I Want People To Be Aware Of How Scared I Am Of Getting Ill Again.

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It’s World Suicide Awareness Day. Or week, or month – I forget how long this empty virtue signalling exercise goes on. And I thought to myself, as a survivor of more than one serious suicide attempt, what do I really want people to be aware of?

I want people to be aware of how scared I am of getting ill again.

Some background: I was in a severe mental crisis for about 16 months of my life, from January 2016-April 2017. I have severe episodic depression, which makes my obsessive-compulsive disorder get very bad. When it flared up in January 2016 I thought I was a child murderer or molester. It is hell on earth, and I did not see a way out of it. Everything was just a black hole of despair, the joy fell out of everything I was interested in. I didn’t want to do anything. Anyone who knows me knows how up for a laugh I am, smutty, sweary, irreverent, BUSY. When I was ill I was just a humourless void, a bit like a walking corpse. Lads, I was fucked.

Things got very bad at the end of 2016 and I was admitted to the bin three times – on two occasions attempting suicide due to various factors, but being weaned off opiates too quickly was one, and going onto antidepressants that didn’t suit me was another. These medication issues led to very bad akathisia (an inability to stop moving) which often leads to suicide attempts.

After the second attempt I ended up getting sectioned and spent over three months on an acute ward. You can read parts of my story over on my blog.

Anyway so I was really ill, right? And you’d think it’s the worst thing about being in recovery, that fear of getting that sick again?

It is, but not in the way you think.

The symptoms of the illness, as bleak as they were, are not the thing I’m most worried about if things go south.

[DISCLAIMER: I had a lot of help compared to some people I know, but the bar is extremely low. I am also super privileged: I’m white, educated, intelligent, with a stable family and partner who can provide for me. I have lots of good friends around me. I had work I enjoyed and valued to go back to. I’ve never had to deal with the DWP. I’m cisgendered, straight and physically abled. In my case I also won the postcode lottery in terms of getting access to the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, one of the only specialist centres for treating OCD in the country. AND IT WAS STILL ABSOLUTELY BLOODY AWFUL FOR ME.]

Here is why I’m really worried about getting ill again:

I’m worried about getting ill again because I might have difficulty even persuading my GP to refer me to the CMHT. I might end up with absolutely no help for a severe crisis where my brain is trying to kill me.

I am worried that if I am referred to the CMHT, I might only be able to see a patronising CPN once a week for three months, with very occasional psychiatrist meetings. Things the CPN said to me have included ‘Well, if you’re going to kill yourself it’s your choice’.

I am worried that if I present at A&E because I feel unsafe and I’m fighting an almighty battle in my head to try and not kill myself, I will likely be sat there for hours before a condescending member of staff comes and tells me to go home because I am attention seeking. Damn straight I’m attention seeking. I’m fucking poorly.

I am worried that if I get referred to the Crisis Team, they will probably come to my house once a day for a month for about 10 minutes at a time. They will tell me to do a crossword or have a bath when I tell them I feel unsafe and suicidal.

I am worried that if I go into an acute ward, I will be treated like a child, punished for harming myself, and patronised beyond belief. I will be assumed to have so-called ‘Borderline Personality Disorder’* and ‘punished’ by staff accordingly. I will be completely at the mercy of whichever staff are on the ward on a given shift, and whatever patients are in at the same time as me. Patients I developed real beef with while in there last time might also be there (you end up falling out over stuff like ‘who gets the jacket potato for lunch’ and ‘who gets to choose which channel the telly is on’, because you revert to being a toddler). Staff I complained about after I left might be there. It scares me shitless.

I am worried that if I need to access my specialist treatment centre again, there will be a six month plus waiting list even after I am accepted on assessment. This nearly killed me last time.

I am worried that if I need to go off work again, I will have to deal with Occupational Health. This has been both a positive and terrible experience for me at different times.

I am worried that if something happens to my partner and/or parents, I will have to deal with the DWP in order to be able to eat. This is unlikely, but possible.

All these worries are actually scarier to me than the symptoms of my illness.

Please stop telling us to ask for help, and start thinking about how society and the psychiatric system needs to change in order for people to receive the care and help they need.

I ‘recovered’ despite the system, not because of it.

by Jo Edge @hagenilda

*I’m aware this is a very controversial diagnosis and do not wish to denigrate anyone’s experience.

Please also see RITB Position statement on BPD

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Positivity, Terrorism, & Neorecovery

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The imperative to be positive, to have what is lauded in the workplace under neoliberal capitalism as a ‘Positive Mental Attitude (PMA)’, has seeped into every area of human life, and it is terroristic. The obligation to wrap up one’s distress in a gift box with a pretty ribbon, to mask the absolute horror show that can be bestowed upon some of us in the form of mental torment, is nothing less than a violence. As we have learned from those who are subject to racism and intersecting oppressions, it is what these things do to the psyche, the way they get under the skin, into the marrow, and woven into the very fabric of our selves, that does the most damage. It is a colonization of the mind.

The positive police have set up shop in every mental health service. We should write gratitude lists, mindfully eat raisins, HOPE (help other people every day), list our strengths on care plans, and think about where we might want to be in five-year’s-time when the next hour feels unsurvivable. My current care plan asks me to document my long term goals and how I will achieve them; the boxes to fill in read like an appraisal form, or something to put in a personal statement in which I try to convince someone I deserve a particular position. The form used to be about the difficulties we experience, what help we need – not an instruction to account for oneself and how we might materialise the things we want out of thin air, driven by pure (and probably literal) hunger for it.

I run a writing group for people who experience ‘psychosis’. Last week one of the members was trying to write something based on a prompt I gave them and said, apologetically, that she had nothing positive to write. I was a bit startled because I have never asked them to write in a particular way, and certainly not to write with their positive pants on. I said that the group wasn’t a space that demanded positivity, but was a space in which to be real with yourself and others, to the degree with which you are comfortable. Her reply? “That makes me want to cry”. Her response made me want to cry. And shout. What are we doing to people that we feel that unless we can speak positively we shouldn’t speak at all, particularly about the reality we experience? This violence rips words from throats; puts a sterile spin on the diverse range of human experiences; whittles us away to silt; isolates; individualises; and expects us to swallow patronising platitudes in the name of ‘recovery’ so that we may be deemed worthwhile (read: productive) subjects.

I don’t want to go all John Lennon on you, but imagine if we let people be. Imagine if we accepted that it isn’t wallowing and being resistant to treatment to be honest about how we feel? Imagine if we were willing to hold that space for people with care, and to sit alongside them in it. Imagine if we decolonised the narrative, stopped asking people to superficially cover wounds that need suturing and healing from the bottom up. Contrary to neoliberal propaganda, of which the recovery discourse is fast becoming a sacred part, this doesn’t cause people to be stuck in a sick role and too dependent (whatever that means given we are all dependent on others), but allows for the possibility of being seen, being accompanied, and possibly moving through it with help.

Interestingly, the group member I mentioned above, though speaking of her fears and upset of the previous two weeks, wrote a very positive poem. I am not convinced this is because she miraculously felt that way, but because the obligation to be positive has hijacked her from the inside. Violence isn’t always bloody.

– Eleanor Higgins

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The Invisible Prison – Panopticon Of The DWP

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One of the things I’m feeling a lot at the moment is the massive divide being successfully constructed between:

1. Those of us who are long-term dependent on state disability benefits to live.

2. The rest of society.

This is absolutely deliberate.

People who aren’t dealing with the DWP for disability benefits have no idea how traumatic and violent and all-encompassing it is. It is an ongoing trauma for a lot of us.

Pretty much everyone I know who, like me, relies on disability benefits for rent/food/bills/life money, has had multiple traumatic experiences. And that’s on top of the GIGANTIC amount of work that the assessment process involves: do to it successfully requires a lot of specialist knowledge, writing skills, capacity for loads of admin, having to contact people, arrange medical appoints which are a total waste of patient and NHS resources, attend horrific ‘assessments’ , try to find advocacy etc

And being forced to do this all to the tightest timescale possible.

We deal with a level of surveillance and arbitrary punishment that, rightly,
has been judged by multiple independent analyses to be a state driven deliberate breach of the human rights of disabled people who have the fucking gall to be poor and/or unable to work.

Loads of the techniques of psychological pressure were developed first in one of the home office/ foreign office/ DWP, and then exported to the others. Nice, huh?

If you’ve a strong stomach and/or are not directly affected, more on that here.

Nudging conformity and benefit sanctions: a state experiment in behaviour modification

Basically the gist of this is, in which we discover until recently there really was a controversial government department which researched and tested “behaviour modification techniques” for implementation in aggressive state policy:

“Conservative anti-welfare discourse excludes the structural context of unemployment and poverty from public conversation by transforming these social problems into individual pathologies of “welfare dependency” and “worklessness.”

The consequence is an escalating illogic of authoritarian policy measures which have at their core the intensification of punitive conditionality. These state interventions are justified by the construction and mediation of stigma, which is directed at already marginalised social groups that the policies target. The groups, which include sick and disabled people, people who are unemployed, are painted with a Malthusian brush, as a “burden on the state” and a drain on what are politically portrayed and publicly seen as scarce resources in an era of austerity.”

Political processes of scapegoating, stigmatisation and outgrouping have been amplified by a largely complicit UK corporate media. Examples of its work are all over the DWP. PREVENT. The whole Hostile Environment project. There’s plenty more, I’m sure.

Which is why I’m not exaggerating when I name this as state terrorism.

A bunch of disability and civil liberties activists/campaigners/lawyers discovered  the existence of the ‘nudge unit’.  So they made Freedom f Information requests to try and find out what the hell government money is being spent on.

Government solution? To privatise the department and turn it into an ‘institute’ to avoid scrutiny. And to drain more state cash into private pockets.

Anyway, back to us, trying to survive in an increasingly violent and reactionary society with the vast machinery of the  right wing state bearing down on us.

This shit and much more stuff like it = many of us are scared to leave the house, post any pictures of us looking happy on social media, be photographed at events/protests.

We’re cut off from participating in civil society.

Police force admits agreement to share information about protesters with DWP

It’s absolutely deliberate: the more surveillance, the more the DWP poke their nose and disclosure agreements into every area of our lives, the scarier it is to be out in the world even when we aren’t disabled by society.

And – for many of us – there are multiple other oppressions we’re dealing with too. Disability is inextricably entwined with race, class, gender, gender id, immigration status, sexuality and poverty.

Our lives are FUCKING HARD.

The surveillance/sanctions regime is a deliberate tactic to put extra pressure on already vulnerable people. It’s punishment for being vulnerable and in need. It’s also eugenics: it’s about disabled people being regarded as disposable/barely/not human. It’s an idea with deep roots in British society.

And they’re only just getting started. Looking at Bloody Boris’ fucking cabinet terrifies me, eg right now the DWP is trying to get its hooks into NHS files. The proposal is dressed up in fake nicey language but basically it would mean that if you claim disability benefits, you have no privacy or confidentiality during medical appointments. It would be horrific. I know that there’s a lot of pushback against this from loads of NHS groups, thank fuck.

I don’t have much hope, and I feel a lot of the time the clock is ticking on how long I can survive before they break me, or make me homeless again or otherwise fatally fuck me up. That worry never leaves me. Which is another reason for stopping dealing with them for now.

Because I realise now: I’ve become institutionalised. I live inside an invisible cage built by the DWP (and social Scare, of course. Let’s not forget them. Bastards)

By institutionalised, I mean, for eg – I anticipate and strategise against DWP sanctions automatically whenever I think, open my mouth, and especially if I leave the house. Any time I think about doing anything out of the house that might improve my life, (eg an art class, or an event that a photographer is at) I freak out over whether it will trigger sanctions.

Because although it’s not likely, it does happen.

It’s a perfect panopticon. They fuck over just enough people to make all of us realistically terrified about it.

And it’s a deliberately and increasingly asymetric system.

Ie: getting the benefits takes huge amounts of work, and can take years. But the state can take them away in an instant.

There’s also the alienation: I deal with this monster that infests every area of my life. People who don’t deal with it mostly have absolutely no idea how hard our lives are. How we don’t go a week on social media without hearing about yet another death caused by the system we’re reliant on.

A system that is our right.

And it should be the right of anyone living here, btw. And isn’t anymore – that’s a whole other pile of DWP fuckery that’s been happening over the past decade or so.

Fuck borders and fuck nativist politics always.

But my one hope is that I see so many grassroots people/groups/organisations/communities doing mutual aid, advocacy, support, skill sharing etc. A lot of it is very informal and grassroots and it’s amazing. So you get people on random fb forums putting hours into helpful /detailed/informed responses to questions. You get people sharing often traumatic details of the assessment process because they care about someone else going through the same thing. It’s fucking amazing. But we shouldn’t fucking be going through this shit in the first place.

More specific stuff re the ”invisible cage’/panopticon:

CW: moar DWP ranting. Also, tho, theory.
Which isn’t actually fucking theory for me. It’s my daily life.

The DWP is absolutely a panopticon. I’m living in a fucking panopticon. Except it’s invisible. And specifically designed to marginalise already vulnerable people.

So most people don’t even know it exists. And often don’t believe you when you tell them. And it fucks you up so sometimes* you forget that you’re living in a panopticon and just blame/hate yourself.

I’m living in a panopticon in twenty fucking nineteen in a rich White Western country that likes to think of itself as:

1. Liberal (it isn’t. There are important  traditions of liberalism in this country. Traditions f radical internationalist anti colonial/anti racist socialism, communism, anarchism. Powerful histories of working class people of all races doing practical radical political work. And loads more. Britain’s dominant character as a ‘nation’ in general, in practice ends up  defaulting to English norms’ . Which prize conformism, hierarchy, subtle powerful coded signals.
Its all about us ‘knowing our place’.

Riz MC nails it in ‘Englistan’:
“God save the queen
Nah she ain’t mates with me
But she keeps my paper green
Plus we are neighbours see
On this little island
Where we’re all surviving
Politeness mixed with violence
This is England”

Track: Riz MC Englistan on Bandcamp
Lyrics: https://genius.com/Riz-mc-englistan-lyrics

2. Modern. Modernity isn’t inherently good – in English, it’s a category inseparable from white supremacy and capitalism and patriarchy and and and.

But my main issue is that the idea that the UK is modern is fucking laughable. UK = basically feudal neoliberal empire-hangover capitalism. Doesn’t that sound just GREAT?

If you think I’m exaggerating – bear in mind that our new Prime Minister is related to the royal family. in twenty fucking nineteen.

Thinking about the DWP as a panopticon also usefully reminds me that there’s a reason that a fucking White English public school-and-oxbridge man came up with with the panopticon. These same people still largely run the country OVER TWO HUNDRED YEARS LATER.

“Jeremy Bentham, an English philosopher and social theorist in the mid-1700s, invented a social control mechanism that would become a comprehensive symbol for modern authority and discipline in the western world: a prison system called the Panopticon.

The basic principle for the design, which Bentham first completed in 1785, was to monitor the maximum number of prisoners with the fewest possible guards and other security costs. The layout (which is depicted below) consists of a central tower for the guards, surrounded by a ring-shaped building of prison cells.

The building with the prisoners is only one cell thick, and every cell has one open side facing the central tower. This open side has bars over it, but is otherwise entirely exposed to the tower. The guards can thus see the entirety of any cell at any time, and the prisoners are always vulnerable and visible. Conversely, the tower is far enough from the cells and has sufficiently small windows that the prisoners cannot see the guards inside of it.

The sociological effect is that the prisoners are aware of the presence of authority at all times, even though they never know exactly when they are being observed. The authority changes from being a limited physical entity to being an internalized omniscience- the prisoners discipline themselves simply because someone might be watching, eliminating the need for more physical power to accomplish the same task. Just a few guards are able to maintain a very large number of prisoners this way. Arguably, there wouldn’t even need to be any guards in the tower at all.”

“Michel Foucault, a French intellectual and critic, expanded the idea of the panopticon into a symbol of social control that extends into everyday life for all citizens, not just those in the prison system (Foucault 1970). He argues that social citizens always internalize authority, which is one source of power for prevailing norms and institutions. A driver, for example, might stop at a red light even when there are no other cars or police present. Even though there are not necessarily any repercussions, the police are an internalized authority- people tend to obey laws because those rules become self-imposed.”

* ie almost all the time.

A final thought:

The tories are trying to kill me.
And a LOT of other people.
And they’ve already killed so many.

Black people. Muslims. People of Colour.
Migrants, particularly guess what, black people, muslims, people of colour.
Disabled People. Mad people.
Trans* people
Queers
The ‘wrong kind’ of women.
Working class people

*

Think about what it’s like for those of us who tick most or all of these boxes.

Try to conceive of the firestorm that we’re living in.

quotes are from here Internalized Authority and the Prison of the Mind: Bentham and Foucault’s Panopticon

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Mental Health Professionals Are Asking People To “Take Responsibility” For Surviving Their Suicidal Crisis – Even When Sectioned In Psychiatric Hospital

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Ella and I were patients on the same psychiatric ward. We were both detained under section two of the Mental Health Act. She was perhaps the quietest and most withdrawn patient on the ward at the time. She seemed deeply depressed.

We all felt very protective towards her, because she seemed so young and vulnerable. Indeed, on the day I was discharged, I recall hugging her tightly and wishing I could take her with me.

A few weeks later, Ella took her own life. She was still sectioned in the psychiatric hospital at the time.

Ella had been allowed to gain access to items which she used to end her life. At her inquest, the psychiatrists said they had not restricted her access to them because they wanted her to “take more responsibility” for her own safety. But surely the state had taken responsibility for her safety at that point – she was detained under the Mental Health Act.

It is known that restricting access to lethal methods reduces the number of suicides: https://www.psych.ox.ac.uk/publications/168536.

I run a Suicide Crisis Centre which is independent from mental health services. Clients often tell us that mental health teams are emphasising that they need to take personal responsibility for managing their own crises. Perhaps the teams feel that this will discourage service users from becoming dependent or expecting that a service will “save” them.

It’s possible to argue that we should all take responsibility for trying to stay as mentally well as possible and use as many strategies as we can in order to do that. Indeed, that can feel very empowering. But we may all reach a stage when our strategies no longer work, and we need significant help. When we reach that point of crisis, it may be the least appropriate time to expect someone to be able to “take responsibility”.

When a person is in mental health crisis, their ability to think clearly is very often impaired. That’s the nature of crisis. Our thinking may be chaotic at that time. It is not always going to be possible for someone to think clearly enough to take steps by themself to start to navigate their way out of the crisis.

At the point of crisis, it is the time when you are least likely to be able to see a route forward, without support and care to do so.

There are ways to help empower people who are under the care of a service so they do not become dependent on it. These alternative methods do not involve telling someone in crisis to “take more responsibility.” Giving people more control over their care at an earlier stage, when they are not in crisis, can be an effective way of doing that.

As I wrote last year: “Our approach is to give clients as much control over their care as possible, but to actively and tenaciously work to protect them and help them to survive, when they are in crisis and at risk of suicide” (“Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”).

Requiring someone in crisis to “take more responsibility” may heighten their despair, because they simply cannot do so at that point.

They have taken the step of asking for help, but have been told instead that they need to find their own resources. Surely they need to feel reassured that if they seek help, there will be support, kindness, empathy and care.

I know that the other patients on the ward continued to wrap Ella in care and kindness. They watched over her and alerted staff to the fact that they were extremely concerned about her suicide risk. But that responsibility of watching Ella should not have fallen on other patients.

Ella’s death should make us question to what extent the emphasis on service users “taking responsibility” has gone much too far, and risks causing a failure to adequately protect life.

As Ella had died while under the care of the state, in a psychiatric hospital, there was a jury at her inquest. The jury concluded that her death was a suicide which was “contributed to by her ability to gain access to items to aid suicide”. They took a very different view from the coroner, who in my opinion accepted too readily the mental health service’s justification for not restricting access to certain items. The coroner commented that such restrictions would be “draconian.”

Please also see this article which challenges the approach of clinicians who tell patients that it is their “choice” or “their decision” to end their life : Suicide: why do mental health professionals tell patients ‘It’s your decision’?

In memory of “Ella”. Ella’s name has been changed.

Joy Hibbins is the CEO of the charity Suicide Crisis: www.suicidecrisis.co.uk

Republished by kind permission from Saving Live Blog

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Fake News: What Psychiatric Wards Aren’t Telling You On Twitter

Emoji Anon

Did you know that psychiatric wards run their own Twitter accounts now? What’s next, Instagram?  Perhaps we can lose the Care Quality Commission and start carrying out reviews of hospitals on Trip Advisor instead.

Sussex Partnership Foundation Trust has an extensive Twitter network, with official ‘ward twitters’ and multiple ward staff running their own accounts. They call the patients ‘service leaders’ – language that denies the actual status of patients, often detained against their will, on psychiatric wards. The staff are referred to as ‘leader leaders’, trained through the ‘Leader Leader Academy’ which promises ‘quality improvement through Clarity, Competence, Control and Courage’ (is satire dead?). These ideas are taken from an American naval captain, turned public speaker, who suggests every business should adopt a ‘leader-leader’ model of management rather than a ‘leader-follower’ approach. The aim is to push responsibility as low on the organisational hierarchy as possible and for all employees to take ownership of leading the business. I somehow don’t think he was talking about patients detained under mental health legislation when he came up with that.

Am I really a ‘service leader’ while locked on a ward with little say about when I leave, whether I take medication and what belongings I have access to? If we flatten hierarchies to the point that we deny their existence, aren’t we just gaslighting those at the bottom? My own experience in a Sussex Partnership hospital was not one of a ‘service leader’. The problem with using such dishonest language is that it obscures the power and responsibility of those who can actually wield it. For example, a Sussex Partnership nurse tweeted a debrief form that had been filled in by a ‘service leader’ after they’d been restrained. What led to such poor judgement? Perhaps an unintended consequence of this language change is that staff begin to actually believe that patients have equal power, and that it’s OK to share their private, medical information on Twitter.

One of the wards using these terms is a psychiatric intensive care unit at Mill View Hospital. I was appalled to see multiple pictures of ‘service leaders’ posted on their Twitter feed, with smiley emojis superimposed on their faces. One of these pictures was posted by the ward manager, then ‘liked’ and retweeted by the CEO of Sussex Partnership, Samantha Allen. The patients would be clearly identifiable to anyone who knew them and the photos were humiliating, degrading and in clear contravention to multiple data protection laws (not least, that staff had the original, unedited pictures of patients on their phones).

Who are these Twitter accounts serving? Every kind of ‘professional’ Twitter sphere can come across as self-congratulatory, but the stakes are so high here. While I can understand the value in mental health professionals using Twitter to share best practice, it should never be at the expense of dignity and confidentiality. The tone of these ward accounts is all wrong – happy, smiley emojis covering the faces of those detained, talk of infantilised fun with the ‘service leaders’ – it paints an idealistic picture of life on the ward that is pure fantasy. I don’t go into hospital looking for ‘fun’. I hope that I receive timely care, that my human rights will be upheld, and that my dignity and confidentiality will be respected. Sadly, none of this has been the case in my own recent experience of Sussex Partnership hospitals.

The emoji pictures of patients have since been removed, after an uproar from professionals and service users alike. However, data still remains that could be used to make a jigsaw identification of a patient. The ward ‘newsletter’ includes a patient blog section where details about patient’s care and life stories are shared, and so-called ‘service leaders’ are still visible in some pictures.

It is all the more galling because the problems at Mill View Hospital have been well documented in recent years. There was a death on one of their wards as recently as December last year, that resulted in a coroner ordering an immediate investigation into safety. She described the ward involved as “mismanaged and chaotic”, and accused Mill View staff of giving the subsequent police investigation “the run around”. I am left wondering how the families of those who died there would feel about this kind of gratuitous self-promotion on social media.

Another problem on Twitter is that the ideas shared can be lost in their repurposing. One ward in Leicestershire, posted a picture of postcards with motivational quotes on, stating they were writing a personalised crisis plan on the back for each of their patients being discharged. A nurse from Sussex Partnership took this idea and recreated it, but instead of a personalised crisis plan, they listed generic crisis numbers on the back. What was a nice idea – personalised crisis plans on more than just hospital stationery – lost all it’s substance and became just another opportunity for ‘likes’ on Twitter. I left a Sussex Partnership hospital earlier this year without a proper care plan. If they had given me a motivational postcard with generic crisis numbers taped to the back, it would have felt like a punch in the face.

There are real people in vulnerable situations behind these Twitter blunders, that are having their human rights totally disregarded by Sussex Partnership staff – just for some ‘likes’ on social media. It suggests a culture where PR is valued over anything else. Until Sussex Partnership take raising their standard of care seriously, we should watch their Twitter rebrand with caution.

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More Evidence Of Service’s Suicidal Neglect

Thanks to Suicide Crisis and their founder Joy Hibbins for this excerpt, the full report can be downloaded HERE > Research Into Deaths By Suicide In Gloucestershire, Report of First Six Months (June to December 2017) Headline Findings

Patients with Emotionally Unstable Personality Disorder expected to “take responsibility” for their safety.

It appeared that a level of responsibility was being given to patients with Emotionally Unstable Personality Disorder (Borderline Personality Disorder) to keep themselves safe, even when they were detained under the Mental Health Act or “sectioned” in psychiatric hospital. “Keeping safe” was used in the sense of refraining from self-harm or suicidal acts.

However, it was not apparent what preparation or help they had been given to enable them to “take responsibility” for their safety.

Having spoken to family members, there are indications that there will be more evidence of this being repeated in other cases, in inquests to be heard in 2018.

In terms of the inquests already attended:-

AF was detained under the Mental Health Act in psychiatric hospital.  AF had been given a diagnosis of Emotionally Unstable Personality Disorder/Borderline Personality Disorder.

The psychiatric staff giving evidence spoke repeatedly about the need for AF to “take more responsibility” for maintaining her own safety. The coroner asked if she had “the tools” to do this.

AF had not been provided with therapies such as those referred to in the NICE guidelines for Borderline Personality Disorder e.g. Dialectical Behaviour Therapy (DBT). NICE refers to DBT as “an intensive psychological treatment that focuses on enhancing a person’s skills in regulating their emotions and behaviour. The therapy can help a person gain control of behaviours such as self-harm and substance abuse”. Psychiatric staff gave no indication of what they had done to prepare and support AF to be able to “take more responsibility” for her safety.

Therapies are particularly important as there is no specific medication. Indeed the NICE guidance (Clinical Guideline 78) states: “You should not usually be offered medication specifically to treat Borderline Personality Disorder or for any related symptoms or behaviour (such as self-harm, unstable moods and risky behaviour).”

SH had been given a diagnosis of Mixed Personality Disorder (Borderline Personality Disorder and Antisocial Personality Disorder). His family told us that they felt he had been given too much responsibility for maintaining his own safety and refraining from suicidal acts. SH was not provided with mental health care and support (such as the Crisis Team) after suicide attempts or self-harm incidents during the last few months of his life.

There was no indication at inquest that SH had been provided with therapies referred to in the NICE guidelines for Borderline Personality Disorder, including DBT which NICE states can help a person “gain control” of self-harm. There was also no indication that he had been given the recommended treatment for Antisocial Personality Disorder.

The NICE guideline on Antisocial Personality Disorder recommends psychological therapies for managing and treating the symptoms and behaviours associated with Antisocial Personality Disorder. “Group‑based cognitive and behavioural therapies help to address problems such as impulsivity, interpersonal difficulties and can help to reduce offending”.

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Unrecovery As KerPlunk!

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We have all played Kerplunk I hope. But as a recap there is a tube with holes, sticks are crisscrossed holding up some balls, and the trick is to remove the sticks without all the balls falling.

Our mental health is like a game of Kerplunk, and our issues are a combination of the balls and sticks. ‘Recovery’ is the ability to remove the sticks without the balls falling. As a slight adaptation to this analogy some of the balls can be removed by moving sticks, and ‘life’ adds balls all the time. The sticks are ‘safety’ adaptations that stop all the balls falling at once.

This game of Kerplunk is mostly played by us alone (in our own minds), so in this analogy the game is played in a room on your own. But we can always hear people telling us which sticks we ‘should’ remove, whilst we are sitting there looking at the problem, even though these people are not in the room with us. Government policy also demands we remove sticks, and moreover can add balls (as can other aspects of life), as well as remove sticks if we don’t keep an eye on them.

Unrecovery practices are an ad hoc practice, that is a temporary solution to keep control of our own Kerplunk game, knowing that a wrong move can send all the balls falling. ‘Bad’ recovery is one size fits all and insists on this or that stick must be removed, and then blames you when the balls fall. ‘Good’ Recovery, and other therapeutic practices, listens to your knowledge of what you can see of the game, and merely supports you with your autonomy whilst you play the game. This latter ideal however from our observation seems to be at odds with current government policy and market/ capitalist needs, as it doesn’t meet the outcomes measures of outside forces.

For those who don’t know the term, that I have added some changes to the games with sticks and balls being added and removed whilst you play, like a Heath Robinson machine, is what is called an assemblage. Unrecovery is an ad hoc practice with which to deal with such an assemblage.

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