“It is easy to cast a critical eye back over history; much harder to face up to it in the present.”
Don’t Turn Away, by Penelope Campling, offers a searing account of the traumas encountered by the author during her work in psychiatry and psychotherapy over the past forty years. She started her training in one of the large Victorian asylums that were earmarked for closure. She has experienced first hand the changes in mental health treatment from then through to the fallout from the Covid pandemic.
Having recently moved from the NHS to private practice, Campling can now be entirely honest in her assessment of where patients are failed by the systems imposed on frontline staff. As a young and inexperienced doctor she was expected to follow procedures without question, the consultants at the time revered. These days consultants are also facing mental breakdown, the pressures under which they are required to work often proving too great. It is no wonder there are severe staff shortages, exacerbating the problems caused by rising numbers of acute cases in need of treatment.
Following the closure of the asylums, there was great hope that moving patients into the community would remove some of the stigma attached to many mental health issues. While this appeared to be improving for a time, changes to funding and therefore staffing levels diluted the impact of what is necessarily a building of trust in the therapeutic relationship. Joined up medical care becomes problematic when departments are competing for dwindling resources. Outsourcing to companies looking to make a profit further diminishes the quality of day to day care. Patient need cannot be properly met when criteria for accessing treatment admits only the most desperate, and even they may have to wait months for any sort of limited consultation.
The book is structured around patients Campling has encountered during her long career. The problems they live with are shocking, stemming as many of them do from horrific abuse, especially in childhood. These triggers can be difficult for the patient to acknowledge, often leading to substance abuse and sometimes criminal behaviour. Self harm is common, the risk of suicide real. The author writes of the importance of granting agency to the mentally unwell, offering support alongside non-judgemental discussion, paying attention to cues offered that too many dismiss with platitudes. Prescribed drugs can be helpful but core issues need to be recognised if progress is to be made.
Chapters focus on some of the problems that can aggravate mental health patients’ afflictions. In the asylums bad practice could occur in what was a closed community that few outside wished to even think about. These days failings are more common because those in need are locked out by gatekeepers whose job is to decide who qualifies for available treatment.
Some of the most harrowing cases detailed were encountered in a more successful unit that offered in-patient counselling led by supervised peers. As a lay reader it is hard to see how such damaged minds can ever be rehabilitated. It is no wonder psychiatrists are affected by their work given the experiences they must listen to and counsel. Patients will not always engage however much effort is made. Cases can haunt a doctor’s mind for years.
Not a book, then, for the faint-hearted but one that opens up a section of society that is too often ignored or condemned without consideration. A well written and engaging memoir that lays bare the failings of our healthcare system, the toll this takes on overworked staff, and on the patients it should be existing to help.
My copy of this book was provided gratis by the publisher, Elliott & Thompson.
This sounds like a very disturbing read which makes me think how lucky I was to have had outpatient treatment with group psychotherapy during the early 90s from which I emerged much better and able to deal with my issues
Good to hear of a positive result from psychotherapy. This book does make clear there is much need in this area.
I remember the introduction of the ‘care in the community’ policy which seemed a good idea but one which required considerably more funding to have a satisfactory outcome as is so often the case.
The author writes of it working well for some until funding constraints hit. Her thoughts on mental health services now compared to in the asylums are particularly interesting given the horror with which they are generally remembered.