Tag Archives: Atos

South London and Maudsley on film: humanity and humour

28 Oct

Bedlam (4) OCT 2013Bedlam (1) OCT 2013

Looking at a newspaper story about the murder of drummer Lee Rigby earlier in the year, Lloyd, who has a diagnosis of paranoid schizophrenia, said that hearing about schizophrenics in the news made him feel worse. He worried that he didn’t know his own mind and wondered if he himself could turn into a murderer too, since that’s what he read in the papers. Dealing with the symptoms of psychosis can be difficult enough in itself. Having to deal with society’s perceptions that people with your diagnosis are violent and unpredictable adds another level of difficulty.

Earlier today, I attended an advance screening of Channel 4’s new series on the realities of modern mental health care at the South London and Maudsley (SLaM) mental health trust.  In the screening room in the basement of Channel 4′s headquarters in Horseferry Road, a select audience sat in red plush seats watching one of four programmes in the series on modern mental health care. The series is entitled Bedlam and the name choice has caused controversy. To an extent it can be argued that, when a respected NHS trust calls a television series after a medieval asylum, it dilutes the strength of the case against Thorpe Park’s “mental patient scary fun” horror maze Asylum. But what of the series itself?

The episode previewed profiled the work of Speedwell community mental health team (CMHT) in Deptford, south London, over the course of a year. The four-part series, which starts at 9pm this Thursday, also covers the Anxiety Disorders Residential Unit, Lambeth Triage (the front line for emergency cases) and the older adults unit (over 65s).

Without giving too much away, we followed patients Tamara, Lloyd and Rosemary, all of whom experience psychosis. We saw them trying to cope with periods of illness, voices, delusional beliefs about bed bugs and with children being taken into foster care.  We saw them using prescription drugs as well as speed and alcohol to help manage their troubling symptoms. We saw them at times chaotic and disturbed, and at other times funny and happy.

We saw social worker Jim Thurkle doing his best to hunt down and help patients, a third of whom refuse to engage with him. We saw Dr Tom Werner doing his best to confirm the stereotype of the psychiatrist in the bow tie. We saw the fine line between enabling someone to live the life they choose and intervening in the interests of their own health and safety.

Not once did we see someone who could be considered a danger to anyone else. Not once did any of the patients present as anywhere remotely near the stereotype of the paranoid schizophrenic mad axe murderer. What we saw was patients struggling to manage their lives in difficult circumstances, and the professionals who tried to help them.

It was particularly interesting to see the work of a CMHT  which, along with GPs, carry out the bulk of psychiatric care in this country. As the booklet handed out at the advance screening says:

“The lion’s share of SLaM’s work takes place in a community setting, looking after more than 35,000 people with mental health issues. SLaM treats 8,000 psychosis patients a year; 6,000 of whom are based and treated in the community. We touch on different treatments available and see intense and moving interaction with social workers and mental health teams.”

As Pete Beard, the producer of the episode, who answered questions after the screening, said:

“We wanted to reflect the realities of this challenging work, following the actual narratives of people walking a tightrope with their mental health as it happened and the teams who act as a safety net. I feel that these realities are rarely reflected accurately in the media and as a result it is important to demystify the work performed as community teams, especially taboo subjects such as being sectioned”.

It was profoundly moving to see someone taken away from their own home, against their will, and detained with no legal authority other than the personal opinions of a social worker and doctors. No police arrest, no court process, no judge, no jury. Just a simple form signed, and you have no choice about even the simplest things like what you eat, where you sleep or what shampoo you use to wash your hair. And, on a more intrusive level, you have no right to refuse medication.

This extended scene cannot help but make you reflect on the balance of power between the state and the individual, and on what society deems to be acceptable norms of behaviour. This is especially so when you’re dealing with someone you don’t really know, as can be the case when a mental health team is called out to consider sectioning someone. Britain has a proud tradition of eccentricity, but that is not tolerated if you are deemed to be mentally ill. Simply being a nuisance to others but in no way dangerous to yourself or others can, ultimately, mean three people decide on your behalf that your quality of life will be improved by a compulsory stay in a locked psychiatric ward.

The sectioning sequence made me think about the boundaries or free will and autonomy and to what extent people’s peculiarities are tolerated. I have been on the receiving end of such a process, and it changed my life irrevocably. As Dr Baggaley said, when he’s taken part in sectionings he does wonder whether this was what he trained for. Although he sees it as difficult, he does see it as necessary.

Dr Baggaley described the person in question as a “revolving door patient” who would face repeated hospitalisations, some under section (compulsion), for the rest of their life. And yet this is someone who will – under the current welfare benefits system – also face repeated Work Capability Assessments. It is hard to see the point of such assessments in this case particularly since, as Dr Sarah Wollaston MP wrote today, WCA’s are not geared towards helping people with mental health problems find and retain employment.

One of the things which struck me in this episode was the amount of humour. Despite their difficult circumstances and troubling symptoms, the patients followed could come across as affable, amenable and warm-hearted. Ripples of laughter would regularly rumble across the audience, and not just because viewers were looking for a little light relief in what was, after all, a serious topic. As with any other fly-on-the-wall documentary, the colourful charaters in this episode were full of humour. The seriousness of the subject matter made the flashes of levity even more welcome.

Overall, this preview episode was intimate, insightful and profound. It showed human beings in all our difficulties, complexities and ambiguities. It showed the realities of trying to combat the stigma around mental illness with humanity and humour. It showed that danger and fear are the least of the concerns of the CMHT.

On a final note, I will end with a criticism that was raised by audience members with personal experience of mental health services: namely that the episode was somewhat naive and unrealistic. Audience members had received far worse experiences of mental health care, or had been able to deliver a far worse service due to cutbacks. It was acknowledged by the film makers that Speedwell CMHT had a ring-fenced budget, so had not been under the same constraints and workload other CMHT’s they’d liaised with had.

It was also highlighted that a lot of the difficulties patients needed help with were practical, and that these needs were not being met. The patients were unable to deal with these matters themselves and therefore they were stuck in difficult circumstances. Examples were the bedbugs which did actually exist in Tamara’s flat. It was not a delusional belief (though its extent may have been) and dealing with that practical problem may have lessened her delusional symptoms. This and her use of amphetamines may also have been the way she managed the immense sorrow of losing her children. Lloyd appeared to be using alcohol to numb his pain.

With a series planned over two years and filmed over twelve months, much footage will have ended up on the cutting room floor. It’s a shame, however, that the close relationship between medical help and social support, and the parts played by talking therapies and thereapeutic activities, were overlooked completely in this preview episode.

Nor was the 9% reduction in inpatient beds in the past 2 years mentioned.  Nor were the terrible cuts to community mental health services mentioned.

On the other hand, as Madeliene Long, SLaM chair said:

“Despite it affecting so many people, mental illness is still poorly understood. The stigma and discrimination that people face can make their mental health even worse and can prevent them from seeking help. So it’s really important that we do everything we can to raise awareness, challenge stereotypes and promote the facts about mental health. I’m really pleased that we have been able to work with Channel 4 and The Garden Productions on such an ambitious project which sets out to do exactly that.”

As executive producer Amy Flanagan said,

“Many of these patients had lived long lives with no history of mental illness. It could happen to our parents, to us.”

And, if it does happen to us or someone we know, programmes such as these will mean it feels a little less alien and a little more a part of everyday life.

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Media coverage:

  • Channel 4 press release about Bedlam
    • Anxiety (Episode 1/4) – 9pm Thursday 31st October – “It’s a condition every one of us experiences from time to time, but imagine if one day you woke up and found your anxiety had spiralled completely out of control.”
    • Crisis (Episode 2/4) – 9pm Thursday 7th November – “At Lambeth Hospital in south London, the Trust has pioneered the use of short-stay emergency wards for patients in crisis. It’s effectively run like A&E but for those with mental illness.”
    • Psychosis (Episode 3/4) – 9pm Thursday 14th November – “In this episode we explore the world of the mentally ill who live in the community.”
    • Breakdown (Episode 4/4) – 9pm Thursday 21st November – “In the final episode of Bedlam, cameras gain access to a psychiatric ward for over 65s at the South London and Maudsley (SLaM).”

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South London & Maudsley NHS Trust:

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People involved:

  • Dan Charlton – Head off communications & media at SLaM (twitter @Dan_Charlton1)
  • Dr Tom Werner (twitter @TellDrTom) – psychiatrist & CBT therapist – website

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Related coverage:

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What does mental illness look like? The head clutcher

31 May
The Scream by Edvard Munch, 1895

The Scream by Edvard Munch, 1895

Once you start to notice them, they seem to be everywhere: the head clutcher. What are they? Not the image above, The Scream, an iconic portrayal of human misery, which has been much copied and parodied. Instead, they are stock pictures trotted out to illustrate media stories with a mental health angle, typically showing someone with their head in their hands.

I’ve tweeted about them before and, last week, I started to do so using the hashtag #headclutcher after seeing one stock photo (below right) appear in 3 separate media stories in the same day! Poor woman.

Head clutcher woman - she's popular with the press

Head clutcher woman – she’s popular with the press

In this blog post, I’ve drawn together what others have written about the head clutcher, including the blog by tweeter @Huwtube. After seeing my #headclutcher tweets, he wrote an hilarious post entitled The Rise of the Headclutcher, critiquing various such shots. It’s well worth checking out if you want a laugh.

Of course the serious side of this is that using stock head clutcher photos perpetuates an image in the public mind of what mental distress looks like. And, if you don’t meet that stereotype, well clearly you’re not deserving of help.

I’ve commented on this before (here) and I’ve experienced this myself. I can appear confident and cheerful and this counted against me in an Atos medical assessment (for eligibility for state sickness benefits): after checking I could touch my toes and reach overhead, the assessor noted in his written report that, because I had made eye contact, I must be fine. No mental health problems whatsoever. Perhaps if I’d spent the assessment with my head in my hands I’d have met with his expectations of what mental illness looks like and scored more than the zero points I was awarded.

As national anti-stigma campaign Time to Change says (in its guidance to journalists on choosing images to accompany stories with a mental health angle), “Some really strong stories that may include great content and have educational value can be weakened by the use of an inappropriate image”. We can do better. We should do better. We must do better.

Check out the links below for more examples of head clutcher shots, together with others’ blogs on the subject. And, if you come across more head clutcher shots or other stereotypical representations of mental illness in the media, please feel free to add them in the comments below.

Happy head clutching!

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My head clutcher Storify stories (with links):

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Links to others’ stories on the head clutcher and other media representations of mental illness:

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Media guidance:Head clutcher Simpsons The Scream

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Other stories about the use of stock photos:

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Mainstream media stories illustrated by head clutcher pictures (often the same one):

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Headclutchers in stories by other commentators:

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Hot baths & how I relax

4 Feb

The new cover for The Bell JarIMG-20130124-00982

“There must be quite a few things a hot bath won’t cure, but I don’t know many of them.” So wrote poet Sylvia Plath in her novel The Bell Jar, whose central character has clinical depression. Hot baths are certainly a remedy I turn to when feeling out of sorts. There’s a reason my Twitter avatar is a bath filled with hot water.

Last weekend, I was with a group who took turns to share one thing they did to nurture themselves, as a pick-me-up, to relax. Naturally I  mentioned my favourite cure all, the hot bath. One woman, when asked what she did to nurture herself, burst into tears and said she never had any time for herself. Then she remembered she’d recently had her nails done, and her nails were indeed a glorious deep berry colour. And, as we went round the group, we all learned new ways we could try out to relax ourselves.

I was really inspired by some of the suggestions, so thought I’d share them with the lovely Twitter people and at the same time ask them for their tips. If you can’t think of some way to nurture yourself, or are looking for some inspiration from things that work for others, take a look at the suggestions below and in the linked Storify story of tweets where there are many more.

I’m pretty sure there’s something for everyone! And if you have a tip of your own to share, please feel free to comment below or tweet me to be added to the Storify story of tweets.

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Here are some things the women in the group said they did to relax, to nurture themselves, to care for themselves:

“I sit in a coffee shop & watch people.”

“On Sunday, when I go for my long run, I take off my watch, leave my phone behind & just go.”

“I read gossip magazines like Okay. It feels good to focus on something completely superficial.”

“I put on my snuggly dressing gown. Whatever I’m doing, it’s really comforting.”

“One Sunday a month, I turn everything electrical off for the whole day.”

“Walking in nature” & “Walking my dogs.”

“On summer afternoons, I lie on the trampoline in the garden in the sunshine. In winter, I watch TV series.”

“I go to a spa or get a pedicure” & “I paint my nails”.

“I try on clothes in expensive shops!”

“I sit on my prayer mat & imagine it’s a magic carpet transporting me somewhere calm.”

“I spray my favourite perfume in the air” & “I use aromatherapy oils”.

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Here are some suggestions from the lovely Twitter people when I asked the following:

What helps you to nurture yourself when you’re feeling out of sorts? What says “me time” to you? What do you to relax? What are your tips? #howIrelax

  • I bake, put radio 4 on and create yummy food … lifts my spirits always (Fibrogirl @fibro_girl)
  • I always watch police programmes – watch someone else get into trouble for a change! (Petrolhead999 @Petrolhead999)
  • My garden, birdwatching, long hot bubble baths, my cats and music (I make ‘rescue’ cds/playlists) for when things are bleak (Liz (@redliz)
  • Do something you enjoy: baking, reading, dancing, seeing friends/family, walking, running, painting. Put a hole in your stress bucket. (LYPFT Library @lypftlib)
  • Hot bath,relaxing music, undersea nature documentary, drawing/painting/collage, writing poetry and masturbation (Michael Brown @brownie1983)
  • Long hot bubble bath seconded. (Stroppy Ambo Woman @Stroppyambo)
  • Watching my pets, baking, knitting, youtubing animals. (Just another one @priorynutter)
  • With mental health specifically: just stopping & forgetting any responsibility I feel to “work through” the feelings of anxiety & depression. (Coffee Zombie @xcoffeezombiex)
  • I play the keyboard. When low it brings me out of myself, when high it burns off rocket fuel safely (Polarbearcub @megandoodah)
  • Knitting, as it helps to keep my mind and my body occupied. I also essential oils as smell is an easy distraction technique. (Bexatron @DuckBeaki)
  • Bath, music, horlicks, clean sheets. oh, and crochet! (Ceri Jones @liberatedwomble)
  • People watching is great. Listen to music. (ForeverMorrissey @Mozgirl71)
  • I take a nice long hot bubble bath, light some incense and candles and play calming music (Sarah @sarahxXx1990)
  • I tend to put headphones on to block out the world with music or a marathon of a favorite tv show. (Roiben @roiben)
  • I’ve always been helped by music, both listening and playing, can relax, elate, or show you’re not on your own (Shaun Blezard @cluttermusic)
  • I watch the sunrise, and sunset! (Rokayah415 @Rokayah415)
  • Read novels, swim, workout at the gym, pat my cat, go shopping (not food), watch movies (Anna Butterfly @aButterfly123)
  • As a nerd I play computer games to purge my mind of the insanity of my day. Nothing like wiping out Alien hordes to destress (Notjarvis @notjarvis)
  • Has to be the relax cd by Paul McKenna for me with benzoin aromatherapy oil! (Michelle @oldtrouty)
  • Favourite music, lush baths & clouds. Oh … and Twitter – for good virtual support from good people. (Kimbohud @Kimbohud)

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If you have any suggestions of your own, please comment below, or tweet me to be added to the Storify story (check it out – there are many more helpful suggestions here too).

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  • Storify story “How I relax” of my tweets & those of others. (Last week I learned from Victoria Betton (@VictoriaBetton) that asking people to contribute in this way is called “crowd sourcing”!)
  • Another good way (backed up by science) for reducing stress and anxiety is to look at images of nature & other cute stuff – so I also have a page of cute stuff that I update as I come across new material.
  • Sylvia Plath’s novel The Bell Jar was in the news last week when a new 50th anniversary edition was issued with a controversial “chick lit” cover (pictured above) – eg “The Bell Jar’s new cover derided for branding Sylvia Plath novel as chick lit” (Guardian, 1st February 2013)

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What does mental illness look like? Panorama & the Great Disability Scam

29 Jan

Panorama - The Great Disability Scam

Last night, BBC One’s Panorama presented a half hour documentary on the government’s Work Programme. This was introduced 18 months ago to help people who’ve been out of work for a long time get back into employment. The focus of the documentary was on how this programme was working for those with disabilities – the “hard to place” candidates. It exposed a culture of paid-by-results private providers cherry picking the easiest to help, parking those considered hard to help and insulting attitudes towards clients who who some staff labelled as LTBs – Lazy Thieving Bastards.

When I watched the programme earlier today, I was shocked by the interview with Mark Gould, diagnosed with anxiety and depression and out of work for several years.Panorama - The Great Disability Scam 3 The interviewer, Samantha Poling (pictured left) appeared to goad him into demonstrating behaviour that would make him “look like” he was mentally ill. It’s not an easy segment of the programme to watch.

That sparked a series of tweets, which I’ve collated here (links below), on the subject of what mental illness looks like, how it is perceived by the public and what that means in terms of access to welfare benefits when you’re unable to work – both in terms of the public’s perception of those who don’t “look” ill, and how Atos conducts Work Capability Assessments of people signed off by their own doctors as currently unfit to work. Panorama - The Great Disability Scam 2

I then commented on the fact that what you look like also forms a component of a psychiatric assessment. The Mental State (or Status) Examination includes observations such as whether you have a bizarre hairstyle or unnatural hair colour. I’ve written and tweeted on this before, in the blog post “You can’t dye your hair red”. I look at the contents of the MSE in more detail in these tweets.

It was interesting that the final segment of Panorama ended with an extended shot of a man in a wheelchair making his way slowly up a sloping street. That, it seems, is how people view disability.

Hope you find my tweets interesting. The best part, of course, is the responses of others. All the links are below.

If you have any comments on the post or the programme, please feel free to add them below. I’ll include new tweets that come in by updating the Storify story.

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Mental health & Atos: my doctor says I need to rest my brain, but Atos says I must jump through mental hoops

12 Nov

I’ve been feeling strange for a few days, building up from when the Atos letter dropped onto my doormat. It seems I’m struggling to face the Atos process.

My brain feels overloaded by the thought of it, and that prevents any action. I’m focussing on trying to bring myself back to calmness. Hopefully at some point soon I will be able to get a little further than picking up the letter, turning the form over in my hands, feeling overwhelmed by the seeming enormity of the task at hand & all the various permutations & the implcations of getting it wrong … then having to put it back down and leave the room & distract myself with something restful. I’m just not up to it now, and I know I shouldn’t be putting myself through this.

My recovery so far is based on listening to myself and knowing when I can do more and when I should be resting. I tried to take on too much earlier in the year and it backfired.

I don’t want that to happen again. So I’m trying to take baby steps. I should be resting my brain now. But I know the Atos timetable is ticking down. The deadline is looming …

[Here’s a link to a Storify story on this topic]

My tweets on the topic

 

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