“Inadequate” is such an insipid inadequate term to describe an abject failure to manage critical mental health services and to continue over 5-years to fail to improve.
Norfolk & Suffolk NHS Foundation Trust is the seventh largest mental health trust in the UK, running over 100 community
services across 50 sites and GP practices for 1.6 million people in an area of 3,500 square miles for £227m a year. In any one month they may have 25,000 patients being seen or served. No small feat.
I’ve had great NHS care and compassion, supported by superb individuals via NSFT, Wellbeing, CMHT, Therapy services within Norfolk Mental Health – indeed CQC scored it “Good” for caring. However, the waiting lists for many are criminally irresponsible. This isn’t even my usual rant about transgender waiting lists, although they form a part of mental health. The Government austerity cuts and CCG and NSFT financial and provision managers are presumably to blame as every other trust must be facing similar challenges. Mental Health services remain grossly underfunded and in crisis. Parity for mental health services with physical health and its 18-week guarantees are years away. NSFT tops the table in the worst possible way, making national news today. Norwich topping the football – great; NSFT topping the worst mental health care trust for 5 years – fail!
“NSFT doctors first raised concerns over cuts in January 2013, as more than 500 mental health jobs faced the axe in what was known as a radical redesign of services. Senior psychiatrists warned at the time that patient safety would be put at risk and said the trust was being “downright dishonest’’ for failing to state that the cuts would have detrimental effects on patient care.” – EDP
I had to fight for well over a year to get seen, assessed (I was “lost” in the system three times but with zero response to internal complaints raised), and keep my care – which I am losing in 3 months – apparently, long-term mental health symptoms can be in “recovery” (mine can be episodically), and bipolar and anxiety disorder be signed-off.
“36 people had waited five years to be seen and 2,732 were waiting for their first contact with services… 2,400 adult patients across the trust had not been allocated a care coordinator in community mental health services.” – EDP
This is the problem when capitalist market budgeting is applied to health, and recovery models applied to long-term ailments. I prefer a “discovery” model that supports but doesn’t focus on discharge until you yourself know you are ready. Instead, a benefits and unemployment model of punishing mental health as if it was an aspect of an alleged “work-shy” culture leads to shaming those in need of its services and a seemingly deliberate or incompetent policy of actually signposting ease of access to services resulting in many people never even finding the door, let alone making it through it. Whilst I am currently being “shown the door“, having had an exit strategy meeting, others are shown the door but not let in. As many friends of mine know all to well, just as with PIP applications and appeals, if you weren’t ill when you asked for help by the time you eventually get it the very wait will have made you ill, and certainly resulted in a deterioration of any conditions you have.
“The Care Quality Commission found patients desperately needing care were waiting so long for help they harmed themselves or took overdoses during delays – or were being turned away completely…Staff were covering up the length of waiting lists by allocating patients to staff or running several lists whilst agreeing that nothing would be offered until space was available. And some patients had been waiting five years for help.” – EDP
During a suicidal day, several years ago, I rang the 24hr acute line at Hellesdon on a Friday night and got a locum of some form who said: “I can’t help you, I can’t access your notes at a weekend” and was generally unintelligible and useless in several other ways. I never rang them again.
With a history of suicide, I’ve learned to stay alive by building my own care package and it includes my partner, friends, Wellbeing, CMHT – the “severe and enduring mental health needs” service (keeps getting renamed!), cats, honesty, whisky, and avoiding pills as an accessible suicide kit.
I have nothing but praise for 95% of the frontline staff who’ve helped me. I would not have survived continuing mental health challenges and rebuilt some of my life had it not been for my care team who have gone above and beyond their job descriptions to support my whole wellbeing and not just my mental health. That has included helping me with referrals to physio and general health, and applying for Housing Benefit, PIP and ESA for me, when I was in no state to do so. They are my heroes. The system of cuts and carelessness elsewhere that meant I needed them has probably meant that others have had less support or are still waiting.
“We want services which are provided for those who most need care. That may mean those who don’t have as much need wait a little longer.” – Antek Lejk, Chief Exec NSFT, EADT
Clearly, they are people that carry on caring despite the system and resources they are forced to work with. It is a wonder why so many keep working and don’t leave. Indeed, NSFT has 1-in-4 unfilled nursing posts.
“A perfect storm of cuts, incompetence and stigma has seen services unravel, with people struggling to access services, being discharged too soon, and staff under intolerable pressure with unmanageable caseloads. Following a savage real-terms budget cut, the number of doctors has been reduced by 51 (around 25pc) and the number of nurses by 163 (1 in 8) compared to when the trust was formed in 2012, while referrals have rocketed. The number of patients referred but still awaiting their first contact is 2,732 (as of October 12). That’s a lot of people in distress, without support.” Emma Corlett,EDP
When the CQC interviewed me for a previous report, I said that continuity (and accessibility) of care were critical as my care team kept getting changed or staff going off long-term sick themselves (probably stress at work based).
What happened? Three months later they shuffled the deck chairs (a “radical redesign” no doubt) and changed my care-co again, and I’ve had 3 more since. NSFT is that Titanic on which the deck-chairs get regularly rearranged rather than addressing the approaching iceberg of yet more service-users drowning in a cold heartless sea where the lifeboats are knocked-off the list of necessary equipment to save money.
“The key to keeping people safe is a trusting relationship. How can that be possible with repeated, persistent disruption. Worse of all, it’s deliberate disruption as like you describe, inept managers with a lack of a clue about what else to do opt to do another reorganisation, over the heads of staff and in some cases not even bothering to tell the service user.” – Emma Corlett, Nurse and Norfolk Councillor
Every 24 hours a trans person is murdered, 369 this year, nearly 3,000 the last 10 years – that we know about, i.e., it may only be the tip of the iceberg. It is a number that is rising annually and particularly affects those in the Americas but also in over 70 other countries around the world.
TDOR Candle lights
Since 1999, the Transgender Day of Remembrance (TDoR) has taken place every November, now following the newer Trans Awareness Week. It is the day when we recall and respect those trans and gender-diverse people who have been victims of murder or manslaughter. It does not include the countless numbers that take their own lives through suicide. Trans women of colour are the most likely to be killed of all transgender people, especially, but far from exclusively, those involved in sex work. Also, everyone from hairdressers to artists and activists, and many who were migrants.
The person picked up in the media for being trans and a victim of violent crime in England and hence the only UK trans person this year to be added to the long list of transgender people killed was Naomi Hersi. Sadly, she typifies the fairly common context for many. She was a trans woman of colour, and a victim of violence during or after a sexual encounter. Ironically, she last tweeted 3-years before her death about trans women of colour facing an epidemic of violence and murder.
Sadly, around the world, trans people are often in the news for the shocking recurrence of their frequent murders. Not in the news are the statistics that trans women can be even more prone than cis women to sexual violence and abuse, as many as 1-in-2.
That flies in the face of the alternate narrative put out by those fearing Trans rights and suggesting that trans women are rapists and murderers in drag, abusing gender self-ID (which in the UK we haven’t even got yet). The statistics of male-born sexual assault perpetrators in prison who may now be transitioning actually shows that gender self-ID isn’t the problem, but abusers are. The majority never dressed as women in order to abuse.
Transgender people are in the news or online media nearly every day. Frequently, there are several trans-questioning or outright transphobic articles in The Times every 7-10 days, not to mention other papers such as the Daily Mail, (I counted 7 in a 4-day period during late October in the DM alone) and continuous TV and Radio programmes to boot.
Last year, Ruth Hunt, CEO of Stonewalldescribed Britain today as “at an absolute crisis point in how it treats trans people”, in no small part down to media attention.
“Britain is no longer considered a safe part of the world for trans people to live in…It should be considered a national embarrassment that this is where we now are as a nation.” – Ruth Hunt, Stonewall
Instead of the prurient public interest being in trans ‘sex changes’, former lives, and scaremongering fears of ‘sex pest perverts’ in toilets or prison (where they should be), the media should be concerned about the levels of abuse, bullying, murder and suicide that so blight trans lives.
The escalation to a “hostile environment” due to the ‘debate’ around an updated Gender Recognition Act (GRA) between some feminists (colloquially known as TERFs by trans people, but not a term owned by the so-monikered trans or gender critical radical feminists) and transgender people – mostly but not exclusively directed at trans women, has led to a toxic atmosphere.
Trans people’s lives are already under a microscope as part of their transition pathway, but to be so in the media spotlight too puts their private and social lives up for involuntary discussion and invasive dissection.
Lucy Meadows took her own life in 2013 in strong part due to “the toll the press was taking on her mental health”, says her former partner. “The media later claimed, [that] by putting out an “official” letter, the school [where she taught] had “officially” placed Lucy’s transition in the domain of public interest.”
Speaking on ITV Anglia news during Transgender Awareness Week
More positive has been the campaigns of Stonewall, Comic Relief, various public bodies, and open-minded news outlets using the opportunity of #TransgenderAwarenessWeek to balance the negativity online. ITV Anglia broadcast a piece on transgender workplace discrimination and homelessness that can affect 1-in-4 trans people.
2017-18 Transgender Monitoring Data
Two years ago, saw 295 trans and gender-diverse persons added to the list of those killed for being trans. Last year that number was 325, up 10%. This year it went up 13% to 369. Improved news monitoring could account for it but hate and visibility are also on the rise.
“These figures only show the tip of the iceberg of homicides of trans and gender-diverse people on a worldwide scale.”
The majority of the murders occurred in Brazil (167 static but up 40% from 2016 and who knows what climate Brazil’s new leader will bring), Mexico (71 up from 56), and the United States (28 up from 25 and 23 in 2016), adding up to a total of 2,982 reported cases in 72 countries worldwide between 1st of January 2008 and 30th of September 2018.
16 trans people were killed in Europe (up 300% from 2017 and 60% from 2016)
28 in the USA (4x more likely than in Europe, 6x UK)
71 in Mexico (up 40% on 2017)
167 in Brazil (37x more likely than in Europe, 53x UK)
You are 17x more at risk in the US than in India but 8x more at risk in Pakistan than India. Hate crimes against trans people in America were up 44% in 2016, according to FBI data. Donald Trump has recently tried to define sex in such a way that would make gender transition a legal non-entity.
“Since the election of Donald Trump and Mike Pence, there has been a notable increase in the vitriol and anti-transgender rhetoric — from the top levels of government down through the rest of American society.” – HRC Report
The majority of murders were of trans women (80% in the US)
Over 15% were sex workers (6% were hairdressers & 3% were activists)
Majority of the reported murder victims in W.Europe were migrants
Most of the victims in the US were people of colour
The majority of the victims were under 30 years old
In many countries, trans and gender non-conforming people live riskier lives, not by choice, but usually as a last resort due to the oppression, rejection and lack of rights within their cultures and societies. Many struggle to find work to survive, let alone to transition, and resort to sex work and/or flee their countries as migrants. Either or both of these paths putting them into the line of fire of greater exploitation and risk.
These numbers do not include suicides, the countless thousands who take their own lives – around 40% try, twice as many consider it. Sometimes it is the result of an attack:
Today I think about my smart, beautiful, open hearted friend Sarah. She was a courageous woman who fought every day for a more equal kind world. After a brutal attack ripped her of her dignity she took her own life, today we light candles but everyday we must love harder #TDOR
These numbers barely scratch the surface of the actual violence trans people experience, as much goes unrecorded, or are cause/status unknown.
Trans flag and candles, TDOR, UEA, 20 Nov 2017
Many countries don’t mention trans status in reports of violent death or in their internal statistics – particularly in anti-LGBT regimes and regions. Again, many may be killed in their acquired gender but the death not be because of it, or their pre-transition life simply not known about.
In addition to violent deaths, 1-in-2 trans people experience domestic abuse and/or sexual violence (DASV). Trans men and women alike often suffer in silence and fear that shelters and services won’t be there for them.
81% of trans people have suffered physical and/or verbal abuse.
Are they not women if people and society perceive them as such and treat them equally badly?
Yes, their social and biological experience when growing up is not that of natal/cis women but many in medicine now recognise a biological rather than purely psychological basis for the origins of gender dysphoria.
“Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity.” – The Endocrine Society
How then can some in society – conservative religions, some feminists, right-wing journalists, far-right radicals think that being trans male or female is something we need to fight against?
Intersectional Feminism?
The personal is political and it’s hard to avoid the political, for murder is as personal as it gets. The irony that this was a rallying cry of late 1960s/70s Second Wave Feminism and yet is also the lived and embodied risk of being trans is not lost on me. Women regularly experience sexism and discrimination because of their sex. Black women even more so, adding racism to the crimes against their person.
The majority of feminists recognise the intersections between sex, sexuality and colour, not to mention class. Again, most modern and particularly young student feminists recognise the further intersection with gender identity. A few do not, and instead regard trans women as a threat to gendered spaces and trans men as traitors erasing butch lesbianism.
The conflation of sex with gender and/or sexuality is an issue needing improved education to better understand people’s authentic ‘born this way’ identities.
Don’t scapegoat us as perverts and rapists. Don’t harm us and kill us. Instead, be allies, support us to be ourselves, and let’s bring these murder, abuse, and suicide rates down in future years!
What can we do?
end discrimination at work, in training and employment opportunities
provide decent healthcare
create healthy environments at school to explore identity and expression
recognise that Domestic Abuse and Sexual Violence happen to trans women and men too, at the hands of cisgendered men and women
ensure prejudice is rooted out of criminal justice and police systems
provide legal protections against online and offline hate
end the language of erasure and exclusion between TERFs, as well as other vociferous transphobes, and Trans
develop positive dialogues rather than debate our right to exist
foster greater unity with allies of the wider LGBT+ and feminist communities
“When people die
Their smiles are taken from us
Who might have seen them
And smiled back.
Their songs are taken from us
Who might have heard
And listened and been glad. Their stories are remembered By us, on this day And always.”
TDOR remembrance meetups are held around the UK including London, Liverpool, Brighton, and Norwich, as well as worldwide including Paris and New York and dozens of other locations.
Norwich City Hall, lit up during trans awareness week, pink and blue
“Our Service for Transgender Day of Remembrance is a way of showing our commitment as people of faith; of declaring that the lives and the rights of transgender people matter to us all and ultimately to our community and our society if prejudice and intolerance are to be banished in the name of equality, diversity, justice and peace.” – Fr Christopher Wood, Rector of St John’s Timberhill Church, Norwich
Ten years of Norwich Pride and decades of trans support groups stretching back to Barbara Ross, OBE, Oasis and now more than half a dozen active groups supporting trans youth, non-binary, trans men, trans women, and families of trans, mean that Norwich provides a generally safe and supportive environment for trans people and gender dysphoric or questioning youth.
“These statistics are horrific and we all need to do more to support transgender people and ensure they can be safe and proud to be themselves.” – Michelle Savage, Norwich Pride
Six years to the day after the 1500 v 200 EDL counter demo and the fine welcoming city of Norwich has another small demo, Norwich Against Fascists! Counter demonstration! “There are many many more of us than you” was being chanted by 750 anti-racists and Remainers (mostly) and 50Unity UK pro-Leave Brexiteers shouting back the same and “More of us voted Leave than you” and “you lost”!
The atmosphere was mostly good-natured, carnival-like with drums, whistles, chanting, occasional discussion and the odd rant. One masked protester was led away, possibly anarchist/anti-Fa, certainly a scarf covering their face but there was no violence.
Police engage with Unity UK Pro-Brexit demonstrators
The police, some 30-40 or so, created a thin blue, well hi-vis yellow line, to keep the sides apart, sadly also blocking the dialogue, the lack of which has left us in Brexit impasse land. Initially, kept to opposing pavements, and allowing the traffic to pass, the police eventually surrendered to the sheer size of the counter-protest and even re-drew the line in the centre of St Peter’s Street.
After an hour, they also mostly gave-in to allowing people to cross the street and engage with each other. At times, it was clear some of the police were struggling to keep their serious and professional faces on given the number of humorous moments.
Cllr Jess Barnard and Abby Hoffmann debating the issues with Joe from the Unity UK demo
Even the police giggled when Lab Cllr Jess Barnard started playing Benny Hill over the megaphone! Rather ironically, similar chants were echoed on each side of the street:
“Whose streets, our streets”, “No to racism, No to Nazis, no to fascism” “You’re the racists”, “No, you’re the racists!”
I voted Leave
Towards the end, it was almost comical as the Remainers remained and the Leavers left, leaving perhaps a dozen Brexiteers facing still hundreds of anti-racists. The larger crowd refusing to depart until their counter-demo had fully seen off the other side. Police remained on site waiting for one side to completely depart but were frustrated when the larger crowd decided to cross the street and swamp the “drain the swamp” protesters. A few of the latter repaid the gesture and also switched sides leading to hilarity and confusion.
At the close, some 2-3 hours later, several protesters shook hands after dialogue, others persisted in their polarised positions.
Refugees Welcome Let Them In
The Unity UK Leave contingent tried to convince me that their side of the street was more diverse than the Remainers/anti-racists, but that was hard to accept seeing as how they were 99.9% white, and 75% older people, some dressed in 1950s fashion, a time they perhaps wanted to send Britain back to.
No Hate in Norwich
I had conversations with perhaps half-a-dozen of the pro-Brexiteers including a passionate but polite chap called Joe, an older woman whom we both agreed were opposed to Theresa May, and several others willing to dialogue. Nothing will change without conversation, communication and, probably, compromise about our beliefs.
Fascism 101
* Alleged roots in Ancient Sparta, Plato, and Rome
* Totalitarian belief in the State, order and its Ruler
* Ultranationalism, monolithic unity, racial purity (esp. anti-Semitism, anti-immigration) and ableist idealism
* Ironically, Italian and German fascism both grew out of national socialism but opposed international socialism and communism yet share common antipathy towards liberalism, capitalism, and the individual instead favouring the Party and the State
* Militant strength, masculinity, patriotic rebirth and revolution
* Authoritarian pseudo-democracy, cultic hero worship, national power (Maurice Barrès)
Both sides were a bit confused by the use of the word fascist, both calling each other it. The word really defines those who are totalitarian, anti-democratic and ultranationalist. Along with Nazis – despite the odd mocking salute, it’s a word that didn’t really describe anyone there. One of the Leavers complained about being called a “Nazi” saying “I have an Indian wife”.
Leave voters harking back to 1950s royal jamborees
Poignant, as it was, across from the city’s War Memorial, the day before armistice day, when we remember standing up to aggression, conquest, fascism, hate, imperialistic ultranationalism, and ultimately, cultural xenophobia in two world wars.
We need to stop fighting and start uniting, build better and common futures, that was why the EU was born, for peace and prosperity, and to end wars.
