Читать книгу The Moral State We’re In - Julia Neuberger - Страница 18

In my years of chairing a large community and mental health trust in central London, Camden and Islington Community Health Services NHS Trust, I became sadder and sadder at what was happening to people with mental illness who accessed our services, and, still worse, to those who for some reason or other were not accessing the services they wanted or needed. I remember being taken to see the best of our then three main adult inpatient units. One of the (male) consultants said to me that in the first few weeks of being a trainee psychiatrist you cried and cried; if you did not do so, then you would be no use as a psychiatrist.

In some ways, the issue of mental health is at the heart of this book. For we are not–in the way we structure and think about the services we provide–kind. Kindness is not what we value most, nor does it drive the system. If it did, the services would look quite different and be far more responsive to what users say they want. We would be providing decent housing and trying to provide employment, or at least some kind of daytime activity that makes sense and has meaning; we would be helping with money, with food, with the normal things of life, with talking and engaging with the issues that those with mental illness say bother them. Instead, over centuries now, we have provided a service that is largely based on fear and containment, on a view that those with enduring mental illness are worthless and do not deserve the level of public expenditure that running a series of responsive high quality services would entail.

This chapter is about those who have mental health problems, how we treat them, and how we regard them.

It looks at the stigma attached to mental health and at our lack of kindess towards people who are mentally ill.

It examines how our thinking has grown out of past experience, and tells the history of attitudes towards people with mental illness. It asks whether we are any more enlightened than our ancestors were, and whether our new drugs and other interventions make the lives of those with enduring mental illness any easier.

It looks at whether we use the mental health system as a form of social control and ask whether the experience of innumerable cases where things have gone very wrong tell us that those who work in mental health do not care for their patients.

It will also examine the increasingly risk-averse public policy climate and ask if the mental health world can ever be risk free. And it will also ask whether, if the views of service users were taken more seriously, there might not be better outcomes, with people being able to work and live comfortably, secure in the knowledge that if a crisis arises there will be proper care available from a team already known to the individual.

Finally, it will ask the essential question: if we were seriously concerned to care for, and even cure, those with enduring mental illness, would we ever have invented anything remotely like the present system?