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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What happens when a president refuses to step down?

An approaching constitutional crisis has triggered deep political unrest in the Congo.

Franck Diongo reached his party’s headquarters shortly after 10am and stepped out of a Range Rover. Staff and hangers-on rose from plastic chairs to greet the president of the Mouvement Lumumbiste Progressiste (MLP), named after the first elected leader of the Democratic Republic of Congo.

Diongo, a compact and powerfully built man, was so tightly wound that his teeth ground as he talked. When agitated, he slammed his palms on the table and his speech became shrill. “We live under a dictatorial regime, so it used the security forces to kill us with live rounds to prevent our demonstration,” he said.

The MLP is part of a coalition of opposition parties known as the Rassemblement. Its aim is to ensure that the Congolese president, Joseph Kabila, who has been president since 2001, leaves office on 19 December, at the end of his second and supposedly final term.

Yet the elections that were meant to take place late last month have not been organised. The government has blamed logistical and financial difficulties, but Kabila’s opponents claim that the president has hamstrung the electoral commission in the hope that he can use his extended mandate to change the rules. “Mr Kabila doesn’t want to quit power,” said Diongo, expressing a widespread belief here.

On 19 September, the Rassemblement planned a march in Kinshasa, the capital, to protest the failure to deliver elections and to remind the president that his departure from office was imminent. But the demonstration never took place. At sunrise, clashes broke out between police and protesters in opposition strongholds. The military was deployed. By the time peace was restored 36 hours later, dozens had died. Kabila’s interior minister, claiming that the government had faced down an insurrection, acknowledged the deaths of 32 people but said that they were killed by criminals during looting.

Subsequent inquiries by the United Nations and Human Rights Watch (HRW) told a different story. They recorded more fatalities – at least 53 and 56, respectively – and said that the state had been responsible for most of the deaths. They claimed that the Congolese authorities had obstructed the investigators, and the true number of casualties was likely higher. According to HRW, security forces had seized and removed bodies “in an apparent effort to hide the evidence”.

The UN found that the lethal response was directed from a “central command centre. . . jointly managed” by officials from the police, army, presidential bodyguard and intelligence agency that “authorised the use of force, including firearms”.

The reports validated claims made by the Rassemblement that it was soldiers who had set fire to several opposition parties’ headquarters on 20 September. Six men were killed when the compound of the UDPS party was attacked.

On 1 November, their funerals took place where they fell. White coffins, each draped in a UDPS flag, were shielded from the midday sun by a gazebo, while mourners found shade inside the charred building. Pierrot Tshibangu lost his younger sibling, Evariste, in the attack. “When we arrived, we found my brother’s body covered in stab marks and bullet wounds,” he recalled.

Once the government had suppressed the demonstration, the attorney general compiled a list of influential figures in the Rassemblement – including Diongo – and forbade them from leaving the capital. Kinshasa’s governor then outlawed all political protest.

It was easy to understand why Diongo felt embattled, even paranoid. Midway through our conversation, his staff apprehended a man loitering in the courtyard. Several minutes of mayhem ensued before he was restrained and confined under suspicion of spying for the government.

Kabila is seldom seen in public and almost never addresses the nation. His long-term intentions are unclear, but the president’s chief diplomatic adviser maintains that his boss has no designs on altering the constitution or securing a third term. He insists that Kabila will happily step down once the country is ready for the polls.

Most refuse to believe such assurances. On 18 October, Kabila’s ruling alliance struck a deal with a different, smaller opposition faction. It allows Kabila to stay in office until the next election, which has been postponed until April 2018. A rickety government of national unity is being put in place but discord is already rife.

Jean-Lucien Bussa of the CDER party helped to negotiate the deal and is now a front-runner for a ministerial portfolio. At a corner table in the national assembly’s restaurant, he told me that the Rassemblement was guilty of “a lack of realism”, and that its fears were misplaced because Kabila won’t be able to prolong his presidency any further.

“On 29 April 2018, the Congolese will go to the ballot box to vote for their next president,” he said. “There is no other alternative for democrats than to find a negotiated solution, and this accord has given us one.”

Diongo was scathing of the pact (he called it “a farce intended to deceive”) and he excommunicated its adherents from his faction. “They are Mr Kabila’s collaborators, who came to divide the opposition,” he told me. “What kind of oppositionist can give Mr Kabila the power to violate the constitution beyond 19 December?”

Diongo is convinced that the president has no intention of walking away from power in April 2018. “Kabila will never organise elections if he cannot change the constitution,” he warned.

Diongo’s anger peaked at the suggestion that it will be an uphill struggle to dislodge a head of state who has control of the security forces. “What you need to consider,” he said, “is that no army can defy a people determined to take control of their destiny . . . The Congolese people will have the last word!”

A recent poll suggested that the president would win less than 8 per cent of the vote if an election were held this year. One can only assume that Kabila is hoping that the population will have no say at all.

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage