Last spring my mum took her own life. She was 70 and wheelchair bound, living alone in a retirement village, struggling with MS and severe depression. One evening in April, she mixed wine with too many pills and put a bag over her head, just to make sure. I know I will always struggle to understand. I loved her first before anyone else. I still love her. I feel wrong to be here when she is not.
As a child, I remember arguments with imaginary enemies at the kitchen sink. I remember her not being there. I remember her voicelessness as well as her rage. I remember her telling me as a teenager that life was pointless and if she were braver she would end it all. In fact, she had tried long before, when I was a toddler, but my dad found her just in time, and she survived. Why would a mother do this when her three small children really needed her?
I think there are three things that would help people like my mum, those people who live with deep despair.
The first is compassion. January 2018 saw the launch of the Power Threat Meaning Framework (PTMF), which suggested a new way to think about “emotional distress, unusual experiences and troubled and troubling behaviour”. Developed by a team of psychologists, survivors and academics, PTMF encourages professionals to ask questions such as, “What has happened to you?”, “How did it affect you?” and “What did you have to do to survive?”
I have found this approach tremendously helpful in understanding mum’s ill health by learning what she experienced, what she felt threatened by and how she responded. It has helped me accept and be more compassionate towards the set of destructive behaviours that she developed to survive.
My mum had a controlling father in childhood who stopped her pursuing her life’s ambitions. She was forced into a caring role as the oldest of four siblings and in place of her absent parents, and she suffered the death after only six weeks of her second baby. She experienced alcoholism, domestic violence and a near-complete lack of financial freedom in marriage, as well as the MS and loss of mobility she developed in her fifties and the excruciating shame she felt for being sectioned by the state in her sixties.
Asking “What happened to you?” (rather than “What’s wrong with you?”) encourages awareness and compassion for a person’s struggle with tragedy and injustice. And compassion inspires ambition to help.
The second factor which I believe can help people with mental health problems is “stickability”. We all struggle, at times, to understand others fully, and to maintain strong and nurturing relationships with family, friends, neighbours and work colleagues. How do we stick with those who need us most?
Professionals sometimes find it hard to develop empathetic relationships with their patients. This is understandable. Service users can bring terrible personal pain and suffering and ask their carers, however unconsciously, to share in it. But procedures and systems also make it difficult for professionals to understand the “whole person”. After a series of workshops on children’s mental health, a social worker colleague in Wigan remarked that it felt like local public services are not able to “hold the deep loss and trauma” that neglected and abused children can bring. It’s almost as if those services have been designed to be fragmented, so professionals need only experience a little of someone’s pain before they are referred on to someone else.
Happily, Wigan’s new approach to children’s social care is embracing the “stickability” seen in North Yorkshire County Council’s “No Wrong Door” model, which is highly successful and independently evaluated: a key worker will stay with the child no matter what time of the day or night, and no matter how bad the crisis.
Finally, “connectedness”. When Mum was sectioned 10 years ago, professionals told our family that she was psychotic and needed to be taken to hospital and given medication. The follow-up care from mental health professionals felt half-hearted and ineffectual. Seeing her sitting alone in the hospital garden, head bowed low and motionless, contributed, along with her clinical diagnosis, to everyone around her feeling that she was “other”; that she was untouchable and irretrievably ill.
Today’s public policy and service culture give too much weight to the individual as cause of the problem. When someone is unemployed, for example, we say it’s because they need to be more resilient or hard-working, rather than looking for social and economic causes. Or when someone is mentally “unwell”, we look for illness within the person, and the wider and external forces remain invisible.
When it comes to mental health, we are working person to person, rather than taking a more holistic approach and working with connected groups of individuals, friends, families, neighbourhoods and caregivers. The more we understand people’s life stories and how they connect with other people, the more we will understand their joy and their pain, as well as unlocking a wider range of creative solutions and resources to support people more effectively. In this way we can become more compassionate and build the trust and engagement that is so essential for preventing crises.
Future thriving societies will be places where it is harder to tell whether someone is a service provider or a service user. Places where connectedness is central, compassion is amplified and where services and the professionals who work in them are just as relationship focused as citizens.
This future world will give up the fantasy that people in communities are somehow different from people providing services.
It is not easy to turn the tide on tragedy, or to replace loneliness and despair with companionship and hope. Trust me, I know. It’s not easy, but it’s definitely worth working and living for.
Nick Webb is lead for innovation for mental health at Innovation Unit, a social enterprise that grows new solutions to complex social challenges.
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