I am really bothered by this discussion over on Mental Nurse. To summarise, a number of patients are setting out an appalling catalogue of abuse at the hands of the mental health system, principally in the UK, but also in Ireland and elsewhere. This is truly horrifying stuff – up to and including rape, in one example, but all of it is sickening. That is bothering in and of itself, of course, but what is really bothering me are the responses of the few healthcare professionals who are contributing to the debate.
(And, goodness me, but isn’t it noticeable how disengaged from the debate the MN regulars have been? You can’t move for comments from them when they’re arguing about nursing becoming an all-graduate profession (something that will make slightly less than fuck-all difference to patients), but when it comes to a discussion of what ought to be the single most pressing issue any of them will ever encounter in their entire professional lives – the systematic abuse of the people they are theoretically meant to care for – suddenly there’s all sorts of other things they have to worry about instead. That’s a very revealing set of priorities, I think.)
What’s really struck me is that none of the nurses (and allied professionals) have expressed outrage at what they’ve read. (They have expressed a vague, hand-waving ‘concern’ or ‘disappointment’ instead.) I don’t know if this is because they are familiar with this kind of abuse in their own working lives and so don’t find it shocking, or because the abuse is being described by patients who they are used to dismissing because, you know, they’re mentals…
Either way round, that’s already a fairly major problem right there – that the natural, human response of ‘Oh my god, this is awful. Just reading about it makes me feel sick to my stomach. What can I do to stop this happening?’ has been noticeable by its absence. I would guess that’s what anyone except a mental health professional would think when they read about this kind of thing. It’s not what the MH professionals contributing to the Mental Nurse thread think. Instead, we’ve had a whole bunch of: ‘well, people burn out, what can you do?’; ‘there are faults in the system that make people behave in this way’; ‘sometimes things get really stressful’; ‘I’m a nurse and, I can tell you, some patients have been really nasty to me’; and so on, and so on. Faced with this appalling testimony of abuse, this has been, collectively, their response: we need to think about the issues that cause these problems and see what we can do to address them…
Last month, Amanda Cheadle was banned from keeping animals for life. She had committed acts of cruelty against dogs, including shutting a number of new-born puppies in a suitcase and leaving them to die in the cupboard under the stairs. It was a fairly high profile case – ITN included it in their evening news bulletin, for example. As it happens, and even despite the terrible things she did, I have quite a lot of sympathy for Ms Cheadle. She had been sectioned around the time that the offences took place, and it seems fairly likely to me that she was overwhelmed by the situation with the dogs, and shut them away because she couldn’t cope. I can also understand why the experience of being sectioned might have made her very reluctant to ask official bodies like the RSPCA for help.
But none of this sympathy prevents me from thinking that the court was absolutely right to hand down a lifetime ban on keeping animals. Of course it’s entirely right to try and understand what causes someone to act abusively, and even, in some cases, to empathise with what they have endured – but it’s a secondary concern. The primary concern has to be getting the abuser out of the situation in which they can perpetrate abuse. At one level it doesn’t matter if an abuser is perpetrating abuse because they’re unwell, or under stress, or are a victim themselves, or lack the empathy to understand that what they’re doing is wrong, or are just wantonly cruel – what matters, in the first analysis, is making sure they stop. This is a principle I think all of us would accept when it comes to dogs, so why is it one that MH professionals seem unwilling to accept when it comes to MH patients?
It’s obvious what’s required: a two-speed approach. First and foremost, zero tolerance for the abuse of patients – automatic de-registration for a single instance of abuse (whatever ‘circumstantial defences’ the abuser is able to put forward); also, de-registration for fellow-professionals who knowingly fail to report abusers. This is not, primarily, a matter of punishment, it’s a question of getting abusers out of the situation in which they can perpetrate abuse – in fact, there might need to be a separate, criminal process to look at punitive measures against the worst offenders. Secondly, there needs to be a long, hard look at what factors may be causing MH professionals to perpetrate abuse in the first place, and then a properly funded effort to address them. Are there problems with working conditions? Staff shortages? Is there a lack of practical and psychological support for people struggling with an exceptionally demanding job? A management culture that tolerates (or even encourages) abusive behaviour so long as performance indicators are met?
All of this secondary stuff is hugely important – but it comes second for all that. The first priority has to be to stop the abuse. Sectioned mental patients (or those involuntarily ‘voluntary’ patients who know damn well they’ll be sectioned if they express a desire to leave the ward) have been reduced to the status of children, with the nurses who ‘look after’ them exalted to the position of ‘adults’. Patients are presumed not to know what’s in their own best interests. They are at the mercy, 24/7, of the ‘adults’ who have quasi-parental authority over them. If they’re the victims of abuse, their only hope for redress, or just simply having the abuse stopped, is trying to convince another ‘adult’ about the reality of what’s happening to them – but, as the personal accounts on the Mental Nurse thread make plain, far too often the ‘adults’ will just close ranks and punish the ‘child’ for daring to speak out.
There is, quite rightly, an absolute outcry any time an actual child is found to be a victim of the emotional, physical or sexual cruelty of an adult who is supposed to be caring for them. It’s a matter of grave injustice that there isn’t a similar outcry every time one of the adults infantilised by an Act of Parliament is abused in this way. But what really bothers me, and what has been so eloquently revealed by the selective silences and weasel-words of the professional contributors on Mental Nurse, is that the people who have the authority, in their day-to-day working lives, to stop the abuse don’t see it that way.
Their response isn’t to condemn the abuse and ask themselves what they, personally, can do to prevent it, but to explain what causes it to happen. Their instinct isn’t to try and defend the victims of the abuse, but to justify the actions of the abusers. The old cry of ‘if you’re not with us, you’re against us’ isn’t usually helpful. But it is hard to see how people with instincts like these can ever be part of the solution to so horrific a problem.
Sorry for the lack of posts recently – I haven’t been feeling too good.
Not-feeling-to-good is also the explanation for why, for the first time ever, I’ve closed this post to comments from the get-go. I just don’t have the energy to cope with getting into a discussion, or a debate, or an argument, or a fight. Sorry.