Thursday, 20 August 2015

Sep 2014: Centre for Scottish Public Policy blog post 'Scotland's Mental Health Strategy: Mind the Gap'

Cupar rail station Edinburgh platform
Thanks to the Centre for Scottish Public Policy (CSPP) for featuring my blog post, specially written, 'Scotland's Mental Health Strategy: Mind the Gap':

"The “new” Mental Health Strategy for Scotland was published on 13 August 2012, a 3 year plan, and I was involved in consultation meetings prior to the publication and submitted an individual response, from the perspective of being an unpaid carer and a person who has recovered from a “mental illness” prognosis.  Because of these personal circumstances, at 62, I’m now a writer, activist and campaigner in mental health matters, involved in national groups, speaking out and influencing positive change.

A strategy can be defined as “a method or plan chosen to bring about a desired future”, and I was looking for level playing fields and straight paths so that people with lived experience of mental health difficulties would be meaningfully involved in service design and delivery.  A commitment to action as well as words.  Evidence that Scottish Government senior managers were serious about people power.  I was looking for a strategy that was more than fine rhetoric and a reinforcement of top-down hierarchy.

On first reading the published document it appeared to say the right things in the key themes although the warning bells started sounding when seeing the division between “common mental health problems” and “severe and enduring mental illness” being perpetuated.  Mind the Gap.  Them and us.  The sheep and the goats.  The stigma and discrimination that is endemic for people with a “mental disorder” label who can be coercively treated in psychiatric settings. 

It happened to me on 3 separate occasions, altered mind states after childbirth in 1978 and 1984, then more recently in 2002 when aged 50 and menopausal.  I didn’t like being forced to take psychiatric drugs as they depressed me and the antidepressant gave me suicidal impulse then bone loss, resulting in a fractured fibula and 6 inch metal plate.  Fortunately I was able to take charge of my own mental health, taper the drugs, against the advice of psychiatry, and make a full recovery.  However the mental illness label remains in my “notes”, indelibly written.

The Strategy’s first Key Theme is “Working more effectively with families and carers”.  However in the two years since publication, with only one year to go, I have seen little evidence-based practice.  Healthcare Improvement Scotland is mentioned but my experience of this quango is less than impressive and they don’t welcome critical voices in the mix, preferring the adulation of their peers.  No doubt if I was to tell them they were wonderful then I would be a favourite and invited to participate.

Therefore the themes and key change areas in the Strategy I contend are flawed by dint of their only involving people, cronies, who tell them what they want to hear.  Mind the Gap.  There are 36 Commitments which profess to be either person-centred, safe or effective, some of them claiming to be all three.  But people come in all shapes and sizes, from different viewpoints and perspectives, and it will be difficult to claim person-centredness for everyone.  What suits one person may not suit another.

What is “safe”?  My family members have been injured and denied basic human rights in psychiatric settings, and I have complaints ongoing about this.  Because there is the option for compulsory treatment then a person resisting can be restrained, secluded and subject to force.  The phrases “non-compliant”, “without capacity” and “lacking in insight (anosognosia)” can be used to justify coercion whereas in society the same person might be described as non-conformist, free thinking, wise and creative. 

Mind the Gap.  Therefore I have had no option but to concede that there is a gap between the government’s current mental health strategy and what they should be doing to make straight paths and level playing fields.  A gap between their words and their “commitments”.  I have to question my involvement in the strategy consultation, as to whether it was worth my time and energy in writing an individual response when we just got more of the same. 

There is also a gap between their words and their practice, what is promised in the strategy and what has been delivered so far.  I speak from experience as I have been involved in a number of national mental health initiatives, including a crisis network, clinical psychology training, carers’ groups, Carers’ Parliament, a user led research group and the Cross Party Group on Mental Health that meets in Scottish Parliament.

I’m working to close the gap between words and actions so that people who use mental health services, their carers and families will be treated fairly and justly.  I want there to be meaningful involvement of people with lived experience in strategic and operational mental health matters.  For all voices to be heard, critical or otherwise, to bring about real improvement.  I expect civil servants to deliver." 

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