September saw the first Bristol Anarchist Bookfair for many years. Stalls, activities and workshops were organised and hosted by a variety of groups. South West SF, organised a workshop to discuss the still relatively taboo subject of mental health. Specifically, it was concerned with examples and methods of mental health users and workers organising themselves to resist and/or compensate for a system that treats and contains mental ill health in a fashion that is often distressing and damaging for those concerned. South West SF argued that, although many user-worker relationships are restricted and damaged by the oppressive system in which interactions take place, mental health workers and service users have as much, if not more, that unites them as separates them. There is a need for service users and workers to collaborate to address not only individual care needs but also collective issues.
The presumed starting point for the talk and discussion was that the present economic system can and does have a significant detrimental effect on the mental health of individuals, families (or other networks) and communities. The topic was introduced firstly by a service user and secondly by a mental health worker. Outlines of these introductions are provided below.
Service Users’ Self-Organisation
One of the most important changes in the mental health field in the last 25 years has been the emergence of the service users’ / survivors‘ movement. The movement is diverse and has many dimensions including self help and mutual support, advocacy, training and political campaigning. The movement campaigns around issues such as: compulsory treatment; the Mental Health Act 1983; anti-stigma issues; prejudice and discrimination; and the medical model in psychiatry, including drug treatments and electro-convulsive therapy (ECT).
The development of the large mental hospital system is now seen to have failed users, largely as a result of institutionalisation, lack of funding and the dominance of the medical model combined with repressive regimes.
Major changes in the 1980s have seen the development of care in the community and the care programme approach which was meant to give users the opportunity to influence the care they received. Empowerment was meant to form the basis of good mental health practice by professionals but many have remained ignorant of the existence and demands of the user movement.
The loss of hospital beds has removed the opportunity of a safe refuge and community care has increased public concern about danger and risk. This has resulted in the extension of compulsory treatment in the community. The stigma of institutionalisation has been replaced by the stigma of danger resulting in fear, discrimination, isolation and marginalisation.
Statistics show that you stand twice the chance of being killed by the police (100 per year) than you do by someone with mental health problems (50 per year). However there are about 4,500 suicides a year and this is the biggest cause of death among 10-24 year olds.
In 1974 a group of users formed the first mental patients union which developed a class focused opposition to the psychiatric system and formed an alliance with women’s groups, black groups, prisoners rights groups, etc. This was followed by the formation of PROMPT (Promotion of Rights of Mental Patients) and CAPO (Campaign Against Psychiatric Abuse) in the early 1980s.
In 1986 the Survivors Speak Out Conference formed the first national network for individuals and groups involved in action.
In 1987 a Charter of Needs and Demands was drawn up, while Mind Link was set up as a network of survivors working within MIND.
In 1990 Hearing Voices began to hold meetings with the aim of setting up self help groups.
From 1990 onwards many groups across the country began to seriously challenge practices in the mental health services. In Bristol these organisations now include Bristol Survivors Network; Patients Council, Southmead and North Bristol User Network (SUN), Depression Alliance, Sensation (working with Black users). Other groups are associated with tranquilliser addiction, self harm, eating disorders, manic depression, hearing voices, etc. SURG (Service User Reference Group) is made up of reps from service user groups from this region.
Other parts of the country have seen the development of survivor led crisis projects, safe houses and therapeutic communities. Many of these groups started to develop advocacy projects and have been involved in policy making decisions within mental health trusts and the training of workers. Some are involved in user-led research. However, a long campaign for a safe house in Bristol has failed to be taken seriously.
A lot of work has gone into challenging stereotyping in the media and the development of literature, film and art from a user perspective. For instance, reading a personal account by someone who also has suffered a crisis can be far more therapeutic than being given a diagnosis by a psychiatrist. Examples include work by William Styron, Andrew Solomon, and Elizabeth Wurtzel which deal with their experiences of depression. Mad Pride organises a celebration each year.
Recently over 200 people attended a conference for survivors as professionals working in mental health services. Perhaps the most important part of the movement is self help and mutual support provided by the groups. At present there are about 300 groups nationally.
Demands on Society: These include equality and an end to discrimination in employment, housing, etc; in particular an end to negative stereotyping and for inclusion and acceptance.
Demands on Services: These include respect and dignity, information, choice of treatment options including alternatives to drug therapy, non-judgemental listening, advocacy, the honouring of advance directives.
debates in the movement
The rights of users to be involved in the development of services is enshrined in law, However, since the movement is very diverse this has led to debates around issues such as tokenism, payment, full time survivor consultants and representation. Activists are sometimes accused of not representing users and are often patronised. However, most are aware of the diversity of users” experiences and try to represent them fully. This may mean attempting to represent people in secure units as well as people with mild depression and anxiety who may have only limited contact with a GP.
Black people are over represented in the mental health service and the service is institutionally racist. In response, black people have sometimes found it necessary to develop their own organisations. Women are sometimes the victim of sexism and abuse by users and staff and have concerns that sometimes are not recognised by the user movement. Until recently, sexuality itself was subject to psychiatric diagnosis and treatment. Work-ing class people, women and minority groups are more likely to enter the mental health system as are gay people, migrants, ethnic minorities and people with learning difficulties.
achievements and challenges
In a society, which sees people with mental health problems as a burden, the continuing growth of the user’s movement is an achievement in itself providing evidence of the skills, creativity and persistence of a devalued group. Pioneering approaches have emerged for the treatment of psychosis and self harm as a result of pressure from user-led networks. Traditional psychiatric practices are being challenged with a large body of written work available to professionals. Advocacy services are being developed in some areas, but funding is a major problem
Wide scale prejudice still exists within society in general. The challenge is to widen the focus of the movement to tackle society’s negative attitudes while still trying to change the mental health services.
Although users are involved in the development of their own care plans, mental health professionals still have a huge amount of power over any individual entering the service. Managers may consult with users and invite them on to their committees, but they will set the agenda and retain the power. Develop-ing links between users and sympathetic mental health workers may be one way to challenge this power. Information relating to mental health workers organising themselves to address political concerns is hard to come by and examples appear rare. However, the following sketches out some such attempts over the past 25 years.
1986 – Launch of Asylum magazine: This followed a visit to the UK by mental health workers from Trieste, Italy. At that time the ASYLUM San Giovanni in Trieste comprised of “apartments for clients, art studios, space for film and theatre and perpetual discussion of what more could be done to humanise mental health services. There were co-operatives and a restaurant in town as well as small friendly units with a few beds for short stay during crises as well as facilities to sit together, to eat and to chat and to see the mental health workers. Mental health workers in the UK were attracted by the argument that the total ambience of everyone’s life is of central importance to their mentality. The Italian workers in Trieste had realised that much that is therapeutic comes from the arts, from sharing good things, from eating, drinking and laughing together”. The aim of the Asylum magazine was, and continues to be, to argue and struggle for a system based on the best examples of mental health care.
1994 – Founding of the Psychology, Politics, Resistance (PPR) Group: PPR describes itself as a “network of people – both psychologists & non-psychologists – who are prepared to oppose the abusive acts of psychology. This means challenging the ideas within psychology that lead to oppressive practices, supporting those at the receiving end and using psychological knowledge positively to help those engaged in struggles for social justice”.
PPR held “network festivals” bringing together groups and individuals already campaigning.
1999 – First meeting of the Critical Psychiatry Network
(CPN), aka “the Bradford Group”: CPN provided “a network to develop a critique of the contemporary psychiatric system”.
The network “is influenced by critical philosophical and political theories, and it has three elements. It challenges the dominance of clinical neuroscience in psychiatry (but does not exclude it); it introduces a strong ethical perspective on psychiatric knowledge and practice; it politicises mental health issues. Critical psychiatry is deeply sceptical about the reductionist claims of neuroscience to explain psychosis and other forms of emotional distress. [CPN is]...sceptical about the claims of the pharmaceutical industry for the role psychotropic drugs in the ‘treatment’ of psychiatric conditions.”
The CPN describes their beliefs as follows:
Like other psychiatrists we use drugs, but we see them as having a minor role in the resolution of psychosis or depression. We attach greater importance to dealing with social factors, such as unemployment, bad housing, poverty, stigma and social isolation. Most people who use psychiatric services regard these factors as more important than drugs. We reject the medical model in psychiatry and prefer a social model, which we find more appropriate in a multi-cultural society characterised by deep inequalities.
In particular the group has been concerned with proposals for compulsory treatment in the community.
2003 – Launch of Paranoia Network: The network brought together “ideas from users and survivors of services as well as from clinicians and academics”. In 2004 it held an international conference in association with the Asylum Group and Manchester University in order to create “a space to speak and produce new knowledge rather than simply listen and be subjected to the psy-complex.”
reformist trade unions
Most unionised mental health workers are organised within reformist unions such as UNISON and Unite. They concern themselves mainly with issues relating to pay and conditions and the amount of political discussion at branch level is minimal. There have been some disputes and campaigns around NHS privatisation (e.g. the recent Karen Reissmann dispute – see DA41) but little if any discernible discussion or joint action with service users.
Anarcho-syndicalism in Britain is relatively small yet those involved argue for workers and service users to organise amongst and across themselves. Politics and economics are not seen as mutually exclusive and are considered the concern of those affected, not of elected representatives. Health and social care workers in the anarcho-syndicalist Solidarity Federation are in the process of setting up a network with the view to eventually establishing a healthcare union.
something to think about...
We would like to look at practical ways in which users and mental health workers can develop links and work together. We recognise the importance of both sides continuing to work within their own organisations and maintaining their autonomy. Some users may be wary of working with mental health workers because of the dangers of reproducing the power relationships which exist inside the service. On the other hand, some workers may be wary of meeting up with users outside of their working hours for reasons to do with risk and confidentiality. However, we would like to propose the development of forums where interested individuals and groups can meet to discuss working together to challenge the power relations which are integral to the existing mental health system.
Websites / further info
Asylum Magazine – Psych-ology, Politics, Resistance – Paranoia Network – www.asylumonline.net
Critical Psychiatry Network – www.critpsynet.freeuk.com
Solidarity Federation – Health & Care Workers Initiative – www.solfed.org.uk – c/o The Blackcurrent Centre, 24 St Michael’s Avenue, Northampton, NN1 4JQ – firstname.lastname@example.org