The politics of mental health: Taskforces and commissions, manifestos and madwash

Your vote has value. People with an interest in mental health – whether people with lived experience or carers or professionals – are viewed as one of the many niche markets that political parties will be trying to tempt in the run up to the 2015 general election with the aim of encouraging us to vote for them. So what tempting tidbits have been offered so far?

• October 2012 – The opposition Labour party launched its mental health taskforce. This was an exciting development, as I wrote at the time. Over two years later, however, and it seems less of a priority. The taskforce was due to report in spring 2014, so shadow mental health minister Luciana Berger told me in April. However, in June I was emailed by the Labour party to say it would be summer, with the report published online giving the public the opportunity to comment and help formulate policy. No report. Other deadlines have passed and still no report.  Apparently it is due to report later today. I don’t know whether that means the public consultation aspect has been dropped.
• January 2014 – Nick Clegg MP, Liberal Democrat deputy prime minster, launched the coalition government’s mental health action plan (Closing the gap: priorities for essential change in mental health). This sets out the top 25 areas for immediate action to ensure equality for mental health and increase access to the best possible support and treatment. (Here’s Mind on the action plan.)
• August 2014 – Norman Lamb MP, Liberal Democrat minister for care announced he was establishing a task force into children’s mental health services. We know some of the answers to the questions already. Do we really need to gather more data? Without announcing a plan of action at the same time as announcing a taskforce, announcing a taskforce simply kicks the need to take action into the long grass.
• September 2014 – Prospective Labour party candidate for London mayor David Lammy MP announced he was launching a London mental health commission. (I haven’t seen any details yet.)
• October 2014 – Nick Clegg made mental health a central part of his speech to the Liberal Democrat annual conference. The first ever mental health waiting time standards were announced.
• November 2014 – Nick Clegg announces a cross-government taskforce on mental health services. It is to examine how to improve mental health crisis care and services for young people, and the large numbers of people with severe mental health problems who end up in police cells and prisons. The taskforce will be chaired by Nick Clegg and include senior ministers from across the coalition, such as Theresa May (Home Office), Jeremy Hunt (Health) and Vince Cable (Business).

(For earlier government policy documents, see here.)

Are these developments substantial? Or are they merely what I have termed “madwash”?

I coined the term “madwash” (inspired by the environmental campaigning term “greenwash”) to describe the window dressing done by an organisation (company, government or other group) to try to give the appearance that mental health matters. Madwash is where an organisation makes a show of sympathising with or of prioritising mental health issues, but this is used to hide a festering nest of ignorance and prejudice, or inactivity around mental health issues. This thin veneer of “madwash” is used draw attention away from lack of meaningful activity, or to distract from practices or policies which, overall, are detrimental to mental health – or which operate in a manner which is opposite to the mental health initiatives announced. Madwash may involve actively making misleading or unsubstantiated claims.

Here are some more musings on mental health taskforces.

On the other hand, we have had several manifestos launched in advance of the election. These include:

• Alliance of Mental Health Research Funders (October 2014)
• King’s Fund (September 2014)
• Mental Health Policy Group (August 2014)
• Mind (June 2014)
• Royal College of Psychiatrists (September 2014)

Summaries of these manifestos are set out below. What impact will these manifestos have? And what results will the various taskforces and commissions bring? Watch this space to see if they are any more than mere ‘mad wash’.

And finally, everyone loves a taskforce!

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Mind’s manifesto

Take action for better mental health – Our manifesto for the General Election 2015 (June 2014)

What the next government must do in its first 100 days

1. Commit to reducing mental health stigma and discrimination and to supporting the Time to Change campaign to sustain its work.

2. Mandate that the NHS in England offer a full range of evidence based psychological therapies to everyone who needs them within 28 days of requesting a referral.

What the next government must do in its first year

3. Commit to ensuring everybody has safe and speedy access to quality crisis care 24 hours a day, 7 days a week, whatever the circumstances in which they first need help, regardless of where they turn to first.

4. Transform the support offered to people who are out of work because of their mental health and create a system that really helps people to overcome the barriers they face.

What the next government must achieve by the end of its five year term

5. Increase the overall NHS mental health budget by a minimum of 10 per cent in real terms.

6. Develop, consult on, fund and implement a national strategy for wellbeing and resilience.

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The Mental Health Policy Group

Joint manifesto by the Centre for Mental Health, Mental Health Foundation, Mental Health Network, Mind, Rethink Mental Illness and the Royal College of Psychiatrists

A manifesto for better mental health – The Mental Health Policy Group – General Election 2015 (August 2014)

13 commitments are asked for, grouped under the following 6 headings:

1. Fair funding for mental health – Commit to real terms increases in funding for mental health services for both adults and children in each year of the next Parliament.
2. Give children a good start in life – Ensure all women have access to mental health support during and after pregnancy. Raise awareness of mental health by putting it on the national curriculum and training teachers and school nurses. Invest in parenting programmes across England.
3. Improve physical health care for people with mental health problems – Ensure Government targets for smoking reduction apply equally to people with mental health problems. Create a national target to stop people with mental illness dying early, due to preventable physical health problems.
4. Improve the lives of people with mental health problems – Continue to fund the Time to Change anti stigma campaign. Offer integrated health and employment support to people with mental health conditions who are out of work.
5. Better access to mental health services – Introduce maximum waiting times for mental health care and support, including psychological therapies. Commit to continued improvements in mental health crisis care, including liaison psychiatry services in all hospitals. Continue to fund liaison and diversion mental health services, working with police and the courts.

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Royal College of Psychiatrists manifesto

Making parity a reality – Six asks for the next government to improve the nation’s mental health (September 2014)

The ‘six asks’ are:

1. Tackle the mental health beds crisis – Everyone who requires a mental health bed should be able to access one in their local NHS Trust area, unless they need specialist care and treatment.  If specialist care is required, then this should be provided within a reasonable distance of where the patient lives.
2. Introduce maximum waiting times – No-one should wait longer than 18 weeks to receive treatment for a mental health problem, if the treatment has been recommended by NICE guidelines and the patient’s doctor.
3. Improve crisis care – Everyone experiencing a mental health crisis, including children and young people, should have safe and speedy access to quality care, 24 hours a day, 7 days a week.  The use of police cells as ‘places of safety’ for children should be eliminated by 2016, and by the end of the next Parliament occur only in exceptional circumstances for adults.
4. Improve liaison psychiatry services – Every acute hospital should have a liaison psychiatry service which is available seven days a week, for at least 12 hours per day.  This service should be available to patients across all ages. Emergency referrals should be seen within one hour, and urgent referrals within five working hours.
5. Introduce a minimum unit price for alcohol – A minimum price for alcohol of 50p per unit should be introduced. This will reduce the physical, psychological and social harm associated with problem drinking, and will only have a negligible impact on those who drink in moderation.
6. Invest in parenting programmes – There should be national investment in evidence-based parenting programmes, in order to improve the life chances of children and the well-being of families.

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The King’s Fund

Transforming mental health – A plan of action for London (September 2014)

The plan, though developed for London, is said to be applicable to the whole country. The key steps identified as being necessary are:

1. Developing a process of collaborative commissioning to facilitate change
2. Driving change through collective systems leadership
3. Ensuring that service users and clinicians are at the core of provision
4. Using contracting systems to support integration
5. Building a public health approach to mental wellbeing
6. Developing pan-London solutions to increase impact
7. Improving the availability of meaningful outcomes data
8. Utilising London’s academic infrastructure to disseminate best practice
9. Creating a new narrative for mental health

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Alliance of Mental Health Research Funders

Prioritising mental health researc – General election manifesto (October 2014)

The Alliance of Mental Health Research Funders is a national coalition of charities working to further research into mental health. They call on all UK political parties to:

1. Champion mental health research funding in General Election manifestos – The government can redress the current imbalance in publicly funded health research, influence other funders and lead the way in tackling the stigma that hinders mental health research funding.
2. Seek to remove current blockages to mental health research – We cannot improve mental health and wellbeing without better quality data and information. To unblock research we need better access to high quality data about mental and physical health, improved coordination of data sharing between government departments (for example between Health, Justice and Education) and more mental health knowledge among the wider public service workforce.
3. Give priority to research that will make the biggest difference to people’s lives – The biggest gaps include research into children’s mental health, prevention and promotion of mental wellbeing and the links between mental and physical health. Setting research priorities should begin with the knowledge andexperience of people with mental health problems.

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Related links:

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Manifestos:

• The King’s Fund – Transforming mental health – A plan of action for London (September 2014)
• The Mental Health Policy Group (Centre for Mental Health, Mental Health Foundation, Mental Health Network, Mind, Rethink Mental Illness and the Royal College of Psychiatrists)
  • A manifesto for better mental health – The Mental Health Policy Group – General Election 2015 (August 2014) #BetterMentalHealth (16 pages)
    
  • The manifesto on one page (13 commitments)
• Mind – Take action for better mental health – Our manifesto for the General Election 2015 – (14 June 2014) – #MindManifesto
• Royal College of Psychiatrists –
  • First steps to making parity a reality (9th October 2014)
  • Commentary on the manifesto by the Mental Elf blog – Making parity a reality: RCPsych launch manifesto to improve the nation’s mental health (12 September 2014)
  • Conversation with Mental Elf about why the blog reviewed only the Royal College of Psychiatrists’ manifesto and none of the others (September 2014)

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Labour MP David Lammy’s London mental health task force

• Storify story (September 2014)

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Labour’s mental health task force:

• My endeavours to find out about the taskforce (Storify stories):
  1. February & March
  2. A conversation with Luciana Berger – April 2014
  3. April 2014
  4. Looking for an up date – September 2014
  5. Looking for an update – September 2014 & World Mental Health Day 2014
  6. November 2014
  7. December 2014
  8. January 2015
• The politics of mental health: Labour’s new mental health task force – my blog post from 2012

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Adjust your medication

Damien Hirst – Pharmacy (1992)

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Oops! I appear to have hit the “publish” button rather than “save” and I don’t know how to reverse that. So anyway, I’m in the process of writing a blog post on this topic – Cameron’s “nuts” comment, Pickles’ “advice” to “adjust your medication”, comedy and the use of language around mental health problems. Which will appear at some point … once the ideas have percolated through! 

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• My Storify of tweets – Adjust your medication – conversation with writer and comedian Juliette Burton
• Standing up to bullies – an earlier blog post (September 2012) on being told, “I think you need to take some meds,  luv” by twitter inpatient psychiatric nurse (tweeting as @Fart_Pug)
• Using mental illness as an insult – Mick Philpott, Jon Snow & lunatics – an earlier blog post (April) – “There are so many expressive insults in the English language that there’s really no need to resort to using references to mental health as insults.”
• Laughing at mental illness – good news for Russell Howard – an earlier blog post (April) on getting cheap laughs by using damaging stereotypes to poke fun at a vulnerable group

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Mainstream media:

• BBC
  • BBC Radio 4 Today – interview with Juliette Burton (at 1:45 in/7:45am)
  • Online news – Eric Pickles’ abuse victim comment sparks row – “Eric Pickles has come under fire for telling an alleged abuse victim to “adjust your medication” when she accused him of failing to help her.” (Sunday 29th September)
  • BBC South East Today – Report by Simon Jones (at 5 mins) – (Monday 30th September)
• Gravesend Reporter newspaper – Eric Pickles tells survivor of Gravesend care home abuse to ‘adjust your medication’ (Monday 1st October)
• Metro newspaper – Eric Pickles tells alleged child abuse victim to ‘adjust your medication’ during heated exchange (Sunday 29th September)
• Independent newspaper – Eric Pickles tells survivor of alleged child abuse: ‘Adjust your medication’ – “Mental health campaigners aghast as minister recorded shouting at alleged child abuse survivor ‘adjust your medication’” (Saturday 28th September) – includes audio clip

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Additional links:

• Damien Hirst Pharmacy (1992)
• Eric Pickles‘s website – MP for Brentwood and Ongar and Secretary of State for Communities and Local Government (twitter @ericpickles)
• Teresa Cooper
  • No 2 Abuse – “Teresa Cooper’s No2abuse covers news and articles about Kendall House children’s home and the injustices to children and families” (twitter @no2abuse, @teresacooper)
  • Cooper’s video (sound only) of her altercation with Eric Pickles, which she posted on YouTube on 14th September

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The economics of the lunatic farm – and farming!

“That is the economics of the lunatic farm.” Say what? This curious phrase was used by Ed Balls, shadow chancellor, during an interview about the budget. It was such an odd phrase that it struck me that perhaps Balls had caught himself about to say something else then corrected himself, clumsily, at the last moment. Or perhaps that’s exactly what he’d meant to say, having in mind a particular badly run farm he’d come across during his economics studies at Oxford and Harvard.

This phrase lead me to think about the real life “lunatic farms” – farms within the grounds of long-stay lunatic asylums that existed until the last century, where inmates were required to do unpaid labour as therapy. (The pair pictured above were working on one such farm, based in a Canadian insane asylum.) It also lead me to think about city farms and present day farm-based mental health recovery programmes. And, finally, the Wurzles! A feast of farming thoughts inspired by one oddly-phrased remark. Read on.

When he made his comment. Balls was being interviewed by guest presenter Jeremy Vine for the BBC’s Sunday morning political programme, the Andy Marr Show. It was 3 weeks ago, days before the chancellor George Osborne was due to deliver the budget (Osborne was also interviewed on the show). In a tone of utter incredulity, Balls said:

“Spending cuts and tax rises have choked off recovery: let’s have even bigger spending cuts and tax rises. That is the economics of the lunatic farm! You’ve got to get the economy moving.”

Balls was, it seems, using the phrase in order to brand the chancellor’s “Plan A” not just a bad economic decision but, because of its association with lunacy, an outrageously foolish one too. The phrase was repeated throughout the day in news bulletins on all channels. As I tweeted at the time:

The “economics of the lunatic farm”? I guess Balls isn’t on Labour’s mental health task force, trumpeted by Ed Miliband at the Royal College of Psychiatrists last October.

(I blogged about the new mental health taskforce here and wrote a piece for the winter edition of One in Four magazine.) I had a bit of fun on twitter speculating what a “lunatic farm” really was. Perhaps, I suggested, it’s a place where lunatics are propagated under glass, before being planted out in polytunnels to grow, then harvested – a place where lunatics are farmed. Or, as Charlotte (twitter @BipolarBlogger) responded:

“Or like an ant farm, where they scurry about in transparent pipes for the amusement and interest of those outside?”

Or maybe Balls had had in mind a real life farm, whether existing or historic, that he’d come across during his studies of economics here and in the US, one that was really badly run. Had Balls studied farm economics? I wonder if farm management software (such as the one I came across online) would be useful to the farm Balls had in mind.

Whatever Balls meant, there did used to be real “lunatic farms” (whether badly run or not). Before they were closed down, some of the old lunatic asylums had working farms within their grounds. I wonder what it might have been like for people living in those old institutions and working on those farms.

An online search turned up the Asylum on the Lake, from where the image at the top of this blog post is taken, and which had such a farm. Based in Ontario, Canada, it was called the Lakeshore Psychiatric Hospital when it was closed in 1979. When it opened 90 years before, it was called the Mimico Insane Asylum. As the website says:

“This site attempts to portray the long and interesting history of the hospital, as well as honour the memory of the patients who lived, worked, and died there.”

Looking at the picture above (and there are more here), I wonder what mental health problems the man and woman had. What were their lives like on the farm? Did they enjoy their work? It’s one thing working a field on a sunny and mild April day like today, but quite another to do so mid-winter or in the heat of summer. How did the lives of asylum farm workers compare with those of others who worked on traditional farms in the same era? The website throws up some interesting details of the lives of its inmates.

As I was musing about “lunatic farms”,  Jon Beech (twitter @_jonb) sent me a link to what looks like a wonderful project in the West Midlands: a modern day scheme where farming is used to promote, amongst other things, mental health recovery. There are several such schemes. Search “care farming”, “farming on prescription” and “farm buddies” if you’re interested in the work of these modern day “lunatic farms”.

If you’ve been inspired by my farming musings to find out more or get involved, there are plenty of opportunities. For instance, if you live in a city you can get a little dose of the farming life by visiting or volunteer at one of the many city farms. I visited one only last week and it was an enjoyable (though bitingly cold!) afternoon out. Otherwise, you can get a taste of farming through the radio and TV (for example, on the BBC there are programmes such as Farming Today, On Your Farm and Countryfile). Or why not enjoy a light-hearted spoof on the farming life with the Wurzles’ 1970’s hit record Combine Harvester? That’s sure to bring a smile to your face.

I still don’t know what Balls meant by “the economics of the lunatic farm”. But I think I’d have rather been outside working the land than locked up in hospital with a weekly art therapy class and a windowsill full of plants. So, as I tweeted to Balls after seeing the Andy Marr Show interview:

“Where is this lunatic farm of which you speak? It sounds like somewhere I’d like to go.”

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• My Storify story (with tweets & links) – Ed Balls MP & the politics of the lunatic farm
• Asylum by the Lake – the site from where the picture above is taken – more pictures – more about the patients
• Ed Balls’ website – Transcript of interview on The Andrew Marr Show
• BBC One – Andy Marr Show interview with Ed Balls (on You Tube)
• BBC One – Andy Marr Show (series link)
• BBC news online – Social care cost cap and flat-tier pension brought forward
• My blog – The politics of mental health: the new mental health task force
• One in Four magazine, winter edition – Politics of mental health: raising expectations? Is mental health becoming a mainstream political issue?
• Reuters – UK’s Osborne to stick with austerity, pray for growth

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Farming links:

• Care Farming West Midlands – “For someone undergoing mental health recovery, a care farm can be the calm, supportive, natural environment they need”
• BBC One – Countryfile
• BBC Radio 4 – Farming Today – there’s also On Your Farm
• BBC Two – Toughest Place to be a … Farmer – comparing dairy farming in Devon and Kenya
• Farm Plan UK – “Agricultural software to help farms, estates and rural businesses manage records, demonstrate legislative compliance and access management information”
• Federation of City Farms & Community Gardens
• The Wurzles – Combine Harvester

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Using mental illness as an insult – Mick Philpott, Jon Snow & lunatics

We’ve all done it: casually thrown around as insults terms related to mental illness. This evening, Jon Snow, Channel 4’s lead news anchor, posted a blog in which he used the term “lunatic” as an insult in the tragic Philpott case. When picked up on it, Snow swiftly apologised and earned brownie points for doing so. At present, however, Snow’s blog post still contains the term.

The problem with calling someone convicted of manslaughter a lunatic is that lunacy is a synonym for insanity, a legal defence to murder; its use in relation to the Philpott case is sloppy and inaccurate. And the trouble with casually using terms related to mental illness to insult people is that it turns mental illness into an insult.

As background, Snow’s blog post was in reference to distasteful and misleading political posturing reported during the day. Various pundits and politicians (in particular the Chancellor, George Osborne, later endorsed by the Prime Minster, David Campbell) sought to capitalise on the sentencing of the Philpotts and their friend for the manslaughter of 6 children. (Take a look at the links at the foot of this page to explore the subject further.) To take one example of the coverage, the Telegraph newspaper said:

“The Chancellor has questioned why British taxpayers should be “subsidising lifestyles” such as those of Mick Philpott, who was today sentenced to life in prison for killing six children. Mr Osborne made the controversial comments during a visit to Derby shortly after Philpott and his wife Mairead were handed their sentences for intentionally setting fire to their home. Asked whether the Philpotts were a product of Britain’s benefit system, Mr Osborne said: “It’s right we ask questions as a Government, a society and as taxpayers, why we are subsidising lifestyles like these.”

Jon Snow has, in addition to his platform on a national broadcaster, nearly 300,000 twitter followers. He also introduced Channel 4’s 4 Goes Mad mental health season. He’s influential. Earlier this evening, I saw a tweet of his containing a link to a post on his Snow Blog about the tragic Philpott case. Snow’s post was titled: Can abnormal behaviour affect the welfare policy debate?

Snow, in a strongly worded rebuttal, asked whether there really was a case for regarding Mick Philpott’s behaviour as a valid ground for reforming welfare policy. He referenced, amongst others, statistics showing there were just 50 families in the UK with the same number of children as the Philpotts.

Philpott is not representative of people who are currently in need of the state safety net due to ill health, lack of private pension or inability to find paid work. And of course it is highly distasteful to use the tragedy of the deaths of 6 children for political purposes. Snow’s blog was robust and well-written, apart from this, which caught my eye:

“The idea that an entire system should be re-jigged to cope with a lunatic who burnt to death half the children he’d fathered seems questionable at the least.”

Here, Snow uses the word “lunatic” as an insult, in order very deliberately to convey the deepest disapproval. The trouble with using terms related to mental illness as insults – especially when it’s done by a figure as prominent as Snow – is that it’s just this sort of casual stigma that adds to the big fat stigma pie we’re being served extra helpings of at the moment.

As I then tweeted:

Disappointed @jonsnowC4 refers to Philpott as a “lunatic” when he was judged criminally responsible #casualstigma

Snow swiftly responded:

I apologise..that was sloppy of me.

And, in a response to another tweep, Snow tweeted:

I’m sorry the word ‘lunatic’ was very absuive [sic] usage..thoughtless..I should know better

I tweeted in response:

Credit to @jonsnowC4 for apologising so quickly for calling Philpott a lunatic. (Wish I was so good at apologising when I stuff up.)

Snow received plaudits for his quick apology, as my Storify of tweets shows. His fans hold him in even more affection now. For example, Rich Humphrey (@RichMHumphrey) tweeted:

“completely agree! Few in the media would hold their hands up like that. Even more respect for him now”

Finally, I also asked Snow:

Could you tweak the blog to remove the reference to lunatic? That’d be good.

At present, the blog has yet to be revised. Fingers crossed. There are so many expressive insults in the English language that there’s really no need to resort to using references to mental health as insults.

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Links related to the story above

• My Storify of tweets, including comments from Jon Snow – Using mental illness as an insult (4th April)
• Snow Blog, Jon Snow’s blog – Can abnormal behaviour affect the welfare policy debate? (4th April)
• BBC news – Derby fire deaths: Philpotts and Mosley jailed (4th April)
• BBC News magazine, Washington, US – How offensive is the word ‘lunatic’? ( 9th May 2012)
• Links to guidance on the use of language & reporting mental illness
• Guardian newspaper (2012) – Crazy talk: The language of mental illness stigma – “Terms used to denote mental illness are so common in modern language they regularly pass without comment.” David Steele

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Links on the debate about what (if anything) the Philpott case tells us about welfare benefits, in light of the notorious Daily Mail headline (pictured below right) and George Osborne’s subsequent comments:

Firstly, coverage on 4th April:

• BBC news – Osborne’s Philpott remarks spark row
• Guardian newspaper – Osborne ‘cynical’ to link Philpott deaths with welfare cuts, says Ed Balls
• Not So Big Society blog – The Philpott Case – A Lesson from History
• Telegraph newspaper – George Osborne criticises Philpott’s benefit ‘lifestyle’

Coverage from later dates (added to this blog subsequently):

• Guardian newspaper – Mick Philpott: if welfare’s to blame, so is the army, prison, feminism, TV etc – “Calls for benefit reform in the wake of Philpott’s conviction for manslaughter are predictable but troubling. Can one man’s sick psyche really be a political issue?” (5th April)
• Independent – Mrs Justice Thirlwall: The one woman Philpott couldn’t defeat (5th April)
• ITV (TV) – Debate: Is Mick Philpott a product of the welfare state? – with Owen Jones (Independent newspaper) & Paul Staines (Sun Columnist and editor of the Guido Fawkes blog ) (5th April)
• Sky News (TV) – Owen Jones & Harry Cole debate whether Philpott says anything about the welfare system (an example of the worst sort of taunting & point scoring) (5th April)
• Blog by Mark Thompson – The Daily Mail front page you’ll never see (6th April)

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The politics of mental health: the new mental health task force

Here’s a Storify story I put together from mine and others’ tweets following the major speech by Ed Miliband (leader of the opposition Labour party) on Monday 29th October at the Royal College of Psychiatrists in which he announced the establishment of a new mental health task force.

I started with this tweet:

“Dear @Ed_Miliband, good start, but remember there’s much more to good mental health than the NHS, drugs & treatment.“

Read on to find out what I mean, together with comments from others tweeps.

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• Here’s a link to the Storify story of my tweets

• Here’s a link to Ed Miliband’s speech
• BBC news: ‘Mental illness ‘biggest UK health challenge’ – Miliband (story & video)

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• (January 2015) Here’s a link to the text of Ed Miliband’s speech on the New Statesman website, since it no longer appears on the Labour party website using the link posted.

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