We will see more shocking cruelty to mental health patients under Liz Truss’ cuts

With a government seeking efficiency savings from a health service already skinned to the bone, the likely prospect is more, not less, places like Edenfield

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When I was six years old in 1956, I spent three months in a ward in a hospital in Cork in Ireland, where children were routinely mistreated by the nursing staff. I was so miserable that I stopped eating and my father noticed that I “who had been so gay, so alert, so inquisitive and talkative seemed to be sinking, into a voiceless apathy”.

The nurses, ill-trained and uncaring, would shout at and threaten to punish the children, all of whom were suffering from varying degrees of paralysis after contracting polio in an epidemic. The staff seemed to regard us as irritating problems to be handled with as little as possible inconvenience to themselves.

I ceased to speak in a gradual withdrawal from a world that I found too frightening to cope with and, seeing my decline, my parents feared that I was dying. Against the advice of the doctors, who thought that polio must have affected my throat muscles, they took me home where I rapidly recovered. I spoke many years later to another former child from the ward who told me that she had likewise lived in terror of the nursing staff, so much so that, even after she had left the hospital, she would hide under the table if there was a knock on the door as she feared that it was the nurses come to take her back.

Bullied, humiliated, abused

I was reminded of these grim experiences when watching the BBC Panorama undercover investigation of Edenfield Centre, a medium-secure mental-health hospital near Manchester. The programme Undercover Hospital: Patients at Risk shows the staff bullying, manhandling, humiliating and verbally abusing their patients. The nurses and their assistants behave like a street gang, defining themselves by their joint hostility to those they are meant to be looking after.

At times, they seemed to revel in their power over wholly vulnerable people. Their behaviour showed “corruption, perversion, aggression, hostility, lack of boundaries,” according to Dr Cleo Van Velsen, a consultant psychiatrist appearing in the documentary.

Staff misbehaviour was filmed by an investigator who, having signed on as a health care assistant, saw patients being put in an isolation cell for weeks at a time without knowing when they would be released. Physical force is routinely used to get patients to take their medication.

I have visited many mental hospitals over the years and I was surprised by the absence of doctors and senior staff at Edenfield. At one point, a nurse says that they are a well-paid but distant presence, and, if correct, this would explain much that has gone wrong at the hospital. In my experience, the crucial factor determining whether a mental hospital is good or bad is its leadership which, in this case, it is nowhere to be seen.

Good decision-making crucial

This may sound like a truism because what institution or company does not benefit from being well run by those at the top? But the treatment of mental illness is so complex, particularly when patients are criminal offenders, that good quality decision-making on a day-to-day basis is more crucial than in almost any other organisation.

I asked Dr Ben Cave (a pseudonym), a forensic psychiatrist with 30 years’ experience, what he thought about the situation at Edenfield as portrayed in the documentary. He said he was “horrified” by some of what he saw, but he had never witnessed anything like this in a hospital during his entire career. He had hoped that such scenes had disappeared with the end of the old mental asylum system.

I asked Dr Cave about Edenfield and the general state of the mental health service as he is the author of an important book, What We Fear Most: Reflections on a Life in Forensic Psychiatry, which has just been published. This is a fascinating read about the treatment of mental illness, something which most people find frightening. A majority of the population know little or nothing about it, but a large minority are all too familiar with its destructive power because they have been affected by it personally or through their families and friends.

Both the ignorant and the well-informed will benefit from this book because it illuminates the real world of mental health hospitals and the mentally ill. Cave has worked primarily in prisons and secure hospitals, treating some of the most troubled people in Britain. But beyond that he is perceptive about everything from schizophrenia to drug dependency. Full though his account is of lives lost or damaged beyond repair, the tone is upbeat and proactive rather than gloomy.

Serious failings

Some of the failings filmed at Edenfield are glaring enough, such as the absence of senior staff and of even minimal training for health care assistants. Dr Cave asks why anybody should take the latter stressful and hardworking jobs for which they are paid the minimum wage.

A similar if less spectacular shortage of trained staff was the main reason why I along with other children were mistreated in Cork half way through the last century. Irish nurses were badly paid and the best of them migrated to Britain. The excuse of the Irish government was that Ireland was poor and they had to concentrate their limited resources to save lives in the fever hospitals. But Britain is still one of the richer countries in the world, despite current tribulations, so the failure to provide enough trained staff is far more culpable.

Another deeply damaging failure in treating mental health is the absence of after care, often referred to by the more touchy-feely phrase “care in the community”. This long ago became a sick joke as governments will not pay for the agencies meant to look after patients once they have left hospital. Left largely to fend for themselves, they are soon readmitted to hospital, if a bed can be found for them.

More places like Edenfield

When a system is stretched so thin, then inevitably at some point its worst failings will all fail together and you have a breakdown, as occurred at Edenfield. The only surprise is that it does not happen more often. The explanation is the work of doctors like Ben Cave who paper over the cracks in the system.

Up to now there have been enough good people left in the service to keep it operating, but the cracks in it are getting wider. For an individual suffering from mental illness, the chances of a personal disaster – such as incorrect medication or the lack of any emergency response in the event of a breakdown – is growing greater.

With a government seeking efficiency savings from a health service already skinned to the bone by austerity over the last dozen years, the likely prospect is more, not less, places like Edenfield.

Further thoughts

“All you need in this life is ignorance and confidence; then your success is sure,” said Mark Twain, but he might have added that success will come in getting a job and not in being able to do it. Seldom has the truth of Twain’s saying been demonstrated as swiftly as it has with Liz Truss in her first fraught weeks as Prime Minister. Truly the day of amateur is with us, when confidence is fuelled by ignorance and in this case has brought immediate disaster.

Truss and Kwasi Kwarteng are running second only to President Vladimir Putin for the first prize for making the biggest unforced error of 2022. There is something eery in their blind faith in vague free market nostrums as they hurtle towards the cliff edge. Of course, their confidence is probably not what it seems, but it is too late to put their policies into reverse without accepting blame for the crisis over the last week.

Another similarity between Truss and Putin is that both try to underplay the seriousness of what they were doing, with Putin calling his war “a special military operation”, and Truss claiming her budget was “a fiscal event”. Faced with total failure both leaders pretend absurdly that all is going according to plan.

One can push these analogies too far: Putin appears to me to have ruined Russia, while Truss has merely damaged Britain, and that damage is not irretrievable. Perhaps more destructive is a sense that Britain is becoming more and more unstable with four prime ministers since 2016. Not only have prime ministers and ministers followed each other with a speed usually associated with Italian politics, but the quality of those supposedly in charge gets lower and lower. It is astonishing how quickly the blunders of Truss are displacing the memory of Boris Johnson’s corrupt and shambolic regime.

Beneath the radar

Some pieces of news are too small to be observed by radar and other news items escape notice by flying beneath it. But some big news escapes notice simply because it is so big and people are too absorbed in the details of events to see the larger picture. What is being missed is the way in which the balance of power in the world is being changed by the Ukraine war.

Russia is likely to be the great loser, as many now take for granted. It failed after the invasion of 24 February to occupy Ukraine and has gone on failing ever since. A state that was supposed to be strong enough to confront Nato turns out to be incapable of holding territory at Kharkiv, a few miles from the Russian frontier.

But the European Union is also a loser. Its members can no longer draw on cheap Russian gas, putting it at a disadvantage when it comes to competing with the US and China. Energy hungry industries like aluminum, steel, fertilisers and glass in the EU will all be hit. The EU’s GDP growth rate was already well behind that of the US since the financial crash in 2008/9 and even further behind China and the East Asian states.

This article in Foreign Policy by Jeff D Colgan of Brown University argues that since President Vladimir Putin invaded Ukraine on 24 February – and we entered a period of military and economic warfare in Europe – the door has opened for a return to a bipolar world. This once pitted the US against the USSR, then from 1991 the US dominated alone until the financial crash of 2008/9, when other powers, notably Russia had greater sway in the world.

But since the start of the Ukraine war, we are once more in a bipolar world in which the US competes with China, with Europe dropping in the rankings and Russia a husk if what it once was. It seems to me to be a bit oversimple, but worth thinking about, particularly the point about the competitive decline of the EU.

Cockburn’s Picks

The Faridaily sub-stack is one of the few Russian news outlets that appears to have access to the Russian elite and reports in a nuanced and objective way on what they are thinking and doing. Here are some excerpts from an article on Thursday:

“Although many of our sources foresaw mobiliswation, most complained of Putin’s rashness and reluctance to explain his plans. ‘No one explains anything to anyone,’ said one disgruntled source close to the government. […]

‘”There is a total lack of coordination; it’s a mess. Putin tells everyone different things,’ said a source close to the government. He said this applies not only to the economy but also how the war is run. ‘What were we doing in Kharkiv? No one has a clue – neither politicians nor the military.’

“‘Putin always chooses escalation. And he will continue to choose escalation at any unpleasant juncture, up to and including nuclear weapons,” predicted another source close to the Kremlin.

“Despite awareness of the impending catastrophe, nobody in Russia’s elite has tried to persuade Putin to stop the war for a long time. Whereas in the early months, figures like Alexei Kudrin, head of the Audit Chamber, tried to explain to Putin the consequences of his decisions, this is not happening today. According to our sources, Putin still repeats the mantra about Russia being surrounded by enemies and the machinations of NATO.”

This is Dispatches with Patrick Cockburn, a subscriber-only newsletter from i. If you’d like to get this direct to your inbox, every single week, you can sign up here.

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