‘All In The Mind’ was first broadcast 25 years ago and was fronted by Anthony Clare and is now presented by Claudia Hammond. The playfulness of the title reveals the challenging and campaigning nature of the programme and it is interesting to note that not one of the winners comes from the NHS. Listeners were asked to nominate someone or an organisation who had gone beyond the call of duty to support their mental health problems. Apparently, the programme was staggered by the number of responses they received. The winners had all gone beyond what could be expected from the NHS and, indeed, many, but not all therapists.
It was heartening to hear the stories of people who could possibly be written off as too difficult (personality disordered?) or intransigent in their condition. Additionally two of the awards were given to those who work with minority groups and was a strong recognition of the important and necessary work they are doing.
The Professional Award was given to Pat at Nilaari, a Bristol community based support service working primarily with Black and Ethnic Minority Group clients. She was nominated by Mike who credits Pat and the agency with saving his life and society from the person he could have so easily become. He began a life of crime and drugs at the age of 12 and was regularly imprisoned during his young life. He was not diagnosed with anxiety and depression until an episode of drug induced psychosis and was then introduced to the agency. During this time he became suicidal and relapsed into criminal behaviour and was again imprisoned. Pat and the agency never gave up on him and supported him through thick and thin for 15 years. He now works as a mentor for Lawrence Dallaglio’s Rugby for Change organisation.
The Project award went to Brighton based Mindout. An organisation run by and for lesbians, gay men and transgendered people. I know from my own experience of working at and being chair of Riverhouse HIV centre in Hammersmith that a significant number of people with HIV have co- morbidity with mental health and drug and alcohol problems. Many have issues around their sexuality and it makes it difficult for them to get service that is holistic and understands both their physical and mental health. I recall seeing a young deaf gay men in the NHS who also had mental health problems. He lived in a hostel for the deaf and was experiencing homophobic abuse. He had difficulty getting appropriate treatment because mental health services struggled with his deafness. When he was distressed it could be difficult to understand what he was saying which increased his frustration. on one occasion he was turned away from a mental health unit because he was ‘aggressive’. The nominee, Sebastian, said that it was the first time he had felt understood and he was assigned to ‘allotment therapy’. He remarked that watching carrots grow was far better than any number of SSRI’s.
The Individual Award was given to Steve and was nominated by Andrew. Steve is Andrew’s employer and stood by and supported Andrew through major episodes of bipolar which are often very challenging. Steve saw through the diagnosis to the man and was prepared to give all the help he could to his employee.
Claudia Hammond speaking on BBC Breakfast with Pat and Mike really put her finger on it. She said that unless the NHS are really going to take mental health seriously and offer patients long term and ongoing support then things will never really improve. What would have happened to Mike if he had been left to the care of the NHS alone? It doesn’t bear thinking about. What does concern me is that will projects like Nilaari and Mindout be allowed to continue doing the excellent work they are clearly doing? As funding comes with more and more strings will they be allowed to work as they do or will payment by results kill this off so that the more ’difficult’ and intransigent clients get dropped or are simply deemed unsuitable. This is already happening in the NHS where recovery is all. If you don’t meet the targets for recovery then funding is cut. We were told at Riverhouse that we had to move clients on but, as the project director at the time said, “They’ve moved as far as they can and now need support to stay there”.
The medicalisation of mental health has led to notions of ‘cure’ and ‘recovery’ that are akin to measles and mumps and to seeing medication as the main way forward. This superficially appears to be the best economic option along with short term CBT. Until this is shifted to take in the social aspect of mental health we will never see a great improvement and have a lot of distressed patients. in my previous writing about Barbara Taylor’s ‘The Last Asylum’ I mentioned a moving sequence about her sitting next to a fellow patient, who she was actually frightened of, but felt her human presence a comfort. It is the genuine care and humanity expressed in these awards that tosses aside protocols, that makes that big difference.