David Cameron entered office in 2010 as the leader of a coalition government committed to establishing “parity of esteem” between mental and physical illness in the NHS. Five years later, he’s back as PM, presiding over a majority Tory government, and just about everyone in the country who works with the mentally ill – including the patients – are quaking in their boots. Spending on mental health now comprises just 13 per cent of the NHS budget, while its so-called “disease burden” stands at 23 per cent. In other words, a fifth of all those treated by the NHS are suffering from some sort of mental pathology.
Madness has always had a tendency to be crowded – we think of the foetor of Bedlam in its 18th-century heyday, when the bon ton came to be diverted by the ravings of chained lunatics. After such historical abuses, the foundation of large asylums by the Victorians was a fundamentally humane project. Henceforth the mentally ill were to be regarded as just that, rather than as “moral aments”. Colney Hatch Lunatic Asylum was opened in 1851; the foundation stone, laid two years earlier (by the prince consort, no less), was inscribed with the proud assertion, “No hand or foot will be bound here.” That the asylums didn’t live up to their promise, becoming dumping grounds for social misfits and the misdiagnosed, was in part a function of ignorance but mostly the result of a lack of funding.
It’s salutary for those on the left to recall that it was Enoch Powell who, in 1961, gave a speech in which he spoke of grim Victorian asylums “brooded over by the gigantic water tower and chimney” and committed the government of the day to a programme of closures. At their height, in the mid-1950s, the asylums had housed approximately 150,000 patients. Come the late 1980s and early 1990s, the decision to turf many of them out was animated as much by Margaret Thatcher’s love of fiscal rectitude as by any desire for “care in the community”. This phrase has become one of the many deranging oxymorons of modern discourse, summoning up not visions of happy citizens supporting their benighted brothers and sisters but the isolated and distressed mental patients, often homeless, who clutter up the benches on just about every British high street.
Moreover, it’s well known that our overcrowded prisons are also full of people with mental health problems, as are police cells – while the police often have to work on the front line, alongside woefully underfunded community outreach teams, trying to address the problems of those who’ve fallen through the ever-widening mesh of our so-called social safety net. Meanwhile, those receiving inpatient care are hardly coddled. I don’t know how many of you have ever been on a locked psychiatric ward; let me tell you that these are often not calm and well-appointed therapeutic environments but noisy, smelly, crowded, emphatically institutional ones that resound with cries of distress and crackle with an atmosphere of terminal edginess. Since 2000, the number of beds available on English psychiatric wards has declined by 8 per cent.
I have a friend, a front-line psychiatrist with over a quarter-century’s clinical experience in the NHS, who has been assaulted three times in the past year by patients – one incident resulted in her hospitalisation. She tells me that she’s had numerous rows with administrators who have arranged for patients to be discharged simply to reach quotas. An administrator even colluded with one of my friend’s juniors to rid the ward of patients – which is illegal. Another friend, who has worked as a psychiatric nurse for 20 years, tells me that he has never seen things so bad, with patients being neglected and a culture of bureaucratic form-filling geared to pseudo- (for now) marketisation replacing any real therapeutic engagement. He has been disciplined for giving an incontinent, elderly and demented patient a bath, rather than filling in a form.
The question of whether being institutionalised helps the mentally ill cannot be engaged with on these terms. Being crowded together with a lot of distressed people is always distressing, no matter how sane you may be. The response of many psychiatrists to this predicament is understandable, although not laudable – they reach for the prescription pad, because medication is cheaper than bed space or personal engagement. The mentally ill cannot, under Cameron’s and George Osborne’s caring fiefdom, even be crowded together in hospitals, so instead they must be rendered comatose and piled up in the warehouse that Big Pharma has built and continues to cash in on.
I see the consequences of this in the streets around where I live in south London: mentally ill people who are forced to walk the streets all day often self-medicate with alcohol, heroin and other drugs. Fumbling with numb fingers (peripheral neuropathy is a common “side effect” of antipsychotics), they drop their medication on the pavement. I find half-popped blister packs of drugs prescribed for mental disorders lying in the street all the time and to accompany this week’s column I’ve made a short film about them, called Will Self’s Street Drugs, which I’ve uploaded on to YouTube. I do hope a crowd of you will view it – perhaps it will shame the crowd of Tory MPs into finally honouring their leader’s promise.