In all our sanctuaries we sit at risk

Mental Health Witness – are UK services getting worse ?


I was at an event at the Poetry Society in London the other night, celebrating the 21st anniversary of a small charity concerned with mental health and creativity. The charity’s Chair stood up and suggested that mental health services are actually worse now than they were when the charity was founded, all those years ago.

That was a big and unpleasant thought. I have worked in or on the edges of mental health services for all those 21 years and actually much more. Do I think he’s right ?

Certainly his own small charity is receiving less funding than it ever has before, to the point of reducing its activities almost to nothing. The same is happening to other agencies which until recently provided an important and sustaining service to people with mental health problems, and now cannot.

Certainly too, over the years, dire reports on the mental health services in general have kept coming out, one report after another declaring emergency and failure, and often naming a culprit  – social prejudice, insufficient staff training, insufficient staff empathy,  poor communication between agencies, lack of money, whatever. The reports are headlined in the press and then we forget about them again. Until the next one. The succession implies no real progress, at best.

And, over the years, I have witnessed successive governments stride into power, rolling up their sleeves, saying “Right, we’ll sort this one, we’ve got the answers, the last lot were useless, let’s chuck everything up in the air again, make ’em all scurry and worry, here and there, until some bright new building is in place, with our name on it, solving everything. The care-practitioners will lie about exhausted, abused and disorientated, and we’ll take all the credit.” But somehow nothing much gets solved, the new building looks immediately as tatty and unfit for purpose as the old one, and the practitioners’ exhaustion just continues and continues. Then a new government gets in and throws everything up in the air again.

Much more impressively, much more importantly, I have witnessed, and still keep witnessing, people of calibre and real commitment making it their life’s work and whole meaning to bring amelioration into this dire and complex  territory, to plant the seed, to stem the flow – despite and behind all the political mis-diagnoses and flimsy shows, evasions, dogmas and blame-games.

Certainly, there is a list of policies and developments I can bring to mind which I can say consititute improvement, or at least have good in them and are progressive. I am writing this piece at a late stage of my own working life in mental health care and should set out that list soon. While some of it will inevitably be subjective, it will help me in my assessment of my own life’s work, as well as that of many peers I respect. It will help me understand the value and profit of all that aspiration, all those working hours, way longer than the job description specified, all those relationships, all that hope and good intent, all that application of creative and well-intentioned human energy.

But here and now I need to answer that question left hanging in my second paragraph.  Do I think that, overall, the UK’s mental health services have improved or deteriorated in the last 21 years or more ?

Answer : I have worked as intelligently and as alertly as I can, at or near the work-face of mental health services, in a locality where they are probably better than in many other parts of the UK. That experience suggests to me that, for several years after the large psychiatric hospitals closed and Community Care was introduced, services improved – though always against a strong head-wind brought about by various insufficiencies : a lack of resources, a too frequent  insufficiency of professional skill, quality and co-ordination and, in too many cases and areas, insufficient variety and consistency of therapeutic response.  And they improved precisely into that head-wind  – through gradually accumulating more community resources, with greater variety and complexity to meet the immense range of need that exists in this field ; through improving inter-disciplinary co-ordination ; and through finding and developing approaches and interventions that can help and sustain vulnerable people in the community on a long term basis where necessary.

Then – and I can’t say exactly when, and maybe there is no exact or single “when” – the reverse started happening. Resources started to decrease again ; the complexity brought about by experience began to be replaced by single answer dogmatism and radical and over-simple fundamentalist policies imposed from centre ; wheels started turning full circle so that things once known and accepted became as if they’d never been, platforms once built from a place of practice-learning began to be withdrawn in the name of new theory, leading back to an old familiar pit of nothingness.

So this is my answer to the question. Yes, of course, something has been achieved after all these years of work in this very difficult part and corner of human experience. But recently, something else has intervened which threatens a great deal of that achievement, so that there is a real sense in which mental health services overall are indeed worse now than they were twenty one years ago. Something terrible and perhaps unforgiveable has happened, for reasons and with causes hard to understand. Something hard-won has been  surrendered, given up. Crucial knowledge painfully come by has been passed over and spurned and now lies neglected in the dust, as if it never took form and does not belong.

Can this that I have said really be true ? If so, what has happened ? Can it be  named ? Am I, in my position, qualified to make the attempt at naming ?

I believe in some ways I am.  I shall try this naming exercise on my own terms and from my own place, as honestly and as carefully as I can manage.  In the process, I must leave statistics and laboratory findings to those who work in such territories. I shall wander and search out, seeking particular anecdote and example that seem meaningful and representative of more general tendencies and changes afoot. I shall come at the issue in whatever way I can, and from whatever angle, trying to tease it out into the open.

As I explore the theme, I shall keep posting onto this blog, using the same title as the one I’ve used above – “Mental Health Witness.” I shall keep the posts shortish and the angles they come from and styles they take may vary, since this matter is not simple, nor one-dimensional and cannot be approached as if it were. Mine is not the only witness and in putting it together, I shall refer to and consult with others whom I trust, when it seems relevant to do so and when I can. But ultimately I must take my own responsibility for what is written here.