"It is proverbial in our English asylums that the Welchman (sic) is the most turbulent patient wherever he happens to become an inmate". Those words were written by Samuel Hitch in 1842. Hitch at that time was the superintendent of the Gloucester lunatic asylum. His letter gave impetus to the movement in North Wales which would ultimately culminate in the opening of the first lunatic asylum in North Wales. Hitch had recognised that the mentally ill from Wales sent to Gloucester could speak little English and the wardens at Gloucester could speak no Welsh. From a standpoint of language, Hitch saw a huge problem which would remain unresolved until such time as an equivalent institution was built in North Wales in which Welsh was the dominant tongue. It was more than that though.
While Hitch correctly identified the problems of a language barrier, language is only one part of culture.It was depressing today to read that we have managed to go backwards in this country. We were arguably more advanced in 1848 when it comes to mental health provision. The news today reveals that patients with acute mental illness are once more being subjected to ludicrously long journeys to arrive at destinations alien to them.Last year alone, one mental health trust spent an eye-watering £345,000 on bed and breakfast accomodation for acutely ill mental patients due to a lack of specialist bed provision. Another trust, admitted an acutely ill patient to a ward for people with hearing difficulties. The Government minister responsible for the provision of mental health services branded this practice a "ridiculous waste of money". His response only serves to display his utter ignorance of the real issue. It is not about the money. Acute episodes of mental health can be frightening for both the patients and their families. This is about common sense, not money.
With hindsight, the decision to dispense with the former asylums can now be judged more clearly. In the twenty years since those asylums closed, the provision of care for patients with acute mental health episodes has deteriorated badly. In true British fashion, we have gone from thousands of beds in the days of the asylums to a handful in our current era. The current era is flawed in more ways than one. Huge swathes of public life are now being dictated by accountants whose sight never wanders beyond the precious "bottom line". I'm all for financial responsibility but also recognise that some areas of society are beyond the narrow confines of the accountant. Since all health starts with mental health, it is inexcusable that we have regressed so horribly in the way we treat some of the most vulnerable members of our society. If they were to sit and observe the mentally ill patient and their family in the 24 hours of a crisis, I suggest they might think again. While the Victorian asylums might have been wanting when it came to effective drug treatments, they were way ahead in their aim to provide moral treatment. Our current system has become morally bankrupt.
The treatment of the mentally ill with a cocktail of clever drugs and psychological therapies has become ever more sophisticated and successful. The drugs as with all drugs though come with a price to pay. Not just the price to the wider NHS but also the price to the the individual through the usual glut of side effects. One of the less desirable of these is weight gain. It is today claimed that one bed in seven in the present day NHS is now occupied by an obese patient. Many patients with a long standing mental illness have their condition well controlled with such drugs but are largely powerless to do much about the ensuing obesity. Their obesity is a consequence of their treatment. Their treatment is for their mental illness. Their mental illness is seldom their fault. They did not ask for it.
Of the growing numbers of obese patients presenting to our NHS every day, the vast majority could have done something about it. A small minority will be obese for medical reasons beyond their control but we sadly know that the majority could have been prevented. A recent poll for the BBC claims that two thirds of those questioned favour a ban on sugary drinks in schools and academies. Are our decision makers incapable of looking beyond banning things. It is very difficult to name a ban which has actually worked. For one thing, they are for the most part too difficult to enforce. There is also the added challenge to the human psyche of defying the ban. Rather than resorting to just calling for bans left, right and centre, why don't we adopt a more progressive, pragmatic approach? Why don't we go in to those schools and academies with a focused programme of education led by the children themselves? Involve them and they will take ownership. Dictate to them and they will ignore. I like the fact that we're having a debate on our growing dependence on sugars with a dangerously high glycaemic index. What I don't like is the depressing lack of imagination in how to deal with the problem. Give a man a fish.....
The education programme which I propose should be absolutely honest and deal with all of the more dangerous addictions which will go on to exert even more strain upon the already buckling NHS. Smoking, alcohol, illegal drugs and poor diet should all be discussed openly. If we continue to delude ourselves that bans will work, we will get even more of what we already have - and we can't afford that on any level.
While Hitch correctly identified the problems of a language barrier, language is only one part of culture.It was depressing today to read that we have managed to go backwards in this country. We were arguably more advanced in 1848 when it comes to mental health provision. The news today reveals that patients with acute mental illness are once more being subjected to ludicrously long journeys to arrive at destinations alien to them.Last year alone, one mental health trust spent an eye-watering £345,000 on bed and breakfast accomodation for acutely ill mental patients due to a lack of specialist bed provision. Another trust, admitted an acutely ill patient to a ward for people with hearing difficulties. The Government minister responsible for the provision of mental health services branded this practice a "ridiculous waste of money". His response only serves to display his utter ignorance of the real issue. It is not about the money. Acute episodes of mental health can be frightening for both the patients and their families. This is about common sense, not money.
With hindsight, the decision to dispense with the former asylums can now be judged more clearly. In the twenty years since those asylums closed, the provision of care for patients with acute mental health episodes has deteriorated badly. In true British fashion, we have gone from thousands of beds in the days of the asylums to a handful in our current era. The current era is flawed in more ways than one. Huge swathes of public life are now being dictated by accountants whose sight never wanders beyond the precious "bottom line". I'm all for financial responsibility but also recognise that some areas of society are beyond the narrow confines of the accountant. Since all health starts with mental health, it is inexcusable that we have regressed so horribly in the way we treat some of the most vulnerable members of our society. If they were to sit and observe the mentally ill patient and their family in the 24 hours of a crisis, I suggest they might think again. While the Victorian asylums might have been wanting when it came to effective drug treatments, they were way ahead in their aim to provide moral treatment. Our current system has become morally bankrupt.
The treatment of the mentally ill with a cocktail of clever drugs and psychological therapies has become ever more sophisticated and successful. The drugs as with all drugs though come with a price to pay. Not just the price to the wider NHS but also the price to the the individual through the usual glut of side effects. One of the less desirable of these is weight gain. It is today claimed that one bed in seven in the present day NHS is now occupied by an obese patient. Many patients with a long standing mental illness have their condition well controlled with such drugs but are largely powerless to do much about the ensuing obesity. Their obesity is a consequence of their treatment. Their treatment is for their mental illness. Their mental illness is seldom their fault. They did not ask for it.
Of the growing numbers of obese patients presenting to our NHS every day, the vast majority could have done something about it. A small minority will be obese for medical reasons beyond their control but we sadly know that the majority could have been prevented. A recent poll for the BBC claims that two thirds of those questioned favour a ban on sugary drinks in schools and academies. Are our decision makers incapable of looking beyond banning things. It is very difficult to name a ban which has actually worked. For one thing, they are for the most part too difficult to enforce. There is also the added challenge to the human psyche of defying the ban. Rather than resorting to just calling for bans left, right and centre, why don't we adopt a more progressive, pragmatic approach? Why don't we go in to those schools and academies with a focused programme of education led by the children themselves? Involve them and they will take ownership. Dictate to them and they will ignore. I like the fact that we're having a debate on our growing dependence on sugars with a dangerously high glycaemic index. What I don't like is the depressing lack of imagination in how to deal with the problem. Give a man a fish.....
The education programme which I propose should be absolutely honest and deal with all of the more dangerous addictions which will go on to exert even more strain upon the already buckling NHS. Smoking, alcohol, illegal drugs and poor diet should all be discussed openly. If we continue to delude ourselves that bans will work, we will get even more of what we already have - and we can't afford that on any level.
Obesity is a very complex issue Alistair - educating children is an important part of it but what about educating their parents ? Since cookery stopped being taught in schools, many adults don't know how to cook. That ignorance, compounded by the availability of cheap convenience foods has helped lead the way to the prevalence of obesity. There is also the issue of mental health problems per se causing people with depression or self esteem problems to over eat, not just due to the drugs that they take.
ReplyDeleteHi Jan, I totally agree with you - it's far more complex than the short piece I just shared. It's something I've written about a lot and I certainly agree with you regarding cookery lessons and also aiming education at the parents as well. The availability of convenience foods is sadly here to stay but at least effective education can seek to redress the balance. As you say, radical changes in weight are well recognised symptoms of depressive illness. That said, my goal always is simply to provoke debate and I thank you for your feedback. I truly value it.
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