Paying lip service to mental health

October 9, 2019

Have you ever sat in your car in a hospital car park, trying not to be sick; wanting not to have seen what you’ve seen, not have heard what you heard, not know what you now know?

Have you ever held someone’s hand when the consultant tells a loved one they have cancer? Have you ever been taken into a side room and told by a doctor there is nothing more that can be done?

Have you ever knelt in front of the toilet bowl and thrown up before going into work? Have you ever sat outside your office gripping the steering wheel of your car as tight as you can to try and stop your hands shaking?

Have you ever come home at night and just sobbed over how miserable and isolated you feel? Have you lain awake with the criticism, humiliation and ridicule you’ve endured echoing around your head so loudly you can’t sleep?

Have you ever had that call when someone you’ve shared life’s journey with has decided to end it all because of the pressures they were carrying within them? Have you ever clung to that now lost voice on your answering machine?

If you can honestly answer ‘no’ to every one of these then you truly are lucky. Every single person I know will tick more than one of these.

In the last four years, my wife has dealt with all of them.

The pressures we feel in our personal and professional lives don’t just make us who we are, but who we aren’t.

Despite all the publicity and social media posts about removing the stigma of mental health, the truth is it is probably more dominant than ever… and as intrinsically powerful and destructive as ever.

Go over on your ankle and the pain will lead you to A&E for that x-ray. Feel frightened, intimidated, lost or worthless and you travel inwards, and sometimes you never come back.

The only way you ever really reach someone and understand what they are going through, is to speak to them, and to let them speak. Despite all the lip service and tokenism made from official bodies, it is the individual who understands, not the collective, not ever the collective. And while I certainly am no royalist, I thought that was underlined by the publicity given to mental health issues by Princes William and Harry. It was a rare example where station in life is irrelevant, and understanding it is the individual that matters.

Government, organisations, businesses, bosses, media, can all make the right sounds but in too many cases their actions don’t bear scrutiny, and, more often than not, there is a disgraceful display of double standards.

Even the support organisations, like the Scottish Association for Mental Health, the Samaritans, the Mental Health Foundation, operate on a reaction basis. Of course reaching out to those struggling with the effects is important, but the actual action of addressing the causation is just as vital.

Dealing, if you are able to, with a mental health issue must surely be one of the loneliest journeys you can make. Those around you don’t just have the responsibility of providing support and understanding, but also anticipating and limiting the damage of that psychological explosion or implosion.

Professional help, in diagnosis and prognosis, can literally save a life. It’s not about unravelling the tangle it is about helping to recognise that tangle and the threads that make it, and addressing each and every one of them.

Over the past few months my wife worked on a complaint and then a blog based on her fitness-to-practise hearing held by the Scottish Social Services Council. She fought her corner and fought it well, and lost. That’s life. The blog is finished now and I hope the writing of it did provide at least a partial catharsis.

Some of the events she encountered I found astonishing and disturbing. I witnessed many of them first hand, and that was followed by weeks of helping and advising her and what she could and couldn’t say and put out into the public domain, and realising the damage the whole experience caused her.

But there is one aspect I find revolting and repugnant – the assessment carried out on her mental health.

I majored in psychology at university. The subject I found most fascinating was abnormal psychology and communication. It was a long time ago but even so, when I graduated, I wouldn’t have dared to presume I could even perform an acceptable lab experiment on putting woodlice through a maze.

To assess someone’s personality is a complex and confidential process. It takes years of training, years of practise, along with hours and hours of client sessions.

Unless you are the SSSC.

Now I know there will be groans of “Oh no, not the SSSC again”. Well, to be fair, it’s not just the SSSC, a solicitor told me all governing bodies do it, and that makes it even worse. It some respects it is such a complicated subject, and, bizarrely, it is made complicated by sheer simplicity and idiocy.

No matter how a governing bodies presents a character analysis, it is an assessment of mental health, and of attitudes and values. Yet it has no validity and no authority. There is no data, no methodology, no rationale, no research, no qualification, and absolutely no regard for the mental health of the subject at the time of an incident, during the investigation, at the hearing and in the aftermath. Or the damage this subjective, amateurish puerile pontificating can cause.

What happened to my wife was this. She was assessed as “lacking insight” and of having no “meaningful reflection”. Add to that a personality that was “critical and negative”.

Basically, the classic symptoms of anosognosia, but let’s put that aside.

In the months that led up to the allegations against her, she endured having to deal with disease, death and despair coming from every direction. And when it came time to defend herself, I added to that burden with her trying to deal with the SSSC while facing weeks and weeks of daily winter visits to Ninewells.

And at the very heart of that emotional, sapping period was her work environment. I remember the tears, the rage, the frustration and, to my shame, growing weary of the endless tales of being undermined, criticised, harassed and bullied. It was the final straw and it broke her.

So months later, she dismissed the option to make or accept any compromise on her responsibility, and believed the two superiors she had issues with would be brought to account for their behaviour. Incredibly,they were the only two witnesses called to give evidence on that behaviour. They even arrived together at the hearing. 

Their corroborative statements were accepted without question as proof that none of my wife’s claims had any validity or substance. Together they described an environment that, while busy, was not very far short of bliss and benevolence. It was an atmosphere of care, compassion and concern, but one, however, that did not pick up the signals that a manager was struggling. 

So, after being portrayed as being somewhere between a liar and a fantasist, came that damning personality assessment. It was made without a single meeting, and constructed without conversation or consent. It is hard to believe but it is actually not even tailored - the phrases and buzz words litter the profiles of dozens of others. These are the final off-the-shelf conclusions. issued with authority and finality.

But by whom? It appears that these assessments are  written by someone with no mental health qualifications or expertise at all. Then to compound the insult, ignominy and invasion into your personality, this is then posted online and put into the public domain… forever.

If you look at the rules, published by the Royal College of Psychiatrists, governing psychiatric reports presented in criminal courts, that SSSC assessment breaches every safeguard and professional protocol there is.

But there is the problem. The SSSC's analysis is beyond the reach of all authority as it is neither medical nor expert, but it is protected by law.

The SSSC operates freely within two Catch 22s. There is the Article 6 conundrum of the Human Rights Acts that guarantees everyone has a fair hearing but... the SSSC  doesn't need to be fair as long as there is a right of appeal over anything that might be unfair, because that appeal then makes the process fair. 

Then there are the rules governing psychological profiling. There must be methodology; it can be scrutinised, challenged, and must be confidential - if it is expert and medical. But if it is an amateur opinion simply pretending to be expert or medical, then it doesn't need to meet any of those criteria and can be made public without any recourse. Outwith the hearing process, it would be defamatory. Inside it though it is protected by privilege and by Article 6.

The Tweet from SSSC chief executive Lorraine Gray that
underlined the importance the governing body gives
 to mental health officers.

The sheer hypocrisy of this bizarre state of affairs was underlined by a recent Tweet from SSSC chief executive Lorraine Gray. She posted on Twitter, along with a picture of herself, the SSSC commitment to supporting the training of social workers as mental health officers (MHOs), and inviting those to study the key data the SSSC had collated. The importance of MHOs was stressed yet their governing body actually practises a process of mental health assessments carried out by not meeting or speaking to anyone but just subjectively making them up then sharing them on the internet with the world.

I hope the first mental health officer who faces a fitness to practise hearing appreciates the irony of that.

Think about it. How would you feel if someone you have never met or spoken to went and posted an ‘official’ assessment of you?

Murderers are given more respect than that.

And who has authorised this?

We have, the public.

We have said it is perfectly permissible to subjectively judge another person’s mental health and state of mind and then share it with the world, free of any challenge or comeback.

It would be interesting to find out the impact of that unregulated freedom on people’s lives.

It is outrageous and reckless behaviour, and yet it is publicly condoned. It’s one thing to share a meme proffering support to those with mental health issues with a “I know who will share this” message but just consider where those issues might come from.

My wife has contacted a number of mental health organisations as well as a solicitor, seeking their advice. All have said amateur psychological assessments are beyond reach, but the legal advice was as cynical as it was honest.

The best way to have avoided all of this – the career-ending decision, the humiliation, the public vilification, that damning piece of psychological drivel – was not to have challenged the initial decision in the first place and not to have insisted on going to a hearing.

Contrary to the logic of expecting the governing body of your profession, one you partially fund through annual subscriptions, to legally act on your behalf according to the principle of Scots law, it is just the biggest bully in the playground, and the teacher’s pet.

Surely as individuals and the groups left to pick up the pieces of people’s shattered lives we should be tackling this? The Scottish Government recognises, or at least says it recognises, that mental illness is one of the major public health challenges in Scotland, yet it approves and endorses the behaviour of organisations like the SSSC.

Why aren’t our MSPs, the staff of mental health organisations, support group workers and the general public asking questions?

Questions like, “What are the qualifications of the people making these assessments?”

“On what evidence did you base them?”

“Why do they need to be made public?”

“What is your purpose for permanently stigmatising an individual?”

These are hardly difficult or controversial questions. We wouldn’t let someone with no medical knowledge, who has never even spoken to us, publicly proclaim personal details on our health.

If it was our mental health, we’d be equally aggrieved.

But, if it is someone else? Well, that seems to be a different matter. We can live with that.

Maybe it's harder to live with, when it's you?