State Sponsored Cruelty and Mental Illness in the UK
|Author: Anonymous Guest Date: 27th October, 2018|
Preamble: A conversation maybe …. but conversant?
The State sponsored cruelty shown towards the mentally ill in the UK leads to despair, homelessness and suicide.
With the World Health Organisation predicting mental health problems to be the prime causes of morbidity and mortality by 2030, we, the public, are periodically exhorted to raise our awareness of the various mental health conditions that blight peoples lives by having a ‘conversation’. The media’s general take on this concept is often to roll out mental health ‘ambassadors’ like Stephen Fry or Alistair Campbell to relate their personal journeys with serious mental health issues for the cameras. Whilst their willingness to ‘step up to the plate’ can but be applauded, I fear that the picture painted of these journeys, based as they are in the capital and clearly conducted outside of the limitations of the NHS, fail to give much insight into the lived experience of people who may share similar problems but cannot access the services they have benefited from. It is these stories, generally hidden from view, that I wish to explore here.
What you can absolutely guarantee will not happen, unless you are wealthy or endowed with superior health insurance, is that you will be able to select an appropriate therapist or psychiatrist with whom you can build the important therapeutic relationship and then have cosy chats in their consulting rooms, as and when, about which drug might suit you better.
The 2013 Report from the government’s Chief Medical Officer states that 75% of those seeking treatment for mental health issues may not get access to what they need (Dept of Health, 2014). Supporting this statistic, a 2014 survey undertaken by the Need to Talk Coalition found that only 15% of their 2000 respondents had been offered the (limited) range of therapies recommended by NICE.
Even in economic terms, lack of provision makes little sense. The National Mental Health Development Unit, (2010) estimated that early intervention and home treatments could result in savings of £38million per annum to the NHS alone. This does not take into account the additional costs of pressures on other services arising from lack of suitable provision. BBC South West recently aired an item (1st Oct 2018) wherein the Police were raising their concerns that, these days, the bulk of their time and resources were being expended on dealing with people with mental health problems.  According to a magistrate friend, this is also the case in their courts.
The reality of provision today, as with so many NHS services, is very much a postcode lottery. The South East, which enjoys not just higher mean incomes but has access to many teaching and specialist hospitals alongside respected charities who provide high quality services and, effectively, fill many of the gaps in provision, enjoys the lowest rate of common mental health problems, 13.6%). The South West, a low waged and chronically under resourced area, fares the worst at 20.9% (Adult Psychiatric Morbidity Survey, 2014). There seems to be little by way of either interest or concern about these failures. It is a problem that has, traditionally, been ‘kicked into the long grass’ because sufferers of mental illness are generally unable to fight back. There are therefore serious double standards in evidence. If any other group of chronically ill patients were left untreated, unsupported and alone, there would be national outrage.
1. Treatment Provision
We are now all too familiar with the periodic appearance of the relevant government spokesman, bearing an earnest expression, saying how much additional funding is being made available for ‘evidence based’ mental health provision but how that plays out in reality is worth further examination.
The Improving Access to Psychological Therapies Programme was launched in 2008 which saw the introduction of local Depression & Anxiety teams. Initially this appeared to be presented as a treatment ‘gateway’ whereas the reality is that it is increasingly the only ‘service’ there is. Most commonly (34%), according to the Health & Social Care Information Centre (2014) the offering from Depression & Anxiety teams is short course CBT (Cognitive Behaviour Therapy). This is a very appealing option to the state as it is comparatively cheap and equally appealing to those subcontracted organisations involved in the programmes for similar reasons. Thus, there is a serious, vested interest in this being sold as a ‘one size fits all panacea’. Some major policy players, like universities, have become heavily involved as it’s a win/win scenario for them in that they are generating fees from people training in counselling, have access to a ready supply of patients to get the student practice hours up to qualification requirements and then additional payment for the ‘ successful’ treatments for which they are generating the data. All absolutely fabulous for the policy actors but arguably less so for the patients as it is in the providers’ interests to sideline chronically ill people who will not generate the data required to fulfil funding requirements.
CBT was initially conceived as a 20 week programme for the treatment of mild to moderate depression and anxiety. A meta analysis by Johnson & Friborg (2015) raised some questions about its efficacy as, statistically, it appeared to be yielding higher remission rates over time (i.e. people getting ill again) which became more evident in higher quality studies. Their analysis indicated that the experience level of the practitioner may well be influencing the decline in efficacy alongside considerations of people’s experiences of the treatment and greater patient access to information which may be leading to diminishing faith in the approach. They found that most studies failed to follow up on their conclusions beyond the 20 sessions regarding further improvement or deterioration.
At this point it may be useful to translate the dry academic quantitative data to the personal qualitative experiences of people who have first hand experience of the current system. I have spoken with many people but, for the purposes of this exercise, have opted to focus on the experiences of two individuals, let’s call them Person A and Person B, whose clarity of expression make them good choices to relate their experience of current NHS provision.
Person A described how she had been directed towards the DAS (Depression & Anxiety Service) two years after a serious breakdown/crisis that was the result of extreme and long lasting trauma. At the time she was labouring under a misdiagnosis made by a junior doctor –
“I had a strong feeling at the time that he [the doctor] was a bit piqued when this weeping, vibrating wreck before him suggested that she ‘thought it might be PTSD’. I certainly paid the price for that! After two years of serious illness and no support at all whilst living in very challenging circumstances, the DAS offer seemed, finally, to be a lifeline. I knew that I was very unwell and I was desperate. However, what they were offering all seemed to be a bit vague, so I asked a few questions by letter as I couldn’t take the risk of getting any worse than I was. Stuff like, ’How experienced are their staff, did they have any expertise in trauma, what safeguards and provisions did they have in place if I had an adverse reaction to therapy? As I recall it all went very quiet at that point.”
Later this woman was to be diagnosed with PTSD (post-traumatic stress disorder) of a severity that reflects her experience alongside comorbidities that are common to many PTSD patients. As a result of her experience, Person A is currently considering trying to write book about this complex form of PTSD and explained –
“I have been absolutely staggered how little is known about this illness – and that includes health care professionals. Thus far, everything I have found on the topic has been written ‘from the other side’ and no matter how empathic they may be, generally fails to capture the reality of the experience. I would like to address that if I can and maybe provide something that might offer practical and useful information to patients, their families/friends and people whose day to day work brings them into contact with the condition.”
Her perceptions may well be ‘spot on’. In the Mental Health Foundation’s “Fundamental Facts about Mental Health” (2016) it is noted that only 1 in 8 of PTSD sufferers are diagnosed by a health professional with less that half receiving treatment.
Person B’s experiences of his DAS border on the farcical. He had first been diagnosed with depression and chronic OCD (obsessive compulsive disorder) in London. Following a breakdown in the early-1990s, he declined the offer of pharmacological treatments which had proved unhelpful and even problematic in his past and accepted his GP’s referral to a local counselling centre administered by a charity. The weekly, one hour therapy sessions with a dedicated counsellor had lasted 3 years, a limit imposed by demand for the service. As a result, Person B was able to take an entirely new direction in life, gaining a significant qualification and subsequently moving to the South West. There and as the result of an emotionally painful situation in the mid-noughties, he again sought help from his GP –
“I was feeling low and also noticed that my OCD symptoms had returned after several years of successful management. I was also experiencing panic attacks although I did not know what these were at the time. I cannot say that I felt very ill but decided to see my GP in the hope of nipping this in the bud so as not to become more depressed. My GP was very understanding. I remember that Valium was discussed but we both agreed that its drawbacks outweighed any benefits for the time being. I also remember that it was by some fortuitous circumstance that some counselling was available. This was limited to six 40 minute weekly sessions. After allowing for special introductory and concluding sessions plus time spent on administration at the beginning and end of each session, the course effectively amounted to four 30 minute therapy sessions. The sessions were held in a room at the GP’s surgery, then a converted house and close to my home. The therapist was a nurse. Later I noticed the same nurse regularly visiting my neighbour’s house to attend a stroke victim. The introductory session involved completing a check-box assessment form. This revealed an equivalent score on both the depression and anxiety scales. The nurse seemed very satisfied and emphasised the anxiety score whilst dismissing the depression score. I was given the impression that anxiety was ‘flavour of the month’ (because, unlike depression, that was more easily treatable).
I was told that the sessions were CBT and I soon realised that the emphasis was on self-help. Some time was spent reading glossy booklets that explained CBT through various hypothetical scenarios such as repetitive hand washing and fear of spiders, none of which represented my own symptoms. Although I had mentioned to the nurse that a legacy of my earlier illness was a cognitive dysfunction and that this limited my concentration span making it difficult to read long passages, I was also given a prescription for a library book. There was an arrangement whereby the local library stocked various self help books for the exclusive use of those with a prescription. The book was “Living With Fear” by psychiatrist Isaac Marks. I remember that there was a woman in front of me at the counter who had a prescription for the same book. The librarian had to check that one was available for me and made a comment about the popularity of the book. I struggled to read more than a page of the book at first attempt and although I later purchased my own copy to give me more time, the book was too heavy going and remained inaccessible.
When the sessions ended I was told that I would remain on the mental health service books and given a phone number to contact if necessary. I felt the only benefit from the sessions had been the short opportunities for a one-to-one chat. A few weeks later, I received an unexpected call from a coordinator to offer me a place in a stress management group in an adjoining town. I explained that I did not feel well enough to leave the safety zone of my house and its environs and also that I had found therapy groups stressful in the past. I therefore declined the offer believing it would do more harm than good. I was then told in stark terms that by declining the course I had categorised myself as ‘no longer requiring treatment’. This meant that my treatment was considered as successful and I was therefore discharged from the service with no possibility of further help. This encounter made me feel worse.”
Person B described feeling let down and seeing no point in further approaches to either his GP or the mental health service. Besides, there were some positive changes in his life and his health began to improve. But 2012 saw the beginning of a succession of painful and challenging circumstances that would prove to be on-going. He described how, a year later, he felt so ill that he again contacted his GP –
“GP consultations were then conducted by telephone and I have only been able to see a GP face to face on one occasion since. This may be convenient for many patients but showed a lack of understanding of mental health issues that may involve wanting to see a particular GP, finding telephone calls stressful and difficulties in articulating how you feel over the phone. The telephone call was brief. The GP stopped me in my tracks to tell me I had depression/anxiety and that a prescription to help with anxiety was waiting at my designated pharmacy. I was also told to ring the DAS because patients had to refer themselves.
No explanation of the medication was given. It was called Atenolol and was effective in reducing my anxiety at first. But after a month it became less effective, requiring a double dose and my hair began to fall out in clumps. So I consulted the GP and stopped taking it. About the same time I had an appointment for assessment by the DAS and was offered a course of CBT. Courses were expected to last between 6 and 8 weeks but could be extended to 10 weeks although that was evidently frowned upon.”
Person B began his therapy sessions two months after contacting his GP –
“A month later, in summer 2013, I began my sessions with therapist H. Over time, it became obvious that therapists were based elsewhere and were coming in for specific appointments, usually arriving breathless and apologetic for being late. Some of my later therapy sessions were conducted by telephone because the therapist could not attend in person.
Throughout my attendance at DAS, sessions were characterised by paperwork and in particular an assessment form to be completed before or during each session. When I appeared less than enthusiastic about completing this form I was told (by H) that the centre was funded according to results and with the forms being the indicator of ‘success’, no form meant no funds and no therapy. Another weekly activity was a risk assessment of potential harm to myself or others.
H informed me from the outset that it would not be possible to address all of my mental health issues in the time available and so we would work on a single symptom. In this case H had chosen my cognitive dysfunction and limited concentration span. A form of CBT called ‘Exposure Response Prevention’ (ERP) would be used. Much of the session time was spent by H explaining how CBT and ERP worked (by ‘breaking the cycle’) and drawing diagrams of this. I was given a self-help booklet in the ‘Overcoming’ series entitled “An Introduction to Coping with OCD”. For my part, each week was spent watching box sets and movies without the use of the pause and rewind buttons.
The sessions ended after 12 weeks which I was told included an extension to allow for a couple of times when H had arrived very late. H told me that more help was needed so I should wait until the following spring, see my GP and then refer myself to DAS again. My discharge letter from DAS stated that the focus of the work had been to enable me to enjoy TV again and that I should continue the practice exercises.”
Person B continued to struggle with his circumstances and with his health deteriorating he again consulted his GP in summer 2014 –
“By this time I had begun to seek support (such as advocacy) from other agencies to help with my circumstances. Despite such services being advertised on their various national websites, they did not exist locally. Age UK could only help with benefits and financial advice which I did not need; someone at MIND recommended an OCD clinic in Bristol (100 miles away) and CAB provided incorrect information. I even wrote to my MP whose response was encouraging until he lost his seat. On this occasion my GP prescribed an antidepressant that put my head in an intolerable ‘bad trip’ of a place that I cannot describe. After watching the clock and counting the hours from the most recent tablet, desperate for the effect to wear off, I stopped taking them. Again I was told to contact the DAS.
I resumed therapy at DAS in November 2014 and saw a succession of therapists (J – N) over a two year period. Each therapist either took time off with illness or left the service (or both) after a few sessions. This usually meant starting the whole process again with delay in obtaining an assessment and a further delay in being assigned a new therapist. One therapist (K) did not show up at all due to illness. The first of these therapists (J) decided to continue with CBT using a method called ‘Behavioural Activation Therapy’ (BAT). This involved setting and listing simple household tasks and leisure activities to be performed each week. It was an activity that I was already performing in order to cope. The accompanying booklet from the ‘Overcoming’ series was entitled “Coping with Panic”. At one point J became frustrated with the lack of progress and suggested I might have some other illness that was undermining my treatment. My GP, on the other hand, said that all my problems were mental illness or stress-related.
A subsequent therapist (L) decided that the CBT had not been successful and so assessed me over a 3 week period. L then decided that I needed a higher level of treatment and my sessions were suspended while L investigated this possibility. The next therapist (M) told me that the only other available treatment was EMDR. M said that although I had not suffered a single, major traumatic event, she could make the case for EMDR because I had experienced multiple (albeit lesser) traumatic events over a long period of my life. There was some preparatory work and a period when M was ill before the EMDR began. My first EMDR session was deemed to be less than successful because the wrong topic had been chosen through a misunderstanding. My second session was described as successful after which M left the service due to illness.
It was nearly 3 months before I next saw a therapist (N). N was a ‘High Intensity’ therapist. There were 2 assessment sessions before Christmas after which N wrote to me, agreeing to continue with EMDR after Christmas with a review after session 6. When I returned for my next appointment in January, there was a brief discussion after which N decided that I was too depressed to undergo EMDR treatment that day. It being the aftermath of Christmas, I hoped to feel well enough to resume EMDR later. Instead, a return to CBT was discussed. I could see that N was disappointed by my lack of enthusiasm on the basis that it had not been successful in the past. In an attempt to make her feel better about this, I said that, from my reading of the subject, I understood that CBT was not so successful with older people. I was then offered some mindfulness relaxation exercises but I had already experienced these as preparation for EMDR and did not think they represented progress. N then agreed to investigate the possibility of counselling with the proviso that there was only one qualified counsellor and so there might be a long wait.
However, N phoned me before my next appointment to inform me that they could only offer short-term, focused counselling. I was told that I needed long-term, general counselling and that they could not provide this on the NHS. I was therefore discharged from DAS and advised to look elsewhere. Shortly afterwards I received, through the post, a list of private counsellors that I could not afford (and with no indication as to qualifications) plus a prospectus of courses run by Devon Recovery Learning Community. None of the courses were taking place in my area and I did not understand many of the course descriptions. Those I did understand did not seem appropriate. A week later I received a letter notifying me of my discharge. I was very annoyed to read that the reason given for my discharge was that I had (according to the letter) been reading academic papers that had undermined my confidence in CBT. A copy of the letter had been sent to my GP and I wanted to write to him and explain what had really happened but was too ill to do so.
I was left with the impression that, if DAS couldn’t count me as a success then they wanted to get rid of me and that the letter was just a validation for my discharge when I was too ill for what they had to offer. Overall, I had found that what was on offer had made me worse. I had been asked to do all these trivial things and running through my head was, ‘Is this the best they have? It robs you of hope’. Furthermore, because each of my brief treatments was with a different therapist and using a different approach, there had been no chance of developing what I think of as a therapeutic relationship.
Thus, since January 2016 I have received no help or treatment and this has impacted my physical health. Later in 2016, I woke up one day feeling very weak and painful. As a result of extensive hospital tests this has recently been diagnosed as fibromyalgia together with chronic fatigue syndrome (CFS). The consultant believed that stress had contributed to the condition. I continue to feel very ill and also feel completely abandoned, alone and without hope.”
In relation to Person B’s discharge letter, It is worth noting here that elsewhere in the same Health Trust, patients under the direct care of the NHS, are encouraged to use the internet to ’ find out more about their illness’ as a standard paragraph at the end of every letter they receive, raising issues of consistency if nothing else. Person B’s treatment diary can be summarised in the following table –
Table: Person B’s DAS Therapy Sessions
|Therapist||Date(s)||No. Sessions||Activity||Reason Ended|
|H||summer 2013||12||ERP||session limit|
|J||Nov 2014||4||BAT||J left|
|K||Dec/Jan 2014/5||0||none||K illness|
|L||Feb/Mar 2015||3||T&A||referral to HLT|
|M||April + Aug 2015||3 + 3||T&A + EMDR||M illness + left|
|N||Nov/Jan 2015/6||3||T&A||ended by DAS|
Key to Table: ERP = Exposure Response Prevention; BAT = Behavioural Activation Therapy; T&A = talk & assessment;
EMDR = Eye Movement Desensitization & Reprocessing; HLT = higher level treatment
These experiences are, in some ways, statistically typical. The average number of attended sessions in a course of CBT is 6.4 (Health & Social Care Centre, 2016). If nothing else, this seems an awfully long way from the original treatment design of 20. Both of these individuals are in the mid/late life category where the ERSC (2016) highlights that people are often overlooked or ignored. Both are in lone households and have no meaningful support, which, again, are indicators of likely problems. Whilst the two individuals upon whom I have focussed may well be unusual as neither has much experience of being supported at any point in their lives, it is nonetheless worth noting here that mental health problems can place an enormous strain on the any close relationship. Thus, in NICE guidelines relating to mental health conditions, there is always a section on family members which usual suggest providing them with good information about the relevant condition, its course and treatment. I have asked a lot of people about this, both patients and carers, and not one reported having received this
A report from the Care Quality Commission of 2013/14 found that there were 500,000 persons on GP registers with serious mental health problems. A further report from Aviva (2012) states that 75% of GPs prescribe pharmaceuticals even though they consider therapy to be a more effective solution. By and large therefore, this is the only port there is in a very severe storm.
At this point we must return again to National Institute of Clinical Excellence (NICE). All doctors within the NHS are restricted in what they can prescribe to those detailed in the relevant NICE guidelines. Choices are very limited indeed. Person A, for example, has a ‘choice’ of one as she is very allergic to the alternative. Such limitations on pharmacological choice may well be a known known to readers of this article. What, however, may be less well known is that pharmacies are obliged to supply the lowest cost generic form of the specified original form of the drug to NHS patients. And herein lies a big problem. The original form of any drug has, within its design, a specific chemical delivery system. Generic brands, whilst they should contain the specified amount of the primary drug are therefore obliged to come up with their own delivery mechanisms which may be less effective than the original or problematic to patients. So, in theory at least, if a person taking a particular brand of a particular generic brand has problems with that brand, one would expect that problem to be consistent. But it is not, which in itself is indicative of serious problems at the point of manufacture.
Both the persons mentioned within this text have experienced problems with medication with Person A saying –
“As I move from one pack to the next, I have absolutely no idea how they will affect me. One pack can see you wide awake at 5am , the next drenching the bed with night sweats, another having terrifying nightmares and another renders you comatose till mid afternoon. I have one pack that I could not detect any of the active drug in at all. Often I have to exploit the ’half life’ of the drug until I can access the next prescription because the current pack is so awful or ineffective. I have no idea how one particular company is holding onto its licence. I have kept a range of the unusable packs and I would love to have them independently tested but could not afford this out of my own pocket. The only reason I take them is that, at the end of the half life period, my existence becomes untenable in a hurry. I get the impression that this is not exactly news to either the doctors or pharmacists but their hands are tied. It doesn’t surprise me at all that a lot of people ‘self medicate’ and end up with substance misuse problems where the ‘legitimate’ psychotropic alternatives are of such poor quality and make a difficult life more rather than less difficult.”
The only comment I will add to this is that, assuming this to be is a widespread issue, the consequences regarding people who suffer from Schizophrenia or are subject to psychotic breaks, are very serious indeed. There are often difficulties associated with such patients taking medication anyway without these added disincentives to do so. I would take a lot of convincing that this is actually makes economic sense given the potential ‘on costs’ of adding to a persons ‘disability load ‘with inferior medication. It is, of course, also outrageous that public funds are being used to purchase inferior products.
Necessarily, in the absence of either appropriate treatment or decent medication many people with chronic mental health problems become subjected to the benefits system. Both the individuals referred to here have experience of the system. Person B is now in receipt of a pension and so is freed from it. Person A is not. For this reason, this section will largely focus on her experience. However, before doing so, it is worth noting a phrase from person B that encapsulates the experience well, “You may be going through a period when you are feeling a bit better but the assessment process puts you right back there” (i.e. at the heart of your illness).
Person A has this to say about the assessment process that, at the time of writing, is conducted by subcontractors ATOS-
“I have a lot of trauma triggers. Pretty big ones are communications from official sources and time pressures. From the moment I catch sight of the envelope, I am flooded with adrenalin and these days, that tends to be followed by a migraine that impairs my vision. It may take me a long time to get around to opening the envelope, but even then it will be problematic as the trauma is in control and my cognitive functions have largely shut down. The best I can achieve is scanning it, but making sense of it is another matter entirely. After I have got that far, then the process becomes ‘all there is, day and night, 24/7, for around 6 months. None of the usual strategies I employ to manage my condition stand a chance.
I have had three assessments now and there is a distinct change in approach with PIP. The system has become deprofessionalised. Under the previous system medical assessments were carried out by a doctor who had some understanding of my illness and behaved accordingly. Under PIP it was carried out by an occupational therapist and it was clear from the outset that she had an agenda so I wasn’t that surprised when I saw that my benefit had been cut. Unfortunately I am not well enough to go through the appeals process alone as it would make me even more unwell than the process up to that point. I doubt if I am alone in this which makes it clear to me that people like me are ‘easy targets’ of austerity. For me the whole thing is an act of state sponsored cruelty to ill people. The fiasco that is currently playing out terrifies me. If I fall victim to it, I think that will be the final straw.”
In the last point she will not be alone. Two thirds of ESA claimants report having the ‘common’ mental health issues of depression & anxiety and 43.2% have made suicide attempts (Mental Health Foundation, 2016). I am unable to find any statistics for people who are chronically disabled.
At the time of writing (Oct 2018) very significant problems are emerging within the benefits system. The new Universal Credit system is riddled with problems and seriously failing many thousands. Today (17.10.2018) news coverage revealed that some 180,000 claimants of sickness and disability benefits have been underpaid. Earlier in the week it was revealed by The Herald (15th October 2018) that almost 70,000 people who receive disability support have had their assessments “audited” by the Department for Work and Pensions since 2015 and some 11,705 audits of PIP assessments were conducted between January and August this year.
SNP MP Marion Fellows, highlighted the case of one constituent who suffers from multiple sclerosis and had his payments stopped after an “auditor” altered sections of a nurse’s report. The original said the man required “specialist input”, while the audited copy said he did not. Likewise, an assessment that he “needs prompting” to prepare a meal was changed to say that he could prepare a simple meal himself.
Ms Fellows states in the article –
“These figures show that there are potentially hundreds if not thousands of vulnerable people who may have had their health assessment reports tampered with by someone who wasn’t even in the room.
(This) case . . . . . shows that, for many, the system is rigged entirely against them and that decisions are a foregone conclusion.”
The DWP had previously told the MP –
“If a health professional’s advice is of poor quality which could result in an incorrect decision, the case will fail the audit activity.”
In my view this statement bears very close scrutiny. If we pursue the logic of it, and include the fact that the assessment process has now been taken out of the hands of doctors, then, it follows, that the DWP can, in effect, deploy this tactic whenever they choose to do so which is very dangerous territory indeed. Even the UN has now been prompted to accuse the UK government of grave and systematic abuse of the rights of disabled people (Margaret Greenwood MP, Channel 4 News 17th October 2018 ).
Unfortunately, the Conservative Party tends to have a pretty poor record in areas of Social Policy. Primarily this is due to it often being structured primarily along ideological lines rather than principles of rational choice. The current debacle is the latest in a long line of policy failures that have been implemented with scant regard for ‘unforseen side effects’ and the additional costs these bring.
As we near the end of this overview of the plight of those with serious mental health issues in 21st century Britain, a couple of areas remain unaddressed. The first of these is the core issue of advocacy, or lack thereof. There was a time in this country when ill and vulnerable people could access advocacy support and even Legal Aid if necessary. Those days are long gone. Recent enquiries have revealed that advocacy is only now available is in very limited areas (these services generally being paid for by Local Authorities) and only for those impacted by ‘Sectioning’ regulation within the Mental Health Act (1983) and Mental Capacity Act (2005). Everyone else is on their own.
So, at this point I would like to return to Person A, whose experience encapsulates some of the problems this gaping void produces –
“I have always been a very self reliant person. When I had my breakdown/crisis it was, as I suppose it is for most people, at a time when it was critical that I was my usual ‘effective’ self. And then one day I found I wasn’t. My brain had turned to mush and I was struggling even to find the words to string a sentence together.
At the time, I was considered to be at serious risk by the local Multi Agency Risk Assessment Committee and being bombarded with paperwork as well. I was utterly defenceless with no prospect of any meaningful help. It was absolutely terrifying. I can remember trailing round the town where I was then living and begging one organisation after another for help – far from easy for someone like me. Basically what happened was that I was ‘signposted’ from one agency to the next, each putting a tick in their ‘persons helped’ output box without doing anything meaningful at all. In despair, I ended up at The Samaritans who kindly let me work my way through a box or two of their tissues for a couple of hours before being advised to take myself off to the offices of the local mental health team (on whose long waiting list I already was) and to bang on the door as long as it took to tell them that I couldn’t wait the 5 or 6 months that I had been advised. And that’s what I did’.
Shortly afterwards I found the Crisis Team on my doorstep. I told them what the situation was and asked if they had a social worker who could help. They didn’t. Both then and now it seems to me absolutely crazy that, given a lot of people become mentally ill due to being overwhelmed, that practical support isn’t available It would make a massive difference. The other thing that has really surprised me is the complete inability of people in the caring professions to conceptualise the notion of ‘Its just me – there IS no-one else’.”
In hearing the stories, I was reminded of some work I did with homeless people some 20 years ago. I was fortunate enough to gain their trust and hear many histories. I had hoped to undertake some detailed research at the time but the contract term didn’t allow for this. Nonetheless, I can still recall the numbers. Around 85% of my clients were care leavers who, like both Persons A and B, were completely devoid of support. A very significant number had suffered abuse and sexual abuse, men and women, both historic and recent. Many were traumatised and there were indications of other serious mental health issues as well. Self medication was the norm. None had GPS but, if necessary, went to A&E. That was then.
Given the ‘road crash’ that is Mental Health provision now, the current benefits problems and the total absence of any form of advocacy for the vulnerable, many more have inevitably joined the ranks of the homeless since I last was involved. A combined investigation by the Bureau of Investigative Journalism and Channel 4 News (Oct 2018) revealed last week that ‘at least 449’ people had died on the streets in the past year. This is all too clearly to be expected in the circumstances detailed herein. This is not a problem that is going to go away unless all the problem areas highlighted are addressed.
The Office of National Statistics (2011) reported that the UK has twice the rate of the EU of people citing mental health as a reason for homelessness. Homelessness Link (2014) state that 80% of homeless people reported mental health issues of which 45% had been diagnosed by a medical professional. It is abundantly clear that without providing meaningful treatment and practical support no number of additional roofs will result in sustainable outcomes.
Ill conceived policy choices do not offer ‘best value’ for public money where both implementation and impact costs end up higher than the previous system. For the millions negatively affected, the price is incalculable misery. It is morally indefensible. A state and its government should always be judged by how it treats its most vulnerable members. Its not looking good, is it?
And what of the individuals whose experiences are related here? People who have made, in their own spheres, significant and even exceptional contributions to the society in which they live. At the date of writing neither has access to suitable treatment and no realistic prospect of that changing. Both struggle to cope with their medication and other practical challenges in their daily lives. Neither has any meaningful support from anyone. Both are in need of advocacy which does not exist. A cynic might suggest that, given both are now aged over 60, that the state has no interest in them as they are no longer of economic value. Time will tell.
To ‘open up’ and have a conversation about the mental health problems they may be experiencing is an act of profound trust by the person concerned and renders them very vulnerable. If, having done so, they are confronted with no meaningful provision or support for their illness, the inevitable consequence is a worsening of their condition, despair and heightened risk of suicide. Unfortunately, as in so many current policy areas, there appears to be a heavily spun beginning, or ‘head’ but a notable absence of any ‘tail’.
This is dangerous.
If you are also horrified by these problems, please take the time to write to your MP, urging them to address these issues.
 The edited version of the BBC news report can be seen here.
Image Credits and Sources:
1. “Depression” (female head in hands) by Ryan Melaugh, Flickr – licence: CC BY 2.0
2. “Medication” by Marc Pether-Longman, Flickr – licence: CC BY-NC-ND 2.0
3. “PIP Protest” by Roger Blackwell, licence: CC BY 2.0
4. “Homeless Teen” by Robert Scifo , Wiki Commons
5. “Help” from US State Dept., Non-commercial use
6. All other images from Pixabay, Non-commercial use