This is (or was) Colney Hatch Lunatic Asylum, which opened in Barnet in 1851. These days it has been redeveloped, as has much of our heritage (no matter how dubious) into the ubiquitous "luxury apartments", home to members of One Direction, actress and Strictly Come Dancing winner Kara Tointon, and various Premiership footballers such as Alex Oxlade-Chamberlain; but in its heyday as the "Second Middlesex County Asylum" it was, over the years, home to the likes of serial killer/rapist John Duffy, the historian Barbara Taylor and one Aaron Kosminski, one of many suspects in the Jack the Ripper murders of 1888.
Now I know what you're thinking: "bloody hell, here she goes again with her obsession with serial killers and crumbling buildings!" but alas! Dear Reader, in this instance you would be entirely wrong. I mean I still have my obsession with serial killers and crumbling buildings, but that isn't what prompted me to write this blog.
The actual reason for this particular bit of bloggage is twofold: firstly, unless you've been living under a rock or been lucky enough to get a place on that mission to Mars, you will probably have heard that yesterday a 25 year old man was found not guilty by reason of insanity for the murder of 82 year old Palmira Silva in Edmonton, London, last year. Instead Nicholas Salvador, who was found to be suffering from severe paranoid schizophrenia, was detained indefinitely under the Mental Health Act and sent to Broadmoor Hospital. The attack itself was utterly, utterly horrifying; having seen some of the footage the police released of what happened (although not, thank god, the actual murder), I can't even begin to imagine how terrifying it must have been for Mrs Silva and all the other people who witnessed events that day; but as the defence barrister pointed out after the verdict, it must have been equally terrifying to be inside Nicholas Salvador's head that day. Paranoid schizophrenia is relentless in its distortion of the human brain even when a person is getting treatment for it; when Nicholas Salvador finally starts to retain some sense of equilibrium and realise what he actually did, that is going to take a whole heap of skilled medical care to deal with.
The other reason is Will Self's article in the current issue of the New Statesman on the complete and utter failure of the Government to give mental health services in this country anywhere near the parity it deserves. Say what you like about Nick Clegg, he and the Lib Dems were wholeheartedly correct in their insistence that mental health be accorded the same rights as physical health and, when you see some of the stats, it's easy to see why...
- Shortly after Colney Hatch hospital opened, in 1860, there were 38,058 people in England and Wales who were certified as insane, just under 2% of the general population, although it should be noted this does include people with conditions such as dementia, learning disabilities (like one of my paternal ancestors, who is down on the asylum records as 'imbecile') and 'nervous exhaustion' and does not include people who were not 'certified lunatics' (thanks to the brilliant Sarah Wise's book "Inconvenient People: Lunacy, Liberty and the Mad Doctors in Victorian England" for the stats on this). These days, it is estimated by the likes of MIND and the Mental Health Network that 20% of the population - 1 in 5 of us - will suffer from a mental health condition at some point in our lives; in a 2012 report by the London School of Economics on the cost of treating mental health conditions, 1% of the adult population of England will suffer from schizophrenia or bipolar disorder and 8% will suffer from depression and anxiety disorders respectively. For children, the depression/anxiety disorder figure was 4%. You probably know someone who has had a mental health condition. You may have had one yourself. It's endemic, really; I mean, just from my own personal point of view I have suffered with depression in the past and had to have psychiatric input to deal with it; I have two family members (that I know of) who have had depression; there is the aforementioned 'imbecile' in the asylum in my family history; I have several friends with anxiety disorders/depression/other mental health conditions; and I had a very good friend who suffered with severe paranoid schizophrenia and subsequently killed himself because he couldn't take the ups and downs anymore. That's not including the number of young people I've come across at work who are presenting with a wide range of emerging mental health issues, some quite serious. I could literally throw a stick among my social, familial and work circles and hit several people who've been there, done that.
- Given the fact mental health conditions are so endemic and present the highest 'disease burden' on the NHS - higher than coronary disease and cancer - you'd think we'd have cottoned onto the fact it needs an equally-high financial package to deal with it. Not so. An NHS England report from 2013 found that although mental health issues causes 23% of the 'disease burden', it only gets 13% of the NHS budget - and this has been reduced from the previous financial year (and presumably the years before that). Conversely cancer, while clearly hideous (also had that several times among my circles) causes 15% of the 'disease burden' and cardiovascular disease 16%, they get far more of the budget thrown at them. Now clearly I'm not saying we pull all cancer funding and let the people with heart problems rot, and god knows I'm painfully aware of how stretched the NHS budget actually is, but if you've got something which affects 1 in 5 people in the country, surely you'd sit up and think "blimey, might wanna do something about that!"
But we don't talk about mental health issues in this country. It really is the poor relation when it comes to healthcare and it always has been; Nick Clegg pointed out before the election that mental health services in this country have been neglected for decades. Again, say what you like about him but he's not wrong; we seem to have treated people with mental health conditions appallingly in this country since the day you could pay a penny to go and poke a lunatic at Bedlam. Because that's a wholesome, fun day out for the whole family...
Now clearly when Colney Hatch and its ilk were opening up and down the country and we were locking people up inside them for years for such spurious reasons as having a learning disability, 'hysteria' and having a child out of wedlock, as happened as late as the 1920's according to Sarah Wise's excellent book (because having a child out of wedlock = loose morals; loose morals =moral defectiveness; moral defectiveness = clearly mad so quick nurse, the straitjacket!!!) we were not necessarily acting in the best interests of the often very vulnerable people inside these institutions. Frankly, for the most part, they were often appalling, with little to no therapeutic input and some pretty medieval 'medical interventions'; I always liken the institutionalization of these people to the horrifying footage I remember seeing of the Romanian orphanages when I was 9 - to all intents and purposes it was the same damn thing. But we got better (ish) and started to do all sorts of weird and wonderful things to try and help people and, somehow, we managed to make it work. Yeah sure, some of it was bloody awful, what with the lobotomies and the electro-shock therapies and the anti-psychotic meds that basically turned you into a zombie, but at least we weren't letting posh people pay to come and poke them with sticks.
Then, of course, came Mrs T and her "care in the community" shtick. Never was something so badly named; I don't believe Mrs T gave a flying fig about any of the traumatised people she turfed out of the many asylums she and her cronies shut down, leaving people who had become so institutionalized they genuinely couldn't cope in the outside world to the tender mercies of a struggling community mental health team which was badly funded then and is in an even more parlous state now.
It is this salient point Will Self raises in his article, and the reason I wanted to write this blog. Will Self and I do not always agree on things but in this particular case we are in accord: the NHS needs more funding for better mental health services and it needs it now. I alluded earlier in my article to the (frankly alarming) numbers of children and young people I come across in the course of my day job who are presenting with some form of emerging mental health need, some of which are at the extreme end of the spectrum; this doesn't, of course, include the numbers of parents I come across who have mental health conditions. Trying to get help for these people is, frankly, a nightmare; while I'm not blaming the overstretched, underfunded services for this, there are times when I think if I hear the words "sorry, it doesn't meet our criteria" again I will brain someone. Care in the community could be - is - a great idea: it would free up precious room in psychiatric wards, which are losing bed spaces at an alarming rate; it would mean vulnerable people could be treated and supported in their own homes with friends and family close at hand, leaving only the most severe cases to be hospitalized long-term; it could even, if given a full early-intervention remit, help prevent the young people I work with presenting with emerging needs from ending up severely unwell, to say nothing of the impact such early intervention and community support could have on the prison population which is all but overwhelmed with people who are, frankly, Proper Poorly.
This, of course, would require Serious Cash and it is here, as Mr Self adroitly points out, that my Utopian Scheme falls like Bambi learning to ice skate: smack bang on its face. We live in the Age of Austerity now, after all, and the mad are waaaaay down the list when it comes to being worthy of assistance. You can almost see Cameron, Osborne and their smarmy-git friends visibly recoiling at the thought of having anything to do with lunatics, for sadly we still appear to treat mental illness like some contagious bogeyman which needs either sweeping under the carpet or medicating so much it becomes catatonic and therefore unable to harm us. Because of course all 'lunatics' like to go on cheerfully unmedicated killing sprees at the drop of a hat. It says so in the Daily Mail.
Will Self notes that the current incarnation of "care in the community", through no fault really of the overworked, underfunded organisations struggling to keep afloat in the era of huge budget cuts and trying desperately to help people who are among the most vulnerable in society, is to medicate people until they're practically comatose. This is a Good Thing, apparently because it brings in money to Big Pharma, which as we all know is struggling in these times of auster...well, yeah. Quite. But just chucking pills down people's throats doesn't actually help anybody, least of all the person themselves. It's all very well putting a sticking plaster over your bleeding leg, but until we address the fact your leg is bleeding because half of it's missing then we're not going to get anywhere very fast.
We may not be locking people up and poking them with sticks any more, but I can't honestly say the general treatment of mental health conditions in this country is much improved. No one talks about it for one thing, so it's still seen as the Elephant in the Room, and no one in Government seems prepared to step up and actually do anything about it. All those people who go from prison to the streets to prison to the streets to prison and then hang themselves with a bedsheet or slice their veins open with a bit of a biro...how are we helping them? Is siloing them in a prison without addressing their mental health needs really the way forward? If Oscar Pistorious had had bipolar disorder instead of missing his lower limbs, would he still have got to serve his sentence in the medical wing of a South African prison? When Ronnie Biggs had cancer, did the prison estate just shrug and go "tough luck, mate"? No, of course not - he was given the medical care he needed for his health condition, and rightly so. (Not that I think Ronnie Biggs was a lovely bloke or anything; far from it - I'm glad the bastard finally got locked up, but that's not the point I'm making. You wouldn't withhold medical treatment to diabetics or cancer sufferers in prison because people would start causing A Fuss, but even though "mental health" has the word "health" in it we seem to be able to ignore that perfectly).
People with mental health conditions need help. They need better-funded, better-staffed services with shorter waiting lists, more early intervention work and a plethora of different therapeutic and, yes, medicated approaches in order to help them live the fullest life they possibly can. If they get really sick they should be able to go to a hospital, just as you would if your appendix suddenly burst, and they should be supported to move on from that hospital when they are no longer a danger to themselves or others. Some of them will never be able to do that, and that is why we have the likes of Broadmoor, Ashworth and Rampton, but many of them will and we should encourage them to focus on their recovery and support them to go home again. How can something which impacts so many people in this country be given such short shrift?
Finally, I leave you with this. In the last paragraph of his article Will Self note he sees the effect of this 'care in the community' stuff on a daily basis in South London; peripheral neuropathy is a common side effect of anti-psychotic medications and he often finds half-popped blister packs of prescribed drugs lying in the street, dropped by the numb fingers of someone sick enough to need to take them. He made a short video about this and wants as many people as possible to see it, hoping it might shame the Tories into honouring David Cameron's pledge for "parity of esteem" when it comes to mental health services. I'm not holding out much hope of that, but I am sharing his film. Spread the word. Make some noise. Rage against the dying of the light. Otherwise we might just as well start poking mentally unwell people with actual physical sticks instead of just metaphorical ones...
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