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.
- Guardian newspaper preview
- Radio Times preview
Twitter and blogosphere:
- A memory that haunts me – Skye, the Secret Schizophrenic (@SecretSchizo), writes about one incident on ward
- Restraint and bullying on mental health wards (18th August)
- Thoughts on tonight’s series:
- Conversations with 3 psychiatrists and others
- Tweets of others on the hashtag #secretsfromtheasylum
- Those who think bad things are still happening today and we can’t just look back in shock at long past practices
- Those who watched it purely as a history programme, shaking their heads at what used to be done to those poor mentally ill people with no concept of what happens today
Background – mainstream media:
- Child mental health services ‘stuck in the dark ages’, says Norman Lamb – “Care and support minister says options available to young people are ‘not fit for purpose’ and vows overhaul” – Guardian newspaper (20th August)
- Children’s mental health care at ‘breaking point’ due to council and NHS cuts, charity warns – “Data obtained by YoungMinds highlights extent of spending cuts facing CAMHS teams” – Community Care (June 2014)
- Children’s mental healthcare in crisis, Care Minister Norman Lamb admits – “Children’s mental health services in England are “dysfunctional” and “crying out” for a complete overhaul, the Care Minister Norman Lamb has said, in a stark admission that thousands of children are being let down by the NHS’s “institutional bias” against mental health.“ – Independent newspaper (20th August)
- Hundreds of children ‘detained in police cells’ – “Hundreds of children in England and Wales have been held under the Mental Health Act and locked in police cells because officers did not have anywhere else to take them” – BBC news (January 2014)
- Mentally unwell children sent hundreds of miles for care amid bed shortage – “Community Care and BBC News investigation also reveals hundreds of acutely unwell young people have been detained on adult wards” – Community Care (20th February)
- Scandal of putting mentally ill children in police cells must end, says MP – “Dr Sarah Wollaston condemns use of police stations for under-18s who are having a breakdown rather than taking them to specialist medical units” – Guardian newspaper (14th August)
- Why aren’t we more shocked that people with mental health problems spend time in police cells because we lack beds? – “Wanting to care about mental illness is not the same as caring.” @Glosswitch in New Statesman (02 December 2014)
Background – recent experiences of psychiatric hospitals:
- A memory that haunts me – Skye (@SecretSchizophrenic) (August 2014)
- Forced medication: resistance is futile (March 2014)
- Restraint – 10 ways it harms psychiatric patients (June 2013)
- Treated like an animal (March 2013)