The state is still failing schizophrenia sufferers

Rethink's Schizophrenia Commission shows how a technocratic system is letting patients down.

Hundreds of thousands of carers will be delighted to hear of the publication today of the report of Rethink’s Schizophrenia Commission. Let me explain why.

The other month my friend was sectioned under the Mental Health Act. In anguish after redundancy and a double bereavement, she had begun to see dead bodies through car windows and threatening connections in all she read from the pavement, to the label on a tin of beans to the front page of the FT. She was terrified because constantly, just out her sight, she could sense the presence of someone who was going to do grave harm to her tiny children. Experiencing difficulties on the schizophrenic range of illnesses her family called the "emergency team". They arrived three days later. In the meantime she was admitted to a "specialist unit" having been taken in by her frantic husband after she’d sought to jump in front of a moving vehicle. Soon he got a phone call at home only to realise that the doctor at the other end of the line was talking about a different patient.  Placed on "constant observation" she was twice - and unmissed by the NHS  - found, mud covered, wandering barefoot near home some miles away.  My friend is just one of hundreds who have experienced poor care.

Rethink's report records that 250,000 of us will experience illnesses in the schizophrenic range. In practice that includes the rape victim whose auditory hallucinations mean her attacker will always be with her. It encompasses the lad who screams to his father in fear "are you really my Dad?" as he tries to make sense of the faces, colours and lights that he sees all about him. Not to mention the large number of kids from poorer backgrounds who seem to be disproportionately impacted by this particular form of severe mental ill health. They are not alone of course. Severe mental ill health affects 700,000 citizens and their families.  And in seeking to address their needs the exhaustion of the technocratic, inflexible welfare state is perhaps nowhere better demonstrated.

In city after city, there is now no out of hours social work if your child needs urgent help. Social services advise that you ring the police instead. And so you may soon find you are among the many parents who have ended up sleeping on a police cell floor alongside a family member with, say,  severe  Obsessive Compulsive Disorder while a drunken brawler crashes around next door.  That, or your employer may take to designing redundancy selection to remove you because you need to leave work early for a good while. Why? Well, the only place they could find for your son was a three hour drive away. And when he is in streams of tears from the unit’s phone you just know that you will have to find the petrol money from somewhere to make the six hour return drive for the one hour of visiting time that the nurses allow.  And even there you may encounter a row of doctors advising you that your child will be discharged weeks before you think it is safe to do so. What they cannot tell you is that their new Clinical Commissioning Group has demanded a "faster average churn rate". No wonder the state reaches for the mass produced response of life shortening, menstruation stopping, bone drying, heart pressure inducing, sight blurring, memory stealing, weight adding, medication with the gentle words "there will be some side effects".

Mental ill-health should be a defining political question of our times. It breaches the ramparts of houses, flats and castles in every class and region. It shatters even the strongest of families who set out to stand by their loved one who has become unwell.  And those who face it are the objects of the last respectable form of vicious discrimination: Watch the faces of A&E staff as they turn to admissions that have attempted suicide. Note that it is only this February that it became legal for someone who had been severely ill, and been long recovered, to become a school governor. Register that for eighteen months until last month a large local radio station ran a jingle "you’d have to be mad to work here but if you do we’ll section you" and thought that it was hysterically funny when I rang to ask "why?" Imagine a jingle that offered to lock up black, gay, Jewish or female listeners for being themselves?

And the hundreds of thousands of carers know exactly what I mean.

Francis Davis is a fellow at ResPublica and this week has contributed to Jon Cruddas MP’s Labour List series on One Nation politics.

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How to think about the EU result if you voted Remain

A belief in democracy means accepting the crowd is wiser than you are as an individual. 

I voted Remain, I feel sick about this result and its implications for what’s to come. But I’m a believer in democracy. This post is about how to reconcile those two things (it’s a bit unstructured because I’m working it out as I go, and I’m not sure I agree with all of it).

Democracy isn’t just fairer than other systems of governance, it’s smarter. It leads to better decisions and better outcomes, on average and over the long run, than countries that are run by autocrats or councils of wise men with jobs for life. It is simply the best way we have yet devised of solving complex problems involving many people. On that topic, if you’re not averse to some rather dense and technical prose, read this post or seek out this book. But the central argument is that democracy is the best way of harnessing ‘cognitive diversity’ — bringing to bear many different perspectives on a problem, each of which are very partial in themselves, but add up to something more than any one wise person.

I don’t think you can truly be a believer in democracy unless you accept that the people, collectively, are smarter than you are. That’s hard. It’s easy to say you believe in the popular will, right up until the popular will does something REALLY STUPID. The hard thing is not just to ‘accept the result’ but to accept that the majority who voted for that result know or understand something better than you. But they do. You are just one person, after all, and try as you might to expand your perspective with reading (and some try harder than others) you can’t see everything. So if a vote goes against you, you need to reflect on the possibility you got it wrong in some way. If I look at the results of past general elections and referendums, for instance, I now see they were all pretty much the right calls, including those where I voted the other way.

One way to think about the vote is that it has forced a slightly more equitable distribution of anxiety and alienation upon the country. After Thursday, I feel more insecure about my future, and that of my family. I also feel like a foreigner in my own country — that there’s this whole massive swathe of people out there who don’t think like me at all and probably don’t like me. I feel like a big decision about my life has been imposed on me by nameless people out there. But of course, this is exactly how many of those very people have been feeling for years, and at a much higher level of intensity. Democracy forces us to try on each other’s clothes. I could have carried on quite happily ignoring the unhappiness of much of the country but I can’t ignore this.

I’m seeing a lot of people on Twitter and in the press bemoaning how ill-informed people were, talking about a ‘post-factual democracy’. Well, maybe, though I think that requires further investigation - democracy has always been a dirty dishonest business. But surely the great thing about Thursday that so many people voted — including many, many people who might have felt disenfranchised from a system that hasn’t been serving them well. I’m not sure you’re truly a democrat if you don’t take at least a tiny bit of delight in seeing people so far from the centres of power tipping the polity upside down and giving it a shake. Would it have been better or worse for the country if Remain had won because only informed middle-class people voted? It might have felt better for people like me, it might actually have been better, economically, for everyone. But it would have indicated a deeper rot in our democracy than do the problems with our national information environment (which I accept are real).

I’m not quite saying ‘the people are always right’ — at least, I don’t think it was wrong to vote to stay in the EU. I still believe we should have Remained and I’m worried about what we’ve got ourselves into by getting out. But I am saying they may have been right to use this opportunity — the only one they were given — to send an unignorable signal to the powers-that-be that things aren’t working. You might say general elections are the place for that, but our particular system isn’t suited to change things on which there is a broad consensus between the two main parties.

Ian Leslie is a writer, author of CURIOUS: The Desire to Know and Why Your Future Depends On It, and writer/presenter of BBC R4's Before They Were Famous.