Mental health systems in England and Wales face a string of problems, not least of which is privatisation. As part of our #ourlivesourstories series, The Canary has spoken to a number of experts who told us that there are many issues blocking supportive and accessible care.
Like many countries across the world, the coronavirus (Covid-19) pandemic has made problems with mental health in England and Wales much worse. But the NHS’s mental health services were already underfunded and overstretched.
However, funding isn’t the only problem. The actual services themselves have been criticised at great length. The implications are grave – if patients feel dismissed and isolated, how is that any marker of a good standard of care? How can patients be supported practically? Why aren’t they being supported?
To answer some of these questions, The Canary spoke to a number of collectives that address these very areas.
Recovery in the Bin (RITB) is an activist collective which questions what the concept ‘recovery’ means in mental health circles. An RITB member told The Canary that the group began as a response to people who felt “exiled” from the system:
It’s about whatever works for you. We support the survivor. We support self-definition, and self-define what your recovery is. Not the system’s version of recovery which, by and large, is “get a job.”
Self-definition, as the RITB member argues, would allow patients to decide what recovery looks like for them. And it comes with the proviso that each patient will have different needs.
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Further, their understanding of what recovery looks like for people with mental health issues questions where definitions come from:
So many of these definitions are still tied up with the ideas of professionals, and in turn with the neoliberalisation of academic research – who gets funded to do what research? That’s a very powerful, political process. What gets funded really decides what gets thought about.
The RITB member’s argument here connects academic funding grants to the question of power. If certain academics get funding grants to work on a particular area, it follows that other areas miss out, which in turn impacts patients:
The people using the service are almost the last people listened to.
Timely and respectful
For people who feel mainstream mental health services have isolated or mistreated them, RITB’s social media provides spaces to find community. The RITB member also said that while they agreed privatisation was a problem in mental health services in England, they were concerned about the extent of issues with standard of care:
I would say that we don’t have a working mental health system in England. By that I mean that a system should mean that wherever you are, whatever your situation, you can be seen in a timely way, and in a respectful way that helps you. We do not have that in England, at all.
Patients who don’t feel respected and heard therefore face significant barriers to accessing any version of recovery.
The RITB member told The Canary that another member had a particularly difficult experience while trying to get mental health support:
One of our members had to leave a treatment scheme – he’s a person of colour, and he complained about racist assumptions from care providers and the management. Of course, the minute he left and said he had these issues with structural racism, that was completely pathologised… and said “that’s because you’re a loony, and we’re not racist.” People have had psychologists tell them that they don’t believe racism exists.
This member, who was disbelieved and dismissed, has a story that likely speaks to many people.
The Royal College of Psychiatrists released a statement in 2018 which stated:
We recognise that racism and racial discrimination is one of many factors which can have a significant, negative impact on a person’s life chances and mental health.
There are also other collectives that address how oppression impacts quality of life.
We really wanted to work with people that were putting culturally sensitive work at the forefront of our practice, and intersectionality. We found that when we were in training, it was a module – diversity was a module. It was about bringing it into the fabric of our work, our practice, our thinking, our ethos. Even with the therapists working in the practice, they keep that in mind with their work as well.
Evidently, Aashna’s counsellors are encouraged to continue to develop Aashna’s approach to clients.
Racism in mental health services
Raja-Helm went on to explain, as with the case of the RITB member who experienced racism from service providers, that understandings of oppression are very important:
If you are Black, Asian, or from another ethnic group that is non-white, chances are high that you’ve experienced some form of prejudice, or racism, or oppression within the UK. We call this racial trauma, and the way it can impact one is that its trauma: it lives and sits in your body, and it can be activated, and the work is to find a way to digest that trauma.
Concepts like ‘racial trauma’ contribute to a framework that allows clients to be seen by their therapists. Raja-Helm continues:
If the therapist isn’t equipped to hold that significant difference because of their own journey and development, it means the client can often feel abandoned, and they leave the therapy because it’s not supporting them. What we’re trying to facilitate at Aashna is a space where [clients] feel represented, as do the therapists, as soon as they walk in through the door.
Kohli also went on to stress the importance of training. And she warned that in instances where therapists dismiss racism as a stressor for mental health issues:
Those therapists are actually afraid to talk about these subjects. These are really sensitive topics, and for them to discount it, is really not thinking about their own process in it, and their own prejudices. They’ve not been trained in it, and that’s the thing, they’re not being trained into thinking about these really delicate topics and how to work with it properly, and sensitively.
What does that training look like?
In order to answer the question of what this training could look like, The Canary spoke to Dr Beverley Costa, founder of the Pásalo Project, who’s also a senior practitioner fellow at Birkbeck, University of London. The Pásalo Project focuses on the role interpreters can play for patients speaking languages other than English who require talking therapies.
Costa explained that she often carries out training for psychotherapists. Moreover, she encourages reflection on seeing clients fully:
We are having a lot of big philosophical discussions about oppression… and that’s incredibly important. The bit missing for me is that the people who are not doing the seeing are not being equipped with the tools themselves to be able to see marginalised people. And you could say, well, they just need to step up and make more of an effort. But I think there’s just a void there. And my experience is in training is that trainers just leave trainees with that void to get on with it themselves.
Both RITB and Aashna expressed the need for therapists that think critically. And Costa’s outline of being in the training room lays out the power dynamics involved in both therapy and training.
I think one of the most important things is to create an environment where there is the minimal amount of shame, where mistakes are welcomed as gifts to the group for us all to learn from.
As the impact of poverty, inequality, and racism on declining mental health becomes more apparent, each of these collectives – RITB, Aashna, and the Pásalo Project – show the importance of therapists that continually develop their approaches. Continual training is necessary to address the weight that oppression, in all its many forms, can bear on patients.
Funding for mental health services is important – but it’s just the tip of the iceberg. The actual services on offer, as each of the individuals we spoke to stated, need to meet patient needs. If patients need a radical overhaul of what recovery means, that must happen. If patients discuss the role various oppressions have on mental health, therapists must have the training to address that. And if treatment needs to be unique to each individual, then services must meet that need too. Otherwise, the current mental health crisis won’t be going away any time soon.
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As discussed in our earlier investigation into privatisation of NHS mental health services, it is, and always will be, the case that service users need freely available resources to support them.
- Recovery in the Bin have online spaces available which provide an opportunity for connection and community.
- Aashna+ is a social justice project which provides inclusive therapy. Users can access the service based on what they can afford to pay. Donations to the ‘communal pot’ are welcome.
- The Pásalo Project offers 12 hours of free online training in mental health and multilingualism.
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