Lies, Damned Lies & Tory Jeremy Hunt’s Mental Health NHS Statistics

Lies, Damned Lies & Mental Health Statistics

This month saw World Mental Health Day. For the other 364 days of the year, we are forgotten. Austerity Britain has affected mental health services more than most. Despite promises to ringfence the NHS and bring parity between physical and mental health, this has not happened. Instead, beds have been cut, jobs have not kept pace with population growth, and my own trust, NSFT, has been placed back into special measures again, after being the first mental health trust in the country to be sanctioned in this way by the Care Quality Commission (CQC) in February 2015.

Mental health awareness and NHS service provision improvements are sorely needed as referrals have risen 20% in Norfolk and Suffolk, but staffing and beds have been cut. Complaints, locally, have risen from 430 to 592, 2013-16. The latest CQC report criticised inadequate staff and bed levels but praised staff the caring attitudes of staff as ‘good’.

The recent Stevenson/Farmer ‘Thriving at Work’ report has demonstrated the need to promote mental health at work due to its annual near £99bn cost to the UK economy.

  • 2010-20 will be the most austere decade in NHS history
  • 2010-17 UK population rose 5%, mental health staff up 0.87%
  • 2011-14 33% rise in Police cases with mental health component
  • 2010-13 56% rise in self-harm and suicide
  • Mental health at work costs UK economy up to £99bn
  • Entitlement to be seen <18 weeks applies to mental health too

A week ago, BBC Radio Norfolk ran a mental health week focus with Stephen Bumfrey featuring it each afternoon, and coming together with Nick Conrad, Sue Tebble and myself, on Friday 20th, for an hour-long special. (iPlayer episode – 2hr 32m in

On Radio Norfolk’s Matthew Gudgin programme, the BBC’s Bob Carter challenged Theresa May to apologise to the people of Norfolk and Suffolk for having the worst mental health trust in England. Listen to the interview below:

Theresa May

During a recent visit to Archant, home of the EDP, in Norwich, the Prime Minister said:

“overall if you look across the country there is a good record of actually being able to move trusts out of special measures” – Theresa May

This makes the failure to resolve the local NSFT crisis all the poorer. Patients, or the politically correct – ‘service users’, have complimented the staff but criticised the system, waits, and other failures. Patient deaths and out of hospital suicides have increased whilst beds and budgets have been cut. Hundreds of patients were sent out of county owing to the lack of beds, up to 225 miles away!

In 2012/13 the trust reported 53 unexpected deaths, 105 in 2013/14 and 14/15, 139 deaths, rising again in 15/16 to 158, and 140 in just 9 months of 16/17. When standardised for age it is above the average for England. The figures have risen across all regions during NHS austerity under this government, from 47 per 1,000 to 59 in England – up 25%, but from 44 to 66, a rise of 50% in Norfolk & Suffolk.

Jeremy Hunt

Jeremy Hunt, the Health Secretary, has boasted that provision for mental health has “got better” and that he has increased staffing by 30,000 posts. The reality of the lie, and statistics do indeed damn him, is that 4,100 mental health nurses, 4,596 mental health trust beds, have been cut, and just 692 extra staff employed  – an increase of just 0.87% over seven years, despite population growth of 5% during that time – so, in other words, a cut!

“Although NHS funding is rising in real terms, current plans mean that 2009/10 to 2020/21 will be the most austere decade in NHS history. Total spending on the NHS in England increased by an average of 1.2% a year under the 2010-15 coalition government (0.9% for the UK), and is set to increase at the same rate under the current Conservative government. Between 2009/10 and 2015/16, spending increased from £109.1bn to £119.0bn and is planned to rise to £123.2bn in 2020/21. This growth rate of around 1% is below the historical average for the UK of 3.7% per year.”The Health Foundation

In Norfolk and Suffolk, primary care mental health referrals rose 20% between 2013-16, nearly 7 times faster than the population increase.

Wider Societal Impact

Norfolk has a pioneering mental health within Police HQ service, but nationally, there has been a 33% increase in cases with a mental health component 2011-14. As much as 40% of Police time is spent dealing with mental health-related issues.

Eighteen Weeks, as if!

Under the NHS constitutional pledge, patients have a right to be treated within 18 weeks of referral, including mental health.

“the new waiting time standards will be as follows: 75% of people referred for talking therapies for treatment of common mental health problems like depression and anxiety will start their treatment within 6 weeks and 95% will start within 18 weeks.” Pledge of 2014 to be delivered by April 2016.

Yet, the wait for some treatments can be more like 18 months. Just try requesting something more complex than CBT or other less time-limited ‘quick-fix’ therapies. IAPT referrals seen within 6 weeks were apparently 93-96% in Norfolk and Suffolk.

My personal experience, and that of several friends, has been of much longer waits. Calling the acute care line at weekends can result in complete ignorance or lack of access to your medical records. Support lines have historically been cut. People fall between the cracks, and I know too many people no longer with us due to mental health funding and systemic failures.

Discovery or Recovery

Discharge centred mental health, is solution based, with as much an an economic imperative as a wellbeing focus.

“securing a minimum of 50 per cent recovery rate from treatment” NHS

Mental health in Norfolk has a Recovery College, a course-based approach to improving wellbeing. I prefer to see it as a discovery-centric way of improving self-management with community support. Some mental health issues do not just resolve, yet the NHS insists on “developing a recovery culture” (p13) in mental health which fails those with long term or lifetime conditions.

74% of NSFT patients represented with mental illness symptoms within 6 months, compared to a national figure of 63% (2015 data).

IAPT (Improving Access to Psychological Therapies) approaches such as CBT serve best those with mild to moderate conditions, whereas moderate to severe need additional and more specialised help, as e.g., with OCD.

Suicide Risk

Between 2010-13, there was a 56% rise in self-harm and suicide across 52 NHS mental health trusts. It has been suggested that the over-capacity of up to 138% and staffing cuts has increased the risk of incidents.

I find the language, even if it has a clinical meaning, and the reality of response to people at risk of suicide, horrifying. The provision of “low level psychiatric support” was referenced in a Norfolk and Suffolk response it its higher than average suicide rate:

“There is a gap between the Wellbeing Service, the counsellors employed by GP practices and what is on offer via the mainstream mental health services. Suicide rate in Norfolk & Suffolk is high. GP referrals to MH are only accepted 20% of the time. GPs are left to manage risk the rest of the time.”NSFT, pp11-12

The apparent aim is a “reduction in referrals to mainstream mental
health services by offering more low level psychiatric support in primary care.”

Care not Cuts

What worries me, is the low level of funding, of staff, of beds, and the cure rather than care attitude of the system. In contrast, the caring attitude of the staff is to be praised, and they need additional in-work support themselves to be able to deliver services under such tight austerity conditions.

Jean Cocteau’s Play, The Eagle Has Two Heads, Hostry Festival Norwich

Jean Cocteau’s, The Eagle Has Two Heads, Review

Peter Barrow (actor & backer) and Stash Kirkbride (artistic director) together make up the PBSK partnership that puts on the annual Hostry Festival in Norwich. This year their main play is the L’Aigle à deux têtes by Jean Cocteau, written in 1943 and first performed in Brussels, Lyon and Paris in 1946. The French play both became a film and was ‘adapted’ by Ronald Duncan for English productions as “The Eagle Has Two Heads”. Whilst Cocteau once unfairly derided his translation as “preposterous”, the performance, staging and script, on the opening night (continues till 29/10), were superb.

Melodrama Revival or Tragicomedy?

“It’s a revival of a long lost French melodrama, a romantic play not seen in Norfolk since 1947 when it was performed at the Maddermarket Theatre.” – Stash Kirkbride

Although, Cocteau himself, would rather see it as comic tragedy uniting a “human play” and “great rôles” in “intellectual theatre” with “violent action”. Take the sarcastic bite of these lines, for example:

The Queen: “I have not shown my face to a living soul, except to my reader, Edith. It is questionable whether she has a soul. It is still more questionable whether she is alive.”

Cocteau has sections of Hamlet read during the seemingly multiple plays within a play and references a resurgent theatre in suggesting that the King was killed for building theatres and the Queen criticised for her love of the arts and actors in the family.

The Queen: “…they all wanted to become actors. that was impossible, so what could they do but turn their lives into a play, each living his own comedy. But I dreamed of making mine into a tragedy.”

There were times when I wasn’t sure whether laughter was appropriate in this tragedy, for there were great comic moments and fantastic verbal put-downs by the two leading female roles, and to a lesser extent by the resurgent Stanislas when not in cowardly assassin or fawning lover mode, as for example when he calls the Queen on her conceited notion that suicide was insufficiently dramatic a death.

“All love is a little death, and great love is suicide.”

For those with a knowledge of French, back-translating the dialogue led to some great double entendres, including le petit mort above,  perhaps unintentional, but it added to the depth of the typically French philosophical and somewhat sexy melodrama – or tragic farce, at times.

Tracey Catchpole & Adam Edwards - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Tracey Catchpole & Adam Edwards – Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography

Historic Setting & Political Commentary

“On a wild Autumn night circa 1910, a reclusive Queen dines alone in one of her many castles mourning the loss of her late husband. An assassin appears – he has come to kill the Queen but instead he falls hopelessly in love with her. For a brief moment in time their love blossoms, but it is not long before the corridors of power begin to echo with disapproval. And so, it must all end even before it has begun… but how?…” – Synopsis, Hostry Festival

Indeed, the play has echoes of Romeo and Juliet‘s tragic romance. This 20th-century play, set in the late 19th – loosely based on the “strange death of Louis II of Bavaria” – is, in addition, interlaced with questions of anarchy, the poetic temperament, philosophy of ideas, court intrigues, and even class commentary.

Lucy Monaghan (Edith de Berg) & Christopher Neal (Duke of Willenstein) - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Lucy Monaghan (Edith de Berg) & Christopher Neal (Duke of Willenstein) – Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography

The latter almost creates a play within a play as the supporting actors Lucy Monaghan (Edith de Berg) and Christopher Neal (Duke of Willenstein) carry on their own drama of love, jealousy, position and power among lower order nobility.

The Queen: “Those who are born slaves are free. Compared to us who are imprisoned in this tyranny [love, or indeed royalty].”

Meanwhile, enter the anarchic poet peasant with royalist leanings, with his uncanny resemblance to the dead king, on the anniversary of his death. The hermit Queen, not seen in public for years, has her own anarchic and heroic leanings, owning a copy of the poet’s seemingly anti-monarchy poem. She both dispenses with and asserts class and court etiquette in dialogue with Stanislas – a fact which he gains courage to take advantage of, to both the Queen’s dismay and pleasure for she hates cowardice. He, nonetheless, recognises that it is all within the Queen’s gift and that she is “the axis around which all men must move”.

“You are in the presence of your Queen. Don’t forget it.”

But then comes the distinction, is he, or indeed she, against the office of the Queen, rather than the person? For it is the crown that wields the power, not the wearer alone. Who is to be assassinated, the idea or the individual? Typically French revolutionary political ideas mixed with high philosophy.

Stanislas: “I am not hating my Queen. I fell in love with a cause and let a cold idea ravish me. So that when I broke into your room I was nothing but a mad idea.”

Adam Edwards as Stanislas - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Adam Edwards as Stanislas – Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography

As with the incognito Empress Elisabeth of Austria’s assassination in 1898, the assassin was attacking the system:

“I am an anarchist by conviction…I came to Geneva to kill a sovereign, with object of giving an example to those who suffer and those who do nothing to improve their social position; it did not matter to me who the sovereign was whom I should kill…It was not a woman I struck, but an Empress; it was a crown that I had in view.” – De Burgh (1899). Elizabeth, empress of Austria: a memoir, pp326–327

Staging & Acting

Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Cellist Ivan McCready – Photo © Simon Finlay Photography

The fast-paced three-act play opens with an opulent open stage, set in the round – well a square (squircle?), with raised seating on all four sides. The backdrop is a large piece of double-headed eagle art by local Russian artist Gennadiy Ivanov.

A live cellist, the excellent Ivan McCready, sits at one corner of the stage adding real musical backing overlays and that resonant wooden tone that only a cello provides.

Tracey Catchpole as the Queen - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Tracey Catchpole as the Queen – Photo © Simon Finlay Photography

I was sat on one of the four front rows, next to the cellist and to a card table that the Queen and leading actress sat at during the play, giving the audience a rare intimacy and experience of the action. And, action it was at times, with erotic embraces,  intense thumping dialogue, and not a few near and acted deaths taking place at the audience’s feet.

The actors threw everything into their craft, faces were stretched, contorted, angry, impassioned, spitting, “acting without restraint” like a Jean Marais (Cocteau’s lover) in Les Parents Terribles. This was something Cocteau wanted to restore to modern theatre, including a reading of Hamlet within the play, “with as much violence as [Stanislas] put into [his] last insult.”

“The appearance of a comedian-tragedian is the great novelty of the theatre today. By exaggerating the comic lines he manages, without seeming ridiculous, to put on the sublime grimaces of which the screen deprives us.” – Jean Cocteau

Tawa Groombridge as Tony - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Tawa Groombridge as Tony -Photo © Simon Finlay Photography

Even the deaf and mute role of Queen’s servant was acted with strength, poise and dignity by Tawa Groombridge, despite the scripted abuse by another role.

The calmer role of courtly Baron, yet no less conniving, Chief of Police, was played by actor and executive producer, Peter Barrow, presenting a foil to the rollercoaster love and hate, life and death, of the other interplaying roles.

Baron & Chief of Police, Peter Barrow - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Baron & Chief of Police, Peter Barrow – Hostry Festival, Photo © Simon Finlay Photography
Tracey Catchpole as the Queen - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Tracey Catchpole as the Queen – Photo © Simon Finlay Photography

To be honest, the Queen (Tracey Catchpole) rightly steals the show as both actor and author of some of the best lines, including lengthy monologues, that are far from monotonous because of her range of presentation, and constant movement to ensure that all four sides of the audience can be played to. Tracey describes the role as a “gift of a part”.

In fact, the gifted part was meant to be that of Stanislas, since: 

“The Eagle Has Two Heads was written…in part as a favor for Cocteau’s lover and favorite leading man, Jean Marais. Marais asked for a part in which he did not speak in Act One, shed tears of joy in Act Two and fell backwards down stairs in Act Three.” – The Harvard Crimson

The Harvard article goes on to compare Cocteau to David Lynch and The Eagle Has Two Heads, to Wild at Heart and Twin Peaks. Elsewhere, it has been compared to an inverted Beauty and the Beast!

Adam Edwards as Stanislas - Hostry Festival 2017, THE EAGLE HAS TWO HEADS by Jean Cocteau. Photo © Simon Finlay Photography
Adam Edwards as Stanislas – Photo © Simon Finlay Photography

Adam Edwards, does play Marais’ part well, but the stage presence and gravity of role mostly lie with the Queen’s lines. The to and fro of their interaction, the ebbing strength and weakness, love and morbidity, truly make the play stand up.

The Hostry play runs from the 23rd – 29th October – tickets here or via 01603 598676 (Theatre Royal box office).

World Mental Health Day improving wellbeing for all of us

The shift from pathologising terms like mental illness, disorder, nervous breakdown, has been gradual, and we are seeing more reference to mental health and wellbeing, differences, spectrum diversity etc. This has been a long time coming, since from 1-in-4 to 1-in-3 of us will experience a mental health condition or episode in our lives, if not more of us.

What keeps us from giving up?

The very tools of survival that I’ve learned to use to attempt to thrive rather than just die or dive back under the duvet covers actually aid all of us. They’re very basic, and not pharmaceutical, though some are chemical – or at least release the endorphins (endolphins as I like to call them) and oxytocin type chemistry that aids wellbeing.

When speaking at an event in London last weekend, I was asked how, “how do you keep going, how do you remain strong?” The answer, for me at least, is that I’m stubborn! Practically speaking, though, I talk and walk, and when it’s going well, I walk the talk.

Caring Talk Saves Lives

I talk to people, I talk to myself, to my thoughts – giving them voice and an opinion (but no power) at the table in my head, and I talk to my diary. Well, I write, I reflect, I repeat – yes, I realise that circumstances, feelings, moods, anxieties, they come round in repeating circles, and I begin to recognise that I survive, that I’m still here, despite my best efforts to end that.

I also walk, I get outside as often as I can. Although, that’s not often enough as insomnia and mood disorders often keep me in bed half the day. Inertia destroys all my best intentions. Last weekend, though, I managed something rare, to swim twice and walk 5 miles in a day, taking in my environment and the beauty of the world around me. Fresh air and exercise help, if only we can kick the black dog off long enough to get outside.

Being bipolar, my mood can shift drastically and quickly in the same day. I’ve learnt to be kind to myself, and to forgive, be in the moment, and treat or reward myself for getting stuff done that would otherwise pile up and compound my anxiety.

Laughter is good medicine

I’ve also learned to both respect my mental health conditions, and to healthily take the piss out of them – not others, not the suffering, not the issues, but to occasionally make light of them so that they have less of a hold over me.

Speaking of laughter – Stephen Fry has said of suicide:

“There is no ‘why’, it’s not the right question. There’s no reason. If there were a reason for it, you could reason someone out of it, and you could tell them why they shouldn’t take their own life”

He is spot on. Although every story is different, mine nearly ended 5 years ago, but I am happy to be here now.

Seek help

Seeking help early before one is neither in the mood or position to seek help is important. Sadly, waiting lists are such that it can be a year or more wait for short dose CBT and that is often such a sticking plaster rather than a long-term improvement to wellbeing or coping. 

I’m back in therapy for the second time in ten years, and it feels incredibly healthy. It’s not a sign of failure but of active involvement in one’s own health management.

MAD, BAD, GAD, and quite possibly SAD

I seem to collect three-letter-acronym conditions, so that I’ve been diagnosed with multiple Affective and Anxiety Disorders. Their intensity varies and sometimes I’m the boss, sometimes they try to be. Again, a diary helps me see that I do bounce (well hobble) back eventually, and they never, any longer, keep me down permanently.

Again, a diary helps me see that I do bounce (well hobble) back eventually, and they never, any longer – I hope, keep me down permanently.