Tag: Human Rights

#StopSIM Coalition Consenseus Statement

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

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

We call on NHS England to:

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

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

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

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

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

The #StopSim Coalition

Copied to:
Sir Simon Stevens, CEO – NHS England Lord David Prior, Chair – NHS England, Claire Murdoch, National Mental Health Director – NHS England, Martin Hewitt, Chair – National Police Chiefs’ Council, Sir Tom Winsor, Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Service.

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

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

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

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

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

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

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

I am not a criminal. 

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

The Crime of wanting to die, my story from Scotland

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The actions were as follows:

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

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

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

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

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

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

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

Black Lives Matter – What White People In The UK Can Do

Text on black background saying Black Lives Matter UK @UKBLM

Nila K and C&P

Some things UK white people can do:
1. Get educated.
2. Learn about bystander intervention, practice and use it. If that’s not accessible/safe for you, then tell people about it who can do this work.
3. Donate to UK black led grassroots/radical groups. Or groups that do street medic/arrestee support. They might be about to get VERY busy.
****

1. Get educated

For starters – read or listen to Reni Eddo-Lodge’s fantastic book Why I’m No longer Talking To White People About Race. Google Books

Reni Eddo-Lodge has asked that people borrow/share her book if possible, and send the money you’d have spent black grassroots groups
“This book financially transformed my life and I really don’t like the idea of personally profiting every time a video of a black person’s death goes viral.”

****

2. Learn about bystander intervention
If they’re happening/its accessible, consider doing stewarding/action medic/arrestee support training. Even if you can’t get to demos, i promise you it’ll make you feel more confident about daily street intervention work – which is bloody important too.

Fantastaic ‘riot medic’ manual here: https://riotmedicine.net/
De-arrests are Holy. They save lives.
Persuade other ppl to donate/boost too.

****

3. Donate to black-led grassroots/radical groups.
Examples include BLM UK, Green and Black Cross, UK Mutual Aid, or INQUEST, an incredible organisation who work on Deaths in Custody and holding UK state to account. They work on ALL deaths in custody whether police, psychiatric, prison, immigration detention. And they do all this on no fucking money. Like, they’d have to save up for a shoestring. If you have spare cash, send them some. I guarantee you they’re already busier than usual and gonna get more so.

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 of 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 of 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

Woman-blue-shirt-3-1024x1010

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.