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’.

Screenshot 2018-10-14 23.22.12

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

UK govt naughty MH

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.

The UK Government Has Been Killing Disabled People, A New Government Must Stop This And Make Things Right

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Ok, I wrote this a couple of weeks ago while thinking about the roundtable meeting with John McDonnell and saved it away, I think it needs putting out there now, because clearly even people supposedly aware of what is going on seem to not understand what it is like to be a target of government hostility. This is what a future new government needs to do to make things right and respect disabled people’s rights and lives and to move forward.

1. People have a form of trauma from their dealing with the DWP and contractors over the last decade, we are survivors of state sponsored abuse, that needs recognising and help given.

2. To that end there needs to be a formal state led process of truth and reconciliation and part of that will entail key senior command people face trial, thousands of lives have been taken here and that trauma cannot be dealt with without redress, forgiveness can only happen after an oppressor accepts what they have done and that it was wrong. There is no place for sanctions in a social security safety net. It should also be noted that professional bodies (General Medical Council, Nursing & Midwifery Council & Health and Care Professions Council) have sought to protect their members from complaints and remedying their institutional bias needs to be part of this process. The Coroner System also needs to be changed so the threshold of determining suicide and causes is no longer to a criminal standard and that coroners warnings to government about lethal effects of policy have statutory force and cannot be hidden or dismissed. As for Corporate Charities or Disability Rights UK, when push came to shove, they mostly failed us. If they want to share in this way forward they have to re-orient how they represent the people they supposedly are constituted to help.

3. Long term the DWP is so institutionally dysfunctional it has no future in a civilised society, we need a new Ministry combining Social Security and Social Care closely allied to Health (if not also Health) DHSS, imagine such a thing! And firmly rooted in human rights and the social model. So not Universal Credit.

4. More directly about the future, there needs to be a transition plan so that the Friday morning when Labour walk into Downing Street, civil servants and government lawyers are tasked with ending the contracts with Atos, Capita & Maximus. On this we are happy to provide testimony to show all three are catastrophically in breach of their contacts and deserve no exit clause payments, in fact they deserve prosecutions. The assessments need to be paused, interim payments continued and an emergency process in place to deal with ongoing claims and new claims while new legislation is debated and passed, ideally seeing NHS professionals and the claimants own support network co-produce an assessed support plan that is the gateway to benefits. The era of the fear of the brown envelope must end immediately.

Unsupported Work To Provide For No Family – The Work Cure?

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“Work is good for you” is a mantra inflicted on everyone of working age including mental health service users. I don’t think the reality is straightforward and work can feel perilous when it is insecure, (zero hours contracts being the clearest example), low paid, low skilled with employers whose priority isn’t to ‘promote staff mental wellbeing’. I do work full-time though didn’t achieve regular paid work until I was 33 years of age. Please bear with me as I explain this statement since I feel I need to justify it in case anyone assumes I was lazy or went travelling the world.

When I was 18 I reluctantly dropped out of university with a weight below four and a half stone. I spent the next five years being refed and rehabilitated from Anorexia. At the age of 23 I tried to make a new start with a disabled person’s traineeship for a government funding body. My manager terminated this fixed-term contract after I disclosed in confidence that I was distressed and self-harming outside of work. My life then fell apart and the self-harm worsened with paracetamol overdoses. I was fortunate to meet a community psychiatric nurse who saw beyond the self-harm, encouraged my potential and need to stay busy. I volunteered at a local Citizens Advice for nine years during which time I was hospitalised for countless blood tranfusions and even sectioned on the psychiatric ward due to pressure from A&E medics for services to do something. In my early thirties, while still under the community mental health team, I came across an incredibly hard working, sound and enthusiastic vocational adviser, using the Individual Placement and Support model, who motivated me to finally contemplate a meaningful, appropriate and chosen job.

I believe the structure of work helps me now though work is inherently stressful. I never want to imply that I have done it and so should others with mental health issues. I have seen this bullying attitude amongst peer leaders who had chosen working in a supermarket or self-employed consultancy on mental health over claiming benefits which they saw as a mark of disgrace and welfare dependency. Some service users progress to working within mental health services in peer worker roles which are usually underpaid and undervalued by their NHS trusts. However, I decided to do administrative work away from mental health care, since I feel too much of my life has been lost to mental health already.

I have many friends who don’t work due to their mental health and I would always advocate for their need to be left alone by the Department of Work and Pensions (DWP) and the various organisations, which can include NHS trusts and mental health charities, acting as their agents. While the fear of being made to do ‘any’ job, if found fit for work, did propel me to act before I was forced, I don’t support this underlying threat tactic.

Apart from the benefits questions, I have been wondering whether there are unspoken disadvantages to being in work when you have ongoing mental health challenges. These disadvantages include health services seeing an employed person as recovered, the lack of support in the workplace, the inability to disclose less appealing diagnoses, for instance ‘personality disorders’, eating disorders or addictions, and the difficulty of accessing benefits support which enables you to keep working.

This week I attended a CCG organised ‘Coproduction’ workshop on local care and mental health using my annual leave so that I could speak freely. A consultant psychiatrist was the speaker representing the main mental health trust in this area. His presentation and words were: “only the most severely impaired should access secondary services.” I interrupted at this point to ask how he would define ‘severely impaired’ and if it could include people in work. The speaker said that it would not because: “they wouldn’t want to see us as they are out working providing for their families.” I pointed out that someone in work could still have a crisis, indeed could need hospital admission.  I felt a lone voice in a room of professionals where others probably agreed that all patients who can just about function should be discharged back to primary care to release capacity in the system, outing those who are the equivalent of bed blockers in hospital.

There are logistical difficulties of accessing mental health services if they decide you deserve an appointment when you work. Even the mental health services embedding in primary care operate during core work hours and may be in a town away from your place of work. Since I’m fully aware of the huge demand on specialist services, it does kind of make sense how services view someone working, even if signed off sick, as more able to fend for themselves. Perhaps there is also a mistaken belief by professionals that working is a curative therapy which then creates a lack of comprehension why someone, particularly with non-psychotic conditions, should become ill when in work. Services only want to see people short-term to work to Recovery model goals, so if you have achieved paid employment then this can in itself be regarded as marking the end of the treatment journey.

My experience of applying for Personal Independence Payment, once Disability Living Allowance ended, is that working counted against me. The medical report from my face to face assessment with a general nurse employed by Atos repeatedly said “in her social history she states that she works full-time with no specialist input.” While I scored 6 points these were on account of my eating disorder, thankfully being in a job doesn’t denote that I can eat three meals a day or prepare a simple cooked meal. The assumption made by the assessor and the DWP is that if you hold down a job then you can do all of the activity descriptors involved in daily living. I was turned down for PIP and had to challenge the decision. The short-term award I did get on mandatory reconsideration has meant that I have to go through this claiming process 18 months later, explaining all over again how I can be employed yet still find it difficult to engage with other people face to face.

If you do become more unwell while at work, whether caused by work stress or personal issues, then there may be no support to prevent your job loss. Large employers usually have an outsourced Occupational Health service but this tends to amount to advice for the employer about when the employee is likely to return to work. There is no advice directed towards the employee about how they can cope with work. The provider used by my current employer is OH Assist, which used to be a division of Atos, the private company which performs benefits assessments on behalf of the DWP. The assessment of the employee’s health and subsequent advice report is done through a brief telephone consultation. The Occupational Health Adviser may be a nurse or OT who has no mental health knowledge, leading to a short and generic report for the employer, which is more of a tick box exercise than a considered specialist opinion.  I have had to pay my private psychologist to write a report for my line manager in the hope that it may lead to reasonable adjustments and understanding of how to support me at work.

Many large employers do have an Employee Assistance Scheme (EAP) which is telephone based. My experience is that calls are short, possibly to target times of 10 minutes, unless you wish to access eight sessions of phone counselling. Since the EAP is also outsourced to a national company, there is no familiarity with the employer you work for and their policies. I was overpaid salary of thousands of pounds in error by my employer but had no way of sharing my pay slips with a phone adviser who would be someone different if I called again. The extent of the advice given during 10 minutes about my overpayment was that the employer should be ‘reasonable’. I experienced even greater stress when my employer then demanded in two threatening letters that I repay the total overpayment back in two months leaving me with a nil income for those months. In fact, the overpayment recovery deductions set amounted to more each month than I would have been paid. I had to use my annual leave to see a local Citizens Advice to figure out how to respond to the overpayment that wasn’t my fault though still needed full repayment.

Job retention support is non-existent despite the way that work is a policy priority in mental health and the Five Year Forward View.  I approached the Shaw Trust and was told that they weren’t commissioned to provide job retention and the only way they could help me was if I gave up my job to look for another. I have seen the Disability Employment Adviser at the Jobcentre and was given a leaflet for an NHS funded Improving Access to Psychological Therapies service offering six sessions of web chat and was told that Access to Work wouldn’t cover anything for mental health except taxi fares. After much internet searching, I found Remploy, funded by Access to Work, has a Mental Health Support Service. I self-referred to this service and understood that there would be six months of support. I later realised that the support was telephone based whereas I needed someone to come with me to meetings with senior managers at work. Remploy is in partnership with Maximus, which is another private company that provides benefits assessments for the DWP.

Two weeks after I self-referred, a Vocational Rehabilitation Consultant phoned me and offered the only face to face meeting I would have in six months apart from a 13 week review he said could be done in person or over the phone. He made clear that he was fitting me in on his way by train to another client. His office address is over 150 miles away from where I am based. During our meeting lasting half an hour, he asked my diagnosis and when I said it was ‘Borderline Personality Disorder’ he suggested that I was a ‘complex lady.’ He said that he had other clients with BPD but they did not self-harm and he knew how with BPD one day he may be my best friend and the next day my worst enemy. I tried to explain that I didn’t experience this perception and found such a stereotype offensive. He had emailed me a lot of leaflets produced by Mind in advance of this meeting and asked if I had read them yet. I was in crisis, attending A&E for wound repairs, so reading the leaflets was the last thing on my mind.

My personalised action plan from Remploy stated that the “reading resources were provided to help her better understand anxiety, depression and self-harm so that she can try to develop coping strategies to better manage her mental health.” He drafted a letter to my manager which I had to ask him not to send since it stated that she was the cause of my anxiety! When I gave feedback that the leaflets were too basic and his service didn’t meet my needs he replied in several emails saying:“We deal with individuals who have mild to moderate mental health difficulties who are already in employment and do not require intensive support. I feel you are not benefiting from the mental health support service (MHSS) which Remploy deliver as it provides a much lighter touch as I think you require a level of intensive support which is not designed into the MHSS as it is not designed for that purpose.”  He never suggested where this intensive support should come from. I still have to provide him with monthly updates until the end of the six month support period, even though I have withdrawn from the service.

My employer does have Mental Health First Aiders (MHFAs) who can be approached in the same way that an employee could ask for physical first aid if they had an accident. These MHFAs do have two days of training. I believe that staff with the right qualities training as MHFAs can be a helpful resource in the workplace though their role is to listen, signpost but not to give advice. However, it isn’t easy to approach MHFAs you know as colleagues. While the conversations are meant to be confidential I do have a doubt about whether I may regret being open if later interviewed for a promotion by a colleague who is also a MHFA and may see me in a different light. I have not managed to tell any of my colleagues about my diagnosis as I am sure it would damage my career prospects. There are so many negative articles online about BPD that a manager would only have to look at the wrong Walking on Eggshells type web page to form a judgement that the employee was a problem.

In several places of work I have heard colleagues use what they call ‘gallows humour’ about customers, such as saying those who self-harm seek attention, that it was a waste of resources that an ambulance helicopter was called out for a resident who had taken an overdose and that they wished one of their clients would get run over by a car as he served no useful purpose as a drug addict. I still hear where clients are called ‘manipulative’ as though this is definitive. Even though the colleagues are not talking about me, I start wondering what statements they would make if they knew that I was a frequent user of A&E, covered in scars under my long sleeved shirts and trousers. I want to educate them on the distress behind mental health issues but don’t want to reveal too much about my own history that they either feel sorry for me or form a different opinion other than one based on my strong work ethic.

There is the isolation of being single and in work (I have no family to provide for despite what was suggested by the speaker at the workshop). I have no-one to turn to after a long day in the office where I may have experienced conflict, stress or bad news, for instance there is an imminent restructure. It takes me several hours in the morning to psych myself up to go to work and once home I have no energy left. I eat something simple like cereal, having snacked for most of the day due to my anxiety, I then phone my surviving elderly parent and go to bed. The events at work and whether I said the right thing or have forgotten any task go round in my mind inhibiting sleep. I know that the next work day offers more of the same routine, perceived criticism, uncertainty and self -doubt. Working has created distance from a few friends who think that it is alright for me now I have work and don’t have to worry about work capability assessments. Government policy pitches disabled people against each other. We compare ourselves and who needs the rationed resources more since benefits and services were cut as part of austerity measures. I also feel I have no energy to talk to these friends about their encounters with mental health services when I just need total rest after forced company in the office. I don’t feel like using the computer or answering the phone since I fear I will have no resources left to go into work again.

I often feel like a disaster survivor unable to tell my colleagues what has happened to me through iatrogenic and personal traumas. My world is clearly not theirs. I share in their news of families, childcare arrangements, children’s exam results and their own career promotions. I don’t say how unhappy and empty I feel inside or that I won’t see anyone over the weekend as otherwise I wouldn’t recover to see them again on Monday.

If work is good for you, it should be good to you as well. Work needs to be with a supportive employer, have a benefits package with well funded employee wellbeing resources, open minded colleagues and local NHS and voluntary sector services that don’t exclude the ‘high functioning.’ There should be a raft of supports that are concerned about job retention and not just a job placement, job done approach. Voluntary work should be valued as a meaningful and important part of life for those whose mental health condition means they shouldn’t be pressurised into work to targets or to keep the welfare bill down. We need to work together as allies, those in and out of work, to make sure our voices are heard and that work is chosen, decently paid, healthy and fair.

Hey Binners, Let’s Write To The UN!

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We would like to crowdsource from you lovely binners a submission to Philip Alston UN Special Rapporteur on Extreme Poverty and Human Rights, who is gathering evidence in UK.

>DEADLINE Friday 14 September at 18:00 GMT Respondents are requested to limit their comments to a maximum of 2,500 words. Reports, academic studies and other types of background materials can be attached as an annex to the submission. All input will be treated confidentially by the Special Rapporteur and his team<

Humble suggestion: we take the framework of- our political economy creates and maintains poverty, poverty incites/exacerbates mental illness, with NHS, Local Authorities, and DWP assessing away need in order to make cuts the ‘safety net’ is gone (Police being ‘service of last resort’). So treatment and support is also failing, IAPT is a joke but it produces nice metrics for conferences! Professional response has been (apart from some honourable exceptions) poor & leaving us to fend for ourselves to get care or benefits. All underlined by inequality of- ethnicity, income, power, gender, class etc

To give us time to collate and arrange into a submission all comments etc will be collected by 10th September.

So please, have at it, tell the UN what you want them to know about Mental Health in the context of Extreme Poverty and Human Rights in the UK! Email your wondrous words (preferably not more than a few hundred) to recoveryinthebin@gmail.com marking them with the subject line UN Alston