Very disingenuous article, using sleight of hand and conflating what are in reality very large differences that exist between autism and learning difficulties, personality disorders, and major mental illnesses such as psychoses (schizophrenia, bipolar disorder). The vast differences between these conditions mean that the treatments and appropriate treatment settings are also vastly different. The levels of medication and compulsion under the mental health act will vary greatly. The level of insight patients having to their own condition is a key factor and by definition is largely absent in the psychoses.
The article – like many similar ones – either simply fails to grasp or chooses not communicate the reality that many of our patients are so ill and disturbed that they represent a most profound risk to themselves or to others and require compulsive treatment in levels of varying security. Inevitably that sometimes means big fences and the use of restraint to protect them from themselves and to protect others, while treatment is provided.
As others have already pointed out it’s easy to pander to political and ideological prejudice by slamming the private sector (Priory) but one could just as easily choose 30 deaths or serious incidents within the NHS estate and point to apparent failings.
Penelope Campling’s book sounds like it was written from the perspective of a psychiatrist who led therapeutic communities and therefore was almost exclusively seeing people with severe and enduring personality disorders and not psychoses. The typical therapeutic community patient has insight and agency and responsibility over their behaviours and emotions, and so the model of consensual, collaborative commune type care can – superficially at least – appear to work.
These therapeutic communities are simply not appropriate for the treatment of patients with acute schizophrenia or bipolar disorder Who have lost touch with reality and have no insight into their conditions. Therapeutic communities are also incredibly expensive luxury items on the Mental Health menu, with precious little empirical evidence of their effectiveness. All too often therapeutic communities end up being dysfunctional microcosms of institutionalisation in of themselves, and at worst they can become almost cult like and sinister.
I think that you are partly wrong – I worked in a TC for many years – and we had many clients with psychotic disorders – the key was to enable enough insight so that they would choose to join you in maintaining wellness – early warning signs ,close liaison with psychiatrists , meds up in a stress induced crisis, down again afterwards – all done with a high level of trust conducted with daily one to one or group sessions to keep on top of most developments. We also provided this service very cheaply because there was liittle bureaucracy to pay for. Please Dont make global statements about TC’s unless you have worked in an effective one – they are a godsend for esp young people with no caring community of their own…………………..
Like any open wound best treated early! Sadly it festers in a world that couldn’t care less! Mental health and well being should be front and centre of a caring society. We would do well to stem the continual revolving doors of mistreatment. EIT showed much promise! Easy to pick off the Priory hey… tut, tut just look how well good the public sector did, Whittingham etc, etc!
The way forward is education! Drop in well being centres and psychiatric services at every health centre. Gps are ill prepared to deal with the onslaught from lockdown, the wounds are open and first aid is better value than prolonged delayed, crisis care. Drug misuse intervention is a priority as the connection with mental illness is glaringly obvious. Time for the billions to be spent much more wisely ….. suffer not little children!
The professionals must accept a lot of the blame. Just as ambulance chasing lawyers have bankrupted the legal aid system, psychiatrists have been busy medicalising an ever-widening range of what we used to consider normal, if slightly eccentric, behaviour. No wonder there isn’t enough cash to go round.
And when it comes to the mental health of children, St Greta and her fellow scaremongers have a lot to answer for.
Excellent piece When I worked as a psychotherapist/analyst I had several refugees from The Priory in my practice. I formed a veyr low opinion of their methods many of which seemed designed to keep ptients there as long as possible resumably to rack up their costly fees.
As I tweeted earlier today, as a trianee in the 70s I was shocked to find men and women, often on the top floor of many-floored psychaitric hospitals who had been confined there either as single mothers, or with learning problems or in many cases I uspected simply because theye were a nuisance to their families and the authorities.
Important and very informative article.
Many Mental health and Adults with learning difficulties greatly benefited from care in the the community supported family unit type approach. Some had been locked up for 40 years with low risk needs. Some people were not able to participate and would have been better supported in a specialist hospital setting.
It was similar with the inclusion all all Special Education Needs pupils in schools, rushed through with some benefiting and some finding it too much and not benefiting at all, with the distress of being ostracised. The wider pupils were also negatively affected by disruption.
Well where I live, the fine city of Bristol the Central shopping area called Broadmead which was always a bit crap I never go there now nor do the people I know. We all prefer to go to Bath ,Cardiff,Cribbs,Yate as Broadmead is now one big dossers social club. Its infested by them. How is hanging about in a(naff) shopping centre boozing all day with your mates better than the old asylums. Low risk needs. They get put in a nice flat with a few basics a bed a table,a cooker and within a couple of months they lose it because it takes intense concentration and.self discipline to manage money especially of you’ve little of it. They don’t want to stay in their boring flat all day watching Flog It so they go out to meet their mates for companionship and the craic and I get that. But then none of.us want to go there.
I worked in therapeutic communities in NZ from 1984 till 2002 when they were corporatised and effectively defunded – they were run by Richmond Fellowship originally started in England then spread to other parts of the world. We provided a home, full time rehab programme plus some semi supervised accomodations that appropriate clients could move if they needed it . Clients could return for respite to people they already knew and felt safe with. We ran these facilities for a pittance compared to the corporate models which did away with any semblance of rehab – BUT staff were quite well paid and stayed long term – THERE WAS NO WASTED MONEY ON BUREACRACY you see. By 2010 there were many many middle managers and no one working with the actual clients who were eventually moved out to live by themselves in the caring bosom of the wider community. Apparently there is a mental health support crisis in NZ now. God I detest the ‘experts’ who got to make those decisions and the politicians who enabled them – i hope there is a purgatory with a special section for them all !!
Is it possible for any system of paid personnel, however numerous well-trained, well-remunerated and caring, to replace or create the loving enduring relationships that are the precondition for mental and spritiual well-being? Are there enough kind, wise people on the planet to do care as well as is needed as paid work? How about the loved ones of all these paid personnel – who is caring for them while so much time is spent getting paid to care for other people’s loved ones? Is it possible that funding all these medical workers and corporations and systems comes at the cost of funding unwaged familly care work?
Oh yes. We sold off all those rather dignified and splendid architecturally Victorian asylums to developers to become executive homes and we turfed out the mentally suffering into the warm,caring,sharing community. Great idea. Why spend money on all that maintenance when they can sit in shop doorways all day. The word “asylum” means “,place of safety”.not.”prison”.
Ive been at that dark place and if you’re there you could be in a Palace,you could be surrounded by people who love you but you’re in a burning dark internal hell,the exterior circumstances make no difference. I’m not there now but I’ve been there. Then a few years ago a friend of mine went there,she is.oK now but it was that same unreachableness.
Just because.YOU,the doctor feel.disturbed at seeing the patient or inmate in bed all day,refusing to wash and in rags (I wasn’t quite that bad) doesn’t mean freeing them is going to change anything. Of itself. I always say,”the.community is where they burn witches”. I know it was the Yhatcher administration who closed down and.sold.off all those places to save money but under the guise of caring,so.the poor souls could rejoin “,the community” just like they shut all the mines to destroy the unions power but under the guise of clean energy.
Good article, the sort of thing that would appear in The Atlantic, or – back in The Good Old Days – in New Society.
Other than Prozac-style anti-depressants what are these treatments have been discovered for severe mental illness in the last fifty years? I’m not aware of these breakthroughs.
The writer does bring up his preferred villains as they are easy targets:
“The sums skimmed off into tax havens or to pay off debt-financing by some of the abysmal private firms indicate other factors are involved. These fat cats — now providing one in four NHS-funded mental health beds and close to half the spending on child and adolescent services — skim off hefty profits behind opaque corporate structures”
but another one is possibly the seemingly good guys, the Legal Profession who caused the original system to be discarded, and kept discarded, to protect the ‘Rights’ of the Mental Patients. It brings to mind the animal rights guys who let the farmed Mink free from from their cages as it was cruel, although this just means these farmed mink would starve.
Ah, in Sweden we only _wish_ the American mink would have starved. Instead they have thrived which is bad news for the ground nesting bird and vole populations, and part of the reason why the native mustelids — weasels and stoats — are declining.
I visited a client as their RPR in a care home on one of the hottest days of the year. He was laying on his bed in a t-shirt and incontinence pad and had no fan in his room. He said he had a fan but someone had removed it. I went to see the care home manager to get him a fan and she told me ‘if he wants a fan, the family can buy him one’. He has no family. But anyway it’s her duty to ensure standards of care and comfort. She has become a gatekeeper for the money rather than a gatekeeper for the care. Meanwhile outside sit two of the largest cars I’ve ever seen. So Birrell isn’t wrong when he says private providers see people with dementia and learning disabilities as cash cows. In my experience, sadly, that is all too common.
Yes, it is despicable that the old, the sick, the vulnerable and the mentally ill are seen as cash cows in this way.
Quite a lot of mental health and other problems are caused by the immune system just look up damage to the HPA axis, my mother married a man when I was three years old unfortunately she was passive and he was a psychopath we had 12 years of hell and misery the violence was appalling along with other forms of abuse he left when I was approaching 15 years of age, at the age of around about 19 I started suffering racing mental thoughts and anxiety attacks, This is common with that broken axis along with bipolar disorder irritable bowel migraines are form of anaphylaxis that can be caused by too much tyramine in the food ie like cheese, It took 40 years for me to get a correct diagnosis in the meantime it burnt gigantic holes through my life savings my wife left me one of her excuses was that I was always ill I had to take early retirement after working for forty years that was before diagnosis and I spent £30,000 of my life savings supporting myself waiting three years after being referred by my GP to see the local mental health unit at the hospital, along with all the other problems that Britain’s got I’ve got absolutely no respect for this country anymore.
12 years of Tory Government have cut mental health services to the bone but it wasn’t much better under Labour where in many cases, prisons served as the first stopping off point for the mentally ill until they could find a hospital bed for them.
The problem is that the type of medicine that is mainstream is not adapted to reality. Current mainstream medicine is a model that has been slowly created to feed the medical industry. Dr Malhorta explained this quite well , supported by a number of articles and letters in the BMJ over the last decade, that the majority of the medical world does not know that they do not know the influence of this industry on western medicine. It is high time to change the medical paradigm from trying to treat illness to finding out how to create health. This will totally change the look of medicine but is fiercely resisted….
In America it is my understanding reform to least restrictive environment was a legacy of the Kennedy family, who like my own family, had personal challenges within their family unit.
I think least restrictive environment approach is good however it is extremely difficult for the family even when finances are in place to accommodate home care. America has never fully funded the move.
With the baby boomers aging out substandard and haphazard inpatient care is becoming a nightmare scenario for the infirm and weak.
Family care should be funded instead of care homes by the govt. it would be cheaper and like foster kids, while most family situations have their flare outs – who wouldn’t prefer being mistreated by loved ones over strangers. Within reason of course the dangerously or repetitively abusive environment is untenable.
In my families case my grandmother was loved and while it was exceedingly painful for her husband and kids, there was one son who held some sway with her. I can’t say I loved her but I occasionally saw a spring in her step and a flash of who my grandfather fell in love with.
Well the only other observations I would make is that in my grandmother’s case my grandfather had money and she was in a presumably better private facility to which he convinced her to commit herself. After visiting her there once my horrified mother 20 some years later when watching One Flew Over the Cuckoos Nest with me said if one wasn’t crazy before being committed there one certainly would be after.
And 2). While the Catholic Priests are guilty of crimes against children nuns would be a better option for care providers than minimum wage paid strangers. While some are very compassionate any trinkets the family purchases their loved ones of any value or not would be pilfered. Becoming a monastic is somewhat out of favor and Hospitals and care homes are Catholic businesses now.
And to critics of Faye, she would have worked as a maid before choosing to move us back to that property, but economics and my grandfather wanted her there.
It is what it is people, deal with it and don’t let those ghouls experiment on your loved ones traumas in order to confirm their expert opinion that they know what normal, love, mental health or being fully human is all about.
No these adolescent interests weren’t my obsessions my momma wanted me to understand our challenges because my grandmother hated me and my brother and tormented us when she could.
For instance trying to convince me she murdered my grandfather and would poison others with food if I did not keep watch etc.
She was deranged. She was gleeful when grandpa died. Faye would say yes but she was a tormented soul.
For sooth the “experts” contributed to her derangement and judging from their current idiocies surrounding the denial of biology and transing 2 year olds … have not evolved. Run from the experts! Watch every pill and every idea they force feed your loved ones. The truly deranged are running the asylums and issuing diagnoses.
Charlie’s boot right up you Jew Genuises arses
southern lights over Tel Aviv then door to door retire extermination pest control bahahahaha
You ain’t a funny Qunt
You a known quntress
Slurp it fer us Silverman
We’s jus gettin stahted Jew Genuises
Can you frame it or is you under counter surveillance now Jew Qunts?
We turning it on Gramps… all the way to a final solution
You wouldn’t leave it at the Rape would ya Jew Qunts?
BOOM – a – rang
Southern nuclear lights over Tel Aviv then door to door
Look wut Grandma ETZION done cooked up fer you little Jew Qunts
No you may not trade it fer Mary Queen of Spamalots spoiled ham
Reap whaa as t you have sewn Jew Qunts
Another article saying that the State must provide. The problem is that the State is incapable of satisfying the needs of every good cause but our politicians lack the intelligence or spine to tell people this. So a creaking free at point of delivery for all NHS pretends it is world class and shouts for a yet bigger slice of the pie whilst defence, education, housing, transport, energy etc all shout for a bigger slice too – egged on by politicians pretending there are no limits and all can be done with improved efficiency and/ or more taxation. The truth is we need to make the cake bigger whilst also ordering our priorities within a sensible and constrained budget which will not bankrupt us or encumber succeeding generations. There have to be trade offs. Not all special pleadings can be accommodated and sadly some very good causes must wait or be funded privately. However carrying on in this fashion of spreading public finance further and further and hence thinner and thinner will only result in widening the extent of underperformance and failure across the board – and, worst of all, in the most important of our national priorities such as health, education, defence and energy.
Slurp it in public fer us Silverman you Jew Qunts love you some decades old FOLLMAR juice you slurp off Kenny Keith Goldberg Rapist shaft.
Incoming… Charlie’s golden boot going sideways up yer Jew Qunt arse
Gamer them boards… Granny ETZION and her cadre of Jew guíñeles done built Auschwitz 2 fer you Jew Vehr man dahling
Ah ha ha ha ha
Other countries spend the same per as Britain with far better outcomes I have been paying income tax for 61 years plus other taxes, and what about the inflation linked pension schemes for public services workers have the tax payers in private sector always got to stump up for those the NHS is far to inefficient with bloated bureaucratic overhead with all it costs.
Society or the community is going to pay one way or another, emergency room visits, incarceration or pie housing assistance etc IF the individual is truly unable to stabilize
Realistically, what do you do with a large, mentally disabled man who has no concept of appropriate behaviour, a huge amount of anger and an inability to communicate, and who puts a young female carer in hospital with concussion or rapes her?
My niece works with such people and has been in hospital with concussion twice because the same man has hit her. We dread worse. In one place that she worked, a male colleague had his foot amputated after an attack by a resident exacerbated an old sports injury.
Secure accommodation with properly trained and paid staff is the only solution for some people.
“Bear in mind Britain has the highest depression rate among children in Europe, along with one-third of the continent’s drug overdose deaths as citizens try to blot out their struggles and traumas”
What ‘struggles and traumas’ precisely? Does it seem credible that there has been an enormous increase in mental health conditions in recent decades? Why would this be, when, despite, the rather mild dose of economic austerity since 2008, people are better fed and housed than they have ever been? Is defining millions of people as being ill and almost creating this as the foundation of their identity the right solution?