Time To Talk About Positive Mental Health Charities

How a happy philosophy may be out of step with survivor experiences

Image of Kandyman robot who enforces happiness for the Happiness Patrol in Doctor Who

I write as a supporter of the voluntary and charitable sector in Mental Health. Many survivors prefer voluntary sector services to formal services. Voluntary sector services are often more culturally attuned and user led. Their services are more understanding of different personal identities and equalities. They do not have powers to section, medicate or control. The voluntary sector is there when statutory services discharge long-term service users due to overwhelming demand from new referrals. There are numerous examples of truly user led and compassionate services including Self-Injury Support, Leeds User Led Crisis Service, Speak Up CIC and local Hearing Voices Groups. NSUN lead the way in capacity building and championing user voices. 

There is direct action on social media led by coalitions of survivors, for example, the Stop SIM campaign, Recovery in the Bin (RITB) and Revolution LXP. Social action involves risk and courage for involved activists, many of whom will avoid public recognition because of danger to their jobs or benefits status if retaliatory actions are taken by authorities. I am not an activist and cannot do justice to grass roots and voluntary sector groups. This article is not meant to criticise the hard and underpaid work in this diverse sector but to provoke thought about how services need to listen to the needs of their recipients. 

I want to focus on the apparent happiness mandate from many local mental health charities. It is likely the positive directive is linked to outcome measures and the hoops jumped through for statutory funding. The now complete shift to outcomes reporting is in line with the Recovery agenda. In most cases, survivors have not developed the measures to evidence their expected successful journeys. It is difficult for voluntary sector groups to seek funding for core services when money may only be available for new projects. Ongoing users may be a hindrance to outcomes linked funding, which prefers those who can move on after six months preferably to independence and employment. Demand for services is hitting charities, as it does relentlessly for statutory services, but practice in the voluntary sector starts to mirror the time-limited Recovery framework which RITB has campaigned against. 

Before lockdown I visited a ‘crisis café’ occasionally. The ‘café’ would not admit people unless they were willing to fill in a paper questionnaire about how they were feeling and what led to their visit. At the end of the visit another questionnaire on the back of the form meant self-assessing how you felt after, and what services you avoided using that day due to the ‘café.’ I used to wonder how anyone in crisis could be expected to fill in two questionnaires. A one to one chat, limited to 15 minutes, was their sole service offer for three hours twice a week. 

I fill in questionnaires over the phone every month when I speak to an employment adviser from a voluntary sector organisation. Regular reviews involve questions like whether I feel loved, have energy, feel useful and am showing an interest in other people. The questionnaire is a no argument condition of receiving support. I do not care at all if the score has gone up or down. It is difficult to give ‘real’ answers in case you lose the service if it is viewed not to work. You have a relationship with the worker who asks the questions which means you answer in a generous way. 

Charities in the mental health voluntary sector adapted during the pandemic with online and phone support. A Zoom call cannot truly replace the chance to meet peers socially or share a meal. Many service users cannot afford the internet. The continued gap between meeting up and virtual help appears to have put more emphasis on social media messaging. Charities direct their time into social media pages which reflect positivity and wellbeing promotions. 

My local charity’s facebook page publishes poetry most of which does not relate to mental health experience. There is a new Feel Good Friday poster on there every week. Positive cod psychology sentiments such as “happiness is not by chance but by choice” and “you do not find the happy life, YOU MAKE IT” are posted for likes. During lockdown another local charity encouraged sharing photos from ‘wellbeing walks’ despite the fact that exercise was limited by law. 

Most social media posts from charities are about ‘reaching out’, asking for help or looking out for positives. It makes sense to try to keep spirits up but may feel invalidating to those who are bereaved or on low incomes. Happiness is at odds with the times we have been living through and it can feel infantilising and that we should be unaware of a world beyond our own ability to be mindful. 

The messaging can feel false, as survivors we know that there is no help even if you do ask it unless you can pay for private therapy. This applies mostly where you have a long history of mental health problems and are ‘known to services’ which say they have done all they can. To repeat this ‘ask for help’ message is insensitive when organisations should learn from our rejections. 

Where the voluntary sector promotes ‘wellbeing’ to the exclusion of recognising distress, there will be former members, perhaps those most in need, who disengage. Even before the pandemic, charities had moved away from social drop-ins. All groups must be labelled peer support though the needs of individuals in the group will be varied and negative discussion frowned upon. At the now virtual crisis café, it would not have been possible to mention my self-harm to other visitors, despite this being the reason I was there. Entry to voluntary sector support involves signing up to activity such as pottery classes, creative writing, art or cookery. It can feel like an Occupational Health department when these existed on psych wards decades ago. 

Overall, no-one asked service users nationally if they either wanted to move to the activity model or go it alone. Choice was taken away from us. It can already feel as though you are ‘other’ in a society where people have partners, homes owned outright, children, education and jobs you missed out on from being distressed. Charities could exacerbate this sense of ‘other’ and social exclusion unless they respond to their members who continue to experience severe distress. In an unattainable happy community, there is no space for those who feel despair. This atmosphere drives distress underground, so it is more likely someone could turn to darker parts of the internet such as ‘suicide forums’. 

Mental health experiences may not resolve and medication can lead to side effects which are a secondary impairment in themselves. We need safe spaces to talk about how these real issues affect us. Most of us know about the five ways to wellbeing or local walks so can try these in our own time if we find them of any benefit. When voluntary sector services are open, we need to be heard. I think of palliative care available to those with life-limiting conditions and the philosophy that helps patients to make the most of what life is left. Adopting palliative care approaches to those with ‘chronic’ and long-term suffering makes sense far more than flippant “don’t worry be happy” social media posts. 

As survivors we need to talk to voluntary sector organisation managers and start discussions about how we reclaim the debate. We understand that funding is hard to secure and want this to change. There may be ways to still do the paperwork but have spaces which respond to what we really need. A group could still be called ‘women’s group’ but discuss living with traumatic stress. A ‘happiness group’ could be a cover for discussing what to do when we feel like we can never be content. We need to talk about iatrogenic damage. I have a diagnosis of Borderline Personality Disorder but have had to explain to charity workers what it means and why I reject it. There is a training need with many workers with posts low paid, unless they have their own experiences or learn from members. The voluntary sector should facilitate and not shy away from discussion which may not fit with a diagnostic manual. 

It is already recognised that talking about suicide does not encourage someone to take their own life. If we start talking about realism then it is a relief and we do not have to be something we are not. It will not mean that we suddenly become negative and nihilistic. Individuals with mental health issues face huge challenges with poverty, loss, poor housing and unemployment. We cannot live in a Disney cartoon or pretend social injustice does not affect our peers. 

The voluntary sector workers can help in practical ways, for example going with members to face to face benefit reviews or writing letters. They can get onto the mental health team which has rejected a referral again. They can listen without judgement and not set the agenda topic. Until we lower the volume of the happiness rhetoric our personal stories and needs are not being heard clearly.  

Book Re-release- Mass Murderers in White Coats by Lenny Lapon

This books covers a range of psychiatric abuses but is of particular interest for current service users in helping us know the history of how Nazis treated psychiatric patients and our survivor history of resistance and organising against psychiatric abuses.

Lapon was a militant activist beginning in 1978 with Mental Patients Liberation Front in Boston (MPLF) and the Alliance for the Liberation of Mental Patients in Philadelphia (ALMP), participating in organizing, demonstrations, civil disobedience, advocacy and writing. He was arrested on several occasions and completed a 60-day fast against psychiatric oppression.

Review by Sharon Jean Cretsinger, Tijuana, July tenth, twenty-twenty-one

I am happy to see that Mass Murderers in White Coats (1986) by Lenny Lapon is now in a digital edition.  It is an impressive collection of essay and research that needs a much wider audience, especially now.  While this book technically falls in the category of non-fiction, it is structured more like a doctoral thesis.  This is not to say it is not eminently readable.  The style is spare and intelligently rendered.  I mention the overall construction of the book because the forwards and the appendices are important to the subject and should be read equally with the text.  Lapon’s updated preface (May 2021) serves to contextualize its significance in historical place-time.  He notes that the book is a kind of point-in-time look at the psychiatric inmates’ liberation movement.  It was an important point in time because it was at almost exactly then that the radical and resistant arms of this movement were effectively (and perhaps intractably) broken by the government.

In the original preface, the book’s objectives are carefully laid out:  to document the mass murder of “mental patients” by psychiatry in Nazi Germany and in the U.S (psychiatric genocide); to show common ideological roots of the killings in Nazi Germany and harmful, sometimes fatal, psychiatric “treatments” in the U.S.; to give the ex-inmate’s perspective on the oppressiveness of psychiatry, its violence and danger; to present excerpts from conversations with members of the American Psychiatric Association (APA) who are connected to Nazi Germany; to present a history of the organized resistance to psychiatry by its victims; and, to bring all of these issues into the light of public awareness.

The book achieves all stated objectives except for the last one.  Hopefully, wider access to this digital text will help to publicly illuminate the pervasiveness of contemporary psychiatric atrocities and the almost-lost history of radical resistance to same.

Relevance to Intersectionality and Identity

In contemporary culture, there are emerging and increasing texts and discussions about marginalization and identity.  Mass Murderers is important to this discussion because it clearly illuminates issues belonging to survivors of psychiatric atrocities.  It reaches back to Nazi Germany and documents real conversations the author had with Nazi clinicians.  This aspect of the book’s research is irreplaceable.  Appendix 3, “The Myth and Politics of ‘Mental Retardation’” bears a special mention.  This community remains one of the most oppressed in first-world cultures, with many individuals who carry this label still institutionalized and exploited for pennies a day in sheltered workshops.  The fields of psychiatry and related behavioral health disciplines support the dynamic through large-scale drugging with psychiatric pharmaceuticals and various abusive and reductive behavioral “therapies”.  

The author’s introduction makes the wealth of information presented in the text personal, and perhaps more importantly, relatable to “ordinary” folks.  Psychiatric and behavioral health abuses and atrocities can literally happen to anyone.  Yet, in the context of intersectionality, they happen more frequently to individuals who are otherwise marginalized such as people of color and those with disabilities.  As these narratives become increasingly visible, the perspectives of ex-inmates and survivors are crucial to this body of work, but often missing.  Mass Murderers is so valuable because it subverts basically every authoritarian attempt to control the narrative of the atrocities discussed.  The importance of proletariat scholarship in the narratives of the marginalized and the working-class cannot be over-emphasized.  This book is a beautiful example.

Relevance to the Present-Day, Ex-Mental Patients’ Movement

Particularly relevant in the context of today’s “movement” is Appendix 2, titled “Alternative Therapies Criticized and the Role of ‘Mental Health’ Workers in the Fight Against Psychiatry”.  When seen together with Appendix 5, “Psychiatric Inmates’ Liberation/Anti-psychiatry Groups*”, we find a comprehensive picture of a movement that barely exists today.   In place of most of the liberation groups listed in Appendix 5, we have many government-funded and pseudo-clinical organizations.  These “practitioners” and “non-profits” have replaced radical organizing groups with various “alternatives” ranging from the clearly self-pathologizing to complicated systems of contrived, facilitated communications such as the “Hearing Voices Network”, “Wellness Recovery and Action Plan (WRAP)”, and “Intentional Peer Support”.  The rhetoric of revolution and abolition detailed in Appendix 2 has been co-opted and replaced with these various pseudo-clinical “interventions” and “positions” such as “peer supporter” and “case management aide”.   Lapon states it quite simply in this appendix: “They make money off our pain and suffering.  Some of them have ‘anti-psychiatry’ conferences and invite a token ex-inmate or two.  As with other oppressed groups we buy into our oppression in various ways.”  

Mass Murderers in White Coats is ostensibly a book for those interested in doing serious antipsychiatry organizing.  These individuals may wish to go directly to the chapter five, “The Resistance:  A History of the Psychiatric Inmates Liberation Movement” to find inspiration.  There is also plenty for those who are interested in antipsychiatry and historic and contemporary psychiatric and behavioral health atrocities and their intersections with other forms of marginalization and discrimination.  Hopefully, this e-book will offer resources to readers and researchers interested in antipsychiatry, its intersections, and adjacent aspects of historical and Holocaust scholarship.  

#StopSIM Coalition Consenseus Statement

StopSIM Coalition Consensus Statement relating to The High Intensity Network (HIN) and Serenity Integrating Mentoring (SIM), 21/04/21

We are a coalition of mental health service users and allies who have grave concerns about the rapid, widespread rollout of the High Intensity Network’s ‘Serenity Integrated Mentoring’ (SIM) intervention across NHS England. The intervention is designed for people who have not committed a crime, but are in contact with mental health services, are frequently at high risk of suicide and self harm and are deemed “high intensity users” of emergency services.  Key intervention components include a co-ordinated withholding of potentially life saving treatment by multiple agencies (A&E, mental health, ambulance and police services) and, using SIM’s own words, the “coercive” approach of a police officer as an interventionist.  

We call on NHS England to:

  1. Halt the rollout and delivery of SIM with immediate effect, as well as interventions operating under a different name, which are associated with the High Intensity Network (HIN).
  2. Conduct an independent review and evaluation of SIM in regards to its evidence base, safety, legality, ethics, governance and acceptability to service users.
  3. Respond to this statement within 7 days to communicate the actions taken by NHS England. Communications should be directed to contact@stopsim.co.uk

Our concerns about SIM relate to its evidence, legality (including GDPR, Human Rights and Safeguarding), aims, governance and ethics. Interventions or service models operating using SIM principles may be known by alternative names, however, for brevity, this statement equally applies to those services, interventions and models.

This is a preliminary consensus statement. We have been researching SIM and the HIN for a number of weeks in preparation for the release of a detailed and referenced statement.  However, we are releasing this brief statement since becoming aware that, due to the hard and concerted effort of service users, survivors and allies over many weeks – and in some instances, years – that high level conversations have been prompted.  We felt it was critical to make our position public as soon as possible. A longer version of this statement, with citations, is shortly forthcoming.

We expect to be involved in any high level conversations concerning the High Intensity Network and SIM as a coalition of service users and allies.  We can be contacted by email at contact@stopsim.co.uk or via Twitter DM: @StopSIMMH. We will be publishing further updates on our Twitter account.  

In solidarity with survivors, service users and allies who have worked tirelessly to shine a light on injustice,

The #StopSim Coalition

Copied to:
Sir Simon Stevens, CEO – NHS England Lord David Prior, Chair – NHS EnglandClaire Murdoch, National Mental Health Director  NHS EnglandMartin Hewitt, Chair – National Police Chiefs’ CouncilSir Tom WinsorHer Majesty’s Inspectorate of Constabulary and Fire and Rescue Service.

On Being Wrong In Psychology by Dariusz Galasinski

For me critical psychology was a revelation. It explicitly verbalised what I had been thinking. I still remember my first steps in challenging the certainties of, shall I say, positivist psychology and coming across writings of psychologists who were thinking in similar terms was a revelation. It’s all changing now.

I suppose my relationship with psychology has always been tenuous. As a linguist, understanding and teaching about the role of context, positivist psychology has always been a problem. I remember taking part in a discussion on a PhD proposal in which the student sketched a project on perseverance. I made a point that, surely, perseverance is always contextual, depending not only on, for example, our personality, but also the stakes involved or social importance of the task. And so, your perseverance in getting a new T-shirt is extremely unlikely to be similar to that of trying to resuscitate your child.

In response, I heard that my point was well made, but psychology was interested in ‘pure perseverance’, only that was perseverance proper. And so, the student invented a fatuous procedure that, apparently, enabled them to measure this purity of perseverance and correlate it with all sorts of psychological stuff. Psychologists nodded, I shook my head.

And here come the critical psychologists. Their writings challenge the certainties of mainstream psychology, much as discursive psychology did. All of a sudden, statistics does not provide us with much comfort, while questionnaires are not magic tools harvesting psychological experiences. As I was reading more and more, I was smitten.

Time for a reservation, as I move to offer critique. I do realise that critical psychology is not a homogenous group of people and there are disagreements within such a varied group. I also understand that Twitter psychology might not be representative of its entirety, although it’s worth saying that very prominent psychologists have accounts on Twitter and they are vocal representatives of their subdiscipline, both in proclaiming themselves part of it and in sometimes loudly dismissing those who disagree. I also accept that for rhetorical effect what follows is likely to be somewhat exaggerated.

And so, to continue, misfortune befell me – I joined Twitter. Daily I started witnessing quarrels, skirmishes and veritable battles between critical psychology and the regular one. Arguments I knew and continue to know very well have been rehearsed right, left and centre…Except something else happened. At some point I realised that more often than not I was joining with the ‘bad guys’, with ‘regular’ psychologists (and psychiatrists, to be fair). I started crossing the floor more often than I would have thought possible. When I noticed it, reflected on it, I realised a paradox. I continued to agree with the criticals (at least for the most part), but I actually didn’t want to be seen to agree with them.

What I found extraordinary was that it was the ‘enemy’ who seemed more open and prepared to listen. It was the enemy who was falling back on evidence. It was the enemy who was prepared to question and reflect on their assumptions. Indeed, over the last months, I have written more blogs criticising ‘critical psychology’ than anything else. From PTM framework, through irrational insistence that changing a few words will introduce world peace (under the guise of ‘language matters’), all the way to the recent report called “Understanding depression”. What all those documents have in common is the assumption that they are the revealed truth and those who (dare) criticise them are fatally wrong. There is an intellectual dishonesty underpinning even the major documents which, you would hope, would carry the nuance and sensitivity to other perspectives.

I continue to be disappointed with critical psychology (mostly its British version, at least) which uses a sledgehammer in dealing with its ‘enemies’. There are no arguments, no attempts to understand an Other. No, if you disagree you are in fatal and ultimate error, possibly just stupid. Recently, I was shocked to see those who disagree with the #UnderstandingDepression report being dismissed in highly disparaging terms and with no counterarguments.

That’s not critical psychology I used to read. It doesn’t have even the shadow of its former intellectual depth and clout. Today, it doesn’t argue anymore. It shouts.

This post has been long coming, I am sure I will get a lot of stick for it. I also know that this will be one of those posts that will result in tens of blocks and as many unfollows. What spurred to me to writing it was a recent Twitter exchange I took part in. Extraordinarily again, the only argument those progressive critical psychologists were able to offer was that those who disagreed just misunderstood ‘the real message’. And all from the position of delivering the truth to the minions.

But what really irritated me was this exchange:

I mean, really?! Like really?! If someone does not follow in your footsteps, there is no possibility of meaning or understanding? This is megalomania, this is psychological Trumpism, for pity’s sake.  This is no critical psychology – this is bombastic, grandiose psychology so full of itself that the solar system seems too small for it. This is psychology walking on water.

And so, to repeat my reservations. Of course, I understand that I look at a snapshot of psychology in a particular context. And yet “Understanding Depression” has the imprimatur (those familiar with Vatican’s censorship will appreciate the word) of the BPS. I am really not talking about a few rogue psychologists from a galaxy far far away.

As I walk away from critical psychology as it is (not that it cares about it at all, not only am I a nobody, I am also fatally wrong), I am still up for a fight with positivist psychology, with all those smitten by the alphas, r’s and whatever other letters psychology throws at you. But I would like to be seen as someone who can be persuaded with an argument. There are wonderful quantitative studies, there are zillions of people for whom their nosological diagnoses were a godsend, there are also so many bad qualitative/critical studies that they could blight global agriculture.

And, finally, for pity’s sake, let’s assume, once in a blue moon at least, that we can be bloody wrong!

By Dariusz Galasinski, this article first appeared on his site dariuszgalasinski.com

I am now unable to talk freely about my mental health as I fear arrest

This account of my experience is purposely anonymised because I am not ready for those in my life to know the pain that mental health services and police have put me through. This began during a difficult period of my life in which I was the victim of physical, sexual, emotional and financial abuse in a relationship that I truly believed was impossible to leave safely. I had been under mental health services for most of my life not by choice and had made a lot of progress. Without being too graphic, the abuse started almost instantaneously and I was kept in line with the threat of harm to himself and me. He controlled me and he ran my life for nearly six months during which I attempted suicide a number of times. The police had a lot of involvement in my life at this point, every time I survived, I became more determined that I was the plague on this earth and that ending my existence would solve all the problems we see throughout society. I had graphic nightmares in which I survived and had to watch those around me be tortured and murdered and struggled immensely with trauma symptoms. 

My suicide attempts have been labelled as ‘a cry for help’ when in reality, every time I was saved, I thought I could feel someone else die as a result of my ‘failure’. At the time I wasn’t told about this but my local team and police force made a ‘crisis plan’ detailing how to ‘deal’ with me in a crisis and avoid ‘reinforcing’ what they believe to be attention seeking behaviours. This plan was in place for four months before I was made aware it existed and I was not shown a copy of this plan I had supposedly agreed to until two months after this. Six months in total.

The plan states that if I am found in public in a crisis situation, I am to be taken to hospital for a capacity assessment. If I am deemed to have capacity the officers involved must arrest me for any offence that they feel appropriate. 

When I was told about this plan the explicit instructions I was given were “to not commit suicide in a public environment”. I was also told that I could “do what I wanted in my personal space” AKA I can take my own life as long as it does not inconvenience any other people.

This plan has destroyed my faith in mental health and police services and has meant I am now unable to talk freely about my mental health as I fear arrest if I am honest with how I feel. I also know that I can’t risk surviving future crises and I am sure that if I was to get into such a desperate situation again, I would not walk it off. 

Mental health services are designed to treat a very specific range of presentations. As soon as you fall either side of their ‘worthy of treatment’ parameters you become a disposable commodity like I and so many others have. Knowing that those who should care have no desire to work with you is the total opposite of help. I was in a vulnerable situation and those meant to help me turned their backs leaving me in dangerous and damaging situations because of how they perceive my suffering. 

I am not a criminal. 

I am a survivor and I will not stay quiet any longer.

The Crime of wanting to die, my story from Scotland

For the past two years I had hid my shame and embarrassment. I felt like I was to blame, even though I was the victim. I was told I was to criticize, and it was my choice; my choice to be arrested and my choice to die.

My crime? I tried to kill myself, believe it or not, dying is hard, so I was slow, and I was able to be saved for better or for worst.

In 2018-19 I found myself miserable and just wanted to die, I was expiring the consequences of another person actions against me, I was expensing the symptoms of PTSD or C-PTSD. I did not see a way forward, life felt so painful, and I felt that my death was the only way forward.

I had just been discharged from my first hospital stays in a psychiatric unit. I was just kicked to the curb I had not been told what would be happening, I was told to go home in to the community with no preparation or help. Just after an admission is a time that the NHS have admitted increases rise of death though suicide. I felt so loss and hopeless, I stupidly publicity tried to kill myself, I regret it now, the police took me to the ED, and I was told “I had capacity” after the nurse talked to the police who voiced their concerns and the mental health team told them I was not feeling real depression and the trauma in my life was fictitious. How does one have capacity when I had actively tried so hard to be dead.

The police were left without much of a choice and arrested me. What choice did the police have when I was dead set on killing myself.

Believe it or not, being arrested when you did nothing wrong was traumatizing. Every day I carry the burden of my arrests and I feel my skin crawl with every mild flash back. I went through the normal booking routine, and I was informed that they did it to try and force the hand of mental health services into helping me and that I would most likely be out the next day. I complied with the whole booking proceed, and I was dumped in a concrete cold cell in a paper dress. My mug shot was taken and fingerprints. The police admitted I was mentally unwell and added several comments about how poor the local mental health hospital is, lack of bed and constantly having missing patients (over 200 patients reported missing in just 2 years). I was let go after 14 hours with not even a mark against my name.

This arrest just catapulted my problem and I spun out of control. I felt like I was marked with another label, the label of a criminal. I keep repeating in my head that I should have competed the suicide. That marked my second attempt to end my life and acted as catalyst for my year of hell.

Imagen being abandoned by the NHS at the start of your mental health journey, forced to live though the forced unparalleled consequences of actions that everyone saw as mental illness. A custody cell and under trained police officers is not equal to mental health support. Custody cells should not be used as an extension of the mental heathy system, they are not a resort to be use in times of mental health crisis. Police can not deal with people like me, I, by their own admission had committed no crime. The crime that they did arrest me with was a ‘breach of the peace’, an arrestable offence in Scotland

I find myself here today. Nothing has really changed; police are still being used as an extension of the mental health services without any of the training that come with it. Why should a health emergency be treated the same why as a criminal matter? Why is this acceptable?

How is locking someone up in a custody cell a punishment for trying to end one’s life? Why does someone need to be ‘punished’ for a mental health emergency.

If the NHS trust continues to view the police as a first responder for a mental health crisis, they should be open and honest about their use with the NHS mental health system.

Why did the NHS allow an 18-year girl to be locked up because of a lack of mental health services?

Mentally unwell or criminal? My experience of being criminalised for my mental health.

In June 2017 my life fell apart. I was raped and endured a year long police investigation into the matter. I had always had a good life up to this point but suddenly it was flipped upside down; I was out of work and struggling with thoughts of suicide and self-harm. My way of coping was to overdose and I was constantly in and out of general and psychiatric hospitals.

As some of the overdoses were away from home and, on occasion, I would abscond from hospital when in severe distress, the police decided to issue me with a Community Protection Notice Warning (CPNW). It read:

 “This letter should be considered as formal notification of your need to put these problems right to avoid further consequence. Please ensure you take the following action/s within the timescales detailed.”

The actions were as follows:

  • not to have any unprescribed medications on me
  • not to act or ‘behave’ in a way as to cause another person to believe I’m in danger of harming myself.
  • not to contact anyone by any means to make threats or allude to any thoughts of self harm or suicide. This includes my close friends and family.

In a time where “just talk” and “reach out for help if suicidal” narratives are everywhere, being under a police-ordered notice NOT to talk is incredibly isolating. It goes against all the research that talking about suicidal thoughts is crucial in managing them. It gives the police powers over my health, where they have no place. It is a violation of human rights.

Unsurprisingly, the letter didn’t help my feelings of hopelessness and my struggles to engage with mental health services. Instead of being instantly cured from my mental health problems and suddenly stopping the self-destructive ‘behaviours’ like the police had hoped, I continued to be admitted.  My admissions became a lot more severe each time, and I usually ended up in intensive care units. Health professionals would mention the CPNW whenever I asked about signing forms to leave, and they would constantly threaten to contact the police and tell them I’d breached the notice. Health professionals became an extension of the police force and I found it impossible to trust them.

Eventually in May of 2019 the police decided to issue me with the full Community Protection Notice (CPN). This is valid for 2 years and includes all the same actions contained in the  warning letter that I must abide by. Once when I was struggling I text a friend to say I was thinking of harming myself. She ended up calling for help and the police showed up, who told me I had broken my notice.

I have never felt more isolated than I am now knowing that if I do need help I can’t so much as tell a friend or even a family member. I’m not even allowed to tell my mum I’m struggling. What sort of life is that? If my family call for help, it’s me who will get arrested. The only people I’m allowed to talk to about suicidal distress are specified mental health professionals, yet they are the ones who’ve put me in this situation. My trust in them is at an all time low. Talking about my distress and asking for help is now a criminal offence.

Increasingly more people, often those given a BPD diagnosis label, are being arrested and sent to prison because of suicide attempts or their communication of extreme distress, despite the fact suicide has been decriminalised since 1961. More and more of us are ending up in the criminal justice system because of our mental illness. It seems we are seeing a resurgence of the criminalisation of the mentally ill by the back door, in the name of ‘public protection’.

If you genuinely want to help people like me, please start by just listening. Provide me with appropriate support, talk to me, offer me therapy – just don’t call the police.

Mental capacity and suicide: “He has mental capacity” is not a reason for clinicians to stand back and do nothing.

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Elaine tried desperately to get help for her son during the final days of his life. She felt he was too unwell to ask for help himself. His mental health had deteriorated and he was hearing voices. He was having suicidal thoughts and she was worried that he was going to end his life. He was under a community psychiatric service for people who experience psychosis.

When she asked the mental health crisis team to contact him over that final weekend, they told her that her son needed to phone them. They had often said that they wanted him to take more responsibility. Their usual approach was to tell Elaine: “He is welcome to call us”.  He never did, and tragically he took his own life on the Monday morning, while Elaine was downstairs on the phone trying once again to get help for him.

At the inquest into his death, the coroner commented that he had “mental capacity”. In her summing up, she said that he had the mental capacity to make decisions. The coroner made that statement based on psychiatrists’ evidence at inquest. They emphasised during and after the inquest that James “frequently” had capacity.

In fact, none of us know whether he had the capacity to make decisions or not, in the period leading up to his death. No one from the mental health teams had spoken to him for several days.  A person’s mental capacity to make decisions can change from hour to hour. High levels of distress or mental illness are just two of the factors that can affect it. And James had a history of psychosis.

So why is it so important for psychiatric professionals to emphasise that someone has mental capacity? Too often, it seems to be about “responsibility”. If the person is assessed as having “mental capacity”, then the mental health team can argue that they have no responsibility to do anything. The mental health crisis team didn’t contact James, despite his mum’s pleas. But he had mental capacity, so they didn’t have to – that seems to be the sub-text.

But James’ mum had described James’ deteriorating mental health to the crisis team. He had completely isolated himself, was hearing voices and had a history of psychosis and she explicitly said that she was frightened that he was going to kill himself.  Armed with that kind of information, professionals surely have a duty to take active steps to contact, assess and support the person.

When professionals refer to “mental capacity” as a reason to stand back and place responsibility on the person who is in crisis, I would remind them of article 2 of the Human Rights Act: the Right To Life. It takes precedence.

It is as if the “right to life” is being usurped by the “right to take your own life” when someone is in mental health crisis. Surely the balance is all wrong. If you are in mental health crisis, it is a time when you are least likely to be able to think clearly and rationally, or to be able to “weigh information”. Despite this, the system appears to respect your right to take your own life.

Surely there is a duty to do everything we can to help the person to survive. We should protect life, whether or not someone is assessed as having “mental capacity” – and whether or not they are detainable under the Mental Health Act, which is a different piece of legislation.

We cannot even be fully confident that all professionals are assessing mental capacity accurately. I have described in a previous article how a paramedic and a policeman made entirely different assessments of my mental capacity, on a night when I intended to end my life. I believed I had received messages to end my life on that date.  Astonishingly, one of the professionals concluded that I had mental capacity. He said that I could understand and retain information. Fortunately the other professional quickly intervened and detained me. My ability to weigh information was clearly being impacted by the “messages” I had received. (Reference: Why do mental health professionals tell patients “It’s your decision to end your life”? https://www.savinglives.blog/uncategorized/suicide-why-do-mental-health-professionals-tell-patients-its-your-decision/ )

It is this ability to “weigh up information” which I think professionals may be getting wrong quite frequently. Depression often affects our ability to weigh information. We see life through its distorted lens. If depression makes you feel that things will never improve, that there is no hope and that you have no worth, then this is affecting your ability to weigh information and make decisions. And yet frequently, someone will explain all that and be assessed as being capacitous and able to make the decision to end their life. We know this from what we witness with clients at our Suicide Crisis Centre. I frequently express concerns to our local mental health services about individual clients, when depression appears to be impacting on their thought processes.

We have to redress the balance to place more of the responsibility on us, as professionals. It is our job to protect life.  I run an independent Suicide Crisis Centre where we focus on doing everything we can to help our clients to survive. We actively intervene, whether or not we think someone has mental capacity.  We know that the person is probably about to make a decision that they would not make if they were not highly distressed, or mentally unwell. Therefore, protect life – always.

For information about the Suicide Crisis Centre, which provides face to face supporthttp://www.suicidecrisis.co.uk

Elaine kindly gave her permission for me to write about James, who was known to his family as Jay. Elaine added: “Jay didn’t want to die. He wanted help. He was crying out for help.” Elaine found out about our charity after Jay died. We attended his inquest in 2019, to support his family. This article draws on evidence from the inquest. Our thoughts are with Jay’s family as they continue to fight for justice for Jay.

Other sources of help include The Samaritans on 116123 and the NHS 111 service (just call 111).

 Joy Hibbins is the author of the book “Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”:  https://www.jkp.com/uk/suicide-prevention-techniques-2.html

Reproduced with kind permission of Joy Hibbins Saving Lives ©.

The NHS and self-harm – a gap in care

Rita Binns

Signposts pointing in different directions. Text on each sign: There, Away, Anywhere But Here, Somewhere Else, Anywhere, Just get on and do it, We don’t give a ****

The Covid-19 outbreak has changed all health services. The changes have been far reaching and stretch beyond the pandemic. The pandemic has also highlighted pre-existing inequalities in the NHS – this blog is based on one person’s experience of accessing care and treatment for self-harm. From what other people have told us, they are not the only ones dealing with the same problems.


While emergency treatment has remained available, going to Accident and Emergency (A&E) is a changed experience. Now you have your temperature taken on arrival and are placed in a different waiting area depending on ‘Covid status.’ Staff who greet and treat you are wearing personal protective equipment. At present there are plans, drawn up by the Royal College of Emergency Medicine, to try to limit attendances to those who are referred by 111, their GP or are brought in by ambulance. This change, if introduced, could have a profound impact on people with mental distress, who already feel they are actively discouraged from attending A&E even when they feel at risk of completing suicide.
I self-injure by cutting at times of extreme distress. My self-harm is acutely painful, cyclical and compulsive in response to a number of events which become a personal crisis. The pandemic has made me avoid hospital services through fear of disapproval, shaming, concern about unknowingly infecting others or being infected, and taking up scarce resources.
I know that NHS services may see any temporary cessation of self-harm as a success. In reality, it is still a daily battle to stave off self-harm when I am alone and in difficult circumstances. Because of the lock-down, I have had no video or face to face contact with my two family members for four months. I am forced to work from home in a housing association flat that has no garden or balcony. I have lost the pastimes that served as a distraction and reason to live. I have needed to switch to Skype with my private psychologist, though I am getting used to this. I feel incredibly lonely and have suicidal thoughts at times given the way we now must live for a long time yet.

In truth I felt abandoned by NHS services long before the outbreak changed the services available. Mental health services view my self-harm as ‘impulsive’, ‘longstanding’ and due to Borderline Personality Disorder (BPD). These ‘specialist’ services, provided by a single mental health trust, avoid getting involved at all costs. It feels as though I have been blacklisted and that this status, along with the wretched diagnosis, will never be reviewed.

My experience has been primarily one of signposting and aborted referrals. I’ve had one off assessments that lead to nothing more than more signposting and ‘action plans’ that act as service back-covering tick-lists. All this leaves me feeling worse than ever.
There are misconceptions about those who self-harm feeling some high or adrenaline rush. My experience is that there is no high, pay off, or euphoria. There is only torture which is heightened by the response from NHS mental health services. I do feel the re-emergence of my self-harm in ‘later life’ can be partly attributed to iatrogenic damage.
There is no NHS service help for people who self-harm. It is a service gap which no-one talks about, including the NICE guidelines, NHS providers or Clinical Commissioning Groups. The only way of accessing a chat is to injure, get wound closure by A&E and then see a Psychiatric Liaison practitioner as a one off. Liaison and CMHTs will always assess and discharge someone back to the GP, no matter how serious the recent injury or risk of either accidental death or disability. I was seen by the CMHT in February and told: “you have capacity to make bad decisions and that is the law.”

There is a slightly different approach to suicidal intentions expressed, but still the response to those is that it is our ‘choice’ if we want to kill ourselves as we have ‘capacity’ to do so. This is especially true for people who have been given the diagnosis of BPD where suicidality is seen as a trait rather than a concern.

Self-harm deserves the same level of concern as physical ill health, attempted suicide, eating disorders or addictions. I appreciate there are shortcomings in all mental health services due to historic underinvestment, but eating disorders and addiction services do still exist in principle. Instead self-harm is seen as ‘longstanding’ and not an ‘acute mental health need’, for which someone needs therapies designed for those with ‘dysfunctional behaviours’ which come under PD. There is no crisis care as Crisis and Home Treatment Teams tend to say that they can’t make any difference to ‘chronic difficulties.’ People who self-harm may indeed feel in crisis, as I often do, but they are treated as though doing what they always do, as if it was a hobby rather than a sign of immense inner distress. I sometimes feel I could suffer amputation and still the non-response would be unchanged.

The lack of secondary care help for self-harm, apart from basic medical care, could be understood if there were primary care mental health services. I do believe that GPs and practice nurses are often dedicated and excellent, as my GP surgery has been. But still I now have the third named GP in one year due to GPs leaving the practice. During the Coronavirus pandemic, it has been more difficult to see a GP or practice nurse, phone 111 or access care for injuries. People with mental health issues have mostly all been left to fend for themselves unless they become very ill with the virus.

I have tried to raise with clinicians and commissioners how lacking the response is to self-harm but am just told that “services are not set up in the way that they used to be.” It is as though the reduction in mental health services over the years (due to demand, underfunding, imposed boundaries for BPD, staff shortage and raised thresholds) justifies the worsening of attitudes. The message seems to be that we just have to get used to this basic level of endless signposting service, with any actual intervention aimed at younger people or florid psychoses. It is signposting with no existing service for most of us, just an endless frustrating hunt with advertised crisis text lines along the way. Charity helplines will never replace consistent low- level support that would help people with long-term distress to survive and avoid crises.

I don’t think the lack of resources can be used as an excuse for the current treatment of self-harm in the mental health sector. Using more compassionate and sensitive language doesn’t cost any money. Health professionals should stop using insulting language immediately, and this should be part of any training programme. I could come up with a long list of clinical insults to exclude for starters; Impulsive, PD, chronic, behaviour, neurotic, enabling, and emotional regulation. Liaison teams are making matters worse when they advise medical staff on self-harm by saying not to show emotion or give attention. The doctors and nurses I have met in A&E have often been far more professional, thorough and caring than any of their mental health colleagues.

The NHS front line has deservedly been praised for the heroism and dedication shown during the pandemic. I share that admiration and gratitude to medics who have put their lives at risk because they care as a vocation. But care still needs to be extended to people who self-harm. If the aim is to keep mental health patients out of A&E to help with infection control, then we need alternatives including physical wound care, crisis support and access to a service rather than another plan that isn’t really a plan. All mental health professionals should try to grasp that those who self-harm are not one homogenous PD group. Individuals are not harming to present a problem to the service, but because inner pain has become too much to deal with in any other way. It is an opportunity to listen and avoid further harm.