“This is my life.” “I’m scared.” “I love it here. You get so much support and help.” These powerful, lasting words were three of the things uttered in the second episode of Channel 4’s Bedlam on crisis care last week.
These words ring out across the words of Dr Martin Baggaley, medical director of South London and Maudley NHS Foundation Trust (SLaM), who just weeks ago declared that England’s mental health services are in crisis. As he walked the wards on our TV screens, the details and numbers – the 50,000 patients under his care, the increase in patient numbers by nearly a third over the last 18 months – came alive.
In an article explaining why he’d let Channel 4’s cameras onto his wards Baggaley wrote: “I hope that when people watch the series, they will see that the person being treated for mental illness could be your neighbour, your friend, your relative. It could be you.” And, I can tell you, that it is me.
Mental illness is a difficult thing to talk about, although more people are. It’s difficult for an evolving, thumping, multitude of reasons but it can be and often is that desire to keep yourself whole; so that people will continue to look at you and see you, not you plus your mental illness.
We saw, in a very vivid way, how alive stigma still is with the #mentalpatient story a few month back and we hear it in throwaway conversations and media every day. And we know, as highlighted by Baggaley and outlined here by Arun Chopra the extent of the current crisis going on in our mental health services. So it’s time to talk. And it’s time to change.
In 1247 a place called the Priory of St Mary of Bethlehem was established in the City of London. The bricks have shifted, in their time, drifting from the east at Liverpool Street across city and Thames to Beckenham. Speciality narrowed but the Bethlem Royal Hospital is widely recognised as the first and oldest institution to specialise in mental illness. The place became infamous throughout the city and, as many institutions often do, acquired a colloquial name: bedlam. It is by this name that the current Channel 4 series goes.
Last week’s episode focused on crisis care. It showed the short-stay triage facility pioneered by SLaM and showed the reality for patients and staff alike. When Baggaley set out his reasons for agreeing to the documentary he stated that he wanted to give an insight into the challenges for staff and patients and services as well as the stigma that patients have to face.
The impact of that sort of insight and mainstream coverage of our key services, as we’ve seen with the reaction to Educating Yorkshire, is incredibly valuable. Not only because knowledge and shared experiences are key tools in the fight against stigma but they are key to the fight for better, person-centred services too. And as Dominic, one of the patients featured on Bedlam, has written since: “Isn’t that how we grow as people, by experiencing what we can of other people’s lives and so gaining some insight and empathy?”
I currently live a few streets away from the Maudsley Hospital on the edge of Lambeth where the rate of mental illness is three times the national average. It sits stoically across the road from King’s College Hospital with its rows of neon-trimmed windows, a pool of blue lights and sirens at its feet. The loud, screaming sirens that sometimes make you take a moment to be thankful for your health. But there is no health without mental health – a statement so striking and so true that the mental health strategy for England is named after it – so why does it so often feel like an afterthought, even when we think about our own health?
Our services today
Our mental health services today provide care for a spectrum of people with a spectrum of illness – from secure units and crisis care wards through to minor interventions such as counselling and cognitive behavioural therapy. Mental ill health is calculated to account for 28 per cent of all morbidity and the NHS spends around 13 per cent of its budget each year on mental health support. An imbalance in spending to need, which Secretary of State Norman Lamb has himself described as an “institutional bias” towards physical health. Not only does this lead to huge financial costs, such as the £13bn for untreated mental ill health among people treated for physical illness, but it means that people from across the spectrum often do not receive the support they need when they need it.
At one end of the spectrum are treatments such as talking therapies available through the Improving Access to Psychological Therapies (IAPT) programme in communities. 80 per cent of people accessing IAPT programmes in England will wait longer than the recommended 28-day period and some will wait longer than 12 months for treatment.
When my IAPT referral letter hit the tiles of my cold hallway with a thud it was a daunting thing. To see everything written on paper in black and white. This thing that affects your home life, your work life – the thing that stops you being you. Paper-clipped to the back of the thin, folded sheets were the contact details of all the local services I might want to privately access while I waited for my time. With my first reading came the strange recognition that there is still such a long way to go.
What is clear from this small glimpse into the current state of services, from crisis through to IAPT, is the importance of timely access and availability. It is imperative for both economic and human reason that we can deliver the services that people need – to give them the support that they ask for when they need it, just as we would with a slipped disc, chest infection or broken limb. And what seems obvious is that this support should be available to people 24 hours a day, 7 days a week as a matter of course, not as a luxury to be afforded or an afterthought.
A fight for parity
Recently Andy Burnham found himself surrounded by Tudor trim houses and rolling hills in my hometown of Shrewsbury where he made a speech to a conference on health and wellbeing. There he addressed the importance of parity of esteem between physical and mental health, something parliament have, in fact, voted for. He quite rightly pointed out that without the national survey of investment in adult mental health services being commissioned by the government, there was no way to measure if that commitment to parity is being honoured.
Burnham also used the opportunity to pencil in one corner of Labour’s vision of how to achieve and commit to parity within the skeleton of the whole person care idea – ways of using the NHS Constitution to enshrine further rights such as access to counselling, tapping in to the idea of mental health treatment as a right, as with physical health, however mild or severe.
Achieving parity will be a long-term process and a continued fight. It is a fight on many fronts – a fight against stigma, a fight for the implementation of evidence-based interventions, a fight for coverage, a fight against the separation of the physical and the mental, a fight for the facts (and the data) and a fight for the rebalancing of resources, as outlined in the Centre for Mental Health’s recent work with the Royal College of Psychiatrists on bridging the gap between physical and mental health.
The Department of Health have noted that the national survey of investment will be replaced by better measures, which is something government and oppositions ministers alike must push for. Data is a key element in a fight where battle lines are being drawn – to know how much money is being spent on mental health services and to measure access is key. Just this week Tim Loughton asked the Department of Health how many under-18-year-olds have accessed cognitive behavioural therapy in each of the last five years. The answer? “This is not data collected centrally by the department.” To know about access to such services is to know about over-capacity, and with it false economy and under commissioning.
And these are some of the reasons why Centre for Mental Health is calling for waiting time measures for mental health. To put mental health alongside physical health is a real and measurable way.
How we get there
Without a healthy mind there is no healthy body and this must be at the heart and in the head of Burnham’s whole person care plan and in the way that the opposition hold the government to account – from collecting data and beyond. Talk of enshrining basic rights like access to treatment from top to bottom is a start, but it’s in the balance of resources and it’s in the hearts and minds of the country too, where we need to see true parity still.
For me this is personal. Not just for my own mind. But this is something that has affected, in quiet thuds not always flames, some of the most brilliant, most profound, most thoughtful and kind human spirits I’ve known. And so many others I have not, although many have documented the fight – from Abraham Lincoln to Sylvia Plath to David Foster Wallace to William Styron and Allie Brosh.
And this, with one in four adults experiencing a mental health problem at any given time, is something we have all known in some way. We owe it to ourselves and each other to keep fighting for great care – from the inside to the outside.
You get strength from the strangest of places, from surprising people and not always from the places you thought. The process of mental illness can be a fairly boring and fairly lonely trudge, a quietly vicious battle. Bouncing from numb to shooting pain, a fight against feeling forgotten, feeling like a waste of life. For me, everything feels illuminated and exaggerated while I feel dull, living in shades of myself. The pull and the slack of life suddenly becomes flat, like the tallest of mountains with no summit, or no summit in sight.
I say: be kind. For kindness goes a long way and you never know what’s on the other side of a smile or brave face. But that’s not enough. What we need, what we really need more of, is evidence-based policy, such as the introduction of liaison psychiatry services in hospitals and evidence-based support, such as individual placement and support in employment, and interventions that make a real difference to people’s lives exactly when they need it. Services that put people at the centre of the service they are accessing and work with organisations and individuals within communities to support and improve the commissioning process.
In the recent debate on parity of esteem in the House of Lords, Lord Richard Layard said: “I think that we still live in the materialistic shadow of William Beveridge. As noble Lords know, he identified five great giants—poverty; unemployment; undereducation; poor housing; and physical illness—but he omitted the problems of the human spirit within. This has caused us decades of unnecessary misery. It is time to name the sixth giant, the great, hidden problem in our society, and that is mental illness.”
We must take our minds as seriously as we take our bodies – to look after ourselves in the whole – from top to bottom and from inside to out. And we must be aware of the scale of the challenge on a personal level but on a societal level to: to be supportive, to be equipped and to be educated.
The next episode of Bedlam focuses on psychosis and is aired on Thursday at 9pm.
Sofie Jenkinson is Media and Communications Officer at Centre for Mental Health, former Editorial Assistant at the Fabian Society and member of the Fabian Women’s Network Executive.