Some thoughts on the context of the Forum



Chris Barchard



There are two common misconceptions about the psychiatric system which are implicit in much media coverage of mental illness. The first is that people with severe mental illness are particularly violent. The second is that psychiatry is a gentle caring system of which nobody need be afraid.  In fact, apart from a small well-defined minority, mental patients do not represent any more danger to the public than society generally. Many of them are over-passive in fact. They are  significantly more likely to be the victims of violence than the rest of society. This contingency is hardly ever mentioned publically. Exceptional cases of extreme violence by people with severe mental illness receive a great deal of media attention.


The idea that there is anything soft about a mental hospital could only be credible to somebody who has never been inside one with their eyes open. The treatments are mostly drug-based and many of these drugs are extremely unpleasant and also likely to shorten life. Another still commonly used treatment is electro-convulsive therapy (ECT) which can have lasting adverse effects on memory. These treatments are often not given with the free informed consent of patients but with coercion and sometimes force if this fails. Each year a small number of lobotomies are still carried out in the UK although these cannot be forced on patients today. Although the surgery has become more precise the general principle is still the same. There is occupational therapy which involves patients doing very basic tasks, some forms of relaxation therapy and the so-called milieu therapy of the ward. This last  is nothing more than removing people’s right to privacy and putting them together in an uncongenial environment. The result is invariably a very bad and highly charged atmosphere which is anything but therapeutic. Talking treatments are given a low priority and are severely rationed.


Far from spending a lot of time talking people through their problems, nurses in mental hospitals fulfil a largely custodial role. They spend a great deal of their time in the ward office and their interactions with patients are basically to observe them, get them up and to bed, call them for meals and attend to basic needs. Treatment involves the administering of tablets and injections in the main as well as herding often heavily drugged patients to where they are given ECT under a full anaesthetic. Psychiatric staff frequently exhibit an officious coldness and relations with patients are usually far from cordial.


Although patients are referred to as “service users” this is something of an Orwellian misnomer since few have freely chosen to be under psychiatry.


Psychiatrists offer very little wisdom to their patients, confining themselves mainly to finding out what they need to know to prescribe the physical treatments which are their province. Psychologists and counsellors talk to patients in greater depth but talking treatments can be harrowing.


The system fosters a culture of creating dependency while at the same time being inimical.


Mental patients also have to put up with a huge amount of stigma from society which is often unwarranted and rooted in ancient fears of lunacy. The behaviour of those paid to care for them is also often stigmatising. They face the prospect of never obtaining suitable work and living in a subculture within society on very limited incomes, usually dependent on housing associations and council housing if they are to live independently. The problems of mental illness that receive the most attention result in a skewed view of what it is really all about. Patients are often characterised entirely in terms of their problems and as unproductive members of society and not genuinely as people.


In spite of what one may hear about huge strides being made in psychiatry this basic scenario has remained largely unchanged during the thirty-odd years I have been a patient. However there have been some important developments. There are some markedly better antipsychotic drugs in use now although they are on the whole still life-shortening – in all likelihood to not much less a degree than the older ones. There are a few new anti-epileptic drugs used as mood stabilisers which avoid some of the highly toxic effects of lithium carbonate. This was for a long time the only substance in use to control instability of mood. There are many new drugs in other classes which are not specific to severe mental illness. Community Care, which was really the culmination of a programme to empty the long-stay mental hospitals, which had been going on for many years previously, gave rise to day centres and many mental health community workers who aimed to help people cope in the community. Relations between patients and psychiatric workers outside the institutions tend to be better. However many of the day centres have now closed or changed their function to work rehabilitation, the usefulness of which is highly questionable for many people. Provision of housing has definitely improved. Many who now live in flats would previously have had to put up with bed and breakfast accommodation.


Unsurprisingly those subjected to this system have much to say about it. Finding a voice has always been hard for them, not least of all because their minds are discredited which amongst other things makes seeking redress for abuse extremely hard. National Perceptions Forum continues to provide an opportunity for them to make their voices heard.


The culture of the mental health system is very entrenched. We cannot expect change quickly. Probably our best hope is in reaching a new generation who will start the process. The internet is particularly helpful in reaching as wide an audience as possible. Having the opportunity to express views and finding that other people share the same concerns is therapeutic in itself.