4 NATIONS Event.
BASW
December 1 2023
GRAHAM MORGAN – ENGAGEMENT AND PARTICIPATION OFFICER MENTAL WELFARE COMMISSION.
A lived experience perspective from Scotland.
Hello everyone;
My name is Graham Morgan. I work for the Mental Welfare Commission for Scotland as an engagement officer and have a diagnosis of schizophrenia and have been on a compulsory treatment order for the last 14 years.
I am going to paint a quick picture of what I have seen in Scotland recently, then mention the priorities that people with lived experience say we need to address and finally look at some of the solutions that were suggested by the Scottish Mental Health Law review of which I was joint vice chair.
First, a personal perspective. I used to have a wonderful CPN; she came to my house, knew my partner and her children well, knew me well. I looked forward to her visits and trusted her. That finished some time ago. I now got into our health centre and attend the depot clinic for my jag. I am meant to have a CPN to talk to but he has been off sick for months. Until very recently, staff shortages and sickness meant that our mental health team was down to half a CPN and a few bank nurse hours, so I have either got my jag at a CMHT in a different area or had a CPN from a completely different team come in to jag me. It really isn’t good enough and neither is the fact that for the last ten years my tribunal have agreed I should get psychological treatments and still I haven’t got them.
My picture is a rosy one compared to most peoples, maybe we are better off here than in England and Northern Ireland but here in Scotland we are in our own mental health crisis where, though we may have wonderful ideals and wonderful policies, they in no way match up to the reality of what us patients need and should have a right to.
When, in Highland, people tell me their locum consultant is based in Birmingham and all consultations are carried out by video and phone. They don’t think the locum understands the reality of life in island and remote communities and certainly don’t think he understands them as people because they have never met in person. I have great sympathy for their opinions. When I meet family members who feel threatened with the police because they refuse to take their desperately ill relatives home from A&E and won’t leave the ward until they get care I also feel sympathy and when I hear the same from people sitting down in the offices of their community mental health team; saying they have been waiting for over two years to get a referral and being met by the same response of the police being called, I worry about their safety.
When I hear of people being so upset by their treatment in hospital that they leave against medical advice and then take an overdose and are told that they had the capacity to do so and that they probably did it out of anger and will not get support it, makes me angry and when I also hear of the age old issues of people being discharged from hospital after the last bus has gone home and their journey is over a hundred miles and they are told they could get a taxi, I am aghast.
We have a major issue with staff retention and recruitment. Many areas rely on locums which vastly increases costs and ends up with poorer services in all senses of the word. I hear that mental health officers frequently struggle to even carry out their statutory duties. I often hear that the police are more helpful than the NHS because at least they respond to crisis and try to get help for people, while the NHS seems to be developing a reputation of working out reasons why it can’t help people.
I often visit wards and though the staff do their best and there are beacons of shining practice just as there are in the community; they are nearly always understaffed. Worryingly, I hear that people with lived experience are fed up making suggestions for change or giving feedback because not only does nothing change it is actually getting worse and sadly anecdotally; I hear that under the unsustainable burden so many staff are under, that there is an increasing intolerance in some of their attitudes. Patients are now too often, seen as the problem, as the enemy, as the people that stop them doing a good job and as people who constantly complain and disrupt services. It’s not surprising that we complain.
There have been campaigns for decades trying to give us the courage to seek help when we need it and yet when we do we are often turned away or told it is our choice and responsibility if we choose to live or die.
To many of us, the idea that we can get the help we need, when we need it and where we need it as our new mental health strategy says is an utter absurdity and only serves to highlight our unhappiness.
Having been profoundly depressing I will turn to the most recent priorities that people with lived experience that I work with have set.
Their top four are about support on discharge from hospital, relationships, activity and implementation of the Scott Review findings.
The support we need when leaving hospital is not a new thing; in fact people said lets go back and have discharge plans that patients can hold and see as they used to. Let’s make sure we feel safe to go home and that if our door was broken down in front of our neighbours to get us into hospital that there has been work done to dispel any unease they or we feel on our return. Let’s make sure we have community involved before we leave hospital and that simple things like our bills, the state of our house or having milk in the fridge for when we get home have been sorted out.
In terms of relationships, my personal opinion is that this is key to every interaction we have with people like you. We are not always easy to get on with but often we are begging for connection and respect. It is hard to build a long term trusting, therapeutic relationship when you are rushing from client to client but without it, it seems to me much of your work can come to feel like a waste of time. I went on strike with my mental health team ages ago. I don’t speak to them unless I can help it. They are not unpleasant people but I do not connect with them and they have never made or had the time to try to get to know me in such a way that I will do. I would almost certainly not tell them if I was struggling even though they repeatedly tell me I can phone them in between my fortnightly trips to get my jag.
In my opinion the obvious call that Children in Care made for love to be key to the help they get and which resulted in a wonderful initiative called The Promise should be replicated in mental health services. If we can get to a time where we know when we are sectioned it is motivated by love for us and when we meet professionals like you, we are not met by a boundaried professionally remote exterior, but by people motivated by love for our community and the need to help us with our reality then we will be getting there.
Now moving on to the third priority. Things to do, places to go; such an obvious issue. Over the years we have cycled through the use of day hospitals and drop in centres and periodically they are closed because they are seen as mental health ghettoes or we get dependant on them or we should be working to recover not sit and talk to each other but we will always need them. We can be lonely, poor, lost, fearful and unmotivated and places to be with each other in our community will always be needed because we will not recovery neatly and productively. However much our politicians makers say that work and employment is good for our wellbeing and mental health; for many of us it is the exact opposite.
I do work but I go, when I can, to Jeans Bothy; a community mental wellbeing hub in the town next to my village. I use it for company and belonging. I go to the bookclub, the creative writing and the photography groups but others use if for a cheap meal, free food, mindfulness, art, yoga, walking, upcycling, woodwork, exercise, gaming, badminton, fishing and a host of other things. It is a treasured part of our local community and well supported by it and has been so necessary for us following the decimation that community facilities have faced over the years. I think all communities should have hubs like this and equally all wards should have things to do so we don’t pace the corridors, bored out of our minds, wondering what on earth we are doing there.
The last priority people with lived experience selected and by far the most idealisitic is to implement the findings of the Scott review into new mental health legislation. I headed up the reducing coercion workstream but basically it said we need a society where we are welcomed and belong, whoever we might be and whatever our background. We need the preventative community facilities that keep us functioning as best we can, we need support in crisis, we need to learn from countries that have done better than us at reducing coercion and we need hospitals that keep us safe and where we can feel we are likely to get help and recover and we need research, monitoring and safeguards.
Pretty basic and pretty expensive but much more radical is the emphasis that anyone with a mental disability, whether they are subject to compulsory measures or not, should have human rights enablement as a core to their lives. This means acknowledging that although illness and disability and impairment are very real things, how we manage them and the quality of our lives are also dependent on our economic cultural and social rights. So, quite apart from medication, we need good housing, we need education and employment and income. We need all the things that make everyone’s lives liveable and which so many of us don’t have. The chance to have friends and to be a part of society and the chance to heat our houses or have enough food or buy the occasional treat or even go on holiday or get sanctuary when we are frightened of the world.
This is the basis of and the crux of our mental health review -the switch from legislation based on the involuntary treatment of a small number of us to legislation that promotes supports and guarantees the human rights of any one with a mental disability. For some of you this may seem pie in the sky but with our Human Rights Bill going to parliament in Scotland and that Human Rights Bill hoping to embed economic cultural and social rights into domestic law, we do seem to have the possibility of finding a solution to the problems I have just outlined and which you are all too aware of already.
However; matching the ideals of our review and our policy and our legislation to reality, in an increasingly unstable and fraught society is something I really do not have any answer to.
I hope you do or that this talk might stimulate you to think of similar measures in your own countries and communities.
Thank you