A survivors account of their personal experiences of mental health services in Wirral.
I received an email, via the website, from a service user who was in receipt of mental health services on the Wirral for over 20 years. I found it closely parallelled a lot of things I have experienced myself. Here is an extract from it and we would be really interested to hear your views on this too.
User involvement, services and staff on the Wirral from a user perspective.
Observations from a cynic-by-experience.
When I first had contact with a psychiatrist, I was very disapointed. I had expected an explanation of my overwhelming emotional issues. I expected treatment, understanding, and expertise in the field of mental health. None of this was forthcoming. I am now of the opinion that most psychiatrists, along with most mental health professionals, are in no way experts in mental health issues. They are experts at doing their jobs, I admit, experts at getting work in the mental health system. They’re very good at that. But the system itself is ignorant of the reality of mental distress. Psychiatrists and nurses don’t seem to understand, or feel the need to understand, what mental distress is all about. Many nurses suffer from stress; I am assured it is a major cause of lost work hours in all aspects of nursing. Yet, if a service user is stressed out, it is somehow ‘other’ than the professionals own experience – it is madness.
This ‘otherness’ associated with service users, those deemed mentally ill, is by its nature a construct, an artificial concept. The context in which the distress is expressed or manifests itself, and the mindset of the professional observing it, determine everything. The actual nature, cause and most effective way of dealing with the problem are often not considered. Usually not considered. Psychiatry, so often driven by fear, is loathe to consider the possibility that a person under great stress may behave in an unusual way yet not be out of control and not be unable to asses their own situation and needs accurately.
A basic examination of the mental health care system reveals that people’s distress is cleverly transformed into careers for people with little or no experience of mental health issues, no interest in these issues and very little enthusiasm to learn about them. Anyone trying to promote a more effective understanding of mental distress, often people who have experienced it themselves, find their arguments met by a barrage of objection, disbelief and defensiveness. Mental health professionals are used to having it all their own way, and many of them interpret any attempt at a more efficient, more effective and less dehumanising way to assist people with these problems as a threat to their status as professionals and a threat to the structure of the system that employs them.
In mental health services, there is a strong and unquestioned power structure. It is very much ‘us and them’. The individuals interpretation of their own experience is rejected out of hand as ‘madness’, and I know from personal experience that psychiatrists are unwilling even to hear such explanations – when I spoke about my very pressing concerns, I was told plainly and with some insistence to stop talking about it. I was told what to believe, and I knew that my explanation was no more ‘insanity’ than the psychiatrist’s was – less so, in fact. The events that impact on people’s lives, often involving highly traumatic and stressful experiences, are simply dismissed.
The service user often has important real-world and emotional issues that needed to be attended to. Not only does the psychiatric system fail to address these issues, their importance in the person’s life is ignored. The theory is that these problems are the sole result of inherent chemical imbalances, and therefore the only necessary treatment is medication. You can’t treat childhood sexual abuse with drugs that often seem to make the situation worse. Chemicals don’t change real life at all, and people are often left in a no-mans land between crisis and recovery, their problems still unaddressed decades later. The drugs, however, are a constant during this time.
The situation in psychiatry as it is on the Wirral and, I suspect, in many other places, does not serve the service user. It seems to perform a variety of control functions – it is a tool of social exclusion, a technique to neutralise people who experience, react to and complain about trauma, a way to paste over the very real issues that mental distress is often linked to. It also sustains a lot of people in employment and provides a niche occupation for those who apparently have no interest in mental health issues but who obviously feel that the best way to deal with ‘madness’ is to control it strictly, punish it when they feel the need to, and otherwise ignore it.
In common with psychiatry in most ‘advanced’ cultures, it also a way of channelling vast amounts of money to big, big pharmaceutical companies. These very profitable industries promote each new drug as more effective and less harmful then the previous product. Seemingly convincing research supports these claims, claims that psychiatrists are not shy of backing up. The research, however, is carried out by the company that manufactures the drug, so it is not surprising that they come up with extremely positive results – research that suggests anything other than maximum effectiveness and minimum negative impact on the lives of the people using these drugs tends to be ignored.
A few individual psychiatrists have become millionaires several times over after signing up as consultants for drug companies. They lend their names, followed inevitably by their academic credentials, to articles ghost-written by drug company executives. They are effectively drug company stooges, passing off what is essentially promotional literature as professional opinion. The average psychiatrist is not quite that wealthy or that cynical, yet they read articles in scholarly psychiatric journals and presumably form their opinions on the effectiveness of drugs partly on these questionable writings.
And within this system of routine coercion, amateurish responses to very real and often frightening experiences and often misleading if not downright fraudulent science, service users are supposed to find a role via user involvement. Anyone can see that there has evolved a new understanding of how services should be run. Yet the expressed ideals of those decision makers who promote involvement don’t always filter down to the service user, and on the Wirral have yet to really penetrate the cosy, reliable, safe world inhabited by those who staff our hospitals, day centres and supported living establishments. They, as much as anyone must realise that things really have to change. I’m sure they’d be much happier at work if they felt they were making a real and significant contribution to the wellbeing of the individuals they treat. And yet when offered insight into new ways of assisting people, they inevitably respond in a cynical, defensive manner. They simply can’t understand that it could be any other way than the way it is at the moment.
They see themselves as facing a hopeless task – visiting or caring for people who, no matter how much drugs you prescribe them, no matter how often and for how long they are kept in hospital, no matter how well educated, well respected or well connected their consultants, are not moving forward. The obvious answers – that drugs and hospital help only a minority, that you can have studied at the best universities and still have very little insight into mental distress, that the theories of psychiatry commonly held to be established fact are of little use – seems to elude them. When you try to point these things out to them, they take it as a slur on their profession, and even on themselves personally. They, after all, are the experts. How could a ‘paranoid schizophrenic’ who thinks his TV is talking to him possibly have any greater understanding then they do? It is, to them, plainly obvious that such people are insane, their opinions are therefore toxic and must be fought, in however sugary a manner. If you try to step into their world and suggest change, you are patronised, kept at arms length and, it seems, barely tolerated. Sure, they listen to you – at least they appear to.
A few individuals have been trying to instigate meaningful change in services on the Wirral since the mid 90’s. Their efforts are often in vain, very little change has occurred, and the users and carers involved often feel frustrated, exhausted and stressed out – round here, service user involvement can impact negatively on the user’s mental health. As service users we are often, in many ways, sensitive individuals, and carers are sensitised to the failings of the system as well. To constantly be dealing with opposition, professionals not showing up to user led projects or events, cancelled appointments, disenchanted or unsuitable staff and very little in the way of progress is discouraging to say the least. It is as if the professionals see that change is coming and are terrified of it. They appear to feel threatened. Perhaps they think that all their ‘good work’ is being undone.
Psychiatric patients, thinking and acting on their own terms? Inconceivable!