This is a story about home treatment...
This is what the Conservative government's 1990's Care in the Community policy looks like, in practice. An extremely low-paid NHS worker, who isn't trained as a mental health nurse, is dispatched on public transport to travel across the London borough of Tower Hamlets, to bring me a bag of medication. They're supposed to check that the old packets are empty, which 'proves' I've been taking my medication. They're supposed to escalate any problems to nurses and doctors, back at base. If they can't find me or get in contact, they're supposed to ring the police.
It's that final point that's the important one: the police got co-opted into this half-baked scheme. Of the people the police deal with - the front-line officers - most of them will have mental health issues. The police are picking up the pieces of the mental health epidemic. When somebody is truly having a mental health crisis, the police will be the ones who get that sick person to the place where they should have been in the first place: a psychiatric institution.
There are nurses, psychiatrists, social workers and the like, who are involved in assessing whether you need to be detained under the Mental Health Act - what's known colloquially as a 'section'. If you're seriously mentally ill and out in the community, it's down to the police to find you, catch you, detain you and get you to that assessment where you get 'sectioned'.
Also, the police are out there, picking up body parts off the train tracks and underground railway. The police are there when somebody has jumped off a bridge and landed in a river or on some mud flats, or maybe gone splat into something harder below - perhaps a road. The police are there when somebody looks like they're about to jump under a train or off a bridge - CCTV operators are trained to look out for agitated members of the public, who look like they're about to top themselves.
Around the time of Care in the Community, there was an explosion in prescribing of psychiatric medication by our ordinary general practitioners (GPs) - our regular family doctors - there were 9 million prescriptions for Prozac in the UK in 1991. This is the principle behind Care in the Community: put people in a chemical straightjacket, and they can be safely released back into the general population. Ten years later, there were 24 million prescriptions for Prozac and another ten or so years later again, and London alone gets through over 60 million prescriptions for Prozac. These are almost all issued by a GP, not a psychiatrist.
When it comes to "serious" mental illness - anxiety disorders, bipolar disorder (a.k.a. manic depression), schizophrenia, personality disorders - the NHS kicks you out of the bit where you get various therapy options (e.g. CBT) and instead you're referred to a psychiatrist, who will prescribe some fairly brutal medication. In the case of schizophrenia, you could have a risperidone implant, injected underneath your skin, which will keep you in a chemical straightjacket for up to 6 months.
The other people who got co-opted into this Care in the Community policy were the general public. An average member of the public is fairly fearful of a schizophrenic, believing them to have multiple personalities and a propensity for violence. Several murders that received significant media attention, focussed on the fact that they were committed by formerly institutionalised schizophrenics. Depression is now such a common feature of people's lives, that any stigma has gone, but most people would be fearful of living near, working with, or having their children around a schizophrenic, surveys have found. Lock your doors - there might be a madman lurking nearby.
If I was in hospital, I'd have somebody checking on me every 30 minutes to an hour - making sure I hadn't found some way to harm myself. With the Crisis Team (a.k.a. Home Treatment Team) who are tasked with keeping me safe at home, I see them every other day. I could take a fatal overdose 2 hours before they were due to arrive, and by the time an ambulance got to me, I would be well and truly dead as a dodo.
I had stockpiled 336 tramadol tablets (16.8 grams) which is enough for two people to commit suicide, easily. As part of their responsibility to help keep me safe, they asked me for the tramadol back. I gave them 112 tablets (one box) which was a tick in their box. In hospital, I would never be able to hide the remaining 224 tablets from the nurses. If I took an overdose, I'd be fed activated charcoal, have my stomach pumped, be put on a respirator and given various medications to counteract the deadly effects of a tramadol overdose, in plenty of time to save my life.
I can't tell you what the cause and effect is. I can't tell you whether Care in the Community is the reason for the mental health epidemic, or whether it's something else, such as the collapse in living standards and precarious lives we live now, with our income and housing under constant threat.
Most people don't like to lose their liberty. In fact, it's distressing to be locked up somewhere, and not allowed to leave. There are crisis houses, where you can come and go as you please during the day, but you have to be back by nightfall and sleep there or else the police will be sent out to find you. This seems like a compromise that would suit most people who are having a mental health crisis, who pose no danger to the general public.
With the false security of Care in the Community, the number of beds available for those having a mental health crisis, has been slashed dramatically. You can attempt suicide and be hospitalised - in intensive care - and then discharged out onto the streets, simply because there isn't a free bed on a psych ward or in a crisis house, where you could more safely transition back to normal life. You can be suicidal, and the best the NHS can offer you is to come check that you're still alive once a day.
As a man, I'm many times more likely to commit suicide than a woman, but far less likely to seek help. This means that I have had the good fortune of being looked after once in a crisis house and once under a voluntary 'section' on a psych ward. Not many people receive lifesaving treatment like that - the resources just aren't there anymore.
So, what's the solution? Pharmaceutical companies tell us their medications are better than ever. More and more of us are taking powerful psychiatric medication. But, yet, the percentage of the population suffering from mental health issues is ever-growing; suicide rates keep climbing - there is, undoubtably, a mental health epidemic. My personal opinion is that it's not a medical problem: it's a problem created by insecurity: jobs and housing; it's a problem created by declining living standards and soaring levels of stress.
No amount of pills are going to fix the mental health epidemic, even if you bring them to my door.