nurse, I need some healing…

‘nurse, I need some healing…’ art created by Seth Hunter & some very clever AI for buddi bench™.

Shrink radio - Recreate Psychiatry

Please note: below is the (edited) transcript of a presentation Seth Hunter gave at the Royal College of Psychiatrists International Congress 2017. The orginal audio recording can be heard at the bottom of this text.

Hello everyone. I'm Seth Hunter. I've been involved with Recreate Psychiatry from the very beginning. I'm also the project manager for the Dragon Cafe. Again, from the very beginning. I'm a service user. I'm diagnosed bipolar and it does seem to probably reflect the struggles that I face and I'm also an alcoholic in recovery, so very much a service user. Now, I don't have the time today to talk much about the cafe, but I would just say do scribble it down and do Google us because it is quite a radical & progressive project. And if you like what we're talking about today, I'm sure you'll love what we're doing at Dragon Cafe. Now I've got six main points that I'd like to try and cover today, so I'm just going to try and push on because I tend to be a bit verbose and I'm just trying to get through it.

So my first point I really noticed was my difficulty in accessing mental health services leading to my rapid deterioration in mental health when I really, really needed help. I had really, really poor interactions with services from the very beginning at the time that I got seriously ill. Probably about, I'm not even sure, probably about a dozen years ago, more than that, I was deputy manager for a young homeless people hostel near Covent Garden in London. The job was very stressful. It was a 70 bed unit. There was gang culture, there was drug dealing, there was gun-running, and it was generally a very unstable, aggressive and paranoid atmosphere, and I just really wasn't coping very well. I was new to management and I was drinking very heavily after work to cope. After a relatively short period of time, I left the job sighting stress, but really it was a lot more serious than that.

I was highly anxious and becoming increasingly paranoid thinking that my phone calls and emails were being intercepted by the police and the undercover police and gangsters were following me. As time went on, I became increasingly psychotic and saw sinister meetings in the most innocent of situations. My mental health continue to decline & intensify to the point where I rarely left my flat. And at one point I was even walking around with a knife in my pocket to defend myself should the gangsters try and hurt me. This was all very unusual behaviour for me as I was a very gentle, kind and loving person. I moved back in with my mother and she repeatedly tried to get mental health services to come out and assess me. She was very, very worried about me. By now, I was acutely paranoid, psychotic at times and too anxious to leave my room, let alone the house and go to services.

My mother's attempts were in vain. Eventually the police got involved and a long standoff occurred whereby I barricaded myself into my bedroom. After hours and hours of negotiations, the police eventually broke down my bedroom door. I jumped out of her first floor window into a garden unhurt. It wasn't very high. I was technically arrested for criminal damage. I think I'd thrown a wine bottle and it had hit my neighbour's roof. I was essentially just trying to get help and the charge was dropped, but I was held in a police cell for two nights and this was my introduction into the mental health service. Looking back on it now, it's such a waste of resources and was unnecessarily stressful for me and all those that cared about me. I'm confident coming to mental health services by the police could have been avoided if mental health services had been willing to meet me on my terms rather than insist I go out, go in for an outpatient assessment.

I wasn't treated very well by the police. At one time I was hit several times with a baton, for example. Also, the police got me out of my holding cell while they were dressed in full riot gear. There was about six of them, and I was taken to hospital in the back of a police van handcuffed, wearing only my boxer shorts. So my entry into mental health system was one of oppression and aggression from the very beginning.

The next point was the terrible and physical environment of the average ward leading to dysfunction, unhealthy atmospheres and not a place to recover. I was sectioned under the Mental Health Act and held for a month. In this time I was held at three different hospitals. Each of them were fairly horrible really. In the first one, still paranoid and being convinced that staff were going to kill me and somehow involved with the undercover gangsters, I decided I was going to try and speed up the process by pushing one member of staff, not particularly hard and not in a particularly aggressive way.

I was immediately pushed to the ground by four big strong men and picked up and put on a bed while I had medication forcibly injected into my buttock, supposedly to calm me down I guess. So my first experience with medication was one of force and not so much to help me therapeutically, but to manage my behaviour. I can understand why this occurred, but it really didn't help build trust. The institutions felt like low-level prisons rather than places conducive to good mental health. Double doors for security, awful neon stripped lights, couldn't access hot water to make tea, presumably as hot water could be used as a weapon. No plants, limited access to a garden, terrible food all processed and generally unhealthy. A broken TV on or with a very poor reception in the communal TV room, the only place with an exercise room was closed. The key had been lost.

The last hospital I stayed on, drug use was apparent and some violence was evident, and I slept in a dorm. I don't think they do this anymore, but at the time there was like eight beds just in an open room with white curtains dividing us. So privacy was almost impossible. This all added to an atmosphere of latent and overt aggression, resentment, boredom, and quite frankly of lost souls. I understand that mental health professionals have to deal with life and death scenarios quite a lot, and I guess this is likely to lead to behaviour & environments that are risk averse with an emphasis on containment, not about creativity or taking chances & recovery, but it seems if you go onto your average ward, then it's all about locking doors and making sure that things can't be used to hurt yourself with, it's dehumanising.

Point three, clear power imbalances leading to struggles for power and resentment.

Even in my unwell state, it was clear to me just how hierarchical the setups were in hospitals. It seems to me that the principal power lies with the Consultant Psychiatrists, some of whom should seem to treat the ward a bit like they're personal fiefdoms. The psychiatrists lower down the rank, then next in terms of power, then therapists, then the nurses, and then lastly the patient. Sure, tokenism is given to the idea of flattened hierarchy, but it always seems to me that ultimately power lies with the \consultant Psychiatrist. Why am I so preoccupied with power imbalances? I guess over the many, many years I've been involved with mental health services both personally and professionally. It seems to me that not having power, not having many choices is almost a given for the average person if there is such a thing, with a mental illness.

I think we live in a time where struggles for power are particularly relevant. Social classes, male v female, straight v gay, terrorism, politics, Brexit, we live in polarised and atomised times. That's particularly evident on the psychiatric ward that 'them and us' struggle. Nurses, when I did see them were generally hiding in the staff room, they only came out at medication time. I really have a very strong memory of being requested to line up against a big wall of about 30 people just getting medication. No one explained to me what my diagnosis was. I didn't know why I was in hospital and no one explained to me what my medication was supposed to be doing.

I now work closely with a Consultant Psychiatrist who's very much involved with Recreate Psychiatry called Khaldoon, and he pointed out to me that you are never really going to be able to shift the power dynamic because of course, it's enshrined in law. It takes two qualified people to assess you under the Mental health act, but Recreates Psychiatry is an attempt to at least suspend that power difference for long enough to meet, to really meet each other on a level.

Point four - not being listened to authentically leading to frustration and challenging behaviour. No one really spoke to me at all, certainly no attempt at a therapeutic interaction or when my concern friends called the ward to arrange meetings with me. The staff were difficult and invasive about times my friends could see me.

In many way, it seems to me that its core mental illnesses in part about isolation and lack of communication. So to be so disempowered and ignored in hospital felt awful. I simply just wanted to be heard and validated. It seemed my fragmented psyche was being treated by a fragmented system. I think for me, one of the most maddening things is the feeling of not being authentically listened to. On a rare occasion when I got to speak to a mental health professional, I may have been heard but not authentically listened to. I could almost hear the wheels of the cogs in their brains, going around in their minds. They were listening to me to tick off the symptoms that they were kind of waiting to spill out of my mouth. So it wasn't a very authentic being listened to.

Number five, the dominance of the medical model, not being seen as a whole person and not having my creative needs nurtured and, being defined by limiting labels.

I remain frustrated with the current dominance of the medical model, this search to find the right pill and nothing else. Don't get me wrong, I've benefited enormously from medication and in fact right now I speak to you with being on both so Sodium Valproate & Olanzapine, and it helps keep me very well, but I don't think it should be the only thing. Humans are complex. They must be seen as a whole not squeezed into diagnostic boxes, and the truth is we don't really understand how the brain works, let alone the mind. We have theories but not unassailable facts. We should all be a bit more humble. Could it be an existential crisis? Spiritual wellbeing is not even talked about. The soul seems not considered. The medical model has still got a place, but it might potentially not be the dominant model. It's not the only way of thinking of things, and I think that's very encouraging. Creativity and finding meeting might also regarded as important.

Towards the end of my month section, I was assessed by a room full of mental health professionals. There must have been a dozen from a variety of specialties and varying senior, a very strange process to be asked such personal questions by a room full of general strangers sitting in judgment. Eventually I was allowed out of the ward for escorted leaves. I knew that if I kept my head down, then eventually I'd be allowed out for on unescorted leaves. So already I was learning the system. I went and decided that as soon as this happened, I would go out and not come back. And this is indeed what I did. I'd made up my mind that being at home unwell, vulnerable, drinkingcalcoholically and without support was preferable to being in a ward where anger, boredom and illness were the norm. I kind of knew I wouldn't get well in hospital, and it seemed I was right. I went back to hospital with a friend and arranged to be an outpatient, a far better set up.

Finally, what impact has being involved in Recreate Psychiatry had on my wellbeing? Being involved has really helped my wellbeing in ongoing recovery. It's been very empowering to be able to talk to mental health professionals with the power differential suspended as much as possible. So to be on a level, and to be able to collaborate, reflect, and have honest conversations about how services could be improved for those that work in them as well as for service users. For me, I guess Recreate Psychiatry is a bit of a revolution of the heart, not just for the mental health professionals I get to speak to, but also for me as a patient. It's a two-way thing, and I think we can all do being a bit more compassionate to one another because we're all struggling under a difficult time at the moment due to politically motivated cuts.

Patients project their anger that really is about shortsighted political decisions, leading to under-resourced mental health services. This anger then gets projected onto frontline workers and frontline workers close down and become defensive in return, and it becomes catch 22. I do think that this sort of unbridled anger and resentment can be incredibly poisonous. I had to really let go of mine to recover.

Finally, Recreate Psychiatry helps me to understand that the current system is set up for only the Psychiatrist to hold ultimate responsibility for the patient, and that to me is a problem. One of the things that's been quite important for me to realise in my own recovery now is that now that I'm no longer in crisis is that I'm actually responsible for my physical, mental, and spiritual wellbeing. Mental health professionals and others in my life collaborate with me to stay well, but it's ultimately my responsibility. But this has taken 15 years of long hard recovery, and I'm not saying when you first walk into a ward in crisis, you're going to be thinking like this. What I'm saying is Recreate Psychiatry is a way of furthering a more genuine recovery because of its emphasis on listening, equality, collaboration, creativity, and reflection. I'm pretty sure that I'll never go back to hospital. I think that's because I really look after myself now and collaborate well with my mental health providers, and that's because I genuinely feel listened to. That's really, really healing and empowering.

Finally, I'd like to give a final thought to ish one of Gandhi's truisms: 'If we could change ourselves, the tendencies in the world would also change.' Thank you.