Care we can trust

Mental health campaigner Jane Harris says it's time to put flexibility and trust back into the syste

35% bed occupancy, people sleeping on mattresses, dilapidated wards…one could be forgiven for thinking, on the basis of the Mental Health Act Commission’s recent report Risk, rights and recovery, that we needed a massive injection of cash into inpatient units.

But when we asked Rethink members what they wanted from an ideal mental health system, more inpatient care was not the answer.

Current inpatient services don’t achieve much for the people using them, as one service user told us: "When the crisis hits, you’re grateful for the first few days of inpatient care, and then you spend the rest of the time trying to get out of the wards because you see, they achieve nothing."

Instead of more beds, people want access on a wider scale. Why should people have to wait to be in crisis to get help? 1 in 3 people who ask for help from mental health services are turned away. People are often told not to come back until they’re "sick enough" to pass stringent criteria for access to support. This doesn’t help anyone: not the people turned away, their families, staff or even the Treasury. In mental health, a stitch in time saves nine – and millions of pounds as the earlier treatment occurs, the easier and cheaper it is.

We need a range of services for people at different stages, starting before people even become ill. We’re getting better at investing in prevention for physical conditions, but we need to look at the risk factors for severe mental illness and start minimising them as well. There are well known links between the development of severe mental illness and factors like social isolation, difficulties during birth, teenage cannabis use and poverty, to name but a few. We can’t legislate to prevent these, but we can make sure information and preventative services exist in every community for everyone – because everyone needs to protect their mental health.

When someone asks for help, they need an immediate response, not gatekeepers like GPs, restrictive criteria or crisis services that are only funded to operate 9-5. We wouldn’t accept a ‘working hours only’ ambulance service and nor should we accept a 9-5 crisis resolution team.

In 2005, the IPPR posited a new kind of ‘community health centre’. These centres could signpost people on to specialist services and bring together groups to discuss coping mechanisms. It might be learning what triggers a crisis for someone and learning to stay away from that behaviour. Or simple advice like taking out a mobile phone to talk into if you hear voices while in public. Both physical and mental health could be covered by such centres, ending the current Cartesian split in the NHS. This isn’t a million miles away from Lord Darzi’s much-vaunted ‘polyclinics’ – let’s hope he includes mental health within their scope.

Making sure that people are supported in the long-term will free up resources for better crisis care when it is needed. Instead of large hospital wards, we need more crisis houses, like the one Rethink runs in Rotherham, which has been commended by DH’s Director of Mental Health. This is a genuinely therapeutic environment, which should be the most basic requirement for any crisis service. As one service user told us, “what you need is a secure hotel basically…country house hotel, that’s what we need”. Outside space should be standard at all residential services.

We need to put trust back in the heart of the mental health system. People with severe mental illness and carers should be trusted to ask for help when needed and not abuse the system. People should be trusted to design services and work out what outcomes services should achieve rather than have this decided by professionals.

And on the most basic level, the NHS should trust people with severe mental illness to work as professionals, whether in paid or voluntary roles. One Rethink member, who is studying at a London University, has applied 5 times to different NHS Trusts to work as a volunteer and been turned away every single time because he is considered a ‘risk’.

We need to direct resources into services designed, monitored and cherished by people who use them. In some local areas, this is happening on a very small scale. But only when this is the national norm will we have a mental health system we can be proud of.

Jane Harris is head of campaigns at the mental health charity, Rethink

MATTHIAS SEIFARTH FOR NEW STATESMAN
Show Hide image

Moby: “The average American IQ is around 98”

Moby, the vegan king of chill-out pop, talks wealth, David Bowie’s hat and the average intelligence of his fellow Americans.

In January 2012, two women walking their nine dogs on the hill beneath the Hollywood sign found a man’s severed head wrapped in a plastic bag. His decomposing feet and hands were discovered nearby. First theories pointed to the work of a Mexican drug cartel, or the murderous Canadian porn actor Luka Magnotta. The story piqued the interest of the electronic dance music mogul Moby, who wrote about it in a New Statesman diary in May this year.

Today, the smell of cedar and pine hits you on the canyon path, which is hot, steep and sandy – an immediate wilderness in one of LA’s most exclusive areas. The Griffith Observatory shines like a strange white temple on the hill. Brad Pitt, a local resident, was doorstepped after the head was discovered: he lives near Moby on the streets of Los Feliz, near Griffith Park, where the only sounds are hedge strimmers and workmen’s radios. Moby’s 1920s mansion is all but obscured by Virginia creeper.

As we sit down at his kitchen table, Moby tells me that the body parts were found to belong to a 66-year-old Canadian flight attendant called Hervey Medellin. Shortly before Medellin’s disappearance, his boyfriend, Gabriel Campos-Martinez, had used a computer in the flat they shared to find an article titled, “Butchering of the human carcass for human consumption”. The head, feet and hands showed signs of having been frozen: the rest of the body was never found. He says it was one of those rare times in life where reality was more intriguing than the conspiracy theories.

Moby, of course, eats no meat. Fifteen minutes’ drive away in the hipster neighbourhood of Silver Lake, his vegan bistro, Little Pine, serves a variety of plant-based dishes, proceeds from which go to animal rights organisations including the Humane Society and Peta. His own music is never played there. We are meeting to talk about his new album – but, he says: “It’s 2016 and people neither buy nor listen to albums. And they certainly don’t listen to the 16th album made by a 51-year-old musician. I don’t care if anyone gives me money for this music or for live shows ever again. Once a record’s released, I couldn’t care less what happens with it. I liked making it, but I don’t care.”

He is currently working his way though the stages of grief outlined by the psychiatrist Elisabeth Kübler-Ross. To denial, anger, bargaining, depression and acceptance he has added a new phase: Schadenfreude. On the night of the US election, he left the house at 6pm west coast time to watch the coverage with some friends. He checked his usual round of sites on his phone: CNN, the New York Times, the Washington Post, Nate Silver’s FiveThirtyEight, the Guardian, the Huffington Post, the BBC, politico.com. He was concerned to see that no one was calling any of the early states; with Obama’s election, exit polls suggested the victory by noon. Days earlier, Moby had been predicting humanity’s “wake-up call” in the form of the destruction of Greenland or a zoonotic virus – but not this. He is softly spoken, with a quick laugh and the kind of intelligence that seems to warm him up from the inside when he talks, but today he is angry.

“It is disturbing on so many levels,” he says. “One, that we have elected an inept racist as president. Two, just seeing how dumb and delusional so many Americans are. Because really – in terms of the subsets of people who would vote for Trump – you have to be delusional, or racist, or stupid. I am so confused as to the fact that such a high percentage of Americans are either really stupid or incredibly bigoted.”

The stupidity of Americans is, he says, a matter of “anthropological curiosity” – or simply demographics. “The average American IQ is around 98,” he notes. “So that honestly means – in a vaguely non-pejorative way – that there are a lot of really, really dumb people. The nonsense that people were spouting before the election – that Trump was a good businessman, for example? This phenomenon has been particularly egregious of late: people have an almost adversarial relationship with evidence. Climate-change deniers are another example.”

As a self-described old-timey alcoholic, Richard Melville Hall (nicknamed Moby by his father in honour of his great-great-great-uncle Herman) has a pervasive interest in neurochemistry. He uses it to explain much of the past six months in Western politics. Our failing political systems – the subject, in fact, of the album he doesn’t want to talk about – are underpinned by “a kind of delusional motivation, which is basically to ignore the countless things that are actually going wrong in the world and focus all your attention on things that are arbitrary. In the United States, you have people who have perfectly good jobs in safe communities who are obsessed about Mexico, crime and unemployment. We have these quasi-Orwellian responses to stimuli, and they come from a place of fear and scarcity. Humans are still built to amass as much wealth as possible, and fight off the enemies as quickly as possible, but the only threats are the ones we generate ourselves.”

There’s a dishcloth on the table, a few magazines, a bit of a draught and Moby in a black hoodie pouring two glasses of water.

Fear and scarcity pervade American society, he says, because social policy is an extension of corporate process and “nothing is free from the cadres of professional lobbyists”. Meanwhile the ravenous news consumption that helped drive Trump reflects a human addiction to the “neurochemical jolt” of engaging with the media.

“People have a profound and almost feral attachment to that which makes them feel good in the moment,” he says. “Without thinking of long-term consequences, does their belief give them a shot of dopamine right at this second? If so, they hold on to it. Eating junk food, voting Brexit and voting for Trump.”

 

***

 

Moby is the model of an addictive personality well-practised at controlling itself. He was a fully fledged alcoholic by his early twenties: at ten, he’d been given champagne and made himself the promise, “I always want to feel this good.” Now, he cannot touch a drink, but his modern-day addiction, he says without a beat, is his phone. Every thought is pursued to extremes. He recently released an animated video for a new song, “Are You Lost In the World Like Me?”, showing a procession of grotesque, phone-addicted cartoon characters filming a girl as she throws herself off a skyscraper and hits the ground.

The house is vaguely baronial, airy and open-plan: all dark wood and furniture polish. An Annie Hall poster in the pool house; a coyote postcard on the kitchen wall.

This particular property is a result of serious downsizing: Moby has a habit of buying very big places, doing them up and then moving out. When he was still in New York, he bought a remote mountaintop retreat in Kent Cliffs, 50 miles north of Manhattan. He created a magnificent bedroom of 1,500 square feet with ten skylights – but quickly learned he could only get a decent night’s sleep when he pulled his mattress into the cupboard. He told the New York Times that, living all alone in the big house, he “felt like Orson Welles at the end of Citizen Kane”.

He moved to LA in 2010, swapped vodka for quinoa smoothies and took the keys for another large building – the Wolf’s Lair, the turreted, 1920s Gothic castle in Hollywood once inhabited by Marlon Brando, with the swimming pool historically used for porn movies and the hidden tiki bar. He bought it for $4m and sold it for $12.5m four years later – allegedly to Banksy. He rattled around in that house, too. Right on cue, he tells me: “I felt like Orson Welles at the end of Citizen Kane.”

On the one hand, these were sensible ­investments for the man who’s sold 20 million records; on the other, large impersonal spaces appealed to Moby long before he was in a position to buy them. Raised by his single mother on food stamps and welfare in Darien, Connecticut, he started his adult life squatting an abandoned lock factory, where he could ride his moped around his bedroom, piss into a bottle and read battered Star Trek paperbacks while working on early demo tapes, rather like a ragged, vegan version of the boy in the movie Big.

He was very happy in his penniless state, as he records in his memoir, Porcelain. He’d like to propose something he calls the End of Wealth – but we’ll come back to that.

In the past few years Moby has broken free from the “Beckettian purgatory of touring”. When his biggest-selling album, Play, was released in 1999, his music career was effectively “over”. Before Play, he had changed creative direction, going from progressive house to ambient to thrashy punk – to which he has just returned – and no one knew what to do with him. The only reason he hadn’t been dropped by his UK label, Mute Records, was that its owner, Daniel Miller, was “an old egalitarian socialist”.

Play sampled slave songs of the Deep South – recorded by the ethnomusicologist Alan Lomax in the 1940s – and wove them into a backdrop of cerebral chill-out. The songs of pain and emotion took on an eerie neutrality, and TV shows and ad companies came calling. He was approached by Will and Grace and Grey’s Anatomy. At that point, selling records and touring were still more lucrative than licensing a song to TV – and licensing a song to TV was still considered selling out. But Moby considers himself an ugly duckling: “If someone who was once unattractive suddenly gets asked out on loads of dates, of course they say yes a lot.” He licensed every song on Play and it became the soundtrack of the millennium.

His memoir was unusual because it concentrated on the ten-year period before he got famous. It captured his enthusiasm – and his strangeness – at its source and showed him to have a sense of humour that may have passed people by the first time round. “I’m in London! London!” he wrote. “Benny Hill, Joy Division, Peter O’Toole!” He visited the vegan café in Covent Garden.

The book is filled with money: or with the constant, practical concern of not having it. Navigating poverty is an everyday routine: he is an “alchemist” turning used beer bottles into nickels at the recycler, and thence into soya milk and oranges. In his early twenties he becomes a Christian, partly so that he can repeat the Sermon on the Mount at Bible classes in the households of Greenwich Village and “judge” the rich children.

Book two, which Faber & Faber is waiting for, is more difficult. The period of his fame and fortune in the 2000s is too much of a cliché. “Ten years ago I was entitled, narcissistic, bottoming out, alcoholic, selfish and feral. Robbie Williams has done that story, so has Ozzy and Mötley Crüe. Who wants to read that? It’s tautological.”

Instead, he has decided to write about the first ten years of his life. It will look into his relationship with his mother, who loved him but raised him in various drug dens. He was at her side when she died in 1997, but he missed her funeral, having woken late in the morning to discover that at some point in the night he must have got up and set his alarm clock three hours late. He took a taxi to the wake, worrying about the fare, and for reasons he can’t really explain, turned up cracking jokes.

He has a strange nostalgia for the kinds of friendships you have in early adulthood, when everyone is equal, “before that point when someone starts making money and they think they’ve won: they’re going to have access to a different kind of happiness”.

In 2003, when he turned 38, he was famous, wealthy and miserable. “I’ve been able to see and inhabit almost every stratum on the socioeconomic scale, from extreme poverty and obscurity to wealth and fame, and it gives me an insight into it,” he says. “Because a lot of people who experience wealth are born into it, and a lot of people who experience poverty never leave it. I can safely say that for me there has been no causal effect between increased fame and wealth and increased basic happiness and well-being.”

When Moby talks about himself, he applies many apologetic epithets: clichéd, meditating, yoga-loving, mealy-mouthed. In 2007 he developed mobygratis.com, a large online resource offering independent film-makers and film students a licence to use his music for free. If their films are commercially successful, the revenue from licence fees must go to the Humane Society. He says he wants to propose a more rational, evidence-based approach to wealth.

“We are still attached to the idea of the redistribution of wealth,” he says. “As progressive lefties, we’re all brought up to think that is a good idea. In the old days, it meant the difference between eating and not eating. Nowadays the person on $30,000 consumes twice the calories of the millionaire, and has a bigger TV and works fewer hours.

“There is an underlying assumption that if wealth were distributed more evenly then people would be happier, but there is unfortunately very little anthropological or sociological evidence to support that idea, unless there are institutions to support the basic needs of community, like food and shelter. Confusing materialism with happiness is the essence of our culture.”

While west LA is plastic surgery and gold-plated toilets, he says, his own neighbourhood is “David Lynch wearing an old T-shirt and mowing the lawn”. Among the millionaires of Los Feliz, conspicuous consumption is frowned upon. He knows several who live “incredibly austere lives. I was having tea with Jim Carrey the other day. He’s basically just giving everything away. He just realised that owning three planes was stressing him out . . .”

In his New Statesman diary, Moby said that life in LA offered him miles and miles of lavender-scented name-dropping.

“Coldplay played the Rose Bowl recent­ly,” he says. “And the Rose Bowl holds 75,000 people. It’s a struggle for me to sell 2,000. At first, I winced with a little jealousy. But then I thought, ‘If my career was at that Coldplay level, how would that actually affect my daily existence? Would it make my shoes fit better? Would it make the water pressure in my shower better?’ As long as you’ve satisfied the basic hierarchy of needs – enough to eat, clean air to breathe, bears not eating your legs – happiness is all where and how you put your attention.”

***

He goes to his kitchen cupboard and from among the colanders and measuring jugs he extracts a black velvet fedora – size seven, silk-lined, from a London company established in 1879. In green marker around the inside rim are the words “With love from David – Christmas 2005”. Bowie gave it to him over Christmas dinner that year. “It’s the hat that he wore in The Man Who Fell to Earth,” Moby says. “There’s this amazing picture of him wearing it with John Lennon and it’s clearly when he was doing a lot of cocaine.”

Moby lived on Mott Street in Little Italy and Bowie lived on Mulberry Street. “I had a little roof deck, and he had a beautiful roof terrace, and we could wave at each other.” They were neighbours and friends, worked on music together, went on tour together, had barbecues together. He says the title of Bowie’s last album, Black Star, is a reference to the 1960 Elvis Presley song of the same name “about the end of a life” (“And when a man sees his black star,/He knows his time, his time has come”).

“David had been sick for a long time,” he says. “Or ill, as you say in the UK. So, David had been ill for a long time. I was very pleased that . . . after he died, people were asking me, ‘How do you feel?’ and I’m like, ‘Actually, I’m just kind of happy that he lived as long as he did.’ Because I . . . had thought, yeah, I had thought that he was going to die a little before that. So.”

The Radiohead singer Thom Yorke lives just up the street from him in Los Angeles but Moby has never met him “as far as I know”. Apart from Bowie, he claims not to have musician friends.

“Musicians – and I’m sure you’ve encountered this many times – have a sense of self-importance that is off-putting,” he says. “It is very hard to be friends with someone who thinks that just by showing up, they’re doing something special. At the end of the day, you want to say to them, ‘You know what? You wrote a couple of good songs. Let’s put it in perspective.’”

He was born on 11 September 1965, and on his 36th birthday he watched the twin towers burning from his roof deck. He tells me that when the second plane hit and it became clear the first was no accident, he heard “the cumulative effect of ten thousand rooftops covered with people, and the weirdest scream. A scream of horror but also a scream of understanding.”

Fifteen years on, he talks about this year’s politics as a Manichaean thing. “Half the world are motivated by fear and desire to move backwards, and the other half are motivated by optimism and a desire to move forward rationally. It’s religious tolerance versus fundamentalism; it’s racism versus inclusion. I wonder if there’s a way we can make peace with that whole other half of humanity who are holding on to a non-evidence-based approach to the future. But I don’t know what it is.” He has known Hillary Clinton for two decades, was a vocal supporter of hers during the election run and released a pair of anti-Trump tracks for Dave Eggers’s music project 30 Days, 50 Songs.

He says that many celebrity Clinton backers were cautious to come out for her during the primaries “because Bernie supporters wanted to crucify you. Now Trump has united and inspired Democrats more than anything since the Vietnam War.”

The election result, he says, might just be “the equivalent of a crystal meth addict going on one last bender. Maybe this bender will finally convince Americans to stop voting for Republicans. Because they are terrible. There has always been an understanding that if everyone in America voted, there would be no Republican politicians. The reason Republicans win is that most Americans don’t vote.

“Those of us on the left who were brought up to be tolerant of people who had different opinions from us – well that’s great, ­unless the opinions are bigoted and wrong. If someone is a climate-change denier, they are wrong. If someone voted for Brexit, they are wrong. If someone voted for Trump, they are wrong. There is a lot of ambiguity in the world, but not about these things.”

The clock ticks towards 11.15am and Moby, ever punctual, is done.

“These Systems Are Failing” is out now on Little Idiot/Mute

Kate Mossman is the New Statesman's arts editor and pop critic.

This article first appeared in the 08 December 2016 issue of the New Statesman, Brexit to Trump