“We’d like to see a world mental health day where more understanding of the impact of trauma is shared rather than the medical model”. Rape and Sexual Violence Project
Yesterday, at the incredible Dragon Cafe, I read from a forthcoming poetry collection, ‘Elephants. Fragile’ (Cinnamon Press, 2018) about my mental ill-health experiences and talked about an operatic collaboration with Rose Miranda Hall and Lila Palmer on The Jewel Merchants – based on a fable of ‘coming through’ and re-valuing those who suffer. Real co-production.
Today, World Mental Health Awareness Day, there is the launch of our InHealth Associate’s evaluation report of an amazing back to work scheme run by the Centre for Mental Health. Real psycho-social intervention that could help change the system.
I am starting work as a Visiting Lecturer at The University of Hertfordshire on its MSc (online) in Mental Health Recovery and Social Inclusion. Many of the students are service users. Real inclusion.
These coincidental happenings are making me think more clearly what I want to do with the rest of my work life. This is the sort of work that might, just might, help heal healthcare systems. And it is full of joy and love.
Why don’t we get it (1)?
The other day, a friend asked me to describe what it was like to have mental health problems. He was ‘aware’ of mental health problems – knew the old one in four stats gag as well as he could say we need ‘five a day’. But lacked understanding. Really didn’t get why people couldn’t ‘stand back’ and find ways to psychologically distance themselves from mental distress. Not ever having suffered from depression himself, he couldn’t fathom why it was so hard, yet recognised that it must be.
So I told him my ‘Radio Evil’ theory – that when I have been ill, it is like a radio turned up – that the words in my head become (a) louder (b) nastier (c) more incessant. I can’t hear you through the din. And if you tell me to go running or do the things I used to enjoy, they don’t get rid of it, as I have earphones on and cannot take them off. He seemed to get that. Use the analogy if it works for you. One more person understands a little bit more now. And he says that was useful. See also my blog on The Broken Compass.
Prince Harry – thanks, but…
This left me thinking again why it is that people don’t get mental health problems. I notice that many in the autism world want ‘understanding’ and ‘acceptance’. Rather than ‘awareness’. Maybe there is a clue there.
Meanwhile, we will have a mental health awareness day filled with well-meaning rhetoric, encouragement to put yourself in someone else’s shoes, drum in well worn statistics and encourage you to be ‘compassionate’. Well-meaning, but I fear useless.
Prince Harry coming out is great, don’t get me wrong. But if we continue merely to talk about ‘awareness’ over understanding and equate mental and physical illness, we will not reach the roots of the problems we suffer.
The roots are more about the world we live in, our sensitivity to it (blessing and curse)… how we are often alone, fragile, unsupported or homeless and subsequently react (or get overwhelmed).
This government is cruel and is creating mental distress – I have friends who have been made ill by the housing so-called system and benefits assessments. We could re-label today as ‘Mental Illness Creation Day’ and it might be closer to the truth. Though: let’s also be ‘aware’ that there never was a golden age of psychiatry – that we have always been treated as out sight and out of (our) mind. In need of sympathy at most. But what I am saying is warm words won’t cut it.
Why don’t we get it (2)?
In fact, if it remains all about awareness, if the stress is on statements like ‘depression is treatable’ (that’s a foxy word ‘treatable’), we risk corralling more folk to get ‘diagnosed’. That labelling reframes identity so as to internalise symptoms and we are drawn into the maw of a medically, pharmaceutically and hospital dominated world. Check out my recent BMJ article.
Meanwhile, at a system level, we know there isn’t enough mental health money going round, so what choices are there really in the current cash-strapped mainstream system? Short term CBT, medium term incarceration or long term drugs. And the solution will not be in the genes and amenable to drugs, however ‘precise’ they get.
And why isn’t there enough money to go round for other things? This will be the unpopular paragraph. Because business managers of acute hospitals (for the physical stuff) don’t want to let go of their dosh. If you were one of them, would you give up your organisation’s income?
I have seen closely how hospitals resist yielding power and resources. There are no incentives to let go, no real incentives in the system to hire one less psychiatrist in order to let others hire half a dozen peer workers. Oh no, that would ‘destabilise’ the system.
Unless you think money grows on trees, and huge injections of cash are forthcoming (Dream on, Corbynites). This is reality. And a large proportion of the shrinking pot (god help social care) will be drawn into the biomedical-professional-institutional sphere. This is a caricature but will be largely true – those with power will be largely OK.
Meanwhile, users of services continue to lack opportunities to influence the system – beyond being lulled into focus groups and feedback sessions. See also my bog on ‘What is a patient leader’.
WMHD is not totally useless of course, and there are lots of good initiatives going on. But the ‘awareness’ approach is largely a dead-end. It ain’t going to heal a fractured system. In fact it risks making things worse if it drives us towards a system that by default cannot offer real choice and community support.
At my most cynical, I would re-label the Mental Health Awareness brand: ‘Hugs and Drugs for Poor Loonies’.
So, why is this an important week again?
Because I have decided to follow my joy. Because I will do what I can to serve. Because I will never stop speaking up.
Because collaboration between the arts and user involvement world inspire and there is a fertile and furtive space opening up for real co-production (see my blog on The Jewel Merchants collaboration).
Because the Centre for Mental Health report shows a different way forward – where psycho-social interventions can help (but will need disinvestment from traditional models).
Because mental health is where I belong.
And I can’t change it all – I am not superman, and nor are you. But I do know the direction in which I need to travel.
Go do your bit. But be kind to yourself. Have a good one.
(c) 2017 David Gilbert
If you liked this blog, do read others at futurepatientblog.com