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 Panoramaundercover 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.
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.
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.