Beyond The Asylum Mentality – why now is the time for dialogue in mental health

by David Gilbert

December 14, 2017

A New Yorker cartoon depicts one person saying to another: ‘Things were so much better when things were so much worse’.

Now: ‘things are so much better as things are so much worse’. Better in the sense of ‘readier’.

Never has there been a better time for people with mental health problems to work with staff (clinicians and support staff alike) to change and improve approaches to mental health and wellbeing. Precisely because things are so bad.

Time To Lay Down Arms

Many staff now suffer their own emotional distress. Nobody is more than one degree of separation from someone who has suffered. Many staff see the paucity of what they can offer more starkly than ever. A new generation of staff want to approach mental health more holistically, but are frustrated by a lack of capacity.

Staff ‘wellbeing’ has become a thing. In the NHS and elsewhere. But mental health awareness and provision of mindfulness sessions is not enough. ‘Resilience’ training is often merely 'positivity' exercises in dubious disguise. This won’t cut it.

I know that stigma at work still exists. I have friends and colleagues who will not ‘come out’. For all Prince Harry’s well-meaning forays, people are judged at work. People will not get insurance if they admit to suffering. They will at best, suffer from well-intentioned anxious questioning about whether they are ‘really’ OK.

At worst, rights can be undermined when returning to work. And good employers (yes, there are some) find it hard to reach out to folk who are ill, prevented sometimes by well-meaning, but outdated employment law and occupational health formalities.

Meanwhile, the mental health user movement is well-versed in its campaigning role and has won many important ‘battles’. But, in my opinion, it is time to lay down arms because the 'enemy' has changed.

Yes, there are still huge injustices and power issues. But with the rise of ‘patient leadership’ and the emergence of people who want to co-produce solutions, the time is ripe to build spaces for dialogue. Many users are well-aware of the pressures that staff are under - many are only one-degree separated from family members who work in the service. Social media has helped to carve tunnels under the walls where we can meet.

If we don’t break down the tribal skirmishes and move beyond the asylum mentality, rising anger will swamp future best efforts. People with mental health problems and their families will rage about better access, bemoan lack of choice and rally justifiably against punitive in-patient regimes. Institutional defensiveness will rise and more staff will go on sick leave and pretend they have a migraine. And round and round we will go. It's time to prevent a full on 'war'.

I have less and less belief in national leadership these days. The change will come from those reading this blog and others at local level who somehow find the time to create space for users and staff to meet as human beings and (crucially) share decision making. But, people in the mental health sector and those with 'lived experiences' either side of the wall, can lead the way.

Beyond The Walls

I am not sure precisely what needs to be done – a few learning events that bring staff with ‘lived experiences’ together with service users would be a great start? But hardly sufficient. There are a number of mental health at work initiatives going on. But I don't yet see these as moving much beyond the individual psychology game.

I bet good stuff is happening though. I am also sure there are people out there way ahead of the game. I would like to learn.

I want to do more. I am frustrated by a friend’s story that his son was not admitted to a hospital where he wanted care. But I don’t think hospitals are great for human beings – never have been. I am frustrated when I hear of a health professional with ‘lived experiences’ being unsure as to how to use their experiences constructively in the work place.

I am frustrated by the way colleagues touch me on the arm and say ‘it’s all very well for you, David, you are professionally at a stage in your career where you can be open’. And then have to crawl back into the darkness.

However, a couple of weeks ago I talked with mental health staff from all over London about my experiences of being a service user and of working in the NHS as a professional who has ‘lived experiences’. Those two experiences are twins.

I am me, whichever side of the wall I am on. I was inspired by the way in which staff openly talked about their own experiences on both sides of the ‘wall’. And by the new solutions when we broke down the walls. Ideas about peer support, community resources, challenging diagnostic labels, taking about safe and trusting relationships rather than about ‘containment’. Sharing power, letting go, yes, staff will need to do that. How money flows with good intentions is also a huge issue.

Whatever the difficulties, it is time to break down the walls of the asylum mentality. Those walls, literally and metaphorically, have never been of much help.

At our next staff conference I will run a session on how we look after ourselves and each other. It will need to be safe and confidential. I want us to address system pressures and our organisational culture – not just promote individual ‘resilience’. I want us to do it together, and break down those damn walls.

We may even do a bit of poetry – the ultimate wall breaker. But that's another story ... or verse.




© 2017 David Gilbert

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One comment on “Beyond The Asylum Mentality – why now is the time for dialogue in mental health”

  1. There is so much to comment on in this post. I don't know about you but I think one of the "issues" with mental health is that even if you've "lived experiences" each person is different. But it is about learning.
    I've a friend who was doing really well at work, published a great paper for his local council, really flying who is now off with depression. People don't understand because "his life had everything/he had nothing to be depressed about" are the things he's heard/we've heard. But not everyone with depression is depressed because bad things have happened.
    So much to learn from a subject that is still taboo.
    Yes do the poetry at the session. Are you connected with Lapidus?

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