‘England’s mental health care lacks money, yes – but it also lacks compassion’. New article from me for
@guardian
emphasising the paradigm shift we need is as much about ideology as funding. Can we seize the moment? Can we afford not to?
#IatrogenicHarm
Suicidal ideation IS sometimes a communication in that the communication is 'I am suicidal, help me before this is inevitable'. The communication is not 'look at me' in the way it seems to get imagined.
"Time to withhold benefits from those who won’t look for work", Jeremy Hunt will declare today.
As a consultant clinical psychologist, can I say clearly the government has been doing this since 2010.
This has increased suicidal attempts and self-injury.
It is a dehumanising.
PIP has nothing to do with employment.
PIP is for moderate to severe disability and it is v difficult to qualify for.
It is not something one can blag. I research this.
Sunak's idea people can go off PIP with treatment is wild and dangerous. It is disability denial,no less.
As a consultant clinical psychologist, can I tell you nothing is less true. It is incredibly difficult to get disability benefits. It is not just a case of going to the GP and self-declaring. Claimants are constantly being assessed and reassessed to get and keep needed benefits.
Dear Mr Sunak,
I am writing on behalf of the whole NHS mental health and charity sector services as we are a bit too knackered to do another consultation.
Changing PIP would be disastrous and cost lives +++
Even suggesting it has triggered a lot of people today.
Thanks,
All.
Dear Mel Stride,
PIP has nothing to do with employment.
PIP is for moderate to severe disability and is v difficult to qualify for.
Noone gets PIP 'for' depression or anxiety. It is based on a functional analysis.
Stop playing smoke and mirrors with people's lives.
Jay
The complex trauma/ neurodivergent ability to respond in an organised and useful way to any acute crisis but be utterly incapable of responding to an email or sorting out where one is supposed to be when.
“Mental Illness doesn’t discriminate”.
Except it does.
If you are poor, a woman, or from a disenfranchised group, you are far more likely to breakdown.
I would like to think we can hold this truth whilst recognising that anyone can fall apart.
#WorldMentalHealthDay2018
To be clear given Sunak's discourse today:
Anxiety can be a mild condition. Anxiety can be a moderate mental health problem. Anxiety can be so severe one ends up in psychiatric hospital for a long time and are a high suicide risk.
Anxiety as a signifier doesn't tell us much.
Monitoring benefits claimants' bank accounts is incredibly dangerous.
It will reduce the lives people feel they can have - buy a treat, go to the cinema etc - for fear of being tagged as 'suspicious' by a punitive, distrusting system.
This will hugely damage mental health.
Noone gets £1000s on PIP.
I have never met ANYONE whose disability costs are completely covered by PIP.
Disability is expensive.
PIP is not an out-of-work benefit. It is a disability-makes-life-expensive benefit to level things out just a bit.
Thinking of sixteen-year
#Brianna
Ghey, a beautiful young woman who loved synching to songs on TikTok, her dog, make-up and the hair and beauty course she was about to start. My love and solidarity with the
#trans
community as a cherished part of our LGBTQIA+ family.
Some of us were campaigning against this script a few years back. It's back with a vengeance. Please call it out:
- work is not a therapy or cure
- bad work makes mental health worse
-many will never work
- structure can be great so re-open day centres
- DWP pressure is deadly
As a consultant clinical psychologist, I can tell you why incapacity benefit claims are soaring. Lengthy waiting times worsen illnesses. Social care is fragmented. Countless systemic issues, including the DWP's dehumanizing policies, contribute. It's not individual's 'coasting'.
Someone can be very mentally unwell AND able to articulate the problem.
Someone can also be very mentally unwell AND able to speak this WITHOUT seeming emotion AND still be at great risk.
"Specialist teams linked to the benefits system will instead assess the sick and decide how best to keep them in work." What DWP Health Assessors whose work is so bad that most claimants win at appeal? Who trigger so many with questions such as 'why haven't you killed yourself?"
Selective mutism, often a response to illness, trauma, or a facet of neurodivergence, is frequently misinterpreted in the mental health system as 'behavioural', or being 'difficult' or 'manipulative'.. This is very damaging blocking care and effecting our sense-of-self.
The Borderline label is used to label patients as hostile, manipulative, attention-seeking. It rationalises sadistic counter-transference and justifies the repetition of emotional neglect by mental health services. Often, it's the staff projecting and denying, not the patient.
“Depression doesn’t discriminate”.
Except it does.
If you are poor, a woman, or from a disenfranchised group, you are far more likely to become depressed.
I would like to think we can hold this truth whilst recognising that anyone can become depressed.
Just a gentle reminder Der Kolk didn’t come up with cPTSD in the 00s, Judith Herman did in 1992. Herman’s ‘Trauma and Recovery’ is a brilliant read without the ethical problems.
Got to say when I started working in mental health, I didn't expect to spend half my bloody time fighting a government department seemingly hellbent on depriving people of the means to live tolerable lives.
There are 256 combinations of symptoms by which an individual could receive a ‘borderline personality disorder’ diagnosis in DSM-V. If we bin all that ideology and meet the person relationally, we have what is actually important-a person in agony who deserves compassion and care.
The
#DWP
have just announced another attempt to squeeze benefits claimants so they can perform protecting working-families.
As we saw a few years ago, they are using behavioural techniques and therapists in this mission.
We simply must speak out: work is not a health outcome.
Borderline personality disorder as a label is and always has been an excuse for neglect, abuse, trauma and neurodivergence denial and hate.
It should be an embarrassment to anyone interested in a humane mental health system.
New- Those who experience trauma during childhood are 15 TIMES more likely to be diagnosed with borderline personality disorder later in life.
Evidence from a sample of 93,000
Telling traumatised patients they have a disordered personality violates human rights.
#TraumaNotPD
ADHD = it's rejection sensitivity, super common, let's help
BPD= you are showing 'frantic abandonment' because of your 'unstable sense of self' which makes you 'manipulative'' and 'attention-seeing'. We're going to treat you by rejecting you even more.
TW suicide
If someone is actively suicidal one minute and then enjoying toast with marmite, or similar, half an hour later, it doesn't mean they are no longer at risk or were feigning their earlier state.
I have just written to Jackie Doyle-Price - the new Minister for Suicide Prevention - linking the benefits system with suicide rates and asking her to address this as an urgent priority. I am hoping we can get lots of pressure on her from lots of quarters to action this. 🤞
Beware 'autistic traits' being used increasingly to maintain the construct of 'borderline personality disorder'.
It can be an excuse not to formally assess autism, and to maintain BPD's rightfulness as a diagnosis.
#AutismNotPD
Illness or disability doesn't equate to a lack of duty. You're valuable as you are.
The ups and downs of disabilities/mental health can make us feel we 'should' do more. That's internalized ableism, not truth.
You're doing great as you are—worth is not tied to productivity.
Just a reminder that a diagnosis of Borderline Personality tells you one thing and one thing only.
This is that there is a person in front of you in a great deal of pain who deserves your help and compassion.
Meet the person not the diagnosis. Always.
As
#UnmaskingMyAutism
is helping raise awareness
- one-third of women in an eating disorders service met criteria; few had been diagnosed
- autistic women are 13x more likely to die by suicide
- misrecognition leads to iatrogenic harm that produces distress further misdiagnosed
A child living in a household that can't afford to keep the house warm has a 13.6% chance of reaching criteria for a mental health problem compared to 6% otherwise.
If family hasn't the money for sufficient food, it's 11.8% compared to 4.4%.
Poverty is a mental health issue.
Dear Lived Experience Person
We would like to have you at our conference.
You won’t get paid.
You will be expected to bear your soul.
We will then drop you.
Thanks.
Please remember that many, many people are reading tweets in profound despair, awful circumstances, debating whether to live or die.
The environment we co-create on Twitter can make people feel ‘yes it is worth going on, it is worth hoping’ or ‘no it isnt’.
Compassion, folks.
As
#MyalgicEncephalomyelitis
is trending, I want to acknowledge once more the role my profession has played in the historical and current gaslighting of ME/CFS patients. I fully support increased funding and greater respect for biomedical research in this field. Ditto Long Covid.
Just a reminder if a patient tells you they are feeling suicidal this is a GOOD thing, a BRAVE thing, a thing we are LITERALLY TOLD TO DO. So please don't frame it as manipulation or attention-seeking either overtly or in micro-tells of disbelief.
Just out - all the ‘new’ mental health money is going into employment advisors in IAPT. So not invested in wards, therapists, crisis homes… services that improve QoL and end up cheaper in reducing admission rates but the ‘growth economy’.
Work is not a health outcome.
Private Eye has picked up on the suicide rates for those on ESA, thanks to the amazing work of
@johnpringdns
cf piccies. We will not stop campaigning until there is change.
As a consultant psychologist, I would like to emphasise how dangerous these plans are. Ability to work is a v. complex thing to assess. Getting it wrong is simply life-threatening. 15 years ago it had to be doctors. Now non-qualified people under duress to return numbers to work.
Borderline personality disorder is not an 'illness of character'.
It is an umbrella term that enables contempt, abuse and neglect both in and outside of psychiatric services.
It covers up complex trauma, neurodivergence, discrimination, bipolar and PMDD, sometimes fatally.
When you come for mental health claimants, you don't come for someone feigning depression or anxiety as you are led to believe.
You come for people who are suffering desperately, who have been repeatedly and intrusively assessed, who already have thoughts of being expendable.
The government is now going after PIP (Personal Independence Payment) for pensioners saying 'they are not working, why should they get the money'.
Let's be clear. PIP is nothing to do with work.
PIP is given whether someone is in work or not as disability is bloody expensive.
Can’t believe the Citizens Advice Bureau has sold out to the DWP for £51 million after 79 years of independence. It is near impossible to bite the hand that feeds - as we have seen with so many charities - so a clever way to mute criticism of
#UniversalCredit
.
Please remember if you are a claimant:
This government is on the way out.
Nothing is to change with your benefits.
Disabilty is expensive. If you are on PIP, you deserve it.
Being on benefits is nothing to be ashamed of.
We all thrive in supporting one another.
Jay x
TW- suicide
The psychiatric narrative around me when I was young was that I would be dead by 25.
I am very much not 25, and very much alive.
Many of us have made multiple attempts and been suicidal for many (many many) years but that changed.
Suicide is never inevitable X
I loathe all this psychologists versus psychiatrists bollocks, I really must say. As a patient, all professions in the MDT have both caused me
#IatrogenicHarm
and have the potential to help. The power reframe I want is patient voices first and *all* professionals second to that.
Borderline Personality Disorder as a label is increasingly recognised as a motivated characterisation used as a tool to deny individuals in need care and reinforcing harmful prejudices. It can strengthen patients' deepest insecurities+ further marginalise those already let down.
The patient who you think is being difficult, angry or oversensitive is pretty much always protecting you from the extent of what they are feeling and what they’ve been through.
Managing one’s clinician so they don’t feel overwhelmed or panic is a real thing and exhausting.
Mental health services are hell-bound on diagnosing borderline personality disorder in ever expanding numbers despite the fact both DSM and the latest ICD literally recognise that it has no reliability or validity as a construct, and it's devastating effects on countless lives!
Comments crisis team told Fern:
"If you wanted to kill yourself you'd already be dead."
"If you are phoning us then you aren't really suicidal as you are asking for help."
"If you want to kill yourself that's your choice."
"What do you expect us to do about it?"
#JusticeForFern
'Mental health services in crisis are abandoning patients to meet targets' New piece from me on what I think is one of the biggest problems in mental health
#Offrolling
#MentalHealth
.
TW- suicide
A 14 year old kills herself having looked at pics of suicide on Instagram. The Health Secretary acts immediately.
Disabled people lobby for years on deaths by suicide triggered by the benefits system. The Tories says this suggestion is ‘appalling’ and do nothing.
Piling on pressure for people to work when they are not ready, and may never be, is dangerous.
It demonstrably decreases the likelihood of being able to eventually stay in a job.
It ups the risk of self-injury and suicidal ideation.
It is a form of disability hate..
Preoccupied by that nursing assistant on
#Panorama
who was one of the most contemptuous and verbally abusive and then later comforted the very same patient with a huge hug the patient was obviously collapsing into.
That dynamic is so central in abuse.
#Panorama
#IatrogenicHarm
As a consultant clinical psychologist, can I say literally the last thing patients need is an escalation in rhetoric against benefits claimants, led by the newspapers. Surviving on benefits financially is already near impossible, the hateful discourse already internalised enough.
MH PROFESSIONALS RE: BENEFITS
A draft letter from us to the Telegraph re their appalling 'Benefits Calculator' this week. We know the dire effects this has on claimants and its important to stop this new wave of hate
Please consider signing. Thanks- Jay
Professionals, if you are interested in improving the diagnosis of predominantly female and queer mood, how about focusing on screening for:
- autism
- adhd
- bipolar
- PMDD
- cPTSD
All of which tend to be late or misdiagnosed devastatingly and dont result in care deprivation.
Introducing the SAPAS, an 8-question screening for personality disorders, in primary care is a recipe for disaster. It's a perfect excuse to offroll, exclude and delegitimise patients in an already overwhelmed system with 1.6 million waiting for mental health services.
If someone knows the email of the person in charge of welfare at Twitter, could you dm me asap please.
How dangerous it going to be if someone is suicidal and they seen hundreds of people have viewed a tweet expressing pain but no one has responded?
"Welfare Secretary Stride said: "Work is good. It pays the bills, improves health and grows the economy – so we’re all better off."
This is demonstrably untrue.
Work is good for some people in some circumstance some of the time.
Work can be bad, making people ill and iller.
Super important we never promise a telephone call or text in mental health and fail to do it, especially if the person is suicidal. It is not a commitment in the way we might say ‘I’ll call you’ to an acquaintance. It’s a promise those in desperation can cling to for dear life.
Trigger warning - death
Distraught to hear of the death of
@TraumaPhDandMe
She was utterly brilliant - intellectually, creatively and, most importantly, in her kindness, humour and solidarity with other survivors.
She was badly let down + will never be forgotten.
I miss her💔
For
#AutismAwarenessWeek
, I would like to draw attention to the people, predominantly women, who have been diagnosed as having ‘BPD’ when they are
#ActuallyAutistic
. As our understanding of a different female phenotype for autism grows, I hope we can do better for you + with you.
Give me a good old-fashioned day centre with come gentle support groups, arts and crafts, maybe a bit of gardening, people you'd see on-and-off for decades. Community. Endless tea. Not short recovery course immersion you have to graduate form cos long-term needs, no, or neglect.
Meds have their place. Therapies have their place . Art has its place. Spirituality has its place. OT has its place. Activism has its place. But in crisis, most of this pales in comparison to WARMTH. Be kind. Be present. It really is everything in mental health.
It doesn't only matter if
#DWP
pronouncements end up happening.
It is incredibly damaging on hearts, bodies and minds to have these relentless attacks deliberately pressing on core fears we all have: Am I trying enough? Am I valued? Do I matter?
It is very damaging.
CW. As a consultant clinical psychologist, I cannot emphasise enough how dangerous this messaging is nor how damaging to claimants' mental health. Hate gets into people's heads and bodies as does the idea of having done something wrong. This will provoke sustained fear and panic.
Often people write to me about benefits. It scares me many feel compelled to tell me if they’ve worked before and paid tax. How awful has our society become that people feel compelled to justify their right to benefits this way rather than as a right based on our inherent worth.
Anyone who watches
#Panorama
and think Harley’s treatment is exceptional are wrong.
Autistic people who self-injure are treated horrifically, misunderstood, misdiagnosed and misjudged.
Decent specialist care now please
#Panorama
#IatrogenicHarm
#ActuallyAutistic
Repeatedly asking for disability adjustments and having them forgotten is a common experience for many of us with disabilities. It often leads to feelings of being a nuisance or that one is making a fuss. This cycle is an example of how ableist structures reinforce themselves.
Rishi Sunak declared this week that welfare should serve as 'a safety net, not a lifestyle.' Let’s actualize this! Speaking as a consultant psychologist, I affirm the present system is marked more by instability than safety, leaving individuals half-alive due to relentless worry.
On a ward round not long before Fern's death, Dr said "Although she has reported suicidal thoughts and plans, her intention appears to be to communicate her distress and elicit care and a rescuing response in others, and her suicidal intent does not appear to be high.” 😟😡
T/w
If someone is going to be discharged, and attempts suicide cos they are afraid of being discharged, it doesnt mean they are not really suicidal and they are attention-seeking. It means services haven’t done enough yet to provide a safe re-entry to community. That’s different.
Being on benefits at this time and place in history is bleak.
There is a constant environment of disbelief.
One must near constantly prove one's illness.
We have one of the least generous system in the world.
And one that financially+psychologically punishes via sanctions.
Work is not a health outcome, Labour.
Coupling access to help with access to work has a long eugenics history. It is peak neoliberalism.
Adequately fund mental health services and social services and the benefits bill will shrink.
Please no
#NotAllStaff
tweets tonight.
Survivors have been lobbying for people to get quite how bad and quite how pervasive
#IatrogenicHarm
is for 50 years.
Protecting professional fragility is not a task for today.
#Panorama
85% of patients no longer meet criteria for BPD at ten years.
Symptoms take longer to go than for major depressive disorder but not in a way suggestive of personality at all.
The discourse around BPD tells us more about misogyny than evidence and should be dismissed as such.
RF has won! On every single count! No change as yet as the DWP can appeal, but the Judge ruled it 'illegal discrimination' against people with mental health problems. Thank you, thank you, thank you to the amazing RF. To people power!
Huge day tomorrow. The judgment in the case of RF v Secretary of State for Work and Pensions re the
#PIP
mobility criteria will be announced at 1030am at the Royal Courts of Justice. Everything crossed 🤞🤞🤞and thank you once more to the claimant for her bravery.
Impressed with this from the mindfulness in schools landmark study which showed it didn't work. Prof Kuyken says "we know that inequalities, deprivation and poverty drive mental health problems. And maybe we need to be thinking about interventions which help improve those first."
If a professional thinks a suicide attempt is a 'cry for help', they should respond to the desperate request behind it rather than judge it.
Our response should be compassion and care not condemnation.
One of the consequences of the NHS being so underfunded and overstretched is vulnerable and gravely ill patients with multiple physical and mental health problems having to coordinate their own incredibly complex care between specialisms that won't speak or write to each other.
Dear DWP
It's
#VolunteersWeek
. You stop disabled people feeling able to volunteer as you hover over anyone who shows they can do anything ever. This shows a lack of understanding of the vicissitudes of physical + mental health problems + damages communities.
Please change.
Jay
I actually cant use the term ‘hostile environment’ to describe what the Tories have done and are doing to claimants. It’s worse than hostile, it’s the post-apocalyptic bleakness of poverty and the persecution and terror of constantly feeling watched and accused, more like surely.
Just out from me - 'How can we expect patients with a diagnosis of 'Borderline Personality Disorder' to trust mental health services'.
A breakthrough on this is possible but vested interests keep sucking things back. Lobby, lobby, lobby, folks.
The main argument is 'Britain can't afford the level of mental illness it has now'.
I don't disagree.
But the solution is not to doubt+deny individuals.
It is to address the root causes of such unbearable lives the answer to this rests largely in neoliberalism + its inequity.
If someone is angry, it is often because they have been silenced - as individuals and structurally. It is incumbent on those with power not to pathologise the anger. But, rather, to think how they might have produced it, and what could be done to remedy the rift.
Dyspraxia affects co-ordination, spatial awareness and sensory perception.
Dyspraxic kids and teens are twice as likely to develop mental health problems.
Half of children with dyspraxia also have ADHD.
Dyspraxia is often dismissed as something we all experience to a degree.
The government is messaging that people just say they have a mental health problem and they are put on benefits. This is completely untrue. There are no benefits one gets de facto for having a disability or illness. One has to have serious functioning problems and evidence.
Over-labelling everyday problems as mental health issues is contributing to a surge in benefit claims, DWP secretary has argued
Interesting suggestion from Mel Stride that we "too readily" identify people as ill and push them into diagnosis and welfare
I know of many people, predominantly women, stuck in abusive relationships because
#UniversalCredit
gives one householder all the money. This makes it a 1000x more difficult to leave or to have any agency. It is criminal, dangerous + immoral
#UniversalCreditCrimesAgainstClaimants