The historian Barbara Taylor last year published an acclaimed memoir The Last Asylum, which described her experiences in the 1980s as an in-patient at Friern Hospital, known earlier as Colney Hatch Lunatic Asylum. She also addressed what followed the asylums, the profound failure of the ‘community care’ initiative. Barbara Taylor talks here about the opportunity the general election campaign offers for a more informed debate about mental health provision:
“The Last Asylum has had a lot of attention, but I feel pessimistic that it’s made much difference to the debate about mental health services. I’ve talked to hundreds of people –mental health professionals of one kind or another, especially psychotherapists and analysts, but also nurses and social workers, and service users too. My impression is that the concerns I express in the book about the quality of care on offer these days are shared very widely.
“Nick Clegg made a statement on mental health services early in the election campaign – I was glad to see that. But it’s not his first such statement. He has made promises as part of the governing coalition and the situation continues to get worse. Politicians regularly make statements about mental health provision, but I almost never see them give a rounded picture of what’s happening right now.
“I am a historian of the eighteenth century. I am absolutely not an expert in mental health and I am not involved in policy discussions. I started out to tell my story of undergoing intensive psychoanalytical psychotherapy and to entwine that into the bigger story of changes in mental health services in which I had participated as an in-patient and day patient over nearly four years in the late 1980s and early 1990s. For that, I started interviewing lots of people, reading government reports. That’s how I found out about what’s going on now, and it galvanized me to write the epilogue to the book – a critique of the current situation.
“Since the mental hospital closures, there is a sense that community care has not at all delivered what was hoped of it by many people of goodwill and reformist intentions. There’s been a lot of discussion about what’s gone wrong – but not enough among those responsible for actually shaping and running the services: the policy makers and mental health managers.
“My emphasis in the book is an attack on the ‘independence’ model of care, the notion that it’s wrong for people to be given open-ended care no matter how serious the problems, that it breeds dependence and a debilitating reliance on the system. It’s a phoney argument. It’s become an excuse for denying actual needs.
“Everyone at some point in life needs to be dependent and people with long-term mental health problems need a sustaining, supportive, intelligent environment that they can rely on. An environment which allows them to lead richer and more fulfilling lives.
“I also made a very strong argument in support of psychoanalytical therapy. I don’t think there’s anyone who is responsible for running mental health services who is sympathetic to that argument.
“It’s a very depressing and difficult time for those concerned with psychological approaches to mental illness. While this government and the previous one have declared themselves committed to psychological therapies – which I am very glad of – what’s on offer has been very rigidly defined as cognitive behaviour therapy (CBT), often of a very limited duration. CBT has its place in a range of therapeutic methods, and offering it to people is certainly better than just putting them on drugs. But I haven’t seen evidence that it’s the most effective form of therapy on a long-term basis, nor that it’s useful in the more serious and debilitating illnesses of the type I suffered from. It’s been aptly described as the ‘garage-repair’ model of mental health treatment – ‘give them a few sessions, and get them back on the road and off benefits’.
“People with serious mental health conditions are at the sharpest end of welfare cuts. It’s very difficult to talk about decent mental health care and separate that out from the state of welfare provision in this country.
“I think mental health professionals need to stand up and be counted. That’s very difficult given NHS management structures – whistle-blowers have been victimised, and there’s a terror about issues of funding. There have been very big cuts to mental health funding, real terms cuts, far greater than to physical health services – and that’s in spite of endless promises about parity between them.
“I should say that better things are happening in some places – I’ve witnessed some of them – but that’s not the main story I’ve been hearing from the Royal College of Psychiatrists and from nurses’ and social workers’ organisations. We need to raise strong demands of the government, especially during the election period, and try to ramp up discussion.
“Pressure is increasing because the situation has got so bad, it’s no longer just the poor that are suffering – people with mental health problems who are already poor or who become poor because of the problems. There are endless stories of those from affluent backgrounds who have children, partners, friends who cannot access decent care. I’m encountering students who are having very serious difficulties. Because of my book, I am now getting letters from the parents of students asking me to intervene and help their children.
“As so often, when the better-off start to experience a crisis in services, then pressure does build. But I don’t feel at all optimistic at the moment.”