Tag Archives: schizophrenia

How’s your day been? A Day in the Life

15 Nov

How are you cartoon

How’s your day been? That’s a question you’ve probably asked many times, and been asked a fair few too. It’s part of the normal everyday engagement between people that oils the social wheels. Often it’s not a genuine enquiry in the sense that a detailed response is not expected: instead, it’s a baton being passed, with you expected to pass it back and say, “Fine thanks. How about you?” That “fine” can mask a lot of days that aren’t fine, whether better or worse, but we’re all expected to join in the general cheerleading, pretending to be “fine” too.

For people struggling with mental health problems or managing a long-term mental health condition, how our day has been is probably a bit of a mystery to the general public. This can be a source of assumptions, stereotypes and prejudice, whether that’s the “lazy faker” of depression who just needs to take themselves in hand and go for a brisk walk; or the “dangerous maniac” of schizophrenia who should be monitored and contained for public safety. These prejudices and stereotypes can feed into self-stigma that brings about a sense of isolation.

Our daily lives are also likely to be a bit of a mystery to the professionals who provide our care, whether that’s a therapist an hour a week, 20 minutes with a psychiatrist every 3 months or 10 minutes with a GP every few weeks. What it’s actually like to live with a mental health problem can be pretty uncharted territory unless you’re doing it yourself or living with someone who is. There’s so much more to good mental health, and to good mental health services and support, than the NHS, drugs and talking treatments. People just like me are out there, living our lives, quietly getting on with things day to day, and there’s a new project that aims to capture that reality. It’s called A Day in the Life.Beatles A Day in the Life yellow

A Day in the Life (the mental health project, not the Beatles song) asks people with mental health problems to share what their day has been like – and what has helped or made the day worse – on four set days over a year.

The project aims to shine a light on the everyday lives of people with mental health problems to raise awareness and to help the general public better gain a better understanding: to challenge myths and bust some stigma. It also aims to get people who may never have blogged before writing about how their day went – and perhaps then finding an online voice they never knew they had. There’s guidance on how beginner bloggers can start writing.

But another objective – and the reason the project is funded by Public Health England – is to help policy-makers understand what makes a difference – good or bad – to the lives of people with mental health problems. Although not a scientific study, the project will provide an insight to help influence policy decisions on services provided in future. The online snapshot diaries will also help to highlight emerging themes and suggest future areas for investigation.

I’ve signed up to take part in the project and have already posted my entry for the first day, Friday 7th November. The remaining three days will be in winter, spring and summer 2015.

Follow the project on twitter using hashtag #DayInTheLifeMH and scroll down to find out more about the project and how you can take part.

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Below is my entry for 7th November, which will appear on the Day in the Life website when everyone’s contributions so far – totalling around 370 – go live on Monday 17th.

Please note: I chose to speak very candidly about what I experienced that day, so please read with care if you’ve been affected by suicide, suicidal thoughts or depression – or simply scroll down to the bottom where you’ll find useful links.

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I’m on Twitter – a lot! So, as usual, after turning off my alarm, the first thing I did this morning was to check what tweeps I follow had posted, to catch up on news in the mental health world. Then, returning to bed with breakfast and my pet, as it was the last day to sign up to #ADayintheLifeMH, I sent out a series of tweets to encourage as many people as possible to sign up. The more sign-ups, the more varied a picture of living with mental health problems it will provide.

Next, I checked what had been happening on the #SamaritansRadar hashtag. Samaritans Radar was launched by the Samaritans in October and, ironically, had had a disastrous impact on the Twitter mental health community. Numerous tweeps had contacted the Samaritans by Twitter, email, phone and letter to beg them to take the secret automated surveillance and alert app offline. Experts in various different professions had written about legal and ethical concerns. Mental health experts by experience had blogged about their pain and distress. There was an online petition, an investigation by the Information Commission and even a group proposing legal action against the Samaritans. I was involved in the campaign to have the app taken offline till it could be made safe.

On checking Twitter, it was clear that the outcry was continuing. And the Samaritans had tweeted their followers about A Day in The Life Mental Health!

Next, I tried to work on a blog post about the app. The powerful psychiatric medications I take have an impact on motivation, focus and concentration and, since I’d started taking them, I couldn’t quite connect the dots. It was cripplingly frustrating and is one reason I spend so much time on Twitter: 140 characters just about matches my attention span! Being sedated so your higher functions no longer work properly makes it hard to manage a home and get everyday tasks done, let alone get anywhere near organising your own healthcare in a system that relies on people being pushy. Being a sedated blob doesn’t get you very far and is one reason I haven’t been able to get proper treatment for myself over 3 years since I was discharged from hospital. Here I am, still parked on welfare benefits.

I struggled for a while to try to gather together my thoughts on Radar down on paper, but was unable to do so. I tried to make an overdue phone call, but couldn’t. So I had lunch, then caught the bus to a medical appointment.

Later, as I walked back through a tree-lined park on a beautiful autumn afternoon listening to the radio, I heard a trailer for this evening’s BBC Radio 4 Any Questions saying that one of the topics the panel would discuss was the Assisted Dying Bill. This caused my own “suicide radar” to go off.

Ever since getting notice of eviction from my home so my landlord could sell it (2 months’ notice, out of the blue, after over a decade), I’d been tipped into a deep, debilitating depression. At times, I was utterly tortured by suicidal thoughts. My home had been my security and stability and now I was losing that. And the awful Radar app had thrown a spotlight on suicide, meaning my Twitter feed was full of intellectual suicide talk.

Suicide was being discussed as a fascinating concept, rather than what it was to me and many other mental health folks using twitter: a very real mental pain we were struggling with at that very moment. At times, it seems as if there’s a part of my mind monitoring everything just in case it might be useful in some way in despatching myself – my own “suicide radar”. That’s why the Assisted Suicide Bill caught my attention. Being able to die with dignity alongside friends and family – rather than experience years of unalleviated suffering or go for a secret and uncertain DIY method –  was an option I’d like to have available too.

I’ve had thoughts about suicide in all sorts of places, with all sorts of people and whilst doing all sorts of things. Sometimes I’ll be plagued by all-consuming thoughts of suicide; other times they’d be a background hum, like a reflex response to every turn of events, a mental tic; and sometimes, as today, there’d be calm planning. These thoughts were going through my mind as I walked through the warm autumn afternoon, kicking up piles of fallen leaves. No-one looking at me would have known.

Back home, I checked Twitter again. At 6pm, the Samaritans tweeted to say that, after 10 days of uproar, the Radar app had been suspended! It was a begrudging statement which did not acknowledge the distress the app had caused, and the so-called apology was an example of how not to apologise. But, nevertheless, the announcement meant that mental health folks could sleep easier in their beds over the weekend. I continue to feel uneasy as to what “suspension” means in practice. Whilst no-one doubts the app was developed with good intensions, the way it was imposed on everyone had damaged trust in the Samaritans.

I spent the evening debating with people on Twitter about Samaritans Radar, listening to Any Questions, then retiring to bed to read Everyday Medical Ethics and Law. It didn’t use to be my sort of book at all, but that was before I was unlawfully arrested, sectioned, held in seclusion and treated by force. Nowadays, chapters on patient autonomy and choice and how they are glibly brushed aside for mental health patients concern me deeply.Close quotes

Sadly, lack of concentration scuppered my attempts to read the book – so it was back to Twitter.

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“A murderous psychosis”: mental health and dangerousness

28 Jul
Photo credit: Sean Jones QC

Photo credit Sean Jones QC @seanjones11kbw

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You know the stereotype: the “mad axe-murderer” or “deranged maniac” who appear in the media in the extremely rare and therefore newsworthy instances where someone with serious mental illness commits a violent crime. I wrote recently about how the “unpredictable and potentially dangerous” stereotype is so accepted that it goes unnoticed, assumed to be a natural fact; how it is therefore repeated, and reinforces negative assumptions about those of us managing mental health problems in our daily lives. Almost goes unnoticed, that is, because I for one do challenge outrageously stigmatising and inaccurate stereotypes about mental ill-health when I see them. I say this sort of thing:

  1. People with mental health problems are far more likely to be victims of crime than perpetrators; and are far more likely to be victims of crime than the general population.
  2. People with serious mental illness are far more likely to take their own life than that of someone else; and the vast majority of people with serious mental illness are never violent towards others.
  3. The risk factors for violence – such as being male, having a past history of violence, or of alcohol or drug abuse – are the same as for the general population as they are for people with serious mental health problems; therefore, measures to reduce violence will be more effective if targeted at the general population, not specifically at mental health patients.
  4. Violent acts during psychosis are so extremely rare that it is not possible or practical to predict let alone prevent them – other than by measures aimed at the general population.
  5. Psychosis is causal in violent crime in a tiny minority of cases; where someone with a mental health diagnosis commits a violent crime, the mental illness causes the crime to be committed in only a tiny minority of cases. In other words, almost always, mental illness is simply another of a person’s characteristics, in the same way as diabetes or red hair.
  6. People with mental health problems are, well, people.

Yesterday, I was asked by Sean Jones QC to put my money where my mouth was and come up with research links to dispel his “murderous psychosis” stereotype that I’d just challenged. How did I know that these statements, which all contradict the stereotypical media portrayal of people with mental health problems, are true? How could I prove these points to someone who wants to know – or at least give them sufficient information so that they can go away, do their own checking and make an informed judgment for themselves?

When someone asks me what my proof is that the “murderous psychosis” stereotype is untrue, I usually refer them to organisations like Time to Change, Mind and Rethink Mental Illness. In other words, experts; organisations that make it their full-time business to know what’s what in the field of mental health.

Both are a good starting point. However, they may not satisfy someone who wants to drill down into the details themselves. Of course they could contact those organisations direct themselves, but what can I do to help? What else is there, if you want to dig a little further? Here are some more links I send to people:

Here’s more about psychosis and on still being human whilst having serious mental health problems:

  • Sometimes (I Have Schizophrenia)/All Of The Time (I’m Just Human) (3 mins). There are many more videos in Jonny Just Human, Jonny Benjamin’s YouTube channel on his experiences of schizoaffective disorder and other stuff on being human. In the words of Jonny Benjamin, “We’re not all dangerous or violent, as some papers would have you believe.”
  • Finding Mike – Short film (45 mins) including Jonny Benjamin talking about his experiences of psychosis (here’s the 50 second promo trailer).
  • Facts about psychosis from mental health charity Mind – “Psychosis (also called a psychotic experience or episode) is when you perceive or interpret events differently from people around you. This could include experiencing hallucinations, delusions or flight of ideas.”
  • A personal experience of psychosis from mental health blogger Charlotte Walker (April 2014)
  • Simon says: Psychosis! – Short film in which (amongst others) people with lived experience of psychosis talk about their experiences of psychosis in the context of receiving treatment from a particular Early Intervention in Psychosis service (June 2014)

These are all good places to start. But where else might I point people to? I’m good in 140 characters – but that’s about it. I’ve retweeted interesting studies when I’ve randomly stumbled across them, and that’s how I’ve formed my views. I’m not a mental health researcher. I’m not even organised. I don’t have access to scientific reviews behind pay walls. I haven’t been collating a database of relevant research – unless you count my list of favourites on twitter (currently running to over 2,000).

New research is published all the time but the general public (including me) will mostly only have access to press reports on the research, which typically highlight some juicy aspect to ‘sell’ the story to potential readers. I’ve also noticed that not all research is particularly good quality: sometimes research seems to ask the wrong questions; some studies look at just criminals or just people with psychosis, rather than looking at the whole population. Mostly it seems research conflates cause and correlation, simply counting violent crimes by people with mental health problems when the fact of having a mental health diagnosis (either at the time a violent act was committed or at a later assessment) does not prove that the mental health problem was the cause of the violence.  There was a US study I came across that said, in convicted violent criminals with serious mental illness, the mental illness was the cause of the offence in under 7% of cases. It was interesting because it highlighted the difference between having a mental health problem at the time of a crime and that mental health problem having been the cause of the crime. But then I lost the link to the study and haven’t been able to find it since. Like I say, I’m good in 140 characters.

Like plane crashes, “murderous psychosis” makes the headlines because it’s rare. It’s alarmist, inaccurate and causes suffering to people managing mental health problems in our daily lives. There’s ignorance about psychosis & violence, with the media stereotype we’re fed. But, when challenged, some people do want to know more.

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“He’s a psycho” – Professor Adrian Furnham on the importance of cleansing the workplace of undesirables

19 Jun
Harry Enfield as Kevin the Teenager (PA)

Harry Enfield as Kevin the Teenager (PA)

 

Have you seen this? Rachel Hobbs of mental health charity Rethink Mental Illness asked me this afternoon. She was referring to the charity’s response to a piece in the Sunday Times headed “I’m sorry, he’s not a differently gifted worker – he’s a psycho”. I’d just arrived home so hadn’t but, sadly, I had already seen the piece that prompted the rebuttal – and been shocked to the core.

The Sunday Times piece to which Rethink had issued a response advises employers of the necessity of screening job applicants and employees to weed out undesirable ones. The author writes:

“There are three important questions. The first is how you spot these people at selection so you can reject them … The second is, given that they have already been appointed, how to manage them … Sometimes it is a matter of damage limitation …  The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.”

Putting aside for one moment the reference to “maladaptive personalities” and the telltale use of “these people” (a clue that we’re about to experience a group of people being made “other”), this all seems fair enough. After all, what employer wants to end up lumbered with rogues or duffers, or people who are simply not suited to the post being filled?

In any recruitment process, whether to fill a new role or replace a departing employee, some sort of selection process is inevitable. Indeed it is welcome, since it will give both prospective employer and employee the opportunity to see whether post and candidate are a good fit. I’ve read plenty of books and done courses including interview techniques, networking, career development and workplace psychology. I’ve undertaken interviews and assessments. It’s an interesting field and one that can bear fruit for employers and employees.

So what’s the problem? The problem is that the premise of the piece is – regardless of the role to be filled – people fall into two categories: they are either desirable or undesirable in the workplace, and the “unemployables” are to be hunted down and excluded. “These people” are to be avoided at all costs. “These people” have “maladaptive personalities”.

“These people”, according to the piece, fall into 5 categories, namely people who exhibit what is classified as antagonism,  disinhibition (Harry Enfield’s Kevin the Teenager – pictured above – is the illustration the author provides for this category), detachment, negative affect or psychoticism (bear with me – this isn’t made up). Each, as described in the piece, has a clear link to mental health problems.

Reading the piece, I had several strong immediate reactions – to the extent I sat down and wrote out my thoughts (then, unhelpfully, lost the piece of paper; perhaps there should be a sixth category of “unemployables”, the abstent-minded).

First, I took away the message that (based on the characteristics of the people described in the 5 categories, some of which I share) I was most definitely not wanted in the workplace. I was not wanted in the workplace and there were armies of workplace psychologists devising tests designed to make jolly sure I wouldn’t be able to sneak in undetected.

It felt as if, when I finally feel able to re-enter the competitive employment market and, were I ever to make it through to a job selection process, there would be a head to head battle. On one side would be the selectors, trying to expose my “maladaptive personality”; and, on the other, me, desperately trying to keep my deficiencies and undesirable characteristics under wraps. Then, in the unlikely event I was able to pull the wool over their eyes and win on that occasion, I would always be at risk of exposure and therefore dismissal. And, even if I started a job mentally healthy but then (for whatever reason – even if it was because too much work was loaded onto me at work, causing unnecessary stress) I became unwell, my employer wouldn’t seek to support me, a valuable employee, through that illness – but instead try to get me out.

I was reminded of the recent disappointment of prospective cabin crew Megan Cox. Notoriously, her offer of a dream job with Emirates Air was withdrawn when she disclosed a past history of depressive illness. In Megan’s case, it was clear that the prospective employer had based their decision on generalisations about depressive illness rather than the individual under consideration. Perhaps they were administering a standardised workplace psychological assessment which sought to weed out the undesirables. Megan Cox was deemed undesirable by Emirates Air. Lucky escape for them that they were able to spot her during the recruitment process. The piece made clear that, similarly, I would be weeded out.

Second, the contents made me want to send the piece to all those people involved in making decisions about the social security support of people who, like me, are managing disabilities, to show them the high barriers we have in getting into employment. Only today, it was reported that Employment and Support Allowance and the Work Programme were costing more than the predecessor welfare benefit Income Support and were getting fewer disabled people back into work. Is it any wonder that a system based around the notion that disabled people are out of work because of a lack of motivation (and incentives – or, rather, penalties) to seek work will fail when the actual barrier is the attitudes of employers – fed by pieces such as these – towards people with disabilities?

Third, having assumed at first glance that the piece was written by a generalist journalist to meet a deadline, I was gobsmacked to find it was written by a professor of psychology. A renowned academic – Professor Adrian Furnham – of a renowned institution – University College London – was the author. It simply did not compute.

So then  I did a little reading around the subject on the internet. I discovered that Furnham hadn’t made up terms like “dark traits” or “psychoticism”. No: they were legitimate. These terms came from last year’s new version of the US psychiatric manual (DSM5) and from workplace psychology (for the past couple of years).  The meat of the piece seemed to be almost a cut and paste from ideas that would be familiar to people who’d studied the field: nothing new, surprising or out of the ordinary. This wasn’t some rogue piece by a lazy journalist in a hurry: it reflected current thinking in (US) workplace psychology. That was hard to swallow.

However, on reading the piece again, there were some flaws (whether of the author or in the editing) which meant it was skewed to paint a worse picture than US workplace psychology actually seems to do. Thank goodness. For instance, the professor conflates the DSM5’s “maladaptive personality traits” (undesirable characteristics) with “maladaptive personalities” (undesirable people). To confuse a trait with a person is a big leap – and a damaging one for the people on the receiving end of the “undesirables” label. Furnham also conflates mental illness (with references to “disorders” and “pathology”) with personality disorders (he lists the 3 DSM5 clusters) and personality traits. Thankfully, therefore, the piece isn’t an accurate representation of the current state of play. In fact, it’s a bit of a mess.

In addition – as is common with fear-mongering pieces – the particular damage “these people” could do in the workplace is left vague; but the fact that they will cause damage is made plain.

The trouble is, however, that anyone not familiar with the nuances in the field (and that might be your average Sunday Times reader) would easily be expected to come away with the very clear message that people with mental health problems – yes, people like me – should be excluded from the workplace at all costs. And that is a damaging message.

Which leads me to my fourth thought on the topic: I wonder (and I don’t know) whether the piece might breach disability discrimination laws.

Furnham argues for keeping “these people” – people with “maladaptive personalities”, people whose symptoms which, as described, fall within mental health diagnoses such as anxiety, depression and schizophrenia – out of the workplace. My understanding is that, where a condition impacts on someone’s health for 12 months or longer, that counts as a disability and is protected by law. In other words, discriminating against someone in these circumstances counts as disability discrimination.

I’m trying hard to see how advising employers on how to avoid employing or get rid of people with disabilities is any different to advising employers to not employ black people or gay people or women. Whether or not it amounts to disability discrimination, it’s clear it is not good to advocate discrimination in the workplace.

Rethink Mental Illness has been in contact with the author and are hoping to have a piece – written with other mental health charities – published in this weekend’s Sunday Times. Rethink reports that Furnham and colleagues were surprised at the reaction to the piece and believe it has been misinterpreted. It seems to me there is a clear opportunity for a dialogue, and for largely commercially-focused workplace psychologists to gain a greater understanding of the crossover between their work and mental illness and the role they can play in the negative stereotypes.

Until employers are willing to consider job candidates or existing employees as individuals rather than categories based on assumption, the prejudices and assumptions of employers will impact on people managing mental health problems like a form of modern straight jacket.

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Update smallThe Sunday Times published a letter from Rethink Mental Illness and others on Sunday 22nd; and the following day Furnham wrote to explain, apologise and request that the article be withdrawn. Constructive engagement and a willingness to engage produced a positive result.

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Emirates Air and depression

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Here’s the full text of the piece written by Adrian Furnham and published in the Sunday Times on 17th June under the heading “I’m sorry, he’s not a differently gifted worker – he’s a psycho”:

Open quotesTWO things account for the success of a popular personality test: extensive marketing and the reassuring message you get with your results. Whatever profile you have, or type you are, “it’s OK”. We have different gifts. We can’t all be the same. Everyone is fine. Celebrate your quirkiness.

The message makes it easy for consultants and trainers. Researchers, however, know that one of the best predictors of success at work is (raw) intelligence, along with emotional stability and adjustment. But too many in the selection business are afraid of using well-proven tests to assess these factors for fear of having to deliver feedback such as: “Sorry you were unsuccessful in your application: the reason is that you are too dim and too neurotic.”

However, the message of “we are all OK” is not true. There are people with a distinctly unhealthy personality. There are many words for this. Some talk of “dark-side” traits, others of “abnormal” traits. And for more than 20 years, clinicians have talked about the maladaptive personality.

Researchers have recently tried to spell out traits that are most clearly manifest in the maladaptive personality. There are five of them.

Antagonism
This is defined as manifesting behaviours that put people at odds with others. It has components such as manipulativeness, deceitfulness, self-centredness, entitlement, superiority, attention-seeking and callousness.

Antagonistic people put everyone’s back up. They are selfish, self-centred and bad team players. The clever and attractive ones are the worst, because they use their skills and advantages to get what they want, come hell or high water.

Disinhibition
Defined as manifesting behaviours that lead to immediate gratification with no thought of the past or future. It has components such as irresponsibility (no honouring of obligations or commitments), impulsivity, sloppiness, distractability and risk-taking.

Think Kevin the Teenager. It can mean enjoying shocking others with unacceptable language, outlandish clothing or poor manners. This may be amusing in the playground but hardly acceptable in any form in the workplace.

Detachment
This is defined as showing behaviours associated with social avoidance and lack of emotion. It has various components, such as a preference for being alone, an inability to experience pleasure, depressivity and mild paranoia.

These are the cold fish of the commercial world. They seem uninterested in nearly everything and certainly the people around them. Some seem frightened by others, most just not interested in being part of a team.

Negative affect
This is defined as experiencing anxiety, depression, guilt, shame, anger and worry. It has components such as intense and unstable emotions, anxiety, constricted emotional expression, persistent anger and irritability, and submissiveness.

These are the neurotics of the world. They can be very tiring to engage with and highly unpredictable because of their mood swings. The glass is always empty, and they seem always on edge.

Psychoticism
This is about displaying odd, unusual and bizarre behaviours. It includes having many peculiar beliefs and experiences (telekinesis, hallucination-like events), eccentricity and odd thought processes. Some may see such people as creative, others as in need of therapy.

Psychiatrists have grouped those with personality disorders into three similar clusters: dramatic, emotional and erratic types; odd and eccentric types; and anxious and fearful types.

There are three important questions. The first is how you spot these people at selection so you can reject them. This is easier with some disorders than others. It is virtually impossible to spot the psychopath or the obsessive-compulsive person at an interview. Clearly, you need to question those who have worked with them in the past to get some sense of their pathology, which many are skilled at hiding.

The second is, given that they have already been appointed, how to manage them. There is, alas, no simple method that converts the antagonist into a warm, open, honest individual or the disinhibited worker into a careful, serious and dutiful employee. Sometimes it is a matter of damage limitation.

The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.

Adrian Furnham is professor of psychology at University College London and co-author of High Potential: How to Spot, Manage and Develop Talented People at Work (Bloomsbury) Close quotes

 

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Schizophrenic leaders

9 Feb

Hypocrite

“As long as they’re not two-faced, hypocritical, schizophrenic.”

What would you say if you heard that in a meeting? Would you pipe up there and then to challenge the misuse of a psychiatric diagnosis in that way? Would you seethe and stay quiet, lost for words or not wanting to expose yourself to scrutiny? Would you follow up quietly afterwards? Or let it drop, for the sake of self-care or personal privacy? What’s the best way to educate people about the negative impact of stigmatising stereotypes and the use of terms related to mental illness as insults? What would you do?

Here are some thoughts on the topic of the casual use of the word “schizophrenic” in a derogatory way and how (and whether) to challenge it. First my musings, then the responses and suggestions of the lovely twitter people.

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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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Can stigma be challenged by evoking stigmatising stereotypes? From the Maudsley to Bedlam

2 Oct

Bedlam Hospital

Earlier today, the South London and Maudsley NHS Foundation Trust (SLaM) announced the title of its new Channel 4 mental health series. Filmed over a year, the four-part observational documentary series would take what was billed as an “in-depth and unprecedented look” at “the reality of providing [and receiving] mental health services in the twenty first century”. We were promised “exclusive access” to patients and staff “covering aspects of mental illness you may never have seen before”.

So far, so enticing and, with the prestigious SLaM at the helm, we were sure to be in safe hands. And yet, what title had SLaM chosen for the series? Bedlam.

Yes, Bedlam. That institution dating from medieval times the mention of which evokes images of madmen, chaos and barbaric treatments: just put the word in a search engine and see what pops up. Images of naked people writhing on the floor in crowded rooms, watched over by ladies in crinolines holding handkerchiefs to their noses. Of unhappy people chained to walls – by the neck. Images that play to every negative stereotype – such as dangerousness and unpredictability – about mental ill health.

This post explores my conversation with SLaM over the course of the day, together with fascinating insights from the lovely twitter people on whether Bedlam was a suitable choice for the forthcoming documentary series. Ultimately, SLaM decided that they will publish a statement setting out in more detail the background to the filming as well as what they refer to as “the name issue”.  At present, I’m left with a number of important unanswered questions. Read on to find out more.

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[Update: On Thursday 3rd, SLaM issued a statement – linked below – clarifying their choice of name.]

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My reaction on seeing the title of the new documentary series was: this title has been chosen purely to grab attention, sacrificing stigma-busting on the altar of viewer numbers. So I tweeted to SLaM:

“Curious to know why a documentary series about today’s mental health services has been given a name from the Medieval age. Can we expect footage of today’s treatments to be interspersed with dramatic reconstructions and references to Medieval ones? If so, can we see actors writhing in straitjackets or chained up in baths. Would make for entertaining TV!”

Hey, why not go the whole hog and call it Straitjacket, Chemical Cosh or even Naked Lunatics? SLaM replied, “It’s a reference to our heritage – we can trace our roots back to 1247. Our website can provide more info,” and linked back to the original press release. Indeed, I’d already read this in the press release:

“The title was decided upon both by SLaM and Channel 4. It’s based on the fact that SLaM can trace its roots back to 1247 when the Priory of St Mary of Bethlehem was established in the City of London. The priory, which became a refuge for the sick and infirm, was known as ‘Bedlam’ and was the earliest form of what is now Bethlem Royal Hospital.”

Yes, but … this is a series about modern mental healthcare, not the history of treating mental illness. This was a series which SLaM said they hoped would:

“… help challenge the stigma and discrimination that still exists today and to promote better awareness and understanding of mental health issues.”

Which brings me to the premise of this blog post, namely:

Is it possible to challenge stigma by evoking stigmatising stereotypes? Is it possible to promote better awareness and understanding of mental health issues by conjuring images of medieval madhouses and Victorian lunatic asylums?

SLaM’s view is, it seems, yes. But what did others think? Here are some of the responses I received when I asked the lovely twitter people. They are well worth reading, as they contain some of what Eric Pickles would call “frank advice” as well as hilarious suggestions.

Following feedback from myself and others, SLaM will be publishing additional information about the series and the choice of name. I look forward to reading it because, at present, I have several unanswered questions, based on my personal experience of working with the media. My queries are:

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Queries relating to SLaM:

  • Knowledge and consent: Did participants agree to the series being named after a notorious lunatic asylum? When patients and staff signed consent forms to be filmed for a documentary series on modern mental healthcare, were they asked if they agreed to be linked with most notorious lunatic asylum? Were they asked about the name change from modern-day The Maudsley to medieval Bedlam?
  • Name choice: How was the series name chosen and by whom? Who – Channel 4 or SLaM – suggested Bedlam as the series name? Who at SlaM had the final say on name choice and – given SLaM said to me that it was decided “after much debate” – how were participants (staff and especially patients) involved in the debate and the decision?
  • Name choice: What other options were considered and why were they rejected? Why was the documentary – whose working title was “The Maudsley” – renamed “Bedlam? The team behind the series has produced other fly-on-the-wall documentaries with enticing but non-stigmatising titles such as 24 Hours in A&E, The Audience, Inside Claridges and The Year the Town Hall Shrank. Why is it only their series on mental health problems that gets a salacious title?
  • Timing: When did SLaM know that Bedlam was Channel 4’s preferred choice? SLaM said to me that, “It [the choice of name] was decided quite late in the day after much debate.” But was it really the unspoken agreement from the outset that Bedlam would be the series name of choice? Did SLaM know this when the August press release went out? Did they know earlier but not let on because the controversial name might have put off staff and patients from participating?
  • What will the impact be on SLaM’s reputation? Will trust in SLaM be damaged or enhanced by this collaboration with Channel 4? Will patients and staff feel stigmatised – or honoured by the association?Claridges cricket

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Broader queries arising from the debate:

  • Is all publicity good publicity? There is no doubt that Bedlam has stigmatising connotations for people experiencing mental distress, their families and mental health staff; but is this a price worth paying for getting the subject a TV audience? Do the ends justify the means?
  • What lessons can be learned about engaging positively with the media? Are NHS trusts savvy enough to get what they want from TV companies in deals like this or do they get manipulated and suckered into doing more than is wise? Is working with TV always going to be a pact with the devil and about getting what little gains you can? When you lay down with dogs, will you always get up with fleas?
  • What is the best way to exploit valuable brands like “Bedlam” and “Broadmoor” for maximum positive impact? On Channel 5 at present is a two-part documentary series, Inside Broadmoor, which has been criticised as using every mental illness stereotype in the book. But would a psychiatric hospital get airtime without the hook of a brand name like Bedlam or Broadmoor? And if, using them as a hook risk plays into the zombie apocalypse/dangerous and unpredictable narrative that exists around mental illness, can they be used productively at all?
  • Is mental ill health too boring for TV unless it’s presented in a dramatic way? Is the only way to mental health problems portrayed on TV to provide a hook – like thirteenth century madness and torture? Do TV production companies consider audiences capable of only being interested in a topic if there is jeopardy, conflict or a journey; and, if so, how can that reality be made to work for the mental health lobby?
  • Can a good programme get its message across despite a bad title? National anti-stigma campaign Time to Change says a good story can be weakened by poor image choice; it therefore follows that a good TV series can be weakened by poor title choice. Is it really possible to challenge stigma by evoking stigmatising stereotypes?
  • What does the future hold for mental health documentaries? Will patients and staff in future be happy to participate in such programmes, knowing a stigma dump-and-run could take place?

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These are questions I am pondering and perhaps SLaM’s promised update on their new documentary series will answer some of them. I hope so.

My reservations about the series first arose when I saw the initial press release back in August. I assumed – because of the use of stigmatising language – that it was written by someone in the public relations team who was away the day the mental health awareness training was given. But, even so, someone approved it for publication. For instance, the initial press release makes these gaffs:

  • References to “the mentally ill” and “those who suffer with mental illness”, both of which are advised against in the Time to Change guidance on use of language around mental health issues.
  • Presenting a false dichotomy of what it’s like to manage a mental health condition: “Many people manage their illness with medication; others walk a daily tightrope with the possibility of relapsing at any time.”
  • Referring to “manic depression”, a diagnostic category which was superseded decades ago.
  • Describing Lambeth Hospital’s accident and emergency department in lurid terms: “In a postcode with the highest rates of psychosis in Europe, this is the Accident and Emergency of mental health … For our staff it’s all about risk management … Getting it wrong could have tragic consequences.” This is the zombie apocalypse narrative of mental illness.

Was the person who signed off this press release involved in the decision to call a documentary series on modern mental healthcare Bedlam? I don’t know. But it will be interesting to see what the documentary looks when it’s broadcast at the end of the month. Especially since the production company behind it also brought us a documentary from another residential setting with a long history … namely Claridges.

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See below for further related links.

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  • Time to Change

    • Guidance on image choice in stories with a mental health element, from the national anti-stigma campaign in – “Some really strong stories that may include great content and have educational value can be weakened by the use of an innappropriate image.” Why shouldn’t the same be true of TV? In other words, a really strong documentary that may include great content and have educational value can be weakened by use of an an inappropriate title.
    • Guidance on language use around mental health issues (which advises against using such phrases as “the mentally ill” and people “suffering with” mental illness, as used in the August SLaM press release)

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  • Mental health on TV – some portrayals this year:

    • Inside BroadmoorChannel 5‘s current 2-part documentary – “This remarkable two-part documentary special marks the 150th anniversary of Broadmoor, home to Britain’s most notorious killers. With exclusive and unprecedented access to Broadmoor’s archives, this film unfolds the extraordinary history of the world’s most famous and feared hospital. Why was it originally created, and what has it become?”
    • My Mad Fat Diary“Set in the mid-90s at the height of Cool Britannia, this six-part drama is based on Rae Earl’s real-life diaries. It takes a hilarious and honest look at teenage life through the eyes of Rae, a funny, music-mad 16 year old who, despite an eccentric mother, body image and mental health” – Channel 4‘s drama series which opens with Rae being discharged from psychiatric hospital after months of treatment. Covers self-harm.
    • It’s a Mad World – A season of BBC Three films looking at a range of mental health issues affecting young people in Britain today, including:
      • Don’t Call Me Crazy – 3-part series filmed over a year at a teenage inpatient psychiatric unit
      • Football’s Suicide Secret“Clarke Carlisle investigates the dark side of professional sport: depression, addiction and suicide.”
      • Diaries of a Broken Mind“Using handheld cameras, 20 extraordinary young people with a range of health disorders from OCD to schizophrenia show us what life is really like as they navigate the rocky road into adulthood.”
      • Rachel Bruno: My Dad and Me“26-year-old Rachel is the daughter of Frank Bruno, the ex-heavyweight boxing champion who is one of Britain’s most famous sufferers of bipolar affective disorder.”
      • Failed by the NHS“26-year-old Jonny Benjamin, who has schizophrenia and depression, investigates why many young people with mental illness are failing to get the right treatment from the NHS.”
      • Extreme OCD Camp – 2-part documentary – “6 British teenagers and young adults living with OCD embark on a unique, life changing week-long treatment course in the US, where course leaders use exposure therapy to enable their participants to confront their fears.”
      • Inside My Mind – The science behind mental health problems
      • Free Speech – Young people debate whether modern life is driving us mad

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  • Additional links:

    • Image search for “Bedlam” – the results of this search are not how I perceive modern inpatient mental healthcare (and I’ve been on the receiving end of some of the worst of it)

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Cashpoint

26 Aug

Talking potatoes Family Superfoods

You know the first thing friends from the psychiatric ward ask when we bump into each other? “Have you been back in since?” We just want to stay out. Our ward wouldn’t pass the “friends & family test”: going back to that place is seen as the worst thing that could happen. “Hi! How you doing? Been back in? “No. You?” “No, thank goodness. What’ve you been up to?” “Doing what I need to do to stay out.” “Me too.”

Last night at a cashpoint, a tall young woman approached me. “Got any spare change? My benefits were stopped. I’ve got no food or electricity.” She looked into my eyes, from eye to eye, imploring. “I’ve got no money. My benefits were stopped.” Hang on … We looked again and recognised each other from the ward. Back then, she was so vulnerable, so easily led, so naive. Just a teenager. She’d been in for 18 months.

“Are you still with the community mental health team?” I asked? Last time I’d seen her, she’d been there with her mum, waiting in the waiting room for an appointment. “Yes,” she said. “Let’s make an appointment with the benefits adviser. She’s really good. She’ll help with your benefits. They’re stopping them for the least little thing at the moment. Maybe she can get you help with a loan or a grant or something.” She looked around. “How’s your mum? Is she okay?” “I don’t know. We had an argument. We don’t speak any more. Do you have any spare change?”

“What would you like me to buy you?” I asked her. The cashpoint was outside a supermarket. “I was just going into the shop. Come with me and choose something nice to eat.” She shifted from foot to foot, looked down, looked up into my eyes again. “I just need cash. I’ve got no electricity or food at home. Can you give me some cash?”

“Come back to my house then.” I lived just round the corner. “I’ll cook you dinner. What would you like?” “No thanks. I just want money. Have you got any spare change?” Her skin was bad. She’d cut her hair short. Her glow was gone. She kept looking around behind my head, shifting from foot to foot.

In hospital, she’d been beautiful, naive and full of enthusiasm. She wanted to be a doctor. Or a model. Or both. She had no street smarts or guile. Just an enormous smile.

As a girl, she’d had an argument with her bullying brother one night and had run away from home. She’d been placed in a hostel, a safe place for vulnerable young people to stay. In the hostel, she’d been sexually assaulted by another resident. The mutual friend she’d confided in hadn’t believed her. Had blamed her. She hadn’t told anyone else about the assault. She was young and naive and hadn’t known how to deal with it. She’d kept living at the hostel. With her attacker. Who’d come back for more.

She’d stopped eating when her food started talking to her; when she could see little mouths in the baked beans speaking to her. When she’d become so skinny people noticed, she’d told them about the little mouths in the baked beans. She hadn’t told them about the assaults. It takes time and trust to build up to telling someone something like that. And she hadn’t had that.

She’d been taken from the hostel to the psychiatric hospital. They’d given her drugs for the little mouths in the baked beans; for the food that was speaking to her. They’d kept giving her more drugs and more drugs till she’d told them the food wasn’t talking to her any more and had put on weight.

When I met her on ward, she’d been there for 18 months. She hadn’t had any talking therapy. Just drugs. She hadn’t had any help to prepare for life outside the ward. Just weekly group sessions with the occupational therapists where we painted our toenails or tasted smoothies. But at least she wasn’t skinny any more.

When I met her on ward, she was so sweet and helpless that everyone was protective and did stuff for her. I encouraged her to learn to do things for herself: she’d need that when she got out; or at least the confidence to believe she could learn to do things for herself.

One day, she asked me to put on false eyelashes for her. Instead, I taught her how to do it herself. It took the whole evening. But she did it. Next day, she came back & showed me she’d done it herself. They weren’t on quite straight, but she was so pleased and proud. I was too. False eyelashes rock. She looked fabulous on the outside, with her dramatic eye make-up; and she felt fabulous on the inside, with her sense of achievement.

Next day, she told me about the assaults. She told me about her life and how she’d ended up on ward. She told me she was due for discharge soon. She said she’d started to see the little mouths in the baked beans again.

I didn’t know what to do. My mind was blown by that place, by what they’d done to me there. It was too big for me to process. Hearing her disclosure scorched my brain as I listened. All I could think of to do was to tell her to tell the nurses.

She told the nurses about the little mouths in the baked beans. But not about the assaults. She still hadn’t talked about those. They increased the drugs dose to make the little mouths in the baked beans go away again. She was discharged shortly afterwards and placed in a shared flat with a stranger. After 18 months on ward. And still a teenager. She didn’t know how to wash her clothes, cook, or budget. She couldn’t even keep her room on ward tidy.

Looking at her last night, I wondered whether, all these years later, she’s had any help to process the sexual assaults. Any help with the voices. Any help with managing her life. I wondered if it mattered. Or if drugs were enough. I couldn’t tell how she was. I only knew that she was different. I only knew that I held both her hands and squeezed them as I looked into her eyes, and hugged her and hugged her, then saw her slowly walk away.

And, of course, we both knew – because it’s the first thing we ask when we meet a ward friend – that we hadn’t been back in since.

So tomorrow I’ll drop a note to CMHT asking them to check up on her. She’s too vulnerable to be begging at cashpoints. I don’t know what else to do for the best.

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Links to related websites:

  • My Storify story of tweets – Cashpoint
  • A rather creepy video of talking food (1 min) used to promote TV show Family Supercooks, an initiative of the Food Standards Agency and the Good Food Channel
  • Eleanor Longden: The voices in my head (14 mins) – her recent fascinating and inspiring TED talk

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How much difference can Time to Change make to how print journalists report mental illness?

19 Mar

Newspapers rolled up

On Monday 18th March, Time to Change held the latest in its series of media education events. This one focussed on print journalists, both tabloid and broadsheet. How much difference can this make to the quality of press reporting where there is a mental health aspect? Take a look at the links below – including the live blog and tweets under the hashtag #TTCmeet media – to see what you think.

At the start of the evening, a film was shown with some valuable advice about reporting mental illness. It’s well worth watching the short (7 mins) film for more fascinating insights put in a straighforward manner. These included the following advice on reporting breaking news stories:

  1. Stick to the facts and don’t speculate that mental health is a factor unless you know it to be 100% true
  2. Interview someone with a mental health problem, to give your audience a realistic view of what it’s like to live with one
  3. Put as much of the subject’s voice in the piece as possible. Use quotes. Let them them tell the story.
  4. Include contextualising facts, since homicides by people with mental health problems are incredibly rare
  5. Seek comment and context by a mental health charity like Mind or Rethink Mental Illness, or a professional body like the Royal College of Psychiatrists
  6. Avoid stereotypes, clichés & sensationalism
  7. Mind your language: misusing mental health diagnoses in the media can be offensive, and can cause misunderstanding
Good advice which, if followed by print journalists, would make stories with a mental health aspect far more relateable to their readers – a quarter of whom, after all, experience mental health problems in any one year – as well as less sensationalist and alarmist. However, as Ian Mayes, Guardian associate editor and former readers’ editor, said in 2008:
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“We stand in relation to some aspects of mental health – particularly in the way we refer to mental illness, in the language that we use and misuse – roughly where we stood in relation to race 20 or 30 years ago. The least we can do is to accept that language used about mental illness is important and reflect this in the practice of our trade.”
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The current state of reporting means there are opportunities available for journalists. What do I mean?
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  • The fact there are so many misconceptions around mental illness means there’s an abundance of great stories waiting to be told.
  • There’s a revolution happening in mental health, which gives the best journalists the chance to make their names in an evolving subject.
The best journalists will break out of the old cliches and start reporting mental health in the new way. Hopefully some of the journalists present at the Time to Change event will be inspired to take on board at least some of the messages receive during the evening and put them into practice in their writing. Of course, the worst journalists will continue reporting mental illness in the same tired old way, using the three bog-standard storylines, namely:
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  1. When a heinous crime is committed, journalists speculate that the perpetrator must have a mental illness. This is sloppy journalism of course, based around an incorrect assumption that “normal” people can’t do terrible things. The opposite is born out by the facts.
  2. When a crime is committed by someone who in the past had a mental health diagnosis or contact with mental health services or treatment for a mental health problem, whether recent or in the far distant past, it’s assumed that mental illness caused that crime. Again, sloppy journalism which confuses correlation and cause.
  3. When a crime is committed by someone who’s been diagnosed or treated for mental illness, this is extrapolated to portray all people with mental illness as potentially dangerous. Again, sloppy journalism which is not born out by the facts.

If you’re not familiar with Time to Change or their event that night, here’s some information, followed by all the relevant links. As the Time to Change  website says:

“Time to Change is an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness. These two charities decided to work together, combining their knowledge, skills and expertise, in the biggest attempt yet in England to end the discrimination that surrounds mental health.”

When I first started reading around mental health, I didn’t understand what the word “stigma” meant. And it gets repeated a lot. So I came up with the phrase “negative assumptions” instead, which is pretty straightforward. And discrimination is acting on those negative assumptions.

The Time to Change event aimed to provide:

“a space for journalists to learn more about mental health problems by meeting people with direct experience and hearing their stories, along with some top speakers from the industry.”

It was hosted by Time to Change ambassador Alistair Campbell (writer, communicator and formerly Tony Blair’s press secretary) with celebrity panelists including Denise Welch (presenter of ITV’s Loose Women and former Coronation Street actor), Fiona Phillips (TV presenter and Daily Mirror columnist) and Guardian journalist Mary O’Hara. Media volunteers included Helen Hutchings from Tea and Talking and mental health campaigners Jonathan Benjamin and Erica Camus.

It also aimed to enable journalists to:

  • challenge myths and misconceptions around mental health
  • find out the truth behind the headlines that link mental health with violence
  • join in the debate by asking the panel of experts a question
  • be inspired by the stories of people with experience of mental health problems
  • network with other industry professionals over a glass of wine (the main hook for some attendees no doubt!)

Real stories about mental illness are so much more fascinating than the standard speculation & hyperbole. Hopefully we’ll start to see a gradual improvement in the quality of reporting in Britain’s tabloids and broadsheets when the subject of mental illness comes up.

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Nicola Edgington – the IPCC & the police response

5 Mar

IPCC logo

Edgington - Sally Hodkin

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On Monday 4th March, Nicola Edgington was sentenced in court for the murder of Sally Hodkin (top) and the attempted murder of Kerry Clark (below left) in October 2011. At the same time, the Independent Police Complaints Commission (IPCC) published its report into the police contact with Edgington.

Edgington - Kerry Clark

Below I have collated links to all the relevant reports & media stories I’ve come across in the past couple of days. I’ve also included a link to Storify stories of my tweets on the topic, as well as a debate with Inspector Michael Brown on expanding the role of police in relation to people experiencing mental distress.

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Issues which arose from the case and media coverage include:

  • Whether there is a link between a borderline personality disorder diagnosis and violence (the jury convicted Edgington of murder, finding her criminally responsible not mentally ill)
  • Whether there is a link between a schizophrenia diagnosis and violence (the defence had argued that Edgington was experiencing psychotic symptoms at the time of the attacks)
  • What role mental healthcare providers can play in predicting and preventing rare but heinous violent crimes being committed by people with whom they have had contact or are currently treating

No report has been published into Edgington’s social or mental health care (Edgington was under the care of Oxleas mental health trust at the relevant time) and none are expected for some time (possibly years). Little or no comment has been made so far by the major mental health charities. These factors – combined with others such as a media appetite for the drama of violent crime, conflict and apportioning blame; and the spectre of the dangerous “mental patient” – resulted in media coverage focused heavily on the potential culpability of the police. For instance, the following issues have been raised:

  • Whether police should play an increased role in the management of people with mental health problems
  • Whether all those with whom police come in contact who they suspect are experiencing mental distress should be PNC checked
  • Whether police powers to arrest people in a public place if they think they are in a mental health crisis – under s136 of the Mental Health Act 1983 – should be extended to private dwellings

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This is another extremely rare but tragic violent attack where the link between mental illness, violence and crime  seems reinforced in the minds of the public and media. I’ve written a number of times on this topic. Not because I have an interest in violent crime. Far from it. But it seems the only time mental illness is reported in the media is when a dramatic heinous crime is committed. If the stigma and discrimination against people experiencing mental distress or with a history of mental illness are to be reduced, the myths linking mental illness with unpredictable and violent behaviour must continue to be challenged.

Take a look at the links below and see what you think.

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My Storify stories

  • Nicola Edgington, the police & the IPCC (4th March) – First there are my tweets; then a debate with Insp Michael Brown (@MentalHealthCop) on the topic of extending police powers in relation to people experiencing mental distress; then comments from other tweeps.
  • Mental health and violent crime (5th March) – Just because someone who commits a heinous crime once had a mental health diagnosis or treatment does NOT make it a “mental health murder”.

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Police response

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Law

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Mental health & social care commentators

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Media coverage (4th March unless otherwise stated)

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What advice would you give someone recently discharged from psychiatric hospital?

31 Jan

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What advice would you give to a patient who’s recently been discharged from psychiatric hospital? What would you have wanted to know when you first came out? I was asked these questions yesterday evening by someone I’d known for a long time, someone who’d visited me on ward 2 years ago and thought I might be able to help someone who’d come to them in despair.

The woman had recently been discharged from a mental health ward in the hospital where I’d been detained.  She was angry. Her world had falled apart. Her marriage had fallen apart. She was appalled by her treatment on ward. She wanted the hospital to hear what she had to say about her care, to know it was wrong. She wanted to meet with people who would know, through shared experience, what she had been through. Would I meet with her face to face to offer advice and support.

When I got home I sent this series of tweets which sets out my reaction to the question. I’ve also added in the responses of other tweeps, and there’s some good advice in there so take a look. Read the tweets to see my gut reaction at the time, or read on for a slightly edited version (tidied up from yesterday’s stream of consciousness), including my 10 tips.

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Open quotes“Will you meet a woman who’s just been discharged from psychiatric hospital?” I was asked. “She’s so traumatised by the experience.  Her  world has fallen apart. She doesn’t know where to turn. She feels so angry about the experience.” More details were given about her difficult circumstances and how she wanted to make a complaint to the hospital but didn’t know how to do so or where to turn. “Can you meet her?”

“No,” I said. “No, I can’t meet her. I’m still too traumatised myself to take on someone else’s pain. I have to take care of myself first.” Her experience in late 2012 seems similar to mine in 2011. So nothing has changed. The hospital hasn’t changed, despite a programme of improvements to the physical environment. The culture hasn’t changed. Same leaders. Same nurses. Same bullying, abuse and poor care. I don’t want to relive it with someone else who’s suffered in similar ways to me, nearly two years later.

“Did you know,” I said, “that I was discharged requiring treatment for harm inflicted on ward? For mental trauma and a physical injury? That I’m being treated for PTSD from the ward experience? And I’m being treated by a physiotherapist for a restraint injury?” The trauma of being held in seclusion, forcibly treated, repeatedly restrained, yanked around by my arm by a bully nurse, has left scars that still need help to heal. I’m still vulnerable.

“Did you know,” I said, “that, when I raised a sample complaint with the hospital, I was disbelieved and blamed?” Which felt like being assaulted a second time. Making a complaint made me feel worse, not better. Much, much worse. I don’t want to go through that process again with someone else.

“Did you know,” I said, “that I have to measure carefully how I use my brain? To flex & strengthen the mental muscles but be careful to not stress or weaken them. Did you know,” I said, “that, although I tweeted all day about the Mental Health Act report, I’m not going to read it?” It would be too harrowing for me to read about others’ difficult experiences on ward. To read about forced treatment, restraint, seclusion, lack of care as being far too common an experience on ward. I look like I’m coping, but that’s because I’m practised at measuring out my energy so I can hold it together in public when I need to.

So no. No I won’t meet them. No I won’t offer support or comfort. Right now, for me, I want to meet happy people. To smile and laugh. To rest my brain. To enjoy life. To put clear blue water between me and the hospital experience. Having caring responsibilities before contributed to me landing up in hospital before. I can’t take on someone new to care for.
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“But,” I said, “I can give you some advice to pass on. Some things I would have wanted to know when I was discharged. That will still be some help.” Here are the tips I passed on:
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  1. It’s good to have someone on your side. If you’re within 8 weeks of discharge, the ward IMHA should be able to help you make a complaint or get your voice heard. They know the ropes. Even if the ward IMHA can’t help you, your local branch of a mental health charity like Mind, Rethink or Sane may have advocates who can help you be heard.
  2. PALS can also help you if you feel you’ve received poor care on ward.
  3. If you feel like you want to be heard, that’s different from making a complaint. Hospitals will have a procedure to help you be heard, outside of a formal complaints procedure, and that may be a better option for you.
  4. If you’re thinking about making a complaint, what end result do you want to achieve? What do you want to get out of it? Do you want “justice” and, if so, what would that look like to you? Do you want to get an apology? Do you want financial compensation? Do you want a review of procedures? It’s helpful to have an outcome in mind before starting the complaints process, to ensure it’s worthwhile going through it.
  5. If you want to make a complaint, are you up to it at this time? As the saying goes, you cannot break concrete with a feather. Organisations can become defensive in the face of complaints. They can fight back. Is that something you want to deal with now? Weigh up the costs to you of doing so.
  6. If you want to make a complaint, can you achieve the end result you desire by some other means? For instance, you can report poor care or abuse – anonymously or using your name – though the Care Quality Commission. They can send an inspector to the hospital or ward to check on care. That might lead to improved care for others in future.
  7. If what you want is to know that you’re not alone, that there are others who share your difficult experiences, then one place to start is yesterday’s Care Quality Commission annual report on the care of patients under the Mental Health Act (voluntary and sectioned patients, and those under CTOs).
  8. Don’t focus exclusively on the negatives of your hospital experience but make sure you also do positive things. For instance, find out what support services are available in the area which play to your strengths or develop new ones – eg art, creativity, music.
  9. People you’ve met on ward can be a valuable support. They were there with you. They know what it was like. They’ll know what you mean when you talk about what happened. But also mix with people who nurture your sense of funClose quotes and make you smile.
  10. Consider returning to the ward and thanking the staff who helped you, then walking away. Doing this helped one of my ward buddies to draw a line under the experience and move on.

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These are my tips, off the cuff last night. But what advice would you give to someone who’s just been discharged from a psychiatric ward? What would you have wanted to know? Please comment below.

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  •  Storify story of tweets I sent together with responses of others – some great advice in there from other tweeps, so take a look
  • Some tips from Wardipedia (the resource for inpatient psychiatric staff) of things to think about when planning for discharge, but a useful to do list post-discharge too
  • Link to the Care Quality Commission‘s website where you can report poor care or abuse
  • The CQC’s most recent report into the care of patients under the Mental Health Act – voluntary and sectioned patients (and those under CTOs)

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