Can Channel 4's Bedlam do for psychiatry what Educating Yorkshire did for teaching?

While an under-performing school holds ample opportunities for teachers to turn lives around, inpatient psychiatric units are where lives get put on hold.

There can be few professions more in need of a boost of good PR than psychiatry. The least popular of all medical specialties, we’ve been struggling to recruit young doctors to our ranks for years. In 2012, there were more training posts available in psychiatry than doctors applying for them. So as a psychiatrist, I’m keeping everything crossed, hoping that Bedlam, a new series airing Thursday 31st October on Channel 4 is going to change all that. Set in one of the country’s best-known psychiatric hospitals, it promises to give unrivalled insights into the lives of patients and staff over 4 episodes. With access to actual NHS consultations and treatment, the programme hopes to challenge the ‘myths and taboos’ around mental illness and psychiatry.

We know TV can do wonders for a profession down on their luck. It was with more than a little envy that I witnessed teachers getting a much-needed lift from the final episode of Educating Yorkshire last week. Who could have failed to be moved by Musharaf’s dogged determination to overcome his stammer for his English speaking exam, and the efforts of his teacher Mr Burton to help him? Though the profession has been in for a battering over their recent strike action in hard times, it reminded all of us how magical good teaching can be, the difference it can make to the lives of young people, and the benefits it brings to society as a whole. The inherent value of teaching shone from our screens. Up and down the country, thousands of sparks of inspiration were stuck, and people, perhaps unknowingly, started on a journey to a new career in education. As the credits rolled, I thought, ‘My lot could do with a bit of that.’

While other doctors have positive aspirational role models from glamorous American TV series, psychiatrists are linked in the popular imagination to serial killers like Dr Hannibal Lecter. And if we’re not characterised as evil or flawed, then the ‘go to’ image is comic. I was amused and saddened to learn at a recent psychiatry conference that if you do a Google image search for the word ‘surgeon’, you reveal countless images of attractive men and women in blue scrubs looking important and performing heroic acts, whereas typing ‘psychiatrist’ returns a tranche of barely humorous cartoons, and photographs of couches. In terms of inspiring tomorrow’s doctors and firing up passions, there’s no doubt that we’re up against it.

Am I nervous about Bedlam’s impact? You bet. While an under-performing school holds ample opportunities for teachers to turn lives around, inpatient psychiatric units are where lives get put on hold. Nothing can prepare you for the sheer strangeness of a psychiatric ward, a place that can seem untouched by hope, a temporary refuge for people at their lowest ebb.

I distinctly remember the first time I visited one fifteen years ago, not as a naïve medical student, but as a carer, visiting my friend hospitalised with depression after a serious suicide attempt. Having already seen the inside of many hospital wards, I felt well prepared for the experience, confident I would be unflustered by the surroundings. This left me plenty of emotional room to focus on coming across as sympathetic and patient, rather than showing that I was actually angry with her for what she had done, and petrified that we nearly lost her.

But no sooner had I stepped onto the ward than I was on the back foot. Where were the nurses? And who was in charge? Nobody had uniforms on and people just seemed to be milling about. There was no medical equipment of any type that I recognised. A stranger approached me, a young woman who made no eye contact and started to tell me something I no longer remember, then began to cry. My confidence had left me. I was totally out of my depth. Where was my friend? Was she going to be safe here?

It hardly seemed like the kind of place miracles happen. But the reality is that they do. I try to hold on to that first experience and how it affected me when meeting patients and families for the first time. It is easy to forget that they may not know what I know - that odds on, things are going to get better.

Mental illness can be shocking, devastating, harrowing. It can wreck lives in countless ways, and be harder to come to terms with than heart disease, diabetes or cancer. As mental health professionals, it is our job to do what we can to help turn these lives around. When people are at their most desperate and can’t see light at the end of the tunnel, we must not only be a shoulder to cry on, but help them find a way out.

Despite poor first impressions, psychiatric hospitals can play host to thousands of acts of kindness every bit as moving as Mr Burton’s. Look beyond the peculiarity of its wards, routines and functions, and you will see dedicated professionals doing what they can to make a difference, helping people overcome symptoms, move on, and recover. For too long there has been too much attention on the negative aspects of psychiatry. Yes, some of the medications we prescribe can have horrible side effects. Yes, sometimes we detain people in hospital against their will. But in making these difficult decisions, our intentions are invariably good. The factors and outcomes we need to consider are arguably more complex and life-changing than those faced by other doctors. We don’t shy away from making tough decisions. It’s hard to help people in profound distress, but we’re proud of what we do.

So here’s hoping Bedlam will reveal miracles. Here’s hoping we’ll glimpse some moments of magic. We need to find the next generation of doctors who want to become psychiatrists. People who experience mental illness deserve highly trained, highly motivated professionals who want to relieve suffering and hold their head up high. Here’s hoping sparks of inspiration are struck.

People's ideas about psychiatry are more often than not related to patients lying on couches and inkblot tests. Image: Getty
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Let's turn RBS into a bank for the public interest

A tarnished symbol of global finance could be remade as a network of local banks. 

The Royal Bank of Scotland has now been losing money for nine consecutive years. Today’s announcement of a further £7bn yearly loss at the publicly-owned bank is just the latest evidence that RBS is essentially unsellable. The difference this time is that the Government seems finally to have accepted that fact.

Up until now, the government had been reluctant to intervene in the running of the business, instead insisting that it will be sold back to the private sector when the time is right. But these losses come just a week after the government announced that it is abandoning plans to sell Williams & Glynn – an RBS subsidiary which has over 300 branches and £22bn of customer deposits.

After a series of expensive delays and a lack of buyer interest, the government now plans to retain Williams & Glynn within the RBS group and instead attempt to boost competition in the business lending market by granting smaller "challenger banks" access to RBS’s branch infrastructure. It also plans to provide funding to encourage small businesses to switch their accounts away from RBS.

As a major public asset, RBS should be used to help achieve wider objectives. Improving how the banking sector serves small businesses should be the top priority, and it is good to see the government start to move in this direction. But to make the most of RBS, they should be going much further.

The public stake in RBS gives us a unique opportunity to create new banking institutions that will genuinely put the interests of the UK’s small businesses first. The New Economics Foundation has proposed turning RBS into a network of local banks with a public interest mandate to serve their local area, lend to small businesses and provide universal access to banking services. If the government is serious about rebalancing the economy and meeting the needs of those who feel left behind, this is the path they should take with RBS.

Small and medium sized enterprises are the lifeblood of the UK economy, and they depend on banking services to fund investment and provide a safe place to store money. For centuries a healthy relationship between businesses and banks has been a cornerstone of UK prosperity.

However, in recent decades this relationship has broken down. Small businesses have repeatedly fallen victim to exploitative practice by the big banks, including the the mis-selling of loans and instances of deliberate asset stripping. Affected business owners have not only lost their livelihoods due to the stress of their treatment at the hands of these banks, but have also experienced family break-ups and deteriorating physical and mental health. Others have been made homeless or bankrupt.

Meanwhile, many businesses struggle to get access to the finance they need to grow and expand. Small firms have always had trouble accessing finance, but in recent decades this problem has intensified as the UK banking sector has come to be dominated by a handful of large, universal, shareholder-owned banks.

Without a focus on specific geographical areas or social objectives, these banks choose to lend to the most profitable activities, and lending to local businesses tends to be less profitable than other activities such as mortgage lending and lending to other financial institutions.

The result is that since the mid-1980s the share of lending going to non-financial businesses has been falling rapidly. Today, lending to small and medium sized businesses accounts for just 4 per cent of bank lending.

Of the relatively small amount of business lending that does occur in the UK, most is heavily concentrated in London and surrounding areas. The UK’s homogenous and highly concentrated banking sector is therefore hampering economic development, starving communities of investment and making regional imbalances worse.

The government’s plans to encourage business customers to switch away from RBS to another bank will not do much to solve this problem. With the market dominated by a small number of large shareholder-owned banks who all behave in similar ways (and who have been hit by repeated scandals), businesses do not have any real choice.

If the government were to go further and turn RBS into a network of local banks, it would be a vital first step in regenerating disenfranchised communities, rebalancing the UK’s economy and staving off any economic downturn that may be on the horizon. Evidence shows that geographically limited stakeholder banks direct a much greater proportion of their capital towards lending in the real economy. By only investing in their local area, these banks help create and retain wealth regionally rather than making existing geographic imbalances worce.

Big, deep challenges require big, deep solutions. It’s time for the government to make banking work for small businesses once again.

Laurie Macfarlane is an economist at the New Economics Foundation