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Our mental health facilities are often discriminatory and resistant to change, while professionals in the field are overburdened and underfunded to the point of burnout
Illustration: Chris Bentham
Outside the hallway was dark. I looked down at my hands to find they were shaking. A nurse greeted me as he walked past, flipping up the hood of his rain jacket.
I followed, pushing open the door and staring out on to the wet road. How was it that a doctor became this way? When had she lost her will for change, her energy to try? Her belief that she could make a difference?
There is a pervasive, singular narrative that seems to resist challenge, one which most of us digest without action: the problem with our mental health service is that it’s underfunded and understaffed.
But this is not the whole picture. A picture that is messy and confronting; uncomfortable enough to make
us look away. Yet, it is a truth that we urgently need to acknowledge if things are to truly change.
Much of my post-graduate mental health nurse training was ‘on the job’, so I scribbled notes constantly. These notes became a means to complain, but also as my way of psychologically surviving. I never intended for those notes to become a book, they were an attempt to make sense of my shock and disbelief at what I saw happening to people behind locked doors.
When I began sharing these stories, I realised how profoundly relieved I was that they, too, were furious and saddened and fuelled by hope into action. I wondered if getting these stories into the world could shock people out of their complacency, and encourage others to speak up.
Fragile Minds is not a memoir – it isn’t a book about me. By taking us room by room through a ward, A&E and community team, it is an attempt to counter the systemic silencing of certain voices. The stories I tell are as complex as the messages they contain, and I hope readers are gripped by the woven narrative revealing the human beings behind the labels and titles.
We meet staff who believed they could make a difference, but are worn down by morally ambiguous tasks, impossible workloads and a systemic resistance to change; the patients who are failed by hastily made diagnoses, overreliance on medication, coercion and inconsistency of care and the inspiring individuals struggling for justice.
The nurse turned to William and, lowering her voice as if speaking to a toddler, said: “It’s just a little tablet… just take it quickly all in one go and then you can see your aunt. Do you understand me?” William looked fixedly at her. I could see his chest rising and falling beneath his T-shirt.
“Yes, I understand you,” he said. “I just don’t agree with you.”
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Through my current work as a therapist and mental health mentor, I know how validating it is for someone to say, “I understand” or “That’s not OK” or “I believe you.” We can feel hopeless and gaslit when we aren’t heard.
I speak to so many people who feel worse about themselves and their prospects after seeing a mental health professional. Who feel unseen or judged, pathologised or dismissed. Who feel they are broken. Coupled with this, they worry it is their fault the professional didn’t understand, didn’t really help, rather than questioning the system or care they’re receiving. I speak to trainees and professionals who are interrogating their experiences, asking; “Is there something wrong with me if I feel uncomfortable working like this?”
Through the stories in Fragile Minds, I want to bolster those asking questions and demanding more, both the survivors of poor treatment and the staff who resist the pressure to conform.
It’s not a narrative that laments how our service just needs better funding, it asks more complex questions about whether our whole systemic approach to treating mental ill-health is working.
Mental distress and ill health are not the same as a broken leg. We cannot get fully well without considering that our distress contains meaning. Distress tells us something about our lives. A ‘symptom’ is threaded through with personal narratives, traumas, losses, fears, the societal barriers and discriminations that have plagued us.
If we are aided early on to explore and acknowledge these threads, to heal from them, distress can be a map which enables us to live differently. Despite my ambivalence towards not continuing within psychiatry, I now feel honoured to work alongside individuals both with and without a diagnosis, helping them to validate and make sense of their own narrative.
Because in mental health, the ‘expert’ is not the clinician in the white coat or the cardigan, it is you. ‘Madness’ and emotional distress can and should be temporary. It is a meaningful crisis filled with the potential for change, for hope.
We are not getting well, and our system isn’t working. I hope that Fragile Minds furthers our understanding, empathy, and ability to effect change.
Fragile Minds by Bella Jackson is out 3 July (Transworld, £20). You can buy it from the Big Issue shop on bookshop.org, which helps to support Big Issue and independent bookshops.
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