CW: iatrogenic (i.e. medical) abuse and neglect, psychiatric inpatient settings, suicide
Warning: in no place in this blog will you see a reference to how ‘grateful’ we are for the NHS. State-funded healthcare, paid from taxation and free at the point of access should not be something anyone is grateful for – it is a right. If you came to read an NHS love-in, you may not want to read any further.
At 8pm every Thursday night Clap For Carers happens in the UK. This is a five minute – or longer – display of appreciation for NHS staff who are going into work, risking their lives to do their jobs during the COVID-19 pandemic. There is no talk of the Weekly Clap being compulsory anywhere, but in a short space of time it seems those who don’t participate are being hauled over the coals for their (real or perceived) failure to take part. A couple of weeks ago, a woman posted on Mumsnet that she had been named and shamed in her local Facebook group for not being seen to participate in the Weekly Clap. She should not have to justify herself, but as it happens she was tending to her vomiting child.
The COVID-19-inspired starry-eyed clapping and sentimental outpouring over 100-year-old war veterans raising millions for NHS Charities has been referred to as a ‘Diana-fication’ of the NHS. There are huge similarities here with wearing poppies for Remembrance Day. ‘Who can clap the longest?’ is the new ‘Who can wear the biggest poppy from mid-September all the way through to Christmas?’. If the British do one thing well, it is performativity at the expense of scrutiny and outrage. The clapping, encouraged by the government, is designed to make us feel grateful for a system that is imperfect, and crumbling. It moves attention away from criticism. But the NHS, like any institution, should be proactively encouraging critique and be self-reflective enough to adapt and improve. We must NOT allow it to become above scrutiny, especially at a time when the Conservative government is actively working to privatise it – even using the cover of COVID-19 to accelerate their plans.
On top of this, many of the healthcare workers for whom the clapping takes place are publicly resisting the Weekly Clap, saying they’d prefer adequate PPE and pay. As an intensive care nurse on Panorama noted in late April, ‘calling us heroes just makes it OK when we die’. But there’s another issue with clapping: one that resonates very strongly with chronically mentally ill people and their families, as well as people with long-term physical health conditions. We are being asked to blanketly applaud a system in which we have overwhelmingly experienced abuse, neglect and trauma. When we announced we were going to write this blog and asked people to get in touch if they had anything to add, we were overwhelmed with responses from mentally ill and neurodiverse people who wanted to share their discomfort with the uncritical outpouring of what seems like empty sentiment every Thursday night. The main themes that have come through from their stories are examined below.
Abused and neglected by services
“Did I clap for NHS heroes? I did for the first two Thursdays as many NHS and social care staff are putting their lives at risk to save those with COVID-19. Of course, what my neighbours don’t know is that I know for a fact that not all NHS staff are heroes. When I shut my door that Thursday I was sobbing, thinking of the physical, sexual, and emotional abuse, neglect, discrimination and contempt that I and many others have experienced at the hands of the ones hailed heroes, and which the majority of Joe Public know nothing about.”
The sort of abuse and neglect described here by someone who spoke to us is sadly all too common. How can you stand on your balcony or in your garden (if you’re lucky enough to have either) and clap for a system that has been abusing you for years? Abuse comes in many forms: sexual, physical, mental, emotional; and neglect is just as damaging. We have heard from people who are finding the whole experience so confusing because they have experienced both compassionate care from some staff, while being abused by others. Is it possible to clap for some but not all? One person who contacted us was in the psychiatric unit when the Weekly Clapping began:
“This is very confusing for me because some psych staff were HORRIBLE to me, while others were so lovely…even when we clapped for the staff on the ward one day none of them even came out to that yard where we were clapping…the next week, we all did it again and some staff were clearly touched and felt appreciated. The amount of pain some of them have caused will stay with me and I hope they feel ashamed of themselves.”
Abuse on inpatient wards is especially rife and goes largely unchecked. Those of us who are in and out of psychiatric units know this only too well. The Twitter accounts showing smiling staff doing Occupational Therapy activities can disguise so much. One long-term service user said:
“There is a herd mentality among many NHS staff who think it’s perfectly OK to treat patients with contempt. There is no immunity for us. The TikTok videos all over social media of mental health so-called professionals taking the piss out of patients, the posts in a large mental health nurses Facebook group with so many hideous comments and likes. These are passed off as humour, but as many of us know only too well, they are real.”
A further issue is the general invisibility of mentally ill people, which was a problem before COVID-19 broke out. This came from the partner of someone who is struggling with mental health issues (sent with permission):
“[He] has been isolated due to mental health problems for a long time, not leaving the house more than once or twice a month. He now feels that suddenly everyone cares about this ’cause’ because it’s been affecting them for a few weeks, but that after lockdown is over it’ll all be forgotten again, in fact it will be worse because the scant NHS care available to him previously may well suffer budget cuts. Add to this the hero worship of NHS staff who’ve left him in this isolated position and the weekly clap gives him extreme anxiety all day Thursday. He feels judged by neighbours for not coming outside to clap and also finds the noise triggers his anxiety, too. He also feels guilt because he does appreciate the work of individuals within the organisation.”
That any person already struggling with mental illness should be made to feel any worse by real or perceived judgment for not clapping is difficult to stomach.
Complaints made about iatrogenic abuse and neglect, especially those about mental health care, are quite often ignored or lost. One person who had been on a psychiatric unit recently enough to have experienced the Weekly Clap on the ward gave us a remarkable account of their conflicting feelings about the clapping, and the loss of numerous complaints they made:
“I submitted a number of complaints about things I endured, but my complaints haven’t even arrived at the Complaints Team, and I’d been in hospital for 8 months and only ONE of my complaints made it (the rest presumably ripped up by staff).”
Problems with worry about Coronavirus and social distancing on wards are also resulting in poor care by staff. Someone else recently sectioned told us this:
I was recently sectioned and saw a lot in my time there. Social distancing was impossible. The system abuses human rights and is coercive. Staff are trying really hard, but still forget the basics of introducing themselves. No visitors. No leave. Staff resorted to pushing patients away when they got too close and kicking their feet out. I was told when I was getting better ‘there’s nothing wrong with you’ and when I cried ‘so emotional’. Life in the psych ward wasn’t pretty and glad I was only there for 6 days.”
People experiencing mental distress should not be detained in places that treat them like this. It is that simple.
Some diagnoses – especially that of ‘Borderline Personality Disorder’ – actively encourage neglectful and abusive behaviour from mental health staff, as evidenced by this 2016 study, whose results state, ‘the BPD label was associated with more negative ratings of the woman’s problems and her prognosis, than both information alone and a behavioural description of BPD ‘symptoms’. The invalidating effect of this diagnosis is further discussed by psychologist Jay Watts here. ‘BPD’ can be a carte blanche for mental health professionals to treat their patients with contempt, give them negative labels such as ‘manipulative’ and ‘attention seeking’ and subject them to further trauma. This blog highlights these problems all too well, giving a troubling account of what it’s like to spend time in a psychiatric ward with a presumed diagnosis of BPD. If your experience of the NHS is one rife with neglect, verbal abuse and outright contempt, can you imagine how terrifying it is to see the NHS lauded as an institution that must be above criticism and beyond reproach?
Far too often we hear familiar cries of #notallprofessionals in reply to patients on Twitter telling their truths. Yes we know not every mental health professional is evil. We know that the psychiatric system has been left underfunded and increasingly privatised, with staff shortages and stressed staff. However, this does not excuse appalling behaviour, and never will.
A major worry with NHS staff being ‘heroes’ rather than simply ‘people doing the jobs for which they are paid with adequate protection’, is that accountability and a transparent complaints system become all the harder to achieve.
Some mentally ill and neurodiverse people, especially those living in more densely-populated areas, are experiencing problems with the Weekly Clap in another way entirely. For some people, especially those with autism and PTSD, the sensory overload of five minutes of noise (sometimes now including fireworks!) is too much:
“I have autism and I find the noise really hard and upsetting. I don’t know if it’ll be 30 seconds or over 5 minutes. I turn all my lights off and curl up with my noise cancelling headphones on.”
Added to this, of course, is the fact that fireworks cause a great deal of distress to pets, and many children are in bed by 8pm. Never mind the irony that the beloved NHS staff who are the beneficiaries of the Weekly Clap may actually be asleep too if they’re working shifts. At least we have a weekly day and time to be prepared for it, but it’s never ideal.
If white, cisgendered, straight, physically-abled, middle class mentally ill people are having trouble with the Weekly Clap, it is important to consider that it is may be much worse for their BAME, migrant, fat, physically disabled and LGBTQIA+ counterparts who, on the whole, suffer even more abuse and neglect by mental and physical health services on account of intersecting oppressive structures. See reports by LankellyChase and LGBT Health and Wellbeing for more information on mental health inequality in BAME and LGBTQIA+ groups.
As well as this, we also know that BAME staff working for the NHS are dying at a greater rate than their white counterparts. Efforts to understand this alarming disparity have been slow to materialise. However, one person who contacted us questioned if differences in the work carried out be BAME and white members of staff was contributing to this disparity:
“I am not able to clap for the white, middle-aged, female mental health nurses who repeatedly sat around eating biscuits and gossiping – whilst their BAME colleagues did all the hard and dirty work on the ward. I wonder if this behaviour is still going on, and how it might be contributing to the current crisis.”
Patients on mental health units not only see and experience the abuse of patients by staff in terms of coercion, illegal restraining, forced sedation; but also witness staff on staff bullying and workplace inequality.
A standing ovation
So clap, if you want. We’re not in the business of policing what other people do. But if your neighbour isn’t clapping too, first consider whether they might be indisposed; second consider whether they have suffered iatrogenic trauma at the hands of the NHS; and third, mind your own damn business. The NHS is not an unequivocal force for good. Many people have suffered abuse by its staff: and many of those people at the hands of mental health services. Sayings like ‘parity of esteem’ are flung around and mental suffering is compared to a broken leg (spoiler: it is nothing like a broken leg). But these sayings and awareness campaigns, however well-intentioned, mean nothing without change from above: changes that transform the experience of being under secondary or tertiary mental health services in the UK. We might even clap with you if reform starts to happen.
If you’ve enjoyed reading this blog, please consider donating to our Hardship Fund for people with a mental health condition who are in financial need during COVID19. Mad Covid is an entirely unfunded group.
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