Peter Beresford: We know madness and distress may be within us

From a lecture by the Professor of Social Policy at Brunel University to the Mental After Care Association, in London
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The Independent Online

There is now a real chance to get mental health policy on track. But to achieve this we have to make three key connections.

First, the connection between language and meaning. How do words so readily become degraded and removed from what policy makers, and indeed mental health service users, might want to mean by them? We have seen this happen with words like "care" and "community". We have seen their liberating aspiration reduced to a target for populist tabloid attacks on "care in the community".

At a recent conference based around World Mental Health Day, I heard a service manager talk to local mental health service users about new arrangements for health and social care "service integration". Her speech consisted of one policy cliché after another – "an improved whole system approach... a culture that is open and honest... developing a shared vision... moving the agenda forward... a huge change agenda", and so on, endlessly.

Policy makers, service providers and practitioners must connect the language of their policies and practice with service users' ideas and understanding. If their language is to have real meaning, then it must start with service users' meanings and lives. Otherwise it is disconnected and rootless.

The second connection is between ourselves as individuals and our true identity. This is a personal task. If we are to challenge the populist presentation of madness and distress, we must start with ourselves.

The standard argument is that madness and distress are not part of us – they are abnormal, pathological, deviant, disgusting, something to do with some specific and separate sub-group of humanity. We each of us must resist pressures to collude with this alienating version of reality, which tries to deny the madness and distress that in our hearts we know may be part of us all.

Our first task is to understand and love ourselves for what we are. I'm not suggesting here some West Coast self-indulgence based on self-love and self-absorption. I am simply saying that by being honest with ourselves we will be able to be more understanding and less judgemental of others and of madness and distress.

Finally, there is the connection between people as mental health service users and society. Challenging the desire of society to distance mental health service users, challenging their social exclusion, essentially means challenging the discrimination which we as mental health service users face.

The problem of mental health tends to be presented in terms of something being wrong with people, wrong with individuals. But it is a social problem, with, for example, higher rates of stigmatic diagnosis attached to black people; people with a history of use of mental health services denied insurance and opportunities to foster and adopt children; large scale prescribing of medication with negative side-effects; and inferior access to employment, training and education opportunities. This discrimination is routine, arbitrary and wholesale.

We must challenge at every turn political, media and popular pressures to make outcasts of mental health service users. We must counter stigma and stereotypes to tell it how it really is.

And now, as perhaps never before, with the extended provisions of the Disability Discrimination Act and the support of the Disability Rights Commission, there is a legal framework in which we can safeguard the rights of mental health service users.

If individuals and society are to challenge their prejudices about madness and distress, then they must change – to let mental health service users in – and not just expect service users to change. It is easy to be misled about ourselves and others. But if we can be honest with ourselves and challenge discrimination whenever we meet it, then we may indeed restore real meaning to the idea of "caring communities".

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