The Invisible Prison – Panopticon Of The DWP

Invisible prison 1 art

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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I Have Never Been In A Place More Indifferent To Suffering Than A Psychiatric Ward

I have never been in a place more indifferent to suffering than a psychiatric ward. People walking around in great distress must be so much part of the furniture that mental health nurses can walk past them with barely a glance.

A few nights into my stay a nurse found me crying in my room. “It’s good to cry” she said matter-of-factly, “But sometimes it can go on too long”. She got up and left, promising to return later when I’d calmed down. I wondered what point there would be for her to return when I was no longer in distress, but ultimately it didn’t matter, because she never came back. I had a similar experience a few days later. While I was crying in my room, two health care assistants entered and began to carry out a room search. They didn’t ask if I was OK or acknowledge in any way that I was sobbing. After they finished they smiled and said “Thanks!” brightly, before leaving the room as quickly as possible.

In both these encounters I believe my historical diagnosis of borderline personality disorder (BPD) was at play. My crying was attention seeking, manipulative and proof that I was unable to regulate my emotions. Had they spent time to get to know me, they would understand that I rarely cry, let alone sob in front of people. As someone who OVER regulates their emotions it was upsetting to have my vulnerability responded to in such a callous way.

These experiences reminded me how dangerous the ‘All Nurses Are Heroes’ narrative is. There were some amazing, stand-out individuals working there, whose kindness were the true bright spots of my admission. But there was a culture of indifference which allowed behaviour that was everything from incompetent to genuinely cruel. I saw staff roll their eyes or laugh behind the backs of perceived ‘difficult’ patients. The psychiatrist referred to me in the third person during ward round in a way that should only be reserved for “Does she take sugar?” disability satire. Safety did not seem to be a priority, despite the fact there have been multiple deaths at this hospital. When a patient collapsed in the corridor after taking her nighttime medication, it was other patients who helped carry her to bed. The nurse who’d dispensed it simply shouted after her, “It just means they’re working”.

Two days into the admission I got given somebody else’s medication. I had been given my own meds about an hour before so questioned the nurse whether I really needed them, but she insisted. It turns out they were a different type of benzodiazepine to the one I had just taken and were intended for a woman with a similar name. The last thing I remember clearly from that night is them frantically trying to get a doctor onto the ward when the door to the ward wouldn’t open, but after that is black-out.

The same thing almost happened again two weeks later, but this time I was well enough to refuse and ask them to double check (once again, it was for the woman with the similar name). I was also given the wrong version of my medication on three occasions – an instant release type that left me more sedated and with more side effects. As someone who struggles to take medication, these mistakes left me mistrustful and scared to continue accepting the meds.

It didn’t help that the basic environment was not taken care of. The bathroom was filthy and not cleaned for two weeks, with a blocked drain that meant it flooded every time I took a shower. When I reported these things, the message never seemed to get to the right people. They were unable to find curtains for my room for the first week, and the floodlight outside the window meant I was unable to sleep properly.

To add insult to injury, the hospital I was in has a strong social media presence, where they use buzz words like “quality improvement”, “compassionate care” and talk about being HASHTAG “humbled”. It’s a self-serving denial of reality that’s almost cult-like in nature. It allows them to construct an image of life on the ward that is pure fantasy, all the while keeping genuine conversations about patient’s experiences at bay.

Perhaps most distressing, I was treated as a detained patient throughout the admission, despite being there ‘voluntarily’. This included being prevented from leaving multiple times. On one occasion, I tried to push past a member of staff entering the ward, and a nurse shouted at me, “Hey! You’ll be getting a Mental Health Act Assessment if you’re not careful!”. Her tone was that of a parent threatening a naughty child, not a nurse informing a patient of their rights. Weaponising mental health legislation in this way leaves patients with the experience of being detained without any of the legal safeguards. I was not allowed any ‘leave’ until near the end of my admission and even then, it was hit and miss as to whether the decision to let me out had been handed over. If it hadn’t, I would be left waiting until a member of staff who HAD been informed was on shift, sometimes days.

Despite being ‘de facto detained’ I was told by multiple members of staff that they didn’t think being there would help me. Once again, I’m sure this was related to my historical BPD diagnosis. To tell a patient simultaneously that they aren’t allowed to leave, but that they won’t be helped by staying, is both confusing and cruel. I had lost all hope for myself and saw this hopelessness reflected back at me by the people who were meant to be in a position to help. All of this is contrary to the National Institute for Health and Care Excellence (NICE) guidelines for hospital admission which recommends an “atmosphere of hope and optimism” for service users, with “a clear focus on their emotional and psychological needs”. I was never assigned a primary nurse during my stay and never saw a copy of my care plan, if indeed one existed.

Ultimately, this means I’ve left hospital without a clear plan of care, and with only the side-effects of a traumatic admission. It’s an impossible situation to be in while trying to keep yourself alive through a mental health crisis. The ‘choice’ between being totally unsupported or poorly supported is a catch 22 I’m still scared I might not survive.

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Recovery In The Bin Statement Against Racism

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Recovery In The Bin stand against racism and acknowledge it is pervasive throughout culture and the systems we are subject to. We acknowledge white privilege and the duty for those with it to recognise and strive to remove it and to challenge the culture of Whiteness. We support an intersectional understanding of how each of us may have privileges and oppressions. We oppose anti-Semitism, Islamophobia, and the State-led policies of hostility toward migrants and asylum seekers. Learning to negotiate with each other respectfully and with humanity is an ongoing process that at times is difficult but to which we should all be committed. We also demand professionals acknowledge the presence of institutional racism and workers who collude with this at an individual and/or collective level are contributing negatively to the mental health of Black, Asian, and Minority Ethnic (BAME) service users. Professionals should join us in learning and changing – to listen to and to give platforms to BAME Service Users, and marginalised groups who are not even visible to services or excluded by hostile environments. We draw particular attention to the appalling higher risk of violent and abusive treatment faced by people of African-Caribbean and African heritage. It is massively under-acknowledged that racism contributes to mental distress and illness; we must recognise and work to change that.

RITB With The T

We wanted to add some specific detail to our previous Statement of Support in respect of the intense activity around the Gender Recognition Act Consultation that is creating upsetting misinformation. You can fill in the consultation with advice here. We oppose Transphobia (definition on wiki) which can be described as ‘any oppression that arises from people being trans, or perceived as trans or as not conforming to gender norms. And the structural oppression of transgender people by cispatriarchal society, and prejudicial and/or ignorant attitudes, narratives and actions which contribute to those structures of oppression’.

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We recommend this great post by Rosie Swayne. And we thank activists for their permission to print here the text of a leaflet which was handed out at an ‘L with the T’ solidarity demonstration recently that deals with common misperceptions. A PDF can be downloaded here > TERF rhetoric vs reality

TERF Rhetoric vs Reality
Content warnings: transphobia, mention of sexual assault, rape, suicide, mental health problems, conversion therapy, medical gatekeeping.

TERF rhetoric
Children are being given irreversible medical transition before they are old enough to know that they’re really trans.

Reality
Research confirms that children who assert a transgender identity know their gender as reliably as their cisgender peers of the same age. The effect of hormone blockers is reversible, while the effects of unchecked puberty are much harder to reverse if necessary. Transition-related surgeries are not performed on children.

TERF rhetoric
[Cisgender] women are at danger of being harassed or assaulted in bathrooms if trans women are allowed to use them.

Reality
Trans people just want to be able to use the bathroom in safety, like anyone else. There are no documented cases of this having led to harassment or assault of cis women. On the other hand, trans people frequently feel, and are, unsafe in the bathroom of their birth assignment.

TERF rhetoric
Trans women uphold stereotyped notions of femininity defined by patriarchy.

Reality
Trans women’s style of presentation is as diverse as that of cis women, if not moreso. This is despite the fact that they face even more pressure to conform to stereotypes, in particular by doctors who often continue to enforce discredited gatekeeping standards requiring such conformity before allowing access to medical care.

TERF rhetoric
[Cisgender] female biological reality is a defining aspect of women’s experience of oppression.

Reality
Women’s oppression takes many different forms for different groups of women. For example, lesbian and bisexual women face particular forms of misogyny, flavoured by homophobia, that straight women may not, while lesbians may be less likely to encounter other manifestations which usually take place in the context of relationships with men. In the same way, trans women’s experience of misogynistic oppression is different in some ways to that of cis women, but those experiences are no less oppressive and no less female.

TERF rhetoric
People who claim to be trans should instead be encouraged to accept their birth gender.

Reality
“Conversion therapy” on trans people is as abusive and ineffective as it is on LGB people.

TERF rhetoric
Trans women are men who are “trying to infiltrate women’s spaces”.

Reality
Trans women are women.

TERF rhetoric
[Cisgender] lesbians are being pressured to sleep with trans women, or shamed if they do not.

Reality
The vast majority of trans women want nothing to do with people who don’t consider them women; so the idea that they would want to pressure anti-trans cisgender lesbians to sleep with them is somewhat absurd. There is some discourse around the implications of cisgender people excluding transgender people of their preferred genders from their potential dating pools on the grounds of their transness, but this does not amount to anyone being pressured to sleep with people they don’t want to.

TERF rhetoric
Emphasis on detransition.

Reality
Less than 1% of people who have undergone transition choose to “detransition”. Often, those who do are responding to societal prejudice rather than rejecting their transitioned gender. Statistics about “surgical regrets” are also frequently cited in bad faith in this context. Many of these statistics include people who express dismay relating to complications or poor outcomes, as well as post-surgical depression – both of which are common problems following procedures of all kinds – and may or may not have any second thoughts at all about having undergone surgery. Likewise, even in rare cases where a patient might regret having opted for a procedure, this should not be taken to imply regret for having transitioned or a desire to detransition.

TERF rhetoric
Transition does not improve mental health or rates of suicide and self-harm.

Reality
Untreated gender dysphoria (due to delays or refusals of treatment), unnecessary and intrusive questioning/tests, prejudicial attitudes by service providers, and restrictive treatment pathways, all contribute to minority stress which is detrimental to the mental health and wellbeing of trans people. [shura.shu.ac.uk/8957/1/Ellis_Trans_people%27s_experiences_of_mental_health.pdf]
An article published in the July 2016 edition of The Lancet offers significant evidence that the “distress and impairment, considered essential characteristics of mental disorders” among trans people primarily arises in response to the discrimination, stigma, lack of acceptance, and abuse they face on a regular basis. [thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30165-1/abstract]

TERF rhetoric
Transition surgeries are “mutilation”.

Reality
This is a transphobic insult masquerading as an argument.
“Mutilation” is used here merely as a way to express disgust about trans people’s bodies; it is irrelevant to the actual purpose and merits of surgeries, which are effective and often lifesaving treatments.

TERF rhetoric
Gender is purely a social construct. Or Gender is defined by genitals.

Reality
Traditionally feminism understands both that biology does not determine how we experience the world AND that our biology does contribute to our shared experiences as women. There is no contradiction here for transgender women.

Open Letter To The Organisers, Partners And Delegates Of The Global Ministerial Mental Health Summit #GlobalMHSummit #theworldneeds

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Open Letter to the Organisers, Partners and Delegates of the Global Ministerial Mental Health Summit, London
9th and 10th October, 2018

The UK government is hosting a Global Ministerial Mental Health Summit in London on the 9th and 10th of October, 2018. The Summit aims to “build momentum on global mental health issues such as early intervention, public health, research, tackling stigma, and promoting access to evidence-based services.” The event is set to culminate with a “global declaration committing to political leadership on mental health.” The Summit will also see the launch of the Lancet Commission into the links between mental health and sustainable development.

We the undersigned are concerned about the way in which this event has been organised and about the UK positioning itself as a ‘global leader’ in mental health for the following reasons:

  1. The organisation and planning for this event has been a closely guarded secret. Even the full list of countries participating was not released beforehand, which made any possibility of advocacy by civil society organisations in those countries impossible. Significantly, there has been little or no involvement of organisations led by mental health service users, survivors and persons with psychosocial disabilities in the thinking, planning and design of this event. While a few networks were approached to provide ‘experts by experiences’ to attend panels on themes already decided on, there has been no meaningful consultation or involvement of user-led and disabled people’s organisations not already signed up to the ‘Movement for Global Mental Health’ agenda or funding to enable a wide range of representatives to attend. This is in open violation of Article 4 of the UN-Convention for the Rights of Persons with Disabilities (CRPD) which obligates signatories to closely consult with and actively involve persons with disabilities through their representative organisations in decision-making around issues that directly concern persons with disabilities.
  2. The UK’s positioning as the leader in the global effort to tackle mental health needs is highly problematic for a variety of reasons. In 2016, an inquiry by the UN Committee on the Rights of Persons with Disabilities found that austerity policies introduced by the UK government had met “the threshold of grave or systematic violations of the rights of persons with disabilities.” The Committee found high levels of poverty as a direct result of welfare and benefit cuts, social isolation, reduced standards of living, segregation in schools of children, lack of support for independent living and a host of other violations. The situation has had a direct impact on people’s mental health with rates of suicide attempts doubling and widespread destitution.
  3. In the concluding observations on the initial report of the United Kingdom of Great Britain and Northern Ireland, the Committee raised particular concerns about the insufficient incorporation and uneven implementation of the CRPD across all policy areas and levels within all regions, devolved governments and territories under its jurisdiction and/or control, and about existing laws, regulations and practices that discriminate against persons with disabilities.
  4. In the UK, there is a particular situation of discrimination within mental health services that affect its black and minority ethnic communities and migrants from ex-colonial countries and the global south diaspora. Decades of evidence show that they face consistent discriminatory treatment within UK’s mental health services, including high levels of misdiagnosis, compulsory treatment, over-medication, community treatment orders and culturally inappropriate treatment. The inquiry into the death of David Bennett, an African Caribbean man in the care of the state, found the NHS to be institutionally racist. Yet, the UK government has set out to lead the globe in creating inclusive and just societies while continuing to perpetuate a ‘hostile environment’ not only in its health and social care services but in other areas that impact on people’s mental health such as immigration, policing, employment, welfare and so on.
  5. The Summit is set to announce the global launch of the anti-stigma programme, Time to Change, with programmes planned in India, Ghana, Nigeria, Uganda and Kenya. Millions of pounds have already been spent on this campaign which claims to have made a positive impact on mental health stigma, while evidence also shows that there has been no improvement in knowledge or behaviour among the general public, nor in user reports of discrimination by mental health professionals. The UN Committee on the Rights of Persons with Disabilities, in its concluding remarks, raised particular concerns about perceptions in society in the UK that stigmatize persons with disabilities as living a life of less value than that of others. It also pointed out that existing anti-discrimination legislation in the UK does not provide comprehensive or appropriate protection, particularly against multiple and intersectional discrimination. Given this scenario, it is objectionable that the UK government continues to fund a programme that aims to address stigma while carrying on with the most stigmatising and discriminatory policies that affect persons with psycho-social disabilities.
  6. UK has already taken the lead in exporting the failed paradigm of biomedical psychiatry globally through the ‘Movement for Global Mental Health’. The failure of social contact based anti-stigma programmes to attain any change in structural discrimination and inequalities has not deterred the UK government from supporting the export of another high-cost, low impact programme, with funding from the Foreign and Commonwealth Affairs Office, to the global south. This model of ‘North leading the South’ recreates colonial ‘missions of education,’ significantly impacting on the development of locally relevant, rights-based discourses rooted in the wisdom of CRPD and led by persons with psychosocial disabilities in the global south.
  7. Many professionals in the field of mental health both in the global south and in the global north have cautioned against the application and scale up of western models of mental health care worldwide. User/survivor groups in the global south have already objected to importing failed western models of mental health care into their countries and called for full CRPD compliance that will enable full and effective participation of service users, survivors and persons with psychosocial disabilities in all aspects of life. This is significant at a time when the Mental Health Act is under review in England and there has been consistent resistance to moving towards CRPD compliant legislation.

Given this scenario, it is hypocritical that the UK government is taking the lead in creating a global declaration on political leadership in mental health. As with the Global Disability Summit this government recently staged, we are seeing an intolerant government posing as the upholder of the rights of persons with psychosocial disabilities. The organisation of the Summit is in opposition to the spirit and terms of the CRPD.

We ask the participants and delegates of this Summit to:

  1. Reflect upon the issues brought forward in this letter, including existing structural and multiple discrimination against persons with psychosocial disabilities in the UK by its government
  2. Demand a clarification from the UK government on its position on the CRPD and the measures it is taking to uphold the CRPD within its own laws and policies
  3. Ask the UK government to desist from operating in imperial ways that export failed models and methods to the rest of the world which negatively impact on local innovations and ways of working
  4. Campaign to ensure that any declaration created at the Summit is put forward for wide consultation and ratification by the diverse range of user-led and disabled people’s organisations worldwide
  5. Insist that if the UK government wishes to promote mental health in the global south, it must:
    1. Lead by example by changing its domestic laws, policies and practice that currently threaten the lives of mental health service users and survivors in the UK, including its economic and welfare policies that have widened inequalities, made life intolerable for thousands of disabled people and contributed to their deaths.
    2. Acknowledge the knowledge existing within user-led and disabled people’s groups about what works best as well as provide support for user-led services, advocacy and research
    3. Examine its own foreign policies in order to lessen north-south disparities in health standards and its own ethical standards in exporting western mental health systems
    4. Support local, inclusive innovations in the south to address social and structural determinants of health rather than take over leadership
    5. Enable local people to develop services that are for the benefit of the people concerned as subjects rather than objects of development and sustainable without dependence on or interference from rich countries in the West.
  6. Engage with independent civil society groups and not conform to the wishes of the UK government.

Signatories

  1. National Survivor User Network, England
  2. Recovery in the Bin
  3. Mental Health Resistance Network, UK
  4. Linda Burnip on behalf of Disabled People Against Cuts, UK
  5. North East Mad Studies Collective, England
  6. Transforming Communities for Inclusion – Asia Pacific (TCI-Asia Pacific)
  7. Bapu Trust for Research on Mind and Discourse, India
  8. SODIS (Sociedad y Discapacidad), Peru
  9. North East Together (NEt), England
  10. North East Together (NEt), service user and carer network, UK
  11. NTW Service User and Carer Network, England
  12. Steve Nash, Co-Chair ReCoCo: Recovery College Collective, England
  13. Center for the Human Rights of Users and Survivors of Psychiatry (CHRUSP), USA
  14. Akiko Hart, Hearing Voices Network, England
  15. Akriti Mehta, User-researcher, King’s College London, UK
  16. Alan Robinson, Artist, Buenos Aires, Argentina
  17. Alexandra Reisig, Student (Global Mental Health), UK
  18. Alfred Gillham, ISPS UK
  19. Alisdair Cameron, Launchpad: by and for mental health service users, UK
  20. Alison Faulkner, Survivor researcher, UK
  21. Alvaro Jimenez, University of Chile, Santiago, Chile
  22. Andrea Liliana Cortés, Independent activist in human rights and psychosocial disabilities, Colombia
  23. Asmae Doukani, London School of Hygiene and Tropical Medicine, UK
  24. Brenda A. LeFrançois, Professor, Memorial University of Newfoundland, Canada
  25. Caitlin Walker, Cambridge University, UK
  26. Carolyn  Asher, Service  user of mental health services, UK
  27. Catherine Campbell, Professor of social psychology, London School of Economics, UK
  28. Che Rosebert, Director – interim external communications, Association of Clinical Psychologists UK
  29. Cheryl Prax, Psychiatric survivor, Speak Out Against Psychiatry (SOAP)
  30. China Mills, Lecturer, University of Sheffield, UK
  31. Chris Hansen, International Peer Support, USA
  32. Claudio Maino, Université Paris Descartes, France 
  33. Corinne Squire, Professor of social sciences, University of East London, UK
  34. Cristian Montenegro, PhD candidate, London School of Economics, UK
  35. David Harper, Reader and programme director for the professional doctorate in clinical psychology, University of East London, UK
  36. David Orr, Senior lecturer in social work, University of Sussex, UK
  37. Derek Summerfield, Honorary senior clinical lecturer, IoPPN, King’s College London, UK
  38. Diana Rose, Professor, King’s College London, UK
  39. Dominic Makuvachuma, Co-ordinator, Reigniting the Space Project, England
  40. Doreen Joseph, Service user, advocate/researcher/lecturer/writer, UK
  41. Dorothy Gould, Researcher, trainer and consultant with lived experience of mental distress, UK
  42. Duncan Double, Consultant psychiatrist, Norfolk & Suffolk NHS Foundation Trust, England
  43. Eamonn Flynn, ISPS UK
  44. Elaine Flores, London School of Hygiene and Tropical Medicine, UK
  45. Eleni Chambers, Survivor Researcher, UK
  46. Emma Ormerod, Survivor Researcher, UK
  47. Erica Burman, Professor of education, University of Manchester, UK
  48. Erick Fabris, Psychiatric survivor; Researcher for the Mad Canada Shadow Report, Canada
  49. Ewen Speed, Senior lecturer in medical sociology, Director of research, School of Health & Human Sciences, University of Essex
  50. Farhad Dalal, Psychotherapist, group analyst, and organizational consultant
  51. Fiona Little, MH sufferer, violated for years, UK
  52. Francisco Ortega, Professor of collective health, State University of Rio de Janeiro, Brazil
  53. Frank Keating, Professor of social work & mental health, Royal Holloway University of London, UK
  54. Giles Tinsley, Hearing Voices Network England
  55. Glenn Townsend, Service user of mental health services, UK
  56. Hari Sewell, Independent consultant and author, UK
  57. Helen Spandler, Professor of mental health, University of Central Lancashire; Editor, Asylum magazine, UK
  58. Ian Parker, Emeritus Professor of Management, University of Leicester, UK
  59. Iain Brown, Tortured sufferer at the hands of MH team, UK
  60. Ilma Molnar, London, UK
  61. Janaka Jayawickrama, PhD, Associate professor in community wellbeing, Department of Health Sciences, University of York, UK
  62. Jane Gilbert, Consultant clinical psychologist, UK
  63. Janice Cambri, Founder, Psychosocial Disability-Inclusive Philippines (PDIP), Philippines
  64. Jacqui Narvaez-Jimenez, Carer bullied by the MH team, UK
  65. Jasna Russo, Survivor researcher, Germany
  66. Jayasree Kalathil, Survivor Research, UK
  67. Jen Kilyon, ISPS UK
  68. Jenifer Dylan, Service user involvement facilitator, Camden and Islington Foundation Trust
  69. Jhilmil Breckenridge, Editor, Mad in Asia; Founder, Bhor Foundation, India
  70. Karen Machin, Researcher, UK
  71. Kate Swaffer, Chair, CEO and Co-ordinator of Dementia Alliance International
  72. Katherine Runswick-Cole, Professor of education, University of Sheffield, UK
  73. Lavanya Seshasayee, Psychiatric survivor; Founder, Global Women’s Recovery Movement, Bangalore, India
  74. Leah Ashe, Victim of psychiatry
  75. Leo McIntyre, Chairperson, Balance Aotearoa, New Zealand
  76. Liam Kirk, Member of the service user group of Brent, Wandsworth and Westminster Mind, UK
  77. Lisa Cosgrove, Professor of counselling and school psychology, College of Education and Human Development, University of Massachusetts, Boston, USA
  78. Liz Brosnan, Survivor researcher
  79. Luciana Caliman, Professor of psychology, Universidade Federal do Espírito Santo, Vitória, Brazil
  80. Lucy Costa, Deputy executive director, Empowerment Council: A Voice for the Clients of CAMH, Toronto, Canada
  81. Margaret Turner, Secretary, Soteria Network UK
  82. Margerita Reygan, Mother/Carer of mental health service survivor, UK
  83. Mari Yamamoto, User of psychiatry, Japan
  84. María Isabel Canton Rodriguez, Rompiendo la Etiqueta, Nicaragua
  85. Mark Allan, HVN England and North East Mad Studies Collective, England
  86. Melissa Raven, Postdoctoral fellow, Critical and Ethical Mental Health research group (CEMH), University of Adelaide, Australia
  87. Michael Ashman, Survivor of psychiatry, UK
  88. Michael Njenga, Executive Director, Users and Survivors of Psychiatry in Kenya, Kenya
  89. Mick McKeown, University of Central Lancashire, UK
  90. Mohan Rao, Professor (retired), Centre of Social Medicine and Community Health, Jawaharlal Nehru University, India
  91. Neil Caton, ISPS UK
  92. Nev Jones PhD, University of South Florida, USA
  93. Nikolas Rose, Professor of sociology, King’s College London, UK
  94. Norha Vera, King’s College London, UK
  95. Paola Debellis Alvarez, Universidad de la Republica, Uruguay; CCC PhD-Forum, Geneva, Switzerland
  96. Patrick Bracken, Consultant psychiatrist, Co Cork, Ireland
  97. Paula Peters, Bromley DPAC (Disabled People Against Cuts), England
  98. Peter Beresford, Mental health service user/survivor, Shaping Our Lives, UK
  99. Peter Coleman, A family carer for son currently subject to restriction, UK
  100. Phil Ruthen, Survivors Poetry, UK
  101. Philip Thomas, Writer; Formerly consultant psychiatrist and academic, UK
  102. Raúl Silva, Doctoral student, UCL Belgium/Ecuador
  103. Reima Ana Maglajlic, Senior lecturer in social work, University of Sussex
  104. Reshma Valliappan, The Red Door, India
  105. Roy Moodley, Associate professor and director of Centre for Counselling & Psychotherapy, University of Toronto, Canada
  106. Ruth Silverleaf, User-researcher, Kings College London, UK
  107. Sami Timimi, Consultant child and adolescent psychiatrist, Lincolnshire Partnership NHS Foundation Trust, England
  108. Sarah Carr, Acting Chair, National Survivor User Network, England
  109. Sarah Yiannoullou, National Survivor User Network, Managing Director
  110. Sebastian Lawson-Thorp, UK
  111. Shireen Gaur, Clinical psychologist and psychotherapist, UK
  112. Sofía Bowen, PhD candidate, King’s College London, UK 
  113. Stan Papoulias, Assistant director, Service User Research Enterprise, Kings College London, UK
  114. Stephen Jeffreys, Someone with lived experience, UK
  115. Sue Bott, Deputy chief executive, Disability Rights UK
  116. Suman Fernando, Retired psychiatrist, writer and campaigner, UK
  117. Sumeet Jain, Senior lecturer in social work, The University of Edinburgh, UK
  118. Susan Wolfe, Social historian, UK
  119. Sushrut Jadhav, Consultant psychiatrist and clinical senior lecturer in cross-cultural psychiatry, University College London, UK
  120. Teisi Tamming, Estonia
  121. Tish Marrable, Senior lecturer in social work, University of Sussex, UK
  122. Tracey Lazard: CEO: on behalf of Inclusion London
  123. Will Hall, Host, Madness Radio; PhD candidate, Maastricht University School of Mental Health and Neuroscience, Netherlands
  124. Zsófia Szlamka, Youth activist, Hungary

If you would like to add your support to the letter please email info@nsun.org.uk

Ruth Davidson, Mental Health And Tory Policy

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Thank you to Irene Sutcliffe @hotsexmadrigal and James Loxley @oldnorthroad for permission to repost their article here:

On 16 September, the Sunday Times published an interview with the leader of the Scottish Conservatives, Ruth Davidson. The piece was both about Davidson’s private and public lives (the two can’t really be separated, not in her line of work): her pregnancy and the importance to her and her partner of starting a family, her political career to date, and her desire not to be Prime Minister (despite strong rumours to the contrary). The interview was trying to be a refreshing take on a Conservative politician – as the interviewer points out, on the surface, Davidson is hardly your archetypal Tory, ‘…a working-class, winningly informal, cheerfully profane 39-year-old lesbian former kick boxer…’. The piece even begins with Ruth dancing for the photographer, apparently unembarrassed. She is portrayed as frank, amusing and charming. She has an autobiography coming out, called ‘Yes She Can’, and a lengthy extract from this book, which deals with her breakdown aged 17, is printed at the end of the interview.

It should only be a good thing when well-known figures, especially those in positions of political power, are candid about their mental health issues, for several reasons. Firstly, and perhaps most obviously, it shows that the black dog strikes indiscriminately – sure, Davidson is a lesbian from a working-class background, but she is also an educated cisgendered white woman who can’t fairly be called working-class these days. Secondly, it demonstrates that mental health difficulties needn’t be a barrier to doing such a demanding job. And thirdly, such people are actually in a position to change the way the state provides for those with mental illness – which it does woefully badly at the moment. Woefully badly. We cannot emphasise this point enough. English NHS services are laughably understaffed (for example, when one of us was under section in a psychiatric unit in a hospital with 6+ wards, there was ONE doctor covering the whole hospital outside of 9-5 Monday to Friday hours). Waiting lists for NHS therapy are horrifically long, and even private therapists are stretched. The postcode lottery is a huge factor in terms of what is available to those suffering with mental health problems. While the NHS in Scotland is devolved (in fact, it has always been separate) and hasn’t had to cope with a drive towards marketisation, years of real terms cuts to the Scottish government’s budget and increasing demand mean that there is still huge pressure on resources, and services are certainly not where they should be. The recent allocation of additional resource to mental health care in the Scottish budget is a very welcome step, but will not go far towards solving the problems. Stories of people not getting the care they need will continue to proliferate.

The interview proved points 1 and 2 pretty well, and there’s not much need to go into those here. But let’s take point 3. As an MSP, the leader of the second largest party at Holyrood and an aspirant to the position of First Minister (if not, as she claimed in her interview, that of Prime Minister), Davidson has a prominent platform from which to advocate for significant improvements in this system and – just as importantly – to will the means required to make such improvements happen. One of the most crucial things that mental health services require for improvement is, essentially, a huge injection of cash. But we also need meaningful changes in the way the state – and society – view mental illness in all its various forms: not as the fault of the individual, but as a difficult and unfair thing that could befall anyone. It’s also not the responsibility of the individual alone to recover from their unwellness: it’s society’s duty to help everyone, and to make necessary adaptations for those with mental health problems so that they can operate within society and not on its fringes.

So, what does Davidson have to say about all this? Here is the extract in full, with our commentary:

I went to university at 17 years old. If I’d known then that knowledge was not the same as intelligence and confidence no substitute for ability, I might not have struggled so much. But another event crashed into my world. A boy from my home village committed suicide. I’m not a psychologist and I don’t know why his death affected me as much as it did, but I went into a total tailspin.

I started hurting myself: punching walls, cutting my stomach and arms with blades or broken glass, drinking far, far too much and becoming belligerent and angry, pushing people away. I was punishing myself and hating myself for it at the same time.

So Ruth really was unwell, for whatever reasons – biological, psychological, social, whatever. She showed her interviewer the scars on her arms: One of us, too, has these scars. We know the urge to self-harm, to drink to make the noise in your head shut up, and an awful lot about existing as a ball of sheer anger. Despite the political and personal gulf between ourselves and Ruth, we share that in common. And it resonates.

At 18, I was diagnosed with clinical depression and put on antidepressants. I was frightened, confused and worried that I might be going mad — that this was what a mental breakdown was. After starting medication, I had desperate, dark, terrible dreams that were so vivid, I couldn’t tell what was real. I became anxious and paranoid. I started having suicidal thoughts. Every time I went back to the university health centre with a fresh set of injuries, the doctor on duty just doubled my dose and things got worse.

In the end, I was on the maximum dosage allowed and became so scared of sleep that, in my second year, I spent a whole term living nocturnally. I stayed up through the night and only went to bed once my flatmates had left for lectures. As an arts student with very little structured time — we were in charge of our own required reading and making sure essays were handed in — nobody much noticed or cared if classes were missed.

Here’s the thing. Antidepressants can cause mad, adverse side-effects that do often diminish with time. They can be really horrible. We ourselves, and plenty of people we know, have suffered side-effects that range from the unpleasant to the truly horrible, and we have all had the experience of waiting and wondering if things will improve. We feel really bad for Ruth in this situation. Because it’s horrible, obviously. No-one wants to suffer this way. The problem here is that Ruth doesn’t seem to have been tried on any other types of antidepressant when whatever she was put on was having adverse effects, and doesn’t say whether or not she was offered any therapy. Really, those are the issues here, not antidepressants in themselves. It is easy to stay stuck on meds that don’t work for you if you’re depressed and not really in a place to argue with doctors. What might really have helped Ruth here is psychiatric monitoring, and pathways into therapy. Essentially, providing both those things boils down to money.

But then, things get tricky.

Intellectually, I know that drug therapy helps millions and that in a different time, or with a GP who knew me, instead of the revolving door of a university health centre, I could have received treatment that helped me get better, instead of making things worse: the manufacturer of the drug I was on has since paid out millions following class-action lawsuits after evidence of increased suicidal behaviour in adolescents.

Davidson doesn’t say which drug she was taking, but there have indeed been concerns about the risk of increased suicidal behaviour among young people taking SSRIs, and lawsuits have indeed been settled by manufacturers. Some drugs are no longer prescribed for children and young people because of such concerns, and practitioners are much more alert to the dangers. Serious side effects of this sort were and remain rare, however, and it doesn’t help anybody for a senior politician to make statements that could prove unnecessarily alarming.

But the key point here is actually not one Davidson meant to make. The experience she describes is of being prescribed a drug and then not receiving the consistent help and support she needed when it didn’t work for her. That is what happens to far too many people suffering mental ill health in this country. And it happens precisely because overstretched health care providers are not able to give people the time and attention they need, because the resources aren’t there to pay for them. So we come back to money, and the problem for Davidson here is that she has consistently supported the austerity policies of a UK Tory government since 2010 which have led to so much increased pressure on health services and devolved government budgets. And when the Scottish government increased income tax on the well off in order to address some of the budgetary shortfall, who led the charge against it? Why, of course, it was Ruth Davidson. She’s happy to will the end of better mental health care, but totally opposed to willing the means.

There’s only one way that Davidson can escape the implications of her statement, and that again comes down to what she can will – or thinks she can, at least.

I had mocked the leaflets I was given on the diagnosis — NHS instructions to do light activity, like housework or clearing out my cupboards. But eventually I made a decision to will myself better. I resolved to build a structure to my days and weeks, to set short- and medium-term goals, to engage in purposeful activity that had a measurable outcome, to take regular exercise, moderate my drinking, go back to church and be kinder to myself.

This is where the wheels really start to fall off in an alarming way. Firstly, you simply cannot will yourself better from depression. Fact is, Davidson structuring her days was a very good idea and probably took immense strength of character, but she did not will herself better. That is something we’re told to do when we’re unwell, which we can’t do, or fail to do, and end up beating ourselves up when going for a run or doing meditation or being somehow more mindful doesn’t work. This is where dogmatic Conservative ideology rides in to rescue Ruth from the real lesson of her story. Now she can assert that YOU have to get better ON YOUR OWN and it comes FROM YOU. Yes, there’s an element of truth to that, but it’s also, as we’ve said, something we do in collaboration and something for which we are collectively responsible as a society.

Most importantly to me, I threw away my pills and promised myself that, whatever happened, no matter if I slipped back, I would never take them again.

I couldn’t go back to a place where I didn’t know what was real and what wasn’t, where my emotions were hollowed out but my anxieties heightened.

Well, obviously those particular meds weren’t working for her. I think we’ve established that. But this is just the sort of ‘get on with it yourself with no support’ attitude that Tories standardly resort to and take pride in. It’s also worth noting that her diagnosis was depression. Thing is, not all mental health problems are the same. Schizophrenia, bipolar disorder and psychosis – these are things for which drug therapy is usually the norm, and inpatient stays are often necessary. Ruth’s bootstraps approach certainly wouldn’t do the trick here. All this, what’s more, in a society where both work and welfare are being re-engineered in ways that increase the chances of people – especially those without privilege or capital of any kind – getting ill.

And this inevitably colours her somewhat solipsistic account of where things are at now:

More than 20 years later, the ways in which we understand and respond to mental-health issues are unrecognisable from what they once were. The stigma is much reduced, and depression is something that far more people feel able to talk about. There’s a long way to go, but it helps when more people in more fields open up — when sports stars, royalty and business leaders say publicly that they have a condition they manage, and can demonstrate that it doesn’t stop them achieving.

I am still frightened of going back to the psychological place I once inhabited. When I have periods of heightened anxiety, or I can feel the weight of the black blanket start to descend, I go back to what I know works for me: structure, exercise, forward momentum, measurable outcomes.

Well, yes, openness is important, and great to see. But this is much too rosy a picture. Twenty years on, we don’t actually understand all that much more about the workings of the brain than we did. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is still an evolving document, and there is a huge debate underway about the usefulness of any diagnoses in mental health. We’re also not sure stigma is reduced – the fact we talk about it is one thing, but when we’re told to talk to someone about our mental health – who exactly do we talk to? Many Community Mental Health Teams are now not taking patients unless they have attempted to commit suicide already. That’s the criteria for getting help in some places – try and off yourself. And again, this is down to an already-underfunded mental health system in England being gutted by the Tory government to which Davidson offers her unwavering support. So it’s great that she has her techniques to stave off depression and they work for her, but the idea of pulling yourself up by the bootstraps and getting on with it when you are unwell is simply laughable. The vast majority of people involved in mental health care know this. While Davidson and her supporters comfort themselves with their self-affirming story of self-reliance, out in the real world more people will die.