Those Who Care Are Concerned

Yesterday the Guardian reported that NHS staff were quitting ‘because pay was so poor’ – it was alleged that some NHS staff were using food banks and that some were working stacking shelves in supermarkets. This was attributed to the recent policy of limiting pay awards in the NHS to 1% and it was claimed that this was ‘damaging the NHS’. It was reported that in particular, people with mental health problems were experiencing delays and setbacks. This story emanated from claims made by an organisation called ‘NHS Providers’ which was described as representing almost all of England’s Hospitals, Mental Health Trusts and Ambulance Trusts, their spokesman being the Chief Executive, Chris Hopson. Hopson also turned up on Radio 4’s Today programme with his tale of woe, where again the alleged deleterious effect on mental health care in particular was commented upon. It was said that in recent months, the Medical Royal Colleges, the Health Trade Unions and health charities such as Cancer Research UK have all highlighted the effects on patient care of shortages of doctors, nurses, GPs and paramedics. Various representatives of the Medical Royal Colleges have previously been outed on this blog as having taken part in the neglect and abuse of patients – for example the delightful Professor Rob Poole of the Royal College of Psychiatrists. I have also provided details of very bad behaviour – and research fraud – among leading lights in the Cancer Research Campaign, now known as Cancer Research UK. One of the people who starred was Nicholas Wright, who has picked up a knighthood. Furthermore, if doctors and GPs are either stacking shelves in supermarkets or using food banks they will be doing this for reasons other than being short of money – consultants and GPs all hit about 100k pa and many of them earn an awful lot more. Junior doctors and nurses do not earn as much as that but do not actually fall within the category of the ‘low paid’ – now a lot of them are leaving the NHS but talk to them about their reasons for doing this. It is nothing to do with pay. As I have stated repeatedly on this blog it is nearly always because they have standards which they feel are being compromised by the dysfunction, chaos, bullying and poor patient care that pervades so much of the NHS. The traditional get out clause of junior doctors to avoid the bullying and bullshit that rained down upon them was of course to enter General Practice, where they would in the end be self-employed and have some degree of control over their lives. But there were still hazards to be negotiated – one of the most conscientious medical students that I knew when I was young was sacked from his first post in General Practice. He remarked wryly that the main priority of the senior partner in the practice was the state of the carpet tiles and that medicine was far too much of a conservative profession to allow any trainee to disagree. This man was no firebrand – his ambition at school was to practice medicine for a while and then become a Conservative MP. He is now a hospital consultant and interestingly enough a Conservative Councillor who enjoys writing to the Daily Telegraph and Private Eye. His patients also report that he is a very good doctor – but he managed to get sacked. As for nurses – for years, nurses have been leaving nursing for other jobs if they cannot stomach what they are witnessing at work. They frequently move into teaching or lecturing, but some are so desperate to not remain in nursing that they do take up roles outside of the professions. The first person in this category that I encountered was a nurse who in 1984 was working as a waitress – she preferred to do that than participate in what was happening at Ysbyty Gwynedd which was where she had previously been employed. I have since met many more like her. Not one left nursing because of the pay – indeed if you are a nurse it is quite possible to end up on a very high salary if you go into NHS management and many of them do, particularly those with absolutely no principles at all (I’m thinking of one Grace Lewis-Parry here…). There are some very poorly paid people working in the NHS who may well be using food banks or working in a second job as well, particularly if they are the only wage earner in a family with children, but they are healthcare assistants, porters, cleaners, canteen staff and receptionists. They are treated like dirt although they are often playing a key role and I really don’t think that Mr Hopson the CEO from NHS Providers was thinking of them – he certainly didn’t mention them. Another person contributed to the debate as well, declaring the 1% pay restraint policy ‘stupid’ – that was Norman Lamb, the LibDem MP. Norman Lamb in recent months became well-known for his support for Sara Ryan and her family – Sara is the mother of Connor Sparrowhawk, the young man with learning disabilities and epilepsy who died as a result of neglect, along with hundreds of other patients, whilst in the care of Southern Health. Blame was attributed to Katrina Percy, the CEO, along with the rest of a deceitful dysfunctional Trust Board and a lying psychiatrist who simply moved to Ireland to practice after her cock-ups resulted in Connor’s death. Come on Norman, you know damn well that the death of Connor – and all the other patients – were nothing at all to do with pay restraint. The whole bloody lot of those responsible were on enormous salaries. Connor’s mum was a modestly paid academic and on her twitter feed frequently commented that she would have been sacked long ago if she’d been as bad at her job as Katrina Percy and co were – furthermore Connor’s mum had managed to look after Connor herself for most of his life without him dying. That only happened when she left him in the care of ‘professionals’.

One of the final item’s on the Today programme was another mental health related report, featuring interviews with both the CEO of the Mental Health Foundation and a ‘service user’ called Kerry. The report centred around people sectioned under the Mental Health Act being detained in police cells and Kerry was introduced as someone who had endured that experience. Kerry was actually pretty brilliant, she was very articulate, very frank about the horrors and serious deficiencies of the mental health system – but Nick Robinson the interviewer cut her off mid-flow. Because she’d already spoken and they’d run out of time. But the reason that they’d run out of time was that Nick had allotted so much of the time to the CEO of the Mental Health Foundation – who obviously was going to speak for service users, rather than the one very competent service user being allowed to reveal to the nation just how bad the whole system is. I noticed that in the Mail Online yesterday the Mental Health Foundation was also expressing concern about the Serious Problem of Women Drinking Prosecco At Lunchtime. Now if an elderly male Methodist Minister who was temperance wrote an article expressing similar concerns, he’d be publicly pilloried at worst, a figure of fun at best. But if it’s a ‘mental health charity’ no-one comments on how ridiculous and condescending it is. The Mental Health Foundation also stated that ‘1 in 3’ people will suffer from mental health problems – my God, the figure has gone up, the dreadful Paul Farmer and MIND always claimed it was ‘1 in 4’! We’re all going mad, especially women – the only solution is for the Gov’t to part with millions in the direction of the Mental Health Foundation and MIND, appoint them all to Gov’t Advisory Committees and then give them gongs. Meanwhile they will remain completely silent about the serious neglect and abuse of people who really are mentally ill (far fewer than ‘1 in 4’, which is of course why they can be so shamefully treated without an outcry) by the mental health services themselves – people like Kerry, whose opinions mattered less than those of the CEO of the Mental Health Foundation…. And just to show how effective Radio 4 is at raising awareness and combatting stigma, directly after the Today programme Andrew Marr hosted Start The Week and one of his guests described how he’d written a book about a conman who had swindled him who was a ‘bipolar maniac’ who spent huge quantities of money shamelessly. It’s called acute mania, a serious illness which should not be conflated with criminality and a lot fewer than ‘1 in 4’ or ‘1 in 3’ experience it.

All these dire predictions of the consequences of the UK Gov’t not giving mental health professionals even more money than they get already (God knows what they’re doing with it, one look at the state of the nation’s mental health system makes it quite clear that it certainly isn’t being used to benefit patients) has come at a very opportune time. A few days ago I was sent an excellent PhD thesis written by Dr Vicky Long, completed some years ago whilst she was at the University of Warwick and I have been working my way through it. The thesis is entitled ‘Challenging The Public Representation of Mental Illness, 1870-1970’ and it provides much evidence for a number of things that I’ve noticed myself during my various encounters with the UK’s caring sharing mental health services. Particularly interesting is Chapter Two of Vicky’s thesis, which consists of a detailed analysis of how mental health patients were represented within the literature produced by the National Asylum Workers Union. This is a good deal more relevant to present day concerns than non-historical/sociological geeks might imagine. NAWU later evolved into MHIWU (Mental Hospital and Institutional Workers Union), which in turn evolved into COHSE (Confederation of Health Service Employees), whose successor was UNISON, one of the most powerful players in today’s trade union movement, let alone simply within the NHS arena.

Vicky’s analysis very clearly demonstrates that this Union skilfully controlled how ‘mental patients’ were represented in the wider media, which in turn dictated how they were perceived by the general public and that the union nearly always did this in order to improve the pay and conditions of the ‘attendants’ ie. mental health nurses, rather than to improve the care and treatment of patients. Vicky’s analysis and the material that she presents from the late 1920s onwards is striking – we think of this era as being ancient history where mental health care is concerned, but the attitudes and even some of the language still exists in mental health ‘care’ today. As I read Vicky’s chapter, memories of scenarios and phrases used by staff that I had witnessed and heard at the North Wales Hospital Denbigh and at Ysbyty Gwynedd came back to me.

Vicky analysed in detail the journal of the NAWU as this was the forum for representations of mental illness among asylum attendants. The NAWU was formed in 1910 as a reaction to the poor working conditions of the attendants and it focused on the gulf between the privileges and pay enjoyed by the asylum Medical Superintendents (Gwynne Williams the lobotomist and Dafydd Alun Jones in the case of the North Wales Hospital, although of course they were Medical Superintendents later on in the century) and the very poor pay and conditions of the attendants. Very early on in the NAWU’s history, it seems that the working conditions of the attendants were so bad that they did actually have a lot of fellow feeling for the ‘lunatics’. However this didn’t last. Vicky’s analysis highlights other phenomena that can still be seen among mental health professionals – battles between different unions, the influence of gender and fights over status between nurses and social workers. The NAWU journal was strongly socialist and working class and viewed membership of the rival Asylum Workers Union as an act of class betrayal. The whole thrust of Vicky’s argument is that the living conditions of the patients were only scrutinised when the situation of the staff improved.

The usual strategy of the NAWU to obtain improved pay and conditions was to focus on the unpleasantness of the patients. In 1912 there was a reference to the ‘antics of deluded and degraded ‘mental deficients’ and ‘moral perverts’ and nurses are frequently described as having to ‘manage’ difficult patients. Vicky notes that in the main text used for training asylum attendants, the terms ‘nursing’, ‘management’ and ‘control’ of patients are used interchangeably. (My actions in complaining about the north Wales mental health services are referred to on a number of occasions in my medical records as ‘antics’ and the records are dripping with references to the ‘management’ of me, as well as yes, the occasional reference to the need to ‘control’ me. Because I was writing letters of complaint – about criminal conduct on the part of mental health professionals.) In 1929, as part of the description of the job of a mental nurse, it is stated that ‘patients may be unpleasant, abusive, filthy in habits and language, or ungrateful, suspicious, unwilling and resistive….sympathy, kindliness and tact must be abundant to overflowing for the mental patient…’ Again, I have heard many of these words used by mental health professionals to describe patients. I was constantly viewed as a problem for being ‘suspicious’ and ‘unwilling’ – although the staff using such descriptions for me were detaining me illegally in the North Wales Hospital after Dr Dafydd Alun Jones had concocted a ‘deal’ with a corrupt police officer at Bangor Police Station – the nurses had documented all this in detail on my records and had also stated their unhappiness with being dragged into the ‘deal’. Yet I was pathologised for being suspicious of their motives and not wanting to waste my time in their prison. Again and again I have heard staff complain about patients who swear – indeed, at the ‘hearing’ held by Robert Bluglass into the investigation of my complaint about the North Wales Hospital (which didn’t actually cover most of my complaint or the most serious aspects of it), as part of his rationale for labelling me ‘mentally ill’, Jones maintained that I’d used ‘foul and abusive language’ in front of his young children and that anyone who does this is not mentally normal. (How I managed to swear in front of his children I do not know – I did not at the time know that he had children and had certainly never met them. But Jones was not required to provide evidence of any of it – he said that I did it, so obviously I did.) Bluglass agreed that my language was indeed shocking. Bluglass has a daughter Amanda, who fancies herself as an avant garde artist. A few years ago she took to displaying her creations on the internet. One of them was a sampler of a county cottage, below which was embroidered ‘Happy Fucking Holidays’. Interestingly enough, in his final report in which Bluglass avoided commenting on many of the gross things that had happened to me at the hands of Dafydd et al although there was documentary evidence of these things, Bluglass summed up by stating that ‘doctors and others are caring individuals’ – these were people who had illegally imprisoned me, assaulted me, repeatedly lied about me, threatened me and then when that didn’t work tried to bribe me. Oh and they were concealing the activities of a paedophile ring as well. But their goodwill and patience had no bounds…. Another reference from an early edition of the NAWU journal represents patients as ‘alien, foreign, devious and different from normal people’. The SEN in Denbigh who eventually assaulted me, Stephen Rose, at one point described me as ‘scheming and devious’ (it was never explained why) – and in another reference to my alleged ‘abnormality’, on one occasion Jones lost his temper with me (because I didn’t succumb to the threats and bribery) and he yelled at me ‘any normal woman would have some respect’.

Again and again in the NAWU journal severely ill patients are represented as anti-social and violent and this was repeatedly used to justify better wages and conditions In 1928, the journal dealt with allegations that patients were being brutally treated and abused by attendants by alleging that it was the patients who were violently attacking the staff. Arguments were mounted that attendants deserved better pay and conditions not because they were skilled and professional but because they were managing dangerous violent individuals. Accounts are based on conjecture – a ‘seemingly quiet patient’ may suddenly become ‘violent to themselves or others’, ‘another blow’ from a ‘violent patient’ ‘could well have been fatal’. On one occasion a patient less dishonoured than others – a soldier with shell-shock – published in another journal an account of the violence and abuse that he’d witnessed being dealt out by the staff in an asylum. The NAWU responded by stressing the unreliability of patients accounts. This is all very familiar. At the North Wales Hospital and at Ysbyty Gwynedd, again and again I and other patients made representations about staff assaults on ourselves and other patients that we had witnessed. Throughout the course of thirty years the response from the NHS authorities was the same – either it was the patients who had attacked the staff, or the patients ‘had misunderstood’ the situation, or the patients were all mates and were colluding with each other. On the occasion that staff injured me whilst I was a patient in the Hergest Unit, my injuries were not documented and I was not released from a locked ward until the injuries had healed. When I tried to telephone both the police and a friend to report the assault the telephone was disconnected. The assault upon me was never investigated. Despite all the allegations of ‘violent’ patients made by the north Wales mental health services and the constant stream of scare stories and confected statistics regarding ‘attacks’ on staff that the north Wales mental health services have placed in the local media, I have only ever witnessed one assault upon a member of staff, which was when a very psychotic disorientated man detained on a locked ward threw a book at a psychiatrist. That has been the sum of it. Staff are sometimes assaulted by patients, but it is not a regular occurrence. Furthermore, one of the more robust pieces of research that has been done into assaults on staff by patients in psychiatric units – there has been virtually no research conducted into abuse of patients by staff which is extraordinary really, it can only be that it just doesn’t happen! – concluded that in every case, the assault had been precipitated by staff being extremely aggressive or rude to patients. As for ‘quiet’ patients being suddenly ready to launch into terrifying violence – again, another allegation that was levelled at me. When people outside of the mental health services volubly stated that the lurid allegations made about me by mental health staff were inconsistent with what they knew of me, they were told that they ‘didn’t know’ what I was like, or that I had ‘fooled’ them or best of all that I was ‘charismatic’. Only the mental health services could see my black, black heart. But interestingly enough I have recently obtained documents from my lawyer which include letters from the lawyers that the mental health services were using themselves telling them that there was no evidence that I had ever assaulted anyone and that they had to stop saying this in affidavits. Not that it stopped the ludicrous allegations, the psychiatrists concerned then progressed to stating that they thought that I was going to kill them. No evidence at all, although a lot of evidence that they had repeatedly lied about me, even on oath – but nonetheless I could murder the whole lot of them in their beds, they just knew it.

The journal of the NAWU also contains information very reminiscent of the way that psychiatrists today describe patients who allegedly have ‘personality disorders’: ‘…cannot support themselves…cannot resist criminal impulses…not actively dangerous but are a menace to the community…no idea of…social obligations…a danger to women and children…anti-social tendencies and habits of this kind are not be cured…’ or indeed the ‘social failure’ of an individual. This could have all come from a present day psychiatric textbook.

One Claude Bartlett was elected President of the NAWU in 1926 – and he stayed in that post until 1962 no less. Throughout this time he remained a mental charge nurse and with the exception of his time as Chairman of the TUC in 1959, he restricted his activities to the field of health care. Bartlett was one of the most vocal calling for the amalgamation of the health services trade union into COHSE and he was a member of the Royal Commission whose recommendations were incorporated into the Mental Health Act of 1959. In 1959 Bartlett was stating that he was pleased with the large advances made by the Union regarding the representation of mental nurses as professionals. He commented that ‘I often wonder whether some of my trade union colleagues are not trying to break down barriers which have long since ceased to exist. It is a far cry from the lunatic attendant of less than 50 years ago to the trained and qualified psychiatric nurse of today. I am naturally proud to have played some part, small perhaps, in raising a once lowly occupation into a skilled and honoured vocation’. That was in 1959. During the 1990s a nurse at the Hergest Unit who was one of the best staff there, who really was skilled and professional, was regularly ORDERED by Dr X and Dr David Healy to telephone the police to complain about distressed patients. On one of those occasions, it was because a patient had said that he was so suicidal that he felt like chopping a gas pipe. He ended up in Walton prison on remand, although all charges were eventually dropped against him. None of those grandiose, arrogant psychiatrists saw the nurse’s role as ‘a skilled and honoured vocation’. And that nurse did not feel able to challenge any of them, although she saw the consequences of their actions. Interestingly enough the same nurse, after she retired, told me that she never applied for a position as a lecturer in Bangor University’s School of Healthcare Sciences because in north Wales she witnessed the very nurses who did not have good skills with patients applying for jobs there – her perception was that they didn’t actually like looking after patients and weren’t actually very good at it, so they became nurse tutors instead.

In 1959 and the early 1960s, COHSE’s allegedly patient centred view was undermined, suggesting that once more, the main concern of psychiatric nurses was their working conditions. At the 1959 conference, the new Mental Health Bill was debated and a conference resolution expressed concerns that there was inadequate funding for the proposed measures and the hope that mental nurses skills would be utilised in the new community care system. Psychiatric nurses were well aware that other professions might usurp their roles and threaten their careers. COHSE tried to protect nurses by framing themselves as crusaders for the users of the mental health services and leaders of public opinion. Theresa May has of course announced that a new Mental Health Act is to be passed, which will lead to far fewer people being detained against their will and will also enable them to refuse ‘treatment’. This has of course come hot on the heels of scandal after scandal in the UK mental health services, of numerous accounts of neglect and abuse and of course deaths of patients in the care of the mental health services. Have perhaps the mental health professions realised that they are about to be cut out of the picture and made redundant – because patients certainly aren’t going to agree to the shite abusive treatment that is forced upon them at present if they are given a choice – and is that why they are all busy reminding us at the moment of how they only have the concerns of patients at heart? And that the patients are Suffering because mental health professionals aren’t being paid enough? Oh, by the way, in the late 50s/60s when COHSE were worried about their jobs and pay, they organised demonstrations and pickets. Stand by Theresa, there’ll be a March through central London to show us all how much they Care – all the usual culprits will be there, the BMA, the RCN, the Royal Colleges, MIND and Paul bloody Farmer, Peter Beresford and Rachel Perkins and poor old Jeremy Corbyn will be completely taken in by the whole lot of them and will join in, thinking that he’s helping people who Care. Meanwhile psychiatric patients will continue to be tasered whilst sectioned in hospital, suffocated to death whilst being ‘restrained’, prescribed ‘medication’ that harms or even kills them etc etc. In fact I think I heard on the Today programme that a National Health Action Party has been established to field candidates in the forthcoming election. The Top Doctors must be in trouble then, is there a scandal on the way? Has one of them been arrested for doing something that they shouldn’t have, perhaps removing perfectly healthy bits of the body after telling the unsuspecting patient that they had cancer a la Dr Ian Paterson? Or has another Harold Shipman been discovered?

As for Claude Bartlett’s claims in 1959 that asylums and the mental nursing profession had been transformed, well I think that needs to be taken with a very big pinch of salt. After a visit to the North Wales Hospital Denbigh, the Health Minister Enoch Powell was so appalled by what he saw that he is reputed to have told the assembled ‘professionals’ that he would not allow them to do this to people – Powell returned to London and announced the proposed closure of 75,000 psychiatric hospital beds over the next 15 years. (Of course when Powell witnessed something terrible, Gwynne the lobotomist was Medical Superintendent at Denbigh. Presumably Gwynne was so used to imprisoning, neglecting, abusing and indeed killing people that he had become complete immune to the idea that some people would not appreciate what was going on, hence he felt able to proudly throw open the doors of Denbigh to the Health Minster. Obviously the result of years of cap-doffing and toadying from small town society who could rely on the hideous Gwynne to deal with anyone who was a bit of a nuisance to them. COHSE really freaked out at Powell’s proposals and resurrected the spectre of the dangerous patient (they forgot their user-friendly bit) and wanted nurses paid danger money. COHSE were particularly irked with Powell’s proposals to only place psychiatric patients in Rampton, Broadmoor and Moss Side as a last resort. They also maintained that Powell’s policy of discharging patients on prescription would lead to a nation of drug addicts. Once more psychiatric patients were represented as violent criminals and Vicky Long suggests that this stemmed more out of the fear of the threat to the jobs, future and status of the mental nursing profession than any concern over more outpatient care. Again, I saw something similar when I was a patient at the North Wales Hospital in 1986/87. At the time the UK Gov’t were making much noise regarding closing down places like Denbigh and transferring patients into community care. All the nurses at Denbigh were raging about this, stating that the facilities in the community weren’t there (which was to be fair completely true) and that some of the very vulnerable patients would never cope (which again they didn’t). But the same nurses were concealing and colluding with the most appalling wrongdoing on the part of Dafydd Alun Jones et al – they KNEW that patients were in there illegally banged up, never having been assessed by anyone but had simply been arrested because they’d crossed the path of Jones or one of his mates. They KNEW that some of those patients were not ‘schizophrenic’ or ‘deluded’ as was being diligently documented. And one of those nurses, Iola Edwards – who was one of those who expressed such concern regarding the fate of the patients once Denbigh had shut down – actively stopped a young woman from telling me any more, when she heard the young woman begging me to help her and claiming that she had been abducted, held in an attic ‘by a doctor’ with a group of other men and molested. (Would you know anything about this perchance Dafydd, after all your mistress was named in the Waterhouse Report as having colluded with a paedophile ring whilst she was Director of Gwynedd Social Services). That young woman disappeared within hours – Iola Edwards obviously knew what had happened to her and must have been instrumental in flagging up to someone in authority that the young woman had told me what had happened to her, so they got her out of there quick. I bet they didn’t let her go though, or take her to the police. And of course the community care provided after Denbigh eventually shut was dreadful – because it was managed and staffed by the same people who ran and staffed Denbigh. Did anybody really imagine that their values and standards would suddenly change just because someone gave them offices and clinics in a different building?

The NAWU dwelt on some other familiar themes as well. In the 1930s their journal carried reports on the experimental use of leucotomies and ECT and the Government’s Athlone Report stated that ‘medical staff now require highly skilled mental health nurses to assist’. Although the historian of nursing Peter Nolan argues that physical treatments threatened to erode nursing skills by reducing nurses to doctors assistants, COHSE’s predecessor was enthusiastic about the ‘new therapies’. During the 1940s and 50s there was a reconceptualization of the image of the psychiatric patient as that of a client or guest. By 1961 glossy photos showing the luxurious aspects of public hospitals were displayed monthly in the journal and hospitals were described as if they were hotels. But when the Hergest Unit was built at Ysbyty Gwynedd there was much excitement and boasting about the new facilities – of course they were very much better than what had been on offer at Denbigh, but huge cracks soon appeared in the service, which still contained the former staff and managers from Denbigh.

The NAWU also reflected two other ideas concerning psychiatric patients that were expressed by some professionals – that either sterilisation or euthanasia would be a good idea. In 1929 the Gov’t considered sterilising ‘mental defectives’ and they were depicted as an economic threat to sane ratepayers. In 1934 Prof JA Berry, Director of Medical Services at Stoke Colney, Bristol, argued that some in his care should be killed, a ‘kindly euthanasia’ being the ‘only really kindly treatment’. A Dr EGL Goffe, a Kingston physician, suggested no other alternative for ‘idiots’ than the ‘lethal chamber’ as ‘such people should not be a drag on the community…a waste of money and energy keeping them alive…’ Many doctors wrote in favour of sterilisation – however one Dr Neil Montgomery showed an acute awareness of class power abuse issuing from doctor to patient, commenting that it tended to be the poor who should be recommended for sterilisation and at the same time expressed sentiments of duty to the patients which were not expressed by the working class members of the NAWU. (Remind anyone of the current Tory Govt’s new policy that people claiming tax credits for a third child can only do so if they can demonstrate that the child resulted from rape?) In July 1935, the cartoonist for the MHIWU journal (as it had then become) depicted the Board of Control Chairman’s view – a full page image of a physically deformed figure whose featureless ‘shadow’ fell menacingly over Britain. The figure was represented with palms outstretched, recalling the belief expressed in the journal by doctors, judges, Poor Law guardians and the Board of Control that ‘mental defectives’ were socially inefficient and an economic drain on the resources of the ‘normal’ population. Obviously a bunch of shirkers and skivers like all those people that George Osborne seemed to know of…

In 1963 an editorial in the journal commented that if the Lord Chancellor and Lunacy Commissioners were anxious for the welfare of the patients, the very first thing that they should turn their attention to is the conditions of asylum services to attract and retain the best types of men and women. Sounds familiar – here comes a nurses pay claim, just after revelations that patients were being treated dreadfully. By the end of the ‘60s, the situation of the patients had not improved. Barbara Robb’s famous expose of the appalling treatment of the mentally ill in hospitals, ‘Sans Everything: A Case To Answer’, elicited personal attacks on Robb and COHSE complained of a ‘witch-hunt’ atmosphere and parodied Robb’s expose as ‘Knock Everything’. COHSE was not the only body representing psychiatric nurses – the RCN did as well and in 1970 their conference attacked psychiatric nurses conditions of work. The Chairman of their Psychiatric Committee suggested the patients posed the main limitation to nurses work. Once more a dire representation of your average psychiatric patient was constructed, with it being claimed that being spat at, kicked, scratched and bitten was all in a day’s work and that nurses spent much of their times separating patients who were fighting or warding off assaults on themselves.

The journal of the NAWU also reflected the gender battle that took place within it’s own ranks. From the 1920s onwards there was much opposition from male asylum attendants to women nurses working on male wards. Sick patients were portrayed as violent anti-social misfits whose violent and sexually depraved behaviour would only increase at the hands of kindly female nurses – a similar argument was used at the Hergest Unit as the rationale for their callous treatment of those whom they labelled ‘personality disordered’. Indeed, a suicide attempt by one such patient was constructed by Dr Dafydd Alun Jones as being the result of ‘ire’ of all things. Yet Nursing Times, a journal dominated by women, opposed the NAWU, pointing out that ‘not a single complaint of any kind has been made by the female nurses’ – furthermore, a female nurse was quoted as commenting that constructing all ‘mental cases’ as ‘depraved’ was an ‘insult’ to many patients. This depiction of patients as violent and sexually perverted diminished when it was no longer in accordance with the image that the Union was trying to establish. This turnaround confused members – there is written evidence from one male nurse demonstrating that he was puzzled as to how the Union could have ‘forgotten’ what patients were like.

Throughout the twentieth century, the journal of the NAWU repeatedly published articles on themes that are still pursued at present. An article in the 1940s written by a patient, ‘David’, was the first time that the journal has offered any degree of respect to a patient’s account. David was completely uncritical of his treatment and maintained that it could only have been bettered if the asylum staff were paid more. This is startlingly reminiscent of much discourse from present day ‘service user involvement’. Two of the biggest figures in the UK in this field are Peter Beresford and Rachel Perkins. Beresford is a former social worker and this is very obviously still a major part of his identity and Perkins is the former clinical director of Springfield Hospital. Perkins oversaw a disaster, including a number of murders, and Springfield was subjected to damning comments at a subsequent public inquiry. Neither Beresford or Perkins have ever spoken out about serious abuse and neglect in the mental health services, criminal activity on the part of the ‘professionals’ or the problems of dishonest expert witnesses in psychiatry. Their concerns tend to revolve around ‘discrimination’, ‘stigma’ and the need for more funding and higher staff pay. Some years ago I received a series of very angry e mails from someone who had completed a PhD with Beresford, demanding to know why I would not ‘come out’ as an academic who was a ‘service user’, telling me that Peter Beresford could ‘help’ me. I have made it clear in my publications that I do not hide my involvement with the mental health services but I find the ‘service users movement’ for the most part strangely deradicalised, denatured and institutionalised and I explained this to the person who e mailed me. They became angrier and angrier and made it clear that I was some sort of traitor by not joining the merry band who remain silent about serious wrongdoing but who campaign for higher pay for the people involved in this.

Another article in the NAWU journal from the early middle years of the twentieth century concerned the activities of a charity dedicated to the after care of discharged asylum patients, supposedly committed to their economic and social reintegration. The charity’s President had commented that the work of the charity assisted the state by producing good citizens. Does this sound familiar to you Paul Farmer?

Another article published in the 20s stressed the important of asylum attendants completing the Certificate of the Medico-Psychological Association, in order that the work would be seen as highly skilled and professional. Nurses these days are encouraged to go for postgrad education, because nursing is ‘highly skilled’ and ‘professional’. Some years ago I was forwarded an e mail from a ward manager at the Hergest Unit which frankly declared that he didn’t want to do an Masters because he’d found completing a Bachelor’s degree very difficult, but his boss, the nursing manager Lena Henry, had told him that it would make the Hergest Unit look good if he did enrol for a Masters. Meanwhile patients died.

Again, as far back as the 1920s, the NAWU’s journal was maintaining that the general public only saw the worst side of mental hospitals and that if the public were allowed to enter such hospitals they would receive enlightenment. I witnessed two such Tours of North Korea myself, one in the North Wales Hospital Denbigh and one at the newly opened Hergest Unit. Local dignitaries were guided around the best parts of the building by the nicest members of staff. At Denbigh it occurred on Christmas morning when the Mayor and his entourage paid a visit. They were all very friendly, but of course patients clamoured to desperately tell the Mayor et al what was actually happening to them in there. The accompanying nurses used obviously tried and tested techniques to deflect the conversation onto other matters, such as the Christmas presents that the staff had given us that morning – they did give us thoughtful presents and they gave us a good spirited Christmas dinner as well – but a lot of the patients that the Mayor met had been detained illegally, although he wasn’t told that. The nurses did tell me that the Mayor visited the hospital every Christmas morning – ah, so they knew that he would be coming then! When the doors of the newly opened Hergest Unit were thrown open to some local councillors I took the opportunity to tell them that one of the psychiatrists there was having sex with the patients. A sharp-witted nurse interjected with ‘that man does not have any beds in this hospital’. No, but they let him in every Tuesday to hold outpatient’s clinics…

In 1969 COHSE’s journal concerned itself with the struggle for status between psychiatric nurses and psychiatric social workers. The social work profession made it very clear that they considered themselves superior and expressed concern that nurses would ‘muscle in’ on community work. Interestingly enough, I know a psychiatric nurse who trained in the 70s who considers that social work training is too political, concentrates too much on the identity and place in the world of the social worker and does not pay enough attention to the concept of duty to one’s clients. This nurse believed that this was what lay behind so many of the problems that patients experienced with the Arfon Community Mental Health Team – whether she knew that some members of that team were doing the bidding of people who were facilitating a paedophile gang I do not know. I note that Chapter Three of Dr Long’s thesis is concerned with the development of psychiatric social work. I look forward to reading her account of the evolution of the profession of which Hywel Williams was such a proud member.

Reading Chapter Two of Dr Long’s thesis one can only conclude that very little has changed – unions representing mental health staff in the UK have been very much more concerned with the pay and conditions of their members and have been prepared to denigrate the people that they are paid to care for to achieve this, ruthlessly manipulating public opinion. Was it really All A Very Long Time Ago and that Things Are Different Now? Well when I was in Denbigh a nurse called Bob reminisced about how he used to ‘manage’ the patients in his earlier years – he told me that the nurses had to make the patients more frightened of them than they were of their hallucinations. Bob told me that in 1987 – he may still be alive. As many of the older Denbigh nurses are. It is indeed informative to go on the website of the grandly titled North Wales Hospital Historical Society, which is actually a forum for former staff. There are a number of threads where staff have been chatting to each other – those poorly paid nurses who were constantly in danger from patients are certainly enjoying retirement. They discuss their exotic foreign holidays and one of them has a yacht that he talks about. Whilst I was in the Heddfan Unit a former Denbigh nurse who used to pop in there to do a bit of agency work told me that he owned a property in Florida and he spends his time between there and his place in north Wales. By the way, as mental health workers, all these people were entitled to retire at 55 yrs old with a full pension. Tory Cuts anyone? I know of someone else in north Wales who is both a psychiatric nurse and a psychiatric social worker. This man told me years ago that as a student, he was one of those who exposed the Ely Hospital Scandal – he claimed to have punched a nurse whom he saw assault an elderly man before he mobilised the students. Yet this man sectioned people in Denbigh, he knew about the horrors of Prestwood homes, he knows exactly how bad the mental health services are and he watched highly inappropriate people qualify as social workers when he worked in social work education at Coleg Menai. He has never spoken out about any of it. He now has a leading role in MIND in north Wales. Do you fancy punching a few other people Geoff? Starting with your senior colleagues at MIND who pay your salary and are doing such damage…

Bring on the protests then. Of those who are only protesting because they Care.