems.

What is the hook? What is it that makes people want to watch programmes like Secrets from the Asylum but not care about the way mental health patients of today are neglected and mistreated? And how can some aspect of that be harnessed to our benefit, so that the lessons of the past are learned? Those are questions I wish I had the answer to but don’t.

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It’s okay to ask for help. Yes, but what if there isn’t any?

12 Aug

It is okay to ask for help Mind Charity

It’s okay to ask for help, as today’s Mind charity tweet says. However, it is NOT okay to have to ask again and again and still not get appropriate and timely help – or any help at all.

Thoughts exploring the theme of lack of actual help available for mental health problems, whether or not you’re able to ask.

(To be expanded into a written blog post when I have time.)

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