My son Henry was admitted to a Priory mental health hospital in February 2002 after he tried to swim across Newhaven harbour and was rescued from the freezing water by fishermen. Doctors made the diagnosis that he was in an early phase of schizophrenia, a condition described by one medical authority as being to mental illness what cancer is to physical sickness.
I thought again about the experiences of my wife and myself at that time on seeing trenchant criticisms in a recent inquest and in a newspaper investigation into the inadequate care given by the Priory Group, Britain’s largest private provider of psychiatric care, which receives £400m from the NHS for its services.
My own memory of the facility where Henry had a room is not particularly negative or positive – though I did make friends with a man whose deeply troubled son had been able to get out of the building and suffered crippling injuries when he jumped from the top of a multistorey car park.
A cover for individual and governmental inaction
But I am not going to repeat the endless horror stories about the mistreatment and neglect of the mentally ill in Britain, copious though the evidence is of culpable failures. I fear, however, that one effect of this dismal picture is to numb people into feeling that nothing much can be done given the intractable nature of the illness and the more general meltdown of the institutions supposedly dealing with it.
Talk of a “broken mental health system”, a “culture” that accepts blunders and “institutionalised” shortcomings has a fine denunciatory ring to it. But in practice these jeremiads provide a cover for individual and governmental inaction, since problems seem too big to be resolved except by vastly expensive root-and-branch reforms, which are not going to happen, while blame for avoidable misery and deaths is spread too thin for anybody to be held responsible for them.
Not nearly enough is done for the mentally ill, but this does not mean that nothing can be done by individuals or communally. Horrendous problems face any family affected by psychosis and these are exacerbated by ignorance.
A state of shock
This was certainly true of my wife and I when Henry had his original breakdown, leading us to make a number of mistakes – details of which are worth recounting because many others will face similar dilemmas.
We wanted Henry to stay in the Priory because it appeared to be user-friendly and we dreaded NHS facilities which we feared might be like 19th century lunatic asylums. Henry was in the Priory because the NHS had no bed for him when he was rescued from drowning. But when one did become available, we turned it down because we were in a state of shock and willing to spend any money we had to do what we could to protect Henry and make him better.
I only took on board that this was a mistake when I rang up Marjorie Wallace, the founder and chief executive of the mental health charity SANE, to ask for advice. She said that there were no silver bullets when it comes to dealing with psychosis, though she knew of desperate families bankrupting themselves by paying for expensive treatments for loved ones in private clinics in pursuit of imaginary cure-all treatments. “Unfortunately, they don’t exist,” Marjorie told me. “Whatever you do, stick to the National Health Service.”
Strains on the family
We took her advice, but in those early months I made the mistake of resigning as a correspondent on The Independent to devote all efforts to helping Henry recover. The flaw was that I could not do much more than I was already doing and being jobless simply added to the strains on the family. An element of sympathetic magic probably crept in here, reflecting a subconscious feeling on my part that if I sacrificed my professional career this would somehow help my son.
Another explanation for this decision was that I did not fully understand that coping with mental illness is a long-haul business with no place for self-destructive gestures. I was still confusing full-blown psychosis, from which recovery is likely to be slow and arduous, with neuroses and mental ill health, for which therapies exist with varying levels of effectiveness.
In practice, few therapies help until a person is stable on medication. Such drugs have a bad reputation because they control but do not cure mental illness and have side effects, though these are generally less toxic than they were 50 or more years ago.
Looking back, our mistake we made during Henry’s illness which had the worst impact on him was not to realise over five or six years that he was mostly not taking his medication and that doctors and nurses were not insisting that he did so. His covertly spitting out the pills could have been avoided by giving them to him in dilute form and making sure he did not sick them up.
Why did the doctors and nurses not do something so much in Henry’s interests and in theirs – since his recovery would have freed up hospital beds? At that time there was a reaction against compulsion in mental hospitals and an over-reliance on free compliance, though those suffering from severe mental illness are scarcely in a position to make rational decisions in their own interests. Monitoring compliance is hard and time-consuming work and it was only when the chief doctor at a hospital made sure that staff did this that Henry began to recover.
More of a slogan than a policy
The run-down and under-resourced nature of the mental health service explains many of these failings. Though there are many good doctors and nurses working in it, there are also poor ones and, above all else, an overall shortage of qualified medical staff. The old mental asylum system was run down, but not enough was put in its place aside from “care in the community”, which was more of a slogan than a policy.
Fragmentation of the system is extreme and staff turnover is high. One of our more useful activities as parents was liaising between different groups of doctors, nurses and hospitals to tell them what others were doing or had done. We had decided early on not to quarrel with any of the medical staff, regardless of what we felt about some of them, so we could remain in friendly contact with all of them.
“Care in the community” means, in practice, care by the family and a lot can be done to make this more effective. Relatives and friends usually want to help, but they are often ignorant about mental illness and what they can do – which is frequently a lot more than they think. They need to be kept informed, possibly through a WhatsApp group, and loosely organised, to visit the person and sustain them while they get better.
I have written this rather personal account of some of the experiences of my wife Jan and myself in coping with the mental illness of our son Henry. The occasion for this is a well-publicised coroner’s inquest into the death of a patient at a Priory Group facility and a more wide-ranging newspaper investigation into the failings of the company.
I have been intending to write a piece like this for some time because I see a lot of ill-informed or out of date commentary about mental illness everywhere in the media and in speeches by well-meaning royals that show very limited understanding of its causes, course, treatment and outcome.
Condemnation of the British and American mental health systems is well deserved but often shows scant understanding of their workings. Occasionally individuals, usually with sick children, ask me for advice but in the course of talking to them it becomes clear that they are looking for “a silver bullet” or a cure-all treatment that does not exist. This has made many people vulnerable to harmful fads, fashions and pseudo-science that can have devastating consequences such as lobotomies, electric shocks and other tortures.
I am conscious that panaceas do not work and of the shocking number of the people whom Henry knew when passing through the mental health system who have since died – often by suicide – and how few have fully recovered. Henry has done far better than most, but the shadow of what happened to him never vanishes entirely.
Beneath the Radar
For all the wall-to-wall reportage about the war in Ukraine in the Western media, it remains very difficult to know what is happening at the top of the Russian state. What do the decision-makers really think about President Putin’s decision to go to war on 24 February? And what do they think now of the way he has conducted that war?
Difficult to get such information in a semi-monarchical system, but this article, claiming good sources in the Russian security services, argues that there is anger and consequent divisions about the way in which Putin is fighting his “special military operation” without fully mobilising Russian military resources to fight a total war.
Certainly, Russian tactics and strategy have been shambolic so far, and this article, while generally citing anonymous sources, may be correct in its insights. The next month should give us a clearer idea of what is really going on.
For further insight into mental illness and the pitfalls into which those studying and treating it have fallen, it is worth reading this mea culpa by the eminent psychiatrist Sir Robin Murray about the critical mistakes he has made during a career focused on studying schizophrenia.