Epilogue: After The Asylumsfrom Barbara Taylor ‘The Last Asylum’ (2014)

Friern is closed on April Fool’s Day 1993. Barbara gets into the ruins sometime in 1996 and finds Ward 16. It is post-apocalypse with smashed windows, scattered lockers, and pigeon droppings everywhere. Friern has become Princess Park Manor. Friern has been erased and the place is now home to the rich – football players, pop stars and TV entertainers. In 1998 a film-maker brought together some of the new residents with former patients. One former patient says: I can go now, I’m not frightened any more. The new place has leisure facilities, a cafe and private bus service to the station and shops. The demise of Friern was the culmination of Enoch Powell’s movement from 1961. Today former residents live with families, or in group homes (not for long?), or social housing, or have disappeared into urban homelessness. Even Enoch, a strong supporter of private enterprise, could not have foreseen competing Foundation Trusts, private providers, and third sector organisations.How would Barbara get on today compared to the 1980’s? Community care arrived in a spirit of transformative optimism – a spirit of independence. Minimal care was to be provided, only that which the individual could not meet by his own efforts. Peter Campbell has written of the double whammy – patients’ expectations of dependency and staff willingness to enforce that. ‘The infantalising of institutionalisation. User involvement movement provided Peter and others with their sense of independence and integrity. There was the Paddington Day Hospital fracas, the mad revolution, SSO, HVN and so on. She mentions NSUN. Barbara saw nothing of this, the service user movement, in her time in the MH system. Indeed, when staff offered a Patients’ Union at Whittingdon, this

was rejected by the patients as ‘You’re on our side, we don’t need a union.’ ‘No decision about us without us’ was a distant dream.There was violence and injury ib the asylums.Today we have recovery, wellness and choice, which are token and apparent only and depend on the power relationship involved.Recovery is everywhere. It means to live with a chronic illness as if you didn’t have it. Recovery strategies, Recovery Teams, and Recovery Colleges. Are these reforms really happening? Has recovery been hijacked for a policy of cutbacks, and whose recovery is it anyway? There is now no attempt at open-ended care for these work-limiting illnesses. Interventions are time-limited. Dependency is the flip side of recovery. People are not allowed to congregate with others for solidarity and common support. Where people feel supported is where most success happens. When people do not turn up for appointments or have other issues, this can be seen as their ‘choice’ as if they can choose not to be ill. Is choice more important than care? 2006 – DoH website ‘Our Choices in Mental Health.’ 2007 CTO’s introduced. Compulsion to take medication or return to hospital. Once in system, people have no choice about who cares for them and a high proportion have no choice about their medication. It’s almost impossible to get into hospital unless sectioned. Staff are stretched. Risk may be the watchword most in practice rather than recovery or choice. Risk = public anxiety over violent patients. Some people never see the same psychiatrist twice – they have no idea who the person is. Medical staff, CPN’s etc, just tick the boxes. Barbara mentions Clare Allan’s ‘Poppy Shakespeare’ (2006) and Clare’s moving tribute to her social worker. All that we have now is a mechanistic, formulaic, depersonalised substitute for quality care.Many MH professionals are keen on remedies. But there is little scientific evidence that we know brain chemistry. Overuse of drugs does more harm than good, with debilitating side effects. Studies

show correlation between high meds and poor patient outcomes. In the UK patients on long term meds die 15 years prematurely, in the US it is 25 years prematurely. BJP has called for an end to the pharmacological revolution. Peter Campbell says community care is built on medication. Meds should be limited and monitored, and zombification avoided. Medical model treats people remotely, it does not involve getting close. But also doctors and staff have their own anxieties and vulnerabilities in their complex relationships with patients.Open-ended care breeds ghettoeisation and people are silted up, so care is time-limited, except for drugs. Even CBT is remote via computer or phone. Richard Layard, economist, urged government to bring in CBT. Barbara is delighted that government has brought in CBT and other talking therapies. Every UK citizen is now entitled to psychotherapy. She regrets that the taking of patients’ histories is disappearing, no family, children, jobs etc. What would happen to her today? She could afford privately funded psychotherapy, and she might have got lucky in the route through crisis teams, acute wards, recovery teams and CPA. She might have got lucky. She would not get her havens of Friern, day hospital, Pine Street, all are gone. (These were not all havens for me – not the asylum.) The asylum system’s history is not a happy one, but it will be a tragedy if there is a demise of humane effective mental health care. (Is this what happens at My Story? There are some good times.) (The asylums were not places for humane care. Day centres may not be the only places where humane care takes place.)