Stigma in crisis: mental health, fear-mongering and murder

Opposition to having a charity-run mental health crisis centre in your street is both very telling and depressingly predictable.

Reading the objections to the Planning Permission application, you would think that they were proposing a hostel for unrepentant murderers, not a charity-run mental health centre. Rethink recently submitted an application to turn a house in Sheffield suburb into a “safe haven” crisis house for people experiencing mental health problems, and the opposition they have faced is both very telling and depressingly predictable.

The plan is to provide a place where a maximum of six people can stay for no longer than a week when their mental health is deteriorating towards a crisis point. The converted semi would offer a safe environment where they could receive intensive emotional support, and would also house a 24-hour helpline.

Along with complaints about increased traffic on the street, many local residents oppose the crisis house on the basis that children live on the street and walk to school, and the theme of “danger, danger” is seen throughout. One person complains that people who are unwell “will be frightning (sic) to local residents and may cause risk to children and other people in the area”, while another says that, “I would be reluctant to allow [my young teenager] to return from school unaccompanied if I thought there was a risk of her having to deal with difficult situations arising from this”.

Another uses carefully chosen (dare I say cherry picked?) statistics to prove just how likely residents will be to be murdered if this goes ahead (clue: there will barely be a survivor in the entire city), and the overall message is that those experiencing mental distress are to be feared, avoided, and ostracised. In short, they are most definitely “other”.

Many of those who object to the building's change of use do agree in principle that such facilities are worthwhile and important, they just do not think this one should be on their own street.

Some of the objections are also bewildering in their naïveté. When one woman explains that, “This is a quiet leafy suburb and I am not overreacting when I feel concern about the fact that we cannot be sure of who is coming and going”, I do wonder if she realises that this is the case, crisis house or not. The thing is, with the numbers of people experiencing mental health problems in the general population being so high this community, like all others, already has people experiencing mental distress in its midst anyway. They may not broadcast their difficulties but perhaps this is not surprising: the strength of feeling from those who commented on the planning application is pretty representative of the attitudes towards mental ill-health in our entire society.

So, let's start with the facts. 95 per cent of murders are committed by people who do not have a diagnosed mental health issue. Given that 25 per cent of the population can experience mental health problems, sane people appear to be statistically far more dangerous to be around. And people experiencing psychosis – those that the public seem to be the most afraid of – are 14 times more likely to be the victim of violent crime than they are to commit it.

Rethink are clear that nobody would stay in the house if they were thought to be a risk. They would be in hospital.

When somebody is in crisis they can either stay at home (where they are somebody's neighbour), go into hospital, or go into a crisis house for a few days. Kate Wareham, Rethink's regional Associate Director explained to me: “the intention is that we prevent people's illness escalating to the point where they require a hospital admission. We provide a safe, secure environment for people when they are experiencing a mental health crisis”. It will be used by people who accept that they need a bit of extra support for a while, and if Nether Edge residents (who are replicated the entire country over whenever mental health facilities are proposed) think that stopping the crisis house before it starts means they will have nobody experiencing mental distress living near them, they are seriously misguided. As Kate pointed out, “These people already live in Sheffield! These are people in the community”.

Planning permission has been granted to the facility, and Rethink really want to work with the local community, aware that many service users will not want to go to a crisis house where local people fear them. When someone needs a safe haven, they do not want to come up against this stigma and opposition to the care they need.

Stigma like this does have wide-ranging effects, all of them damaging. It means that the first response, when a horrific massacre takes place in the US, is instant speculation on the killer's mental health status; it means that people with mental health problems can't get a job when they want to work; it means that people feel isolated and excluded; it means people get physically and verbally abused; it means not getting physical health problems taken seriously; and it means that some people don't seek treatment that they desperately need because they are so afraid of what people will think.

Prejudice and bigotry are never pretty, and I'm more worried about children being taught to fear those who are distressed than I am about the statistically tiny threat from somebody who is undergoing treatment and receiving help. If they grow up believing that their own, or other people's, mental health problems will mean they will commit violent disorder and exhibit frightening behaviour, the stigma will continue to grow. Instead, we need to understand that many people experience mental distress, and that some of them will need more help than others. Putting barriers in the way of those people will only exacerbate their problems and their isolation. Society must move to a position of compassion and humanity towards this significant percentage of the population who currently experience it as anything but compassionate and humane.

How would you feel about having a mental health centre on your street? Photograph: Getty Images
Photo: Getty Images
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I'm far from convinced by Cameron's plans for Syria

The Prime Minister has a plan for when the bombs drop. But what about after?

In the House of Commons today, the Prime Minister set out a powerful case for Britain to join air strikes against Isil in Syria.  Isil, he argued, poses a direct threat to Britain and its people, and Britain should not be in the business of “outsourcing our security to our allies”. And while he conceded that further airstrikes alone would not be sufficient to beat Isil, he made the case for an “Isil first” strategy – attacking Isil now, while continuing to do what we can diplomatically to help secure a lasting settlement for Syria in which Assad (eventually) plays no part.

I agreed with much of David Cameron’s analysis. And no-one should doubt either the murderous barbarism of Isil in the region, or the barbarism they foment and inspire in others across the world.  But at the end of his lengthy Q&A session with MPs, I remained unconvinced that UK involvement in airstrikes in Syria was the right option. Because the case for action has to be a case for action that has a chance of succeeding.  And David Cameron’s case contained neither a plan for winning the war, nor a plan for winning the peace.

The Prime Minister, along with military experts and analysts across the world, concedes that air strikes alone will not defeat Isil, and that (as in Iraq) ground forces are essential if we want to rid Syria of Isil. But what is the plan to assemble these ground forces so necessary for a successful mission?  David Cameron’s answer today was more a hope than a plan. He referred to “70,000 Syrian opposition fighters - principally the Free Syrian Army (FSA) – with whom we can co-ordinate attacks on Isil”.

But it is an illusion to think that these fighters can provide the ground forces needed to complement aerial bombardment of Isil.  Many commentators have begun to doubt whether the FSA continues to exist as a coherent operational entity over the past few months. Coralling the myriad rebel groups into a disciplined force capable of fighting and occupying Isil territory is a heroic ambition, not a plan. And previous efforts to mobilize the rebels against Isil have been utter failures. Last month the Americans abandoned a $500m programme to train and turn 5,400 rebel fighters into a disciplined force to fight Isil. They succeeded in training just 60 fighters. And there have been incidents of American-trained fighters giving some of their US-provided equipment to the Nusra Front, an affiliate of Al Qaeda.

Why has it proven so hard to co-opt rebel forces in the fight against Isil? Because most of the various rebel groups are fighting a war against Assad, not against Isil.  Syria’s civil war is gruesome and complex, but it is fundamentally a Civil War between Assad’s forces and a variety of opponents of Assad’s regime. It would be a mistake for Britain to base a case for military action against Isil on the hope that thousands of disparate rebel forces can be persuaded to change their enemy – especially when the evidence so far is that they won’t.

This is a plan for military action that, at present, looks highly unlikely to succeed.  But what of the plan for peace? David Cameron today argued for the separation of the immediate task at hand - to strike against Isil in Syria – from the longer-term ambition of achieving a settlement in Syria and removing Assad.  But for Isil to be beaten, the two cannot be separated. Because it is only by making progress in developing a credible and internationally-backed plan for a post-Assad Syria that we will persuade Syrian Sunnis that fighting Isil will not end up helping Assad win the Civil War.  If we want not only to rely on rebel Sunnis to provide ground troops against Isil, but also provide stable governance in Isil-occupied areas when the bombing stops, progress on a settlement to Syria’s Civil War is more not less urgent.  Without it, the reluctance of Syrian Sunnis to think that our fight is their fight will undermine the chances of military efforts to beat Isil and bring basic order to the regions they control. 

This points us towards doubling down on the progress that has already been made in Vienna: working with the USA, France, Syria’s neighbours and the Gulf states, as well as Russia and Iran. We need not just a combined approach to ending the conflict, but the prospect of a post-war Syria that offers a place for those whose cooperation we seek to defeat Isil. No doubt this will strike some as insufficient in the face of the horrors perpetrated by Isil. But I fear that if we want not just to take action against Isil but to defeat them and prevent their return, it offers a better chance of succeeding than David Cameron’s proposal today. 

Stewart Wood is a former Shadow Cabinet minister and adviser to Ed Miliband. He tweets as @StewartWood.