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
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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear