This is Leicestershire - where comments cannot easily be added...

More views of - or before - Cambridge Film Festival 2012
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18 November

Article from Nicky Morgan MP @nickymorgan01 about the need to improve mental health services ow.ly/fnxC5
— YoungMinds (@YoungMindsUK) November 18, 2012

Comment on : The report provides food for thought for all of us who want to see the best possible treatment, with in-patient units offering the most therapeutic environments


Because I can, I am adding my comment here :


I can say, from experience, that psychiatric units have provided a poor therapeutic setting for at least 15 years, during which nothing much has changed, despite :


1. Initiatives such as Mind's Star Wards

2. The merger of the Mental Health Act Commission with the Healthcare Commission (and a third commission, whose name escapes me) to create CQC, or the Care Quality Commission

3. Much public and parliamentary rhetoric

4. The (patchy and very late) introduction of services for crisis resolution and home treatment, as well as some services for early intervention

5. Any money added to - rather than cut from - spending on mental-health services


What we need is services, i.e. for someone to do something that helps those who are experiencing mental distress. That is therapeutic, whereas these (all too common) experiences are not :


a. Being told that the doctor wants to see you this morning, and waiting in for something that never happens ('Oh, Doctor Jones had people to see at the out-patients' clinic and couldn't get away after all'), rather than being able to go to the cafe or for a walk

b. Coupled with that, misinformation, doublespeak, denial about what someone else definitely said ('Oh, Richard wouldn't have said that', when Richard did), confusion ('Who told you that?', when it was someone who had never been on duty before and who didn't give his or her name)

c. Having no one listen when you report unpleasant side-effects such as constipation, being unable to sleep at night, awkward limb movements, or painful uncontrollable muscle spasms ('Welcome to the world of anti-psychotics such as haloperidol, designed to make you acceptable to the family, friends, neighbours and the requirements of "society in general" who may have had you sectioned or otherwise persuaded into being admitted to become transformed into whatthey approve of !')

d. Likewise with any existing physical-health condition, or a physical complaint that you may develop - these experiences get written off ('The side-effects are worth the therapeutic benefit') or dismissed ('The medication won't do that', even if you later get hold of a patient information leaflet and find it listed') by the doctor, and who are the multi-disciplinary team to challenge him or her (as with any doctor)... ?


Therapeutic environments ? Well, no !



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What things do I point to in Laing and Szasz's thought?

More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)

13 October

Following on from Ronnie, gae hame!, I have some thoughts to share about Drs Laing and Szasz and their place in the order of things...

1. Dignity and respect - talked about in recent days, as if just invented with applicability to being an in-patient, but the story tells us that Ronnie was alongside, literally, someone who, naked, just rocked and would not engage, so he did the same. But, for all these schemes such as Star Wards, because it's not in the culture of mental-health nursing, nothing much is different, not least at the level of patients feeling that they're in an underclass because of being 'ill': on a crude scale, a sort of pecking order, anything that the relatives have to say (and so they can support, and speak up for, the patient about troubling side-effects, because, unlike the patient him- / herself, those people count) carries far more weight, and the status of anything said by the patient is less important than the family pet's views of his or her care.

2. Coercion - if I compel you to do or suffer something, even for your own good, how is it likely that you will feel about the thing that you did (or suffered), about me for forcing you, and about myself for having been a person who is legally allowed to be treated in that way? Whatever a breakdown is, if it leads to an admission, being dehumanized by hospitalization and institutionalization makes for far more trauma for the in-patient (whereas his or her aberrant behaviour hacked off friends, neighbours, relatives and /or the police, and so, for their sake, he or she gets detained) than the breakdown itself. I think that Thomas questioned why, if someone has to be coerced, there can be therapy, rather than distrust, resentment, fear, pain, on the part of the patient towards the detaining authorities - my analogy, but a bit like trying to carry out dentistry on someone who is not willingly opening his or her mouth.

3. Compassion - much more than those basic things at 1, above, - partly involved in doing what Ronnie did in rocking with that patient, and which feeling for and honouring the respect and dignity of patients would not, in itself, lead to. Compassion wholeheartedly and without reservation puts your lot in with the other person's*, often thought of as unconditional love, and is almost at an opposite pole to psychiatric practice of Ronnie's time - you wouldn't have found many endorsing the rocking anecdote as concordant with their views of patients.

4. Criminality - if I lock you up, whether you're drunk and have smashed some things, or in psychosis and have done the same, and you don't appreciate the situation (in the latter case, thought of as lack of insight), you will nonetheless - at some level - know that you are being treated as if you have done something wrong. As I look at what Thomas might have meant at 2, above, and think of mental health in England and Wales, the police can (forcibly) take you to a place of safety, they may be involved in any sectioning process or in taking you to hospital (if you do get sectoned), and they are the people who take you back, if you escape (or try to). In our own system, then, the coercion and the criminal taint are linked, even though, under the Minstry of Justice's control, there is quite separate legal provisions for the foricble detention of people on remand for or convicted of criminal offences: the in-patient not only feels imprisoned, mistreated, misunderstood, misrepresented, but has a perception that some criminal wrong is the reason for all this punishment. And, amidst all this, he or she is supposed to recover, respond to treatment, and - which is itself ambiguous as to health and character - get better.


For what it is worth, those are my thoughts on what Thomas and Ronnie still have to say to us, decades on...


End-notes

* In Ronnie's case, I suggest that he probably took compassion too far, rather than the approach of being empathic, which, for anyone with mental-health issues, is a less costly and, literally, less soul-destroying way of relating to patients. Whatever happened to him in later life, with booze - but he was a Glaswegian - and the effect of efame or whatever, I guess that he may have given too much of himself, and in a way that Adrian, one of his sons, likes to report (he has written a biography) that Ronnie did not do at home, by usually describing home life as a crock of shit.


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