Mental Health in the NHS: Changes and experiences

13 – 19 May 2019 is Mental Health Awareness week, hosted annually by the Mental Health Foundation. To coincide with this, we delve into our Digital Archive to share stories from people who have experienced mental health treatment or provided it in the NHS—as a patient, staff or both.

 

These stories highlight how the treatment and experience of patients has changed over the lifetime of the NHS, reflecting changes in social attitudes to and treatment of mental illness. One in four of us will experience mental illness in our lifetime yet it is stigmatised in many pockets of society.

 

Institutionalisation

 

The NHS was created at a time of critical change in mental health care. Long-stay institutional care came under critique and the large Victorian asylums began to be closed. The Percy Commission, set up in 1954 to review legislation on mental health care, recommended in its 1957 report that individuals experiencing mental illness should not be treated in institutions but rather in the community. The Mental Health Act (1959) set out to deinstitutionalise mental health patients and move care into the community.

 

Facade of mental hospital, Nottingham.

Facade of mental hospital, Nottingham. Credit: Wellcome Collection

No date.

Belinda Jackson reflects on her experience of working in a medical ward attached to a psychiatric unit at Birch Hill, a former workhouse. The patients “weren’t really psychiatric”, she says, “they were just institutionalised”.  Born in 1961, Belinda worked in midwifery most of her career but during her training spent time at Birch Hill in 1980.

 

It was a women’s ward.... They’d been put in for the most bizarre reasons. ‘She’d been put in because she talked to too many boys’ or ‘put in because she was a simple soul’.... I can remember one woman was 92 and she’d lived in that building since the age of seven.

 

Listen to Belinda speak about the reasons some individuals were institutionalised.

Counselling for social anxiety disorder, illustration. Credit: Jasmine Parker.

Counselling for social anxiety disorder. Credit: Jasmine Parker (Wellcome Collection)

Deinstitutionalisation coincided with the rise of alternative treatments for mental illness.

Joan Meredith, born in 1925, trained and worked in social work, later working as a psychotherapist. In her twenties, after the Second World War, she experienced paralysing anxiety.

She recalls her experience with a psychiatrist just back from the war, who “had new ideas”. She saw him for a long period, and intensely for a while, and says her experience may have marked the “beginning of English psychoanalysis”.

What I do remember is lying on the coachvery like Freudian, I came to only understand afterwards. He sat at the back of me and got me to talk about what was troubling me.

 

 

 

 

Listen to Joan talk about her experience with Freudian psychoanalysis.

Another treatment was electroconvulsive therapy or ECT. Jeanette Holmes’ mother had post-natal depression in the 1950s and struggled to receive appropriate treatment. She was told by some medical professionals to “pull herself together”.

It was only when Jeanette’s father sought private medical care that her mother received treatment, which included shock therapy. Aged only 16 at the time, Jeanette reflects on the difficulties the impact of this treatment had on her mother and their relationship.

I knew about the shock treatment, I knew what it was. Again, because my father had told me. But she wasn’t my mum anymore, ... she just wasn’t the same person anymore.

 

 

ECT (electroconvulsive therapy) machine, 1945-1960: first developed in Italy in 1938.

ECT (electroconvulsive therapy) machine, 1945-1960: first developed in Italy in 1938. Credit: Science Museum, London.

Listen to Jeanette talk about her mother's illness and the effects of ECT.

Community Care

 

The rise of psychoanalysis changed mental health care. Born in 1947, John Ashton trained in medicine at Newcastle University in the 1960s and specialised in psychiatry as it was a growing field.  In his interview he reflects:

 "It occurred to me quite quickly that the psychiatry in hospital was ‘too little, too late’. It was largely prescribing medicines, there was no prevention."

Born in Ireland in 1945, John Toman trained as a psychiatric nurse. In the 1960s John worked at Brookwood, a psychiatric hospital that housed 2000 patients. He found ways to break custodial care through creating dance opportunities for the patients and playing in the hospital orchestra. Student nurse training became about understanding mental illness.

"[T]hrough psychotherapy … you could help people, rather than hinder them with sedatives. Or drugs—stand back from drugs, talk to them like people, look at the issues, and then create environments in which they’re living that would help them to solve the problem, rather than exacerbate it."

The 1970s brought continued focus on community care. Revisions to the Mental Health Act in 1983 clarified who could be detained (or sectioned) against their will. Safeguarding of human rights for those struggling with mental illness became a cornerstone of charity organisations like Mind. Many of our interviewees testify to the inconsistency of care during this period. Whilst hospitals closed, the provision of care in the community had yet to be catered for.

 

Ampoules of Diazepam for injection. Diazepam is a sedative and anti-anxiety agent. It is the generic name for Valium.

Ampoules of Diazepam for injection. Diazepam is a sedative and anti-anxiety agent. It is the generic name for Valium. Credit: Paul Griggs

Listen to John reflect on broadening treatment options in the 1970s.

Click here to discover John's interview in full.

None needed.

Credit: Nevin Ruttanaboonta (Unsplash).

Patients and services

 

Patients who are experiencing mental health issues often find it difficult to access appropriate and timely treatment. Joanne Harding has worked for 20 years in drug and alcohol services, and mental health, with charity organisations in collaboration with the NHS. She manages The Sanctuary, which provides overnight services for those in mental health crisis.  She speaks of a friend’s challenges and reflects how a mental health crisis is not the same as a physical health crisis. Resources and time are required due to the nature of a condition.

 

A mental health crisis, you can’t just say, ‘I’ll give you some antibiotics for that’, like you would if somebody had a chest infection. ‘Or take these antibiotics, go away, come back in a week; hopefully everything should be fine’.

 

 

Listen to Joanne talk about the crisis in ‘wraparound’ services.

 

Lauren Massey, born in Sheffield in 1987, experienced low moods as a teenager and depression in university. She speaks about a GP who was dismissive and another who “never engaged” with her properly. Two months later she had her first manic episode. The medicines prescribed had helped her to go manic. Only later, after being sectioned, did they diagnose her as bipolar. Lauren believes she only received a high level of care for her condition once she’d had a crisis.

I think it’s that worry that the mental health services are the Cinderella services of the NHS. They are underfunded and you know there isn’t that parity of care with physical health. It’s so difficult; because one in four people do have issues in mental health, so that’s a big percentage of the population and I kind of understand why there are waiting lists for therapy. But I do just think it’s a long time—especially when you’re depressed—to wait six months or a year for therapy. I think that’s unacceptable, really.

 

Depression.

Caption: Depression. Credit: Stephen Magrath.

Listen to Lauren Massey talk about her diagnosis of bipolar and how mental health services are the “Cinderella services” of the NHS.

Many doctors are aware of the limitations in NHS mental health provision. Sohail Munshi was born in Bolton to Indian parents who migrated to the UK in the mid-1960s. He set up his first GP practice in Worsley and is now chief medical officer of the Manchster local care organisation that connects GP surgeries to hospitals, the local council and the Greater Manchester Mental Health NHS Foundation Trust. In spite of such efforts, he says, mental health treatment is still “woefully lacking in most parts of the country” .

Most GPs are frustrated that they are doing the best with counselling and managing and prescribing, and directing patients, but that some of the right interventions—like psychological therapy, being an obvious example—take months, and that’s a long time in a patient’s life when they really need something quicker.

 

Listen to Sohail speak about the frustrations GPs face.

Experiences

 

Professionals working in mental health have themselves often experienced mental health problems. Most said it proved a valuable experience as it helped them to discover pitfalls in the health service and to understand and reflect on the impact of their own actions.

 

Storthes Hall in disrepair

Storthes Hall administrative block after closure in 1992. Credit: Wikipedia.

Lawrence Benson is a lecturer in health care and has bipolar disorder. Born in Liverpool in 1962, Lawrence was a junior healthcare planner in the 1980s and part of a team to run down the local psychiatric institution, Storthes Hall Hospital. Twenty years later—after being diagnosed with bipolar disorder—he realised the impact of his own actions.

"Looking back at someone in his twenties as a technocrat, thinking I was doing the right thing [by closing down the mental hospital], but then you spin the clock forward 30 years as a service user, so it has given me a different perspective on history, really, on health care history. As a technocrat, I had no idea what we were doing to people’s lives."

Lawrence believes he was fortunate to experience his bipolar condition in the 2000s. Had he had his crisis in the 1980s, he says, “I would have ended up at Storthes Hall [a psychiatric hospital]…. And then I would have thought my career would have been over.” He speaks highly of the University’s disability support team but still sees shortcomings on the NHS side.

 

 

Listen to Lawrence reflect on his role in closing down a mental health institution.

Stephanie Davis LeBrun, born in Sheffield in 1988, is now a trainee clinical psychologist. In her interview she describes how she once faced mental health challenges of her own. She used Cognitive and Behavioural Therapy [CBT] through Improving Access to Psychological Therapies [IAPT] services, which she thinks shapes how she now works.

 

"I actually suffered from really bad anxiety. Something that I think, looking back, I’ve experienced ever since going to university, when I was 18. I think I was just in denial for a long time, which is so silly considering what I work in.... I think it’s a really useful experience to have because I can take [from] my own experiences.”

 

 

Listen to Stephanie talk about her own experiences of mental health difficulties.

Sarah Wollaston studied medicine at Guy’s Hospital Medical School and spent 20 years working as a GP. An MP for Totnes and chair of the Health and Social Care Select Committee, she discusses the impact of her own experience of post-natal depression on her work as a clinician. She believes that sharing experiences of mental health and focusing on recovery is important.

 

“Looking back, although I would never want to be back in that place, … I don’t regret having been through it because it made me a better clinician.... It’s important that people who have been there are prepared to talk about that.... It helps other people, who are then in that place, to know that there is—for most people—recovery. To try as much as possible to look at recovery, so as not to feel so completely on their own.”

 

Labour and post-natal depression.

Labour and post-natal depression. Credit: Heather Spears.

Listen to Sarah Wollaston discuss how her experiences of post-natal depression have made her a better clinician.

Click here to listen to Sarah's interview in full.

None needed.

Credit: Helena Lopes on Unsplash

Born in 1967, in Carmarthen, West Wales, Peter Davies is a hospital chaplain at University Hospital Llandough, Cardiff. At age 19, after a life-threatening car accident, Peter worked as a volunteer in a psychiatric hospital with a hospital chaplain. He trained to be a psychiatric nurse for three years, working in that role for one year. The experience “broke down barriers” for him and helped him to recognise our “common humanity”.

 

“None of us are wholly healthy or unwell; that all of us—in terms of mental health—are on a spectrum. That we all suffer mental health problems and issues at different times and stages in our lives. And just to recognise my own weakness, my own vulnerability.”

 

Listen to Peter Davies reflect on what he has learned from working in mental health.

More information on mental health and support services:

 

Rethink Mental Illness: www.rethink.org/

Mental Health Foundation: www.mentalhealth.org.uk/

Mind: The Mental Health Charity: www.mind.org.uk/

NHS: www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/