On Universal Basic Income, Be Careful What You Wish For

The Expanse IFF protest
A scene from The Expanse, where oppressed citizens of the future exist on subsistence ‘Basic Assistance’ Welfare

Ontario Coalition Against Poverty (OCAP) Organizer, John Clarke writes:

In the last while, I have discussed the issue of basic income with hundreds of people who support it in a range of countries. In all the interactions I have had, I have yet to come across a serious and coherent response to three simple questions.

    1. Since the 1970s, existing income support systems have been degraded so as to create a sense of desperation and force people into low paid precarious work. This strategy has been horribly successful. If we have been unable to defeat this austerity agenda, on what basis is it assumed that an adequate universal payment that would reverse it can be obtained? (If universality is your answer, take note of the attack on public healthcare systems).
    2. Since it is assumed that a truly adequate UBI is going to be created under capitalism, how does that system and its job market function without the economic coercion that is presently at the heart of things?
    3. Right wing neoliberal thinkers have in mind a form of basic income that provides a means tested and inadequate payment. This would serve as a subsidy to low paying employers so as to block struggles for decent wages while, at the same time, it would be used to replace other systems of social provision. This would be an entirely regressive development. It is not enough to say that your version of BI is not like that. What is the plan to ensure the kind of BI the World Bank would like to see is prevented and the progressive model prevails?

If this post sparks interest, I expect some responses but few real answers to these questions. In my view, there aren’t any adequate responses to them because they point to reasons why a progressive UBI is not going to happen under capitalism and certainly not during the neoliberal era.

UBI, Further Reading:
















Open Letter To Some Of Those Attending The Global #DisabilitySummit #NowIsTheTime

Open Letter to some of those attending the Global Disability Summit


Lenin Moreno, President of Ecuador

Gabriela Michetti, Vice President of Argentina

Sophie Morgan

20 July 2018

We are writing this open letter to you on behalf of Deaf and Disabled people across the UK concerning your involvement in the global disability summit being co-hosted by the UK government in London on 23 and 24 July.

We are strongly in favour of international support that improves the lives of Deaf and Disabled people across the world and welcome co-operation between States that lead to stronger human rights laws and protections. We particularly support the building of international solidarity and links directly between Deaf and Disabled People, our organisations and campaigns.

However, we have the following concerns regarding the July summit:

The role of the UK government in co-hosting the event. Following an unprecedented investigation carried out by the UN disability committee under the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), the UK was found responsible for grave and systematic violations of Disabled people’s rights due to welfare reform. The findings of their investigation, published in November 2016, were and continue to be entirely dismissed by the UK government. In August 2017 the UK government was routinely examined under the UN CRPD and again the UN disability committee expressed their deep concerns regarding the UK government’s failure to understand the Convention, the impact of their policies and failure to recognise them. Again the UK government said they disagreed with the findings of the Committee. The involvement of the UK government in co-hosting the summit therefore undermines any aims of the summit linked to strengthening Deaf and Disabled people’s rights under the UN CRPD. Instead it provides a platform for them to showcase to other States how it is possible to get away with ignoring those rights when it comes to your own citizens.

The UK government’s use of its international work to cynically deflect from criticisms of their disability record in the UK. On a number of occasions when government ministers have been criticised for implementing policies with an adverse impact on Deaf and Disabled people, they have cited the poorer conditions of Disabled people in other countries. This represents a misunderstanding of the UN CRPD which is about the progressive realisation of rights. The UN disability committee have such concern about the situation in the UK because it represents a serious and dramatic retrogression of rights, described by the Chair as a ‘human catastrophe’. In deflecting attention from their record in the UK, the Government clearly intend to more easily continue their punitive policies targeted at Disabled people and the poorest members of society. There is now overwhelming evidence, evidence which the UN disability committee considered, that prove the brutal impacts of these policies. It would be a betrayal to all those suffering under them not to raise concerns about attempts such as use of the global summit to divert attention and opposition to those policies.


The suitability of the Government of Kenya as co-hosts given their abuse of the rights of LGBTQI+ people, many of whom develop lifelong impairments as a result. LGBTQI+ people in Kenya are routinely banished from their families, denied work and accommodation, imprisoned and persecuted. They face severe barriers to forming and maintaining relationships and to living as a couple, the ‘Right to Family Life’ that every human is promised. This results in widespread damage to their mental and physical health, creating impairments where none previously existed. This is reflected in the high level of asylum applications to the UK from LGBTQI+ asylum seekers from African countries.

Despite their experiences, the majority are then refused asylum in the UK and forcibly returned home, where many disappear or are murdered. Just this April, President Kenyatta said that LGBT rights are “not acceptable” and not “an issue of human rights”. The Kenyan Government has also claimed this is a non-issue for Kenyans, and no doubt would argue that it has nothing to do with the Summit. However, if you are Kenyan or Ugandan and are lesbian, gay, bisexual, trans, queer or intersex, it is an issue that completely dominates and dictates your life. For many Disabled people from Kenya, it is the reason they developed an impairment in the first place. Under the UN CRPD, the Kenyan government also has an obligation to protect the rights of disabled people who are LGBTQI+.
We appreciate that you may not have had this information when you agreed to involvement in the summit and would be happy to meet to discuss our concerns. Please do not hesitate to contact us with any questions or for further information.

Yours sincerely,

Disabled People Against Cuts dpac.uk.net

Sisters of Frida sisofrida.org

Alliance for Inclusive Education allfie.org.uk

Inclusion London inclusionlondon.org.uk

Mental Health Resistance Network mentalhealthresistance.org

Reclaiming Our Futures Alliance rofa.org.uk

Recovery in the Bin recoveryinthebin.org

RITB Statement of Support

RITB (Recovery In The Bin) members have intersecting identities and social positions such as BME/LGBTQIA+/people in receipt of social security. We are a group of people marginalised in many ways, not just because we are mental and disabled by society. We especially wish to stand in allied solidarity with these groups and condemn racism, transphobia, homophobia, sexism & scrounger rhetoric. We call on liberation movements to stand in solidarity with us.

If you wish to add your name or org to this statement please email the details to


Julie Gosling
– Making Waves
– Nottingham MAD Network

Akiko Hart, Mind in Camden

Andy Fugard, Birkbeck, University of London

Stan Papoulias, King’s College London

Jhilmil Breckenridge, Bhor Foundation, India and PhD Researcher at University of Central Lancashire

Gary, mental health service survivor

Helen Hewitt

Richard Ingram, West Coast Mental Health Network

Jayasree Kalathil, Survivor Research, London

Jayne Linney, Disability & Equality Activist

Dr Annie Hickox, Consultant Clinical Neuropsychologist

Rachel Yates, Central London BAPCA Group

Dolly Sen, mental health researcher and artist

Professor Bee Scherer, Director of the Social Justice Research Center INCISE, Canterbury Christ Church University

Suzi Mackenzie, Counsellor with a commitment to social justice

Jen Kilyon, Activist and campaigner for compassionate mental health services

Clare Knighton, Peer Support Worker

Melanie Davis, Mind in Camden

Alison Cameron, Survivor, activist and advocate

Helen Spandler, editor, Asylum magazine

Debbie Hamilton Newcastle Australia

Joanna Landeryou

Tom Wood, Mayday Self Help Groups

Alisdair Cameron, Launchpad Team Leader, ReCoCo co-creator

Mark Brown @markoneinfour

Jay Watts, Alliance for Counselling & Psychotherapy

Christian Kerr, mental ill health experiencer, social worker

Mirabai Swingler

Dina Poursanidou, Asylum magazine collective

​Derry Hunter. Survivor & Agitator. Recovery Wirral

Eleni Chambers, Survivor, researcher and activist

Crisis Care – alternatives to admission

Crisis Houses: An alternative to Hospital Admission? A look at real world crisis houses at Tees, Esk and Wear Valley NHS Mental Health Foundation Trust.

Up North the Durham & Darlington Crisis house run by Tees, Esk and Wear Valley MH Foundation Trust has been sitting empty since December 2017 while service users aren’t informed it exists. Is this TEWV’s way of maintaining the hospital/medical model status quo by ensuring Crisis Houses are destined to fail, or is it something to do with Crisis House model itself?

The current UK government’s review of the Mental Health Act is placing strong emphasis on reducing detentions. As such, better community services including support in a crisis are high on the agenda with strong calls to introduce more services that support people in acute distress outside the hospital environment. (1)

The question is whether such services would be effective and safe for patients and provide genuine alternatives to hospital. When crisis teams were introduced they too were intended to be a service for people who would otherwise be admitted to hospital. The course of time has shown that suicide is far higher under crisis teams than in inpatient care (2). Nevertheless, steps are being taken to improve community based services.

‘Crisis Houses’ are one of the options frequently mentioned in debates around better community services in crisis and alternatives to hospital. But do we know what would happen if crisis houses were rolled out on a wider scale?

Recently Recovery in the Bin were told about a consultation by Tees, Esk and Wear Valley NHS Mental Health Foundation Trust on the continuation of their County Durham and Darlington Crisis House which opened 4 years ago. The consultation highlighted that an inpatient bed costs the Trust £380 per day whereas a Crisis house bed cost the Trust £480 per day, though the consultation doesnt mention effectiveness – and cost -effectiveness – of shorter stays in the Crisis House than hospital.
The sobering figures showed that very few service users were considered ‘appropriate’ for the Crisis House. Admissions were via the crisis team and the Crisis House had in fact been closed since December 2017 with not a single referral accepted and the staff working elsewhere in crisis services. Unsurprisingly the Trust wanted to ‘review the role and function’ of the Crisis House.


We felt more information was needed on the circumstances behind this situation and asked a member of our group who is under the care of the Trust to find out more.The Trust provided further information as follows:

Question 3.
How have you determined that the lack of referrals to the crisis house are not a result of overzealous gatekeeping?
Trust Response: The crisis and recovery house provides an alternative, safe, supportive environment for intensive home based treatment for those experiencing a period of acute distress and who would benefit from a planned period of time away from home. The service is not used as an alternative to inpatient admissions and is not an element of the gate keeping process.

Question 6.
How many service users have the crisis house on their care plan or have been informed it exists?
Trust Response: Service users are made aware of the crisis and recovery house service, if and when it is appropriate to their care and treatment. As admission is made directly from the crisis teams based on immediate need, it is not identified within individual’s crisis plans (part of the overall care plan).

Question 2.
How have A&E attendances for mental health problems changed during the 4 years the crisis house has been open?
Trust Response: The crisis and recovery house does not provide emergency mental health care services. As such, we would be unable to ascertain any correlation between the service and A&E presentations.

Not all questions were answered (a FOI request may be needed) and we felt the responses that were received raised more questions.

While it is probably obvious to readers how insufficient the Trust responses are we nevertheless spell it out below.

The Trust replied that the Crisis House is not an alternative to hospital admission. Their consultation documents, in contrast, say the crisis house provides ‘an alternative..for intensive home based treatment’ and then explains that intensive home based treatment is ‘an alternative to hospital admission’. It seems somewhat illogical to consider the house not to be an alternative to hospital admission.

The Trust’s reply dismisses the possibility that the empty beds at the Crisis house may be a result of overzealous gate keeping. Yet it also claims all admissions are via an assessment by the crisis team when a service user is in acute distress. In fact, service users are only informed the crisis house exists if the crisis team decide that the house is an appropriate option. It is difficult to imagine a clearer example of impossible to challenge gatekeeping.

The Trust makes clear the Crisis House is not included in advanced crisis planning for known service users – it is not put on crisis plans for example. This seems somewhat contrary to the principles of the crisis care concordat. Furthermore, it calls into question the Trust’s consultation documents which claim that admissions to the crisis house are ‘planned’. A service user in acute distress informed of the Crisis house as an option following assessment by the crisis team is unlikely to experience much delay between assessment and admission to ‘plan’ admission to the house.

The Trust, which is consulting on the function and role of the Crisis House, claims they cannot ascertain any correlation between the Crisis house and A&E attendances for mental health problems on the basis that the crisis house does not provide emergency mental health services. But the Crisis house is designed to provide intensive home based intervention – which is an alternative to hospital admission for people in mental health crisis. The purpose of crisis planning is to prevent mental health emergencies. In addition, the consultation specifically pinpoints psychiatric liaison services as one of the reasons why there has been a reduction in the use of the Crisis house and yet psychiatric liaison is a service that receives referrals from A&E and may divert service users toward the crisis team. A&E attendances for acute mental distress and service users in crisis are essential for understanding and evaluating the role, function and impact of a crisis house.

This ‘case study’ of community based crisis services raises a lot of questions for TEWV to reflect on about the standard of crisis care and crisis planning they deliver and the extent to which they involve service users in decisions about their own care. It also raises questions about the effectiveness of consultations with patients and the public by NHS organisations, especially the quality of relevant information given to ensure stakeholders are enabled to provide fully informed opinions.

Over and beyond these considerations however, there is the wider question of how community based services might be implemented in practice if the drive to reduce detentions continues to call for greater emphasis on support outwith the hospital. And will service users ultimately benefit?

Is TEWV crisis house typical or are crisis houses working better elsewhere? What ensures the model works and why, at TEWV, has it resulted in a farcical scenario, reminiscent of 1980s satire Yes Minister (3), where patients around the country cannot get hospital beds but at TEWV an entire crisis house is sitting entirely empty?

(1) Dorothy Gould is currently seeking views on alternatives to hospital admission to feed into the mental health act review https://www.nsun.org.uk/news/alternatives-to-detentionsectioning-under-the-mental-health-act-1983-can-you-help-with-suggestions

(2) http://www.manchester.ac.uk/discover/news/suicides-under-crisis-services-lead-to-concerns-over-pressures-on-mental-health-care/

(3) https://www.youtube.com/watch?v=x-5zEb1oS9A

Psychiatric Liaison – adding insult to injury?

According to the Royal College of Psychiatrists, “Liaison Psychiatry is the sub-speciality which provides psychiatric treatment to patients attending general hospitals, whether they attend outpatient clinics, accident and emergency departments or are admitted to inpatient wards. Therefore, it deals with the interface between physical and psychological health.” There is a ‘Faculty’ for Liaison Psychiatry at the RCPsych and they are running a pilot to develop a credential in Liaison Psychiatry.

The academic and training view of RCPsych is a world apart from my experiences of Psychiatric Liaison in my local Accident and Emergency, (A&E) department. I am emerging from a mental health crisis which involved at least 12 visits to A&E and minor injury units within the space of just several months. I self-harm by cutting my body as a last resort during times of extreme distress. The self-harm is not ‘addictive’ in nature but it is incredibly painful. I harm for the need to get this act over with in order to have a chance to feel better later. I feel compelled to cut and displace the distress, thereby enacting deep inner pain which is beyond words. In the past I have needed surgeries, multiple blood transfusions and countless stitches. Attendances at A&E have been only the tip of the iceberg of my self-harm and it has been far more usual that I go to see the nurses for wound sterristripping at my GP practice or self-treat.

If Psychiatric Liaison does bridge the interface between physical and psychological health then I may seem an ideal candidate for its expertise. My self-harm does have physical complications, not least iron deficiency anaemia and open wounds that take time to heal. I welcome advice, practise harm minimisation and am crying out in pain during a cycle of self-harm. Recently when cutting one area of my body I hit major veins and the blood loss necessitated ambulance call outs. After the second ambulance I decided to avoid harming this area of my body as I don’t want to bleed to death. I am resolved to reduce the harm and minimise my ‘impact’ on local overstretched health services.

I must report that my experiences with Liaison Psychiatry have added insult to injury. A ‘good’ visit to A&E involves not only physical treatment with adequate anaesthesia, but the treating medical doctor agreeing that I don’t need to be referred to the Liaison or Crisis Team, (the Team which is on call depends on the time of day or night). I explain that I have seen the Crisis Team and Psychiatric Liaison in the past and they have nothing to offer. I usually wait hours in the department for the Liaison Team to come on duty or finish with other patients then they permit me a ten minute chat. This chat usually consists of asking why I am there, was the self-harm superficial, (would I be there if that was the case I wonder?), have I tried counselling and how will I get home?

The Liaison practitioner may feel the need to draw up an action plan which will say something like ‘aware of crisis numbers.’ Since the crisis numbers such as the Samaritans and the local mental health helpline are widely available I don’t need to be given them. I don’t see why I should have waited hours on top of the prior three hours wait for physical treatment for this unnecessary assessment which will just tick a box for the service.

My resistance to Psychiatric Liaison probably relates to the fact that they work for a mental health trust which discharged me in 2015 by saying they would not see me again while I had the ‘same presentation.’ Since I have no history of psychosis I am not sure how I can morph into a different presentation which would be more agreeable to the mental health team. Over 16 years ago I was given a diagnosis of Borderline Personality Disorder and this still follows me around even though no-one ever reviews it. Previous GPs have made referrals to the ‘Access Team’ which get batted back with conversations with the GP along the lines that I should ‘take responsibility’. I have worked full-time for the last seven years and pay to see a private psychologist.

I don’t know what else I can do to prove I am ‘taking responsibility’ except perhaps drop off the radar of all health services. Sometimes my death would seem like a better outcome to mental health services than my attempting to ask for help that doesn’t exist. I know that Psychiatric Liaison presents a dead end since they have no services to refer into which wouldn’t be hostile to that referral. My local mental health trust is taking part in the ‘Open Dialogue’ pilot but this approach, which comes with much praise for its innovation, would never be open to someone in my type of crisis.

My recent experiences of Psychiatric Liaison have confirmed my misgivings about this service area. I was referred to Psychiatric Liaison by a very thorough medical doctor in June. The doctor spent over an hour suturing wounds. He even said that he didn’t like to see those kind of wounds on anyone and believed that I deserved help and that services had changed, with new options available, since they had discharged me several years ago. He asked if I was under a psychiatrist and I said that I hadn’t seen one since 2013 and services would have no desire to help again.

But in the spirit of being a co-operative patient, and truly being grateful that he did bother, I went along with the referral. The problem was that it was 11.30 pm on a Saturday once the physical treatment was over. The doctor escorted me to the Clinical Decision Unit in the hospital to wait for the mental health team. I then endured a nine and a half hour wait sitting in a chair for psychiatric ‘assessment’.

I would expect the Crisis Team to cover at night where Liaison are commissioned to operate from 8 am – 8 pm. However, it seemed like the Crisis Team didn’t want to come to the hospital that evening and I had to wait for Psychiatric Liaison to arrive on shift on the Sunday. I was seen at 9.15 am by an Occupational Therapist and another quieter unknown team member who chatted to me for ten minutes. I explained I was very distressed and needed to get home. I am a key contact for an elderly parent who would wonder where I was since I hadn’t phoned her that day. The OT still insisted on ticking boxes by talking and drawing up an action plan. I signed the action plan rather than waiting for another ten minutes she said it would take for her to write out this plan.

I was never sent a copy of the plan and have no idea what I signed. I imagine that the plan may have said that I had the crisis numbers and was to go back to work. There was no apology for the nine and a half hour wait in the chair or understanding of the distress and total lack of sleep this had caused. I had tried to self-discharge during the night but had been told by medical staff that the A&E doctor had been worried enough about me to call the police if I left the hospital. Since I have no wish to waste police resources I figured I would need to stay no matter how uncomfortable.

On my next two A&E visits I did see a consultant psychiatrist which seemed unusual given the community mental health team operates with locum psychiatrists and has had no consultant for many years. I was initially impressed by the consultant who had read notes I made in 2015 saying I didn’t want to see Liaison due to the long waiting time which led nowhere. My second meeting with him was less thoughtful due to his assumptions. A friend had accompanied me to A&E and the psychiatrist seemed more interested in talking to her about what she felt was behind my behaviour rather than asking for my account. The psychiatrist said that they didn’t want to make it ‘too comfortable’ for me to attend A&E or they were ‘enabling’ me. I tried to explain how I didn’t enjoy attending A&E and was going for clinical reasons, ie a wound that needed closure through stitches and not because I was a bit upset.

My friend did voice that she thought I needed help from services. The psychiatrist, who was meeting me for only the second time, said that the community mental health team couldn’t help someone like me as they only saw people with a chemical imbalance and were better when there was a clear goal like a medication review or getting someone into voluntary work. The psychiatrist said he didn’t think I was someone who needed to be on medication. He also decided that he would have a professionals meeting to come up with a ‘plan.’ He intended to contact my GP and a primary care nurse who I met only twice two years ago. My private psychologist knows me extremely well but he didn’t contact her at any stage though I supplied her mobile number and email address.
The psychiatrist then said that I wouldn’t see him again even if I went to A&E and he wasn’t my therapist. I asked the psychiatrist for sleeping tablets but despite being based in an A&E department he wasn’t able to prescribe any! He instead faxed a plan to my GP suggesting he ‘considered’ a 14 day course of zopiclone at the lowest possible dose. I tried to explain that I have no history of dependency on medication yet still it felt as though I was asking for hard drugs. Thankfully my GP prescribed sleeping tablets and a tranquiliser without questioning my motivation. I use this crisis medication very sparingly.

The psychiatrist also told me that I should go back to work, this was despite my being physically depleted at a level where other patients may be transfused and at risk of my problems spilling out to colleagues in my distress. I only took one week off work but again it was as though no-one except my GP and psychologist recognised the need for me to do this and spend time with supportive friends. The psychiatrist discharged me to a crisis café which is operated by a voluntary sector organisation and only open for two evenings a week. The crisis café does not offer emergency appointments but feels to me like an extension of their day services which have been reduced by funding cuts.

Since these encounters in A&E I have gone instead to a distant Minor Injury Unit for treatment where I won’t have to see Psychiatric Liaison. These units are nurse led and can perform stitches. However, since stitches take a long time the two nurses on duty will use stapling instead. The staff advise that local anaesthetic isn’t needed with staples but I have felt immense pain when wounds were washed then stapled without any pain relief or anaesthesia beforehand. I feel that Liaison is being used as a deterrent to keep people like me out of A&E yet the consequence is that we will instead have to find other urgent care settings willing to treat us.

When I visited the crisis café one of the paid workers said that a member of the Psychiatric Liaison team had visited the café to say that they are focusing on trying to reduce the number of A&E attendances for mental health reasons as there are too many when A&E is under pressure. My view is that a crisis café which is open for eight hours a week isn’t going to offer a real alternative to A&E and statutory services for someone in acute crisis involving active self-harm or suicidal feelings.

One of the alternatives I used during this crisis was a London A&E department. This experience was a more extreme example of Liaison being used as a deterrent. On being referred after stitches by the doctor to Liaison I was taken to a separate area of the hospital where there were bare rooms with security guards outside them. I was searched and patted down, including my breasts being touched without my consent, by a member of staff who confiscated my bag containing all belongings such as my keys and mobile phone. I was then given a blanket and told to lie down while waiting for someone to see me. I hadn’t eaten, drank or been to the toilet in six hours and I felt terrified. It felt as though I was being detained like a suspect in police custody.

The Liaison nurse did see me after 30 minutes and was extremely apologetic during our ten minute chat. She said that all A&E departments in London were like this as it was their ‘protocol.’ She recognised that I wouldn’t go to this hospital ever again. I needed to use friends and my psychologist to deal with a traumatic stress reaction I experienced within the next few days. I blamed myself for ending up in this A&E and having this reaction, even though it was a London walk-in centre that had sent me there as they couldn’t perform the stitches I needed.

Psychiatric Liaison as a service development needs to be clear about its practices including not using de facto detention in hospitals, such as threatening to call the police or positioning security guards outside bare rooms. This type of detention is illegal without formal sectioning. The assessment should be voluntary and advocacy services are really needed. I see no benefit of Liaison services to people who recurrently self-harm and cannot access help in the community other than by paying for this. However, I can see that Liaison may be able to signpost those with drug or alcohol addictions to treatment or to assess an elderly confused patient for dementia.

I did have one helpful experience in 2015, and I wrote to the Trust to give a compliment, where I was on a ward for surgical debridement and closure and the psychiatrist had visited me on the ward then liaised with the surgical team about my needs. The psychiatrist had been encouraging about the progress made over the years and of the view that secondary care services should offer support. While commissioners are investing money in Liaison there should be clear outcome measures and user involvement in the approaches offered. There should be brief interventions not just a one off chat amounting to ‘how will you get home?’.

The Deliberate Self-harm Team, which was eliminated at the local hospital when Psychiatric Liaison came into being, did offer problem solving meetings and handed out a first aid kit for self-harm which ensured clean blades were used and thick sterristrips were tried at home. This dissolved team did at least have a clear purpose and understanding of those attending who do external self-harm.

I would suggest that Frequent Service User Managers for A&E also offer a more meaningful service. Fortunately, I do have a care-coordinator through a high intensity service user project funded by the CCG. The role of this specialist nurse is to meet people whose attendances have hit a certain threshold and to understand the root causes of their presentations to A&E. She takes a holistic view and understands that crises can be triggered by many social factors such as benefit sanctions, financial, housing and work problems. This nurse has given me a mobile number and suggests I call before things escalate. She has accompanied me to meetings with the HR manager at work given the recent crisis was triggered by my job.

She has also visited the police station when a neighbour’s antisocial behaviour put me on edge. She is not at all punitive, shaming or deterring me going to A&E and recognises that until recently I hadn’t attended for over 16 months. Instead she recognises that the A&E visit is necessary and I know myself best, but to suggest other options which may also help before reaching that desperate point. With her input, I have developed a care plan for my self-harm for the GP practice which indicates my choice of dressings and the nurses’ need to understand that I am in pain with injuries.

I am very grateful that this specialist nurse was also able to ask Psychiatric Liaison not to arrange a professionals meeting and for a note to go on my A&E records asking that I am not to be referred to the Liaison team unless I request it. I don’t think this note on my records is ideal given I am in huge distress when I do go to A&E, but it is a means of saving me further distress in being exposed to psychiatric assessment for no purpose. Harm minimisation can apply to steering clear of pointless ‘interventions’ as much as it can to avoiding life and limb threatening injuries.

There is a risk of referral to Psychiatric Liaison raising hopes of help available to those who self-harm or are suicidal. I guess I have reached the point of knowing this help doesn’t happen so hope is futile. This is another reason why referral should be considered and not automatic as it is a false expectation of help. A ‘plan’ won’t pay for my psychology sessions as I find myself having to apply again for Personal Independence Payment.

A ‘plan’ doesn’t provide a support service instead it is another message that this is ‘all down to you’. I have found the medical staff far more compassionate and helpful than Psychiatric Liaison so I don’t see that the Liaison staff have a training role to do in the department.

I am always apologetic to medical staff in A&E and ashamed of my presence there yet the medical staff are usually saying that I should attend if I have a wound that needs proper closure. The timing of the psychiatric assessment, after long waits for physical treatment, is also misplaced given tiredness and pain may make going home the best option.

I hope that there can be debate rather than gratitude for Psychiatric Liaison as its rolled out to all general hospitals. Psychiatric Liaison in its current form could just be adding to the pain.

Rita Binns

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Can you be disabled with a mental “illness”?

The idea of disability, when applied to blindness or an inability to walk, seems fairly straightforward – a simple recognition of difference. But its application to mental distress and psychological conditions seems much more vexed and controversial. This is so amongst both health professionals and the people to whom it might be applied. Why might that be?

Disability has a legal definition. In England, Wales and Scotland the Equality Act 2010 covers work, education, housing and the provision of goods or services. At least in theory, the Act protects people from being discriminated against because of certain protected characteristics such as gender, age or disability. To count as disabled you must show that your condition has a “substantial, adverse, and long-term effect on your normal day-to-day activities”. Many of us will feel we easily meet this condition.

There are several ways of looking at disability.

In the medical model, something is wrong with your “body” (and by extension, your “mind”). You have a mental “illness” or “impairment” which disables you from reaching your full potential.

In the social model, something is wrong with your society, and the arrangements it has made for you. Society is what disables you from reaching your full potential. This model does not necessarily value one kind of life over another, treats people as inherently diverse and allows for a variety of attitudes to our condition. (Although many of us are indeed in distress and desperate for a way out, others accept the way we are and do not necessarily want to be “cured” of anything!).

In the case of mental distress and “ill health” both these models are under attack from a third, neo-liberal recovery model.

For some years now, Government policy in the UK has been dominated by “Austerity”: a programme of reductions to public spending and removal of any constraints on business which interfere with making a profit. Profit is assumed to be the highest good and nobody has any “right” to payments from public funds, not even if they contributed the money via taxes and national insurance in the first place. Austerity lies behind the “Hostile Climate” experienced by the poor in general and by some groups in particular (refugees/asylum seekers, members of ethnic minorities and disabled people – above all, those whose continued existence might involve a cost on the public purse).

Neatly fitting into this context, the Recovery model firmly rejects any concept of permanent or long-term psychological impairment or difference and concentrates on finding quick, cheap fixes which get people back to work. It’s important to clarify what kind of work. Ideally full-time and paid, it certainly doesn’t mean work which provides you with enough to live on, or which is socially useful or “meaningful” in some way. The defining feature is that it must make a profit for somebody else – preferably a large employer.

In this model lack of effort (and too much help from family or society) is what disables you from reaching your full potential. Psychological disability becomes essentially a moral question, much as it was back in the days of demon-possession and sin. Although by no means all NHS mental health professionals agree with this view, most in the UK have had to deal with it one way or another. Many feel obliged to pressure people to “recover” in these terms, as rapidly as possible.

So given that the Equality Act gives disabled people rights and a protected status, why might we be reluctant to call ourselves “disabled”?

We may feel we have no right to claim the label, and feel embarrassed at the need for support it seems to imply. (It took a GP’s recognition that her condition was long-term before the writer felt she had permission to use it, for example.) This is of course nonsense in a social animal like homo sapiens whose daily survival depends on the support of others, but in a society dominated by neo-liberal ideas, “independence” can sometimes feel like a necessary condition for self-respect and dignity.

We may associate it with hopelessness, rejection, degradation and despair. Lurking just behind the shoulder of many of us (especially those aged 50+) is the nightmarish spectre of the old “hospitals” where the mentally “ill” (such as unmarried mothers, or those who had accused powerful people of abuse) the learning disabled and the physically disabled alike were incarcerated, lobotomised, electroshocked, raped, abused and/or abandoned and forgotten for ever. (Because of this, for some of us it took a significant act of courage to “come out” to the NHS as “mentally ill” in the first place.)

In the Hostile Climate, where disabled people face routine hostility, harassment and physical attack, it may be genuinely dangerous. Bullying and abuse from others often makes our psychological distress worse. It may even place us in immediate physical danger.

So why might we want to use the term “disabled”?

Many of us fit the definition in the Equality Act, and we may want to claim the legal rights it gives us. Especially if we are in paid employment, we (or our union representatives) may be able to insist that our employers make reasonable adjustments to enable us to continue working on equal terms to our workmates. (I am assured by Unison colleagues that this still can and does happen on occasion, especially in what remains of the public sector.)

It may help others take our condition seriously, and to accept that we’re in there for the duration. It may help to prevent idiocies like telling the severely depressed to cheer up, or trauma victims that there is “nothing to worry about”.

It may help us to insist on our human dignity. It may help us to make common cause with others who face different problems, but the same oppressor. It may help us to build solidarity. It may help us to take ourselves seriously. I like this quote from one of our members, ‘I am disabled due to my emotional distress, adversity, finances and society. Proud to call myself disabled!’

Rita Binns




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A Simple Guide to Co-Production

It’s co-production week! Here is a handy how-to for any service users, survivors or otherwise-identifying loonies thinking about getting involved with their local NHS trust or research organisation.

1) Be mad enough that your lived experience of madness can be co-opted and used for foreign-to-you agendas.

2) At the same time be responsible and composed enough to hold down a service user representative’s job.

3) Be very, very reasonable. Do not show any emotions when discussing services you rely on to keep you alive and/or services which have traumatised you so much you want to die.

4) Likewise, do not display any emotion when you are exposed to a constant stream of micro-aggressions and attempts to silence. This is called “being professional”.

5) Shower (at least before meetings).

6) Be grateful:
a. Be so grateful for being heard that you learn to live off the power of your own gratefulness. Do not request a living wage.
b. Honorarium payments might be stopped to avoid service users becoming ‘dependent.’ Don’t question if clinicians are dependent on their salaries, it’s different.
c. Payments affecting ESA? It’s your responsibility to know how the trust will pay you and whether it will result in compliance interviews and sanctions.
d. Accept with gratitude the realms of white A4 you are given to read before each meeting taking hours for which you receive no acknowledgement (let alone pay).
e. Be grateful because no other people paid as little as you do get to sit at the tables you have the privilege of sitting at (whilst being ignored and patronized).

7) Listen to the wisdom of the professionals. You should also expect them to ensure the next meeting date is set at a time they can all do but say, “Well we don’t all have to be there” if you can’t do it.

8) Don’t be offended if someone pats you on the head and gives you some tea and a biscuit. It is for their benefit, not yours.

9) Do not under any circumstances dare to read up about your subject, quote relevant literature, or ask why involvement in your organisation does not acknowledge the work of people with lived experience, or seek them out to lead projects. You will be replaced by someone who is closer to the ideal service user – suitably compliant and ensures the pesky service user tick box is filled.

10) Accept the privilege you are granted (for all the wrong reasons).

11) Put aside any expectation that structural inequalities between service users will be acknowledged or countered. E.g. do not request that meetings and training are held in wheelchair-accessible venues.

12) If you are not recovered enough to be socially acceptable, please ensure you conceal this in public.

13) If you are presenting at a professionals’ conference and you have scars, expect to be asked intrusive questions in public and do not tell the asker to fuck off. This is also called “being professional”.

14) For every comment you offer that challenges the status quo, balance this with something that reaffirms the mental health nurse hero narrative.

15) Be a white middle class woman OR pass as a white middle class woman – actual economic capital is optional. NB do not expect any sexism from other service users to be defused by professionals in the room.

16) Remember that when it suits we are all human and all experience distress and are the same. This is collaboration, we are equals. Until we are not. Then you are some kind of personality disordered subhuman who is not to be believed or trusted and will have no say in the decision making.

17) Be prepared for even the critical folk to view you through the lens of your label.

18) Smile and laugh at hostile insults related to your diagnosis just after you have disclosed it.

19) Don’t object to non-person-first language such as “self-harmers”, “BPDs” or “frequent flyers” – that is just your diagnosis talking.

20) You are welcome to get involved with trusts. But be aware they reserve the right to contact your clinician or check your notes to attempt disprove what you tell them.

21) Be prepared to be told at your next needs assessment that your social needs are all met because you sit on committees with real working people.

22) Expect the professional liberals you thought were ok to shuffle papers & look the other way when you call out their colleagues’ discrimination.

23) There’s opinion, clinical opinion and “just your opinion”. Please note that the gold standard of evidence does not include service user evidence and Randomised Controlled Trials rule.

24) Accept that no matter how many other SUs you have consulted with the views you bring will never be representative of all patients, but one clinician speaks for all clinicians.

25) Be prepared to dedicate all waking hours to try and make a difference only to still be treated with utter contempt in your own care. Don’t get frustrated, it’s probably your own fault. You are not working hard enough on your skillz.

26) People will be paid more to listen to your experiences of being traumatized by the system than you will ever be paid for sharing them. Deal with it.

27) Accept that your successes will be used as a stick to beat other service users with, while your weaknesses will become evidence that it is unwise to involve service users at all.

28) You may well find yourself in a position where you feel hated by clinicians for being challenging but also silently hate yourself for feeling like you have sold out.

29) As a service user you can never possibly understand the time and financial pressures of the NHS. If we tell you we need an expert by experience with a diagnosis of schizaloopia to attend a far-away village at 8am tomorrow morning having read a 40 page document and you think that’s unreasonable, it’s because you don’t understand. Be grateful we asked you.

30) Finally, remember: everything that hurts you is outside the trust’s / university’s control. Everything you like is down to their hard work and professionalism.


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