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I've learned the hard way that medication doesn't cure mental illness - but one treatment really does work
When the police marched me into the psychiatric hospital where I was sectioned, I was not thinking about the Mental Health Act 1983. In the middle of a psychotic breakdown, I thought I was working for world peace on behalf of MI6 and aliens, and engaged to Kylie Minogue.
As crazy as a cricket or, in clinical terms, ‘in a manic state and suffering delusions’, I had run my car off the road and dug holes in my ceiling.
Like the 60,000 people in psychiatric hospitals right now, and the one in four of us who will suffer mental illness at some point in our lives, I needed urgent treatment. Tens of thousands of us are affected, and experts know how to help us.
The problem is what we actually do about mental health lags tragically behind what we know about mental health.
This is why the new Government’s proposed reform of the Mental Health Act is so important. They urgently need to get it right because it will make or break the life chances of thousands of us, and those of our children.
The Mental Health Act 1983 contains the most powerful legislation in Britain. It lays out the laws under which you can be held in a psychiatric ward and treated against your will, if you are judged not to have the capacity to make rational decisions.
Having a breakdown is not a crime, but the Mental Health Act gives you fewer rights than a prisoner.
The problem is what we actually do about mental health lags tragically behind what we know about mental health
Horatio Clare at the Hay Festival... the author of many successful books on his childhood and love of nature, he was sectioned in a psychiatric hospital after suffering delusions
Mike Slade, a professor of mental health recovery and social inclusion at the University of Nottingham, explains that after a mental health crisis, sufferers can experience benefits
Horatio Clare's latest work is published on August 29 (Penguin Life, £18.99)
In the middle of a psychotic breakdown, Horatio Clare thought he was working for world peace on behalf of MI6 and aliens, and engaged to Kylie Minogue
If you go to prison, you won’t be pinned down by guards and injected with drugs, as you can be in a mental hospital. (When a nurse explained this to me that first night in the psychiatric hospital, I took the pills.)
In prison you won’t be woken hourly throughout the night with a torch shining in your eyes – or be studied while you eat breakfast, to gather evidence on what should happen to you.
(Have you ever tried to eat Rice Krispies in a ‘sane’ way? I boiled it down to meaning ‘slowly and carefully’.)
You also won’t be forcibly injected with medication that may make you better or may make you worse – nobody knows until you have tried it, which is why my psychiatrist gave me a choice of three drugs, saying, ‘Pick one’.
Those first days on the ward were scary and lonely, but I was lucky to be in a well-run unit.
The ward was quite new (many are old and crumbling), adequately staffed (many are not) and we had our own rooms (most do not). And, luckily, it was near my home – many patients are sent far away from their support networks, disastrously.
Our system is so overloaded that staff turn you away if there is someone more ill than you, however ill you are.
According to the Royal College of Psychiatrists, nearly a quarter of people in urgent mental distress wait more than 12 weeks to see a psychiatrist. That is more than enough time for things to get worse, for you to harm yourself, or, in extreme and tragic cases, to harm someone else.
To reform mental health, sufferers, clinicians and professionals involved in this vital sector – from support workers to politicians – need to understand the causes of the distresses and illnesses of the mind.
The mistaken 20th-century idea that there was a chemical imbalance in the mind of the sufferer, or some other physical defect with the brain structure, has been debunked by psychiatry.
But if you suffer mentally, you may well still be treated as though there is something physically wrong with you.
We now know that whatever you are suffering is most likely rooted in your childhood and your life experiences since. But GPs lack both the time and tools to treat your life (that takes therapy).
Instead, they classify you with a diagnosis and point you to medication. This leads to millions of prescriptions for antidepressants and other drugs – and being told ‘you are bipolar and you need to take long-term medication, possibly for life’, as I was, is terrifying and can dominate your entire existence.
We diagnose many people, especially women, with crushing, stigmatising labels such as ‘borderline personality disorder’.
This can be code for ‘I don’t know how to treat you’, according to clinicians I interviewed for my new book, Your Journey, Your Way, about what we should do about mental health.
Or it can be used punitively, to exclude someone who objects to treatment, or who makes a fuss.
A psychiatrist I spoke to, who was herself hospitalised, said she was careful to be a ‘good patient’ so as not to be given a personality disorder diagnosis.
Many psychologists, clinicians and sufferers say ‘personality disorder’ diagnoses should be dumped and replaced with ‘complex emotional needs’ – because it’s not a dodgy personality that is causing the problem, it’s trauma.
Medication affects your symptoms, making you feel temporarily better – but it does not change the causes or cure anything.
And, while medication can be a lifesaver in a crisis (quetiapine, an antipsychotic, drained the madness out of me), our system does not get the best out of it, according to Juliet Shepherd, a specialist mental health pharmacist. Also former president of the College of Mental Health Pharmacy, working in the NHS in Worcestershire, she is a leading expert on psychiatric drugs.
‘Medication gives you a place to stand, firm ground, a chance to make changes to your life and habits,’ she tells me.
‘But this may only last three weeks. When it stops working, or you hit trouble again, you’ll want more medication.
‘You think the pills are making you better, but they’re not – that’s the work you’re doing, the changes you’re making.’
In my case, changing my life and habits meant separating amicably from my partner, adjusting our lives and our parenting, getting more sleep, eating and exercising better, and managing work better to avoid stress.
This is why psychologists and growing numbers of psychiatrists want to treat the whole person – that’s your body, your mind, your relationships and your life circumstances.
They want to treat you in a ‘trauma-informed’ way. This means unearthing and understanding what has happened to you to cause your distress; delving into your life history. So our future systems should not ask ‘What is wrong with you?’, as the current medical model does, but ‘What happened to you?’
The fascinating thing is that we already know the answers, in many cases.
ACEs are adverse childhood experiences – and the more you have of them, the more likely you are to become mentally unwell.
Abuse, drugs and alcohol in the home, domestic violence, a parent in prison or suffering mental illness, divorce and poverty are all major ACEs.
Most people who suffer them before the age of 18 hit mental trouble.
Don’t just take my word for it: Manchester University NHS Foundation Trust reports that one in three adult mental health conditions stem directly from adverse childhood experiences.
Our new system needs to recognise ACEs and treat them with trauma therapy as early as possible. Instead, at present, many of us leave the GP surgery – as I did – with a label that is stigmatising and powerful drugs that may or may not work, and a hopeless feeling of being doomed to suffer.
To cut down on ACEs we need better services for children and young people, especially for the poor, for people in deprived areas, and non-white communities, who suffer the most mental illness.
Robin Tuddenham, the chief executive of Calderdale, my local council, explains that this means youth clubs; opportunities such as art, theatre, sport and music; and buses to get young people out and about, and home again.
Otherwise, he says, ‘young people can become trapped at home’ with nothing to do but watch screens and smoke skunk – a recipe for depression.
In my case, there was trauma in my childhood: divorce and poverty, family breakdown, alcoholism, stress and drama – and later I abused drugs, especially cannabis.
I did not have therapy for any of this until I was nearly 50. If I’d had it at age 20, I would not have been marched into that mental hospital aged 47.
In New Zealand they’ve set up a new kind of mental hospital: if my policeman had been able to take me to Ke-We-Way, a ‘recovery house’ near Wellington, he would have handed me over to a ‘peer supporter’, someone who, like me now, has recovered and who knows mental suffering from the inside. In this recovery house, the peer supporter would first tell me their story, not ask for mine.
‘Shall we take our shoes off and walk on the beach?’ they might say. And only then my story would start to come out, the peer supporter talking to me about how they recovered and how I could, too.
Professionals across the field are unanimous that the right kind of peer support is life-changing: findings across Europe and the world, and in NHS therapies and current trials, show clearly that massive expansion of peer support will make a mighty difference.
This is not just about funding, though it’s an open secret that mental health services generally – and Child and Adolescent Mental Health Services (CAMHS) in particular in the UK – are a disaster, with a massive lack of access, absurd and cruel waiting times and inadequate care.
But the people who staff these collapsing services are often heroically caring, giving and, crucially, they need money urgently.
We also need remedies for mental misery, which have been cut, to be replaced and funded.
In my mental hospital we had an art room, but the art therapist was rarely available.
Years later I witnessed a professional art therapy session. It was electrifying, lifesaving, said the sufferer.
But the only help we patients got was rare sessions of cognitive behavioural therapy – standard NHS talking therapy that helps manage feelings and behaviour.
As another sufferer said to me: ‘It’s no good telling me how to manage my feelings tomorrow if no one’s helping me with what my dad did when I was a child.’
In other words, we also need effective, personalised treatment for every individual.
We already do this on special wards for mothers with post-partum psychosis. This can come on like a sudden and deadly madness after childbirth, but Britain is brilliant at treating it. Sufferers recover.
It’s not the only new hope. The day I learned that there is a therapy, open dialogue, which reduces suffering and treats your whole network of family and friends – and which cuts the number of nights people need to be in hospital by 90 per cent – I burst into tears.
Open dialogue was developed in Finland and has phenomenal success rates, with patients needing minimal medication and detention in locked wards.
It works by sitting the sufferer, their family, a peer supporter and a doctor down to share honestly their fears, worries and troubles – and agreeing together about what happens next.
Even with the most severe conditions, such as psychosis and schizophrenia, open dialogue gets 70 to 81 per cent of patients back to work or study within two years, most of them unmedicated.
The current medical model, which medicates everyone, has a 5 to 15 per cent success rate over the same period.
It also consumes our police services. The police spend 20 to 40 per cent of their time dealing with mental health cases: our force in West Yorkshire was brilliant with me and my family, but the chief constable later told me he dearly wished he could spend more time fighting crime and less on people having breakdowns.
Intervening before our crises require the police means funding the crisis teams and home-based treatment teams who are busy visiting sufferers in your area as you read this. They support people in the community and stop us needing to be admitted to hospital but they have seen huge cuts, leading to thousands of mental health workers, from support staff to doctors, leaving the profession.
When we start intervening earlier, with parental support and support in schools, and when we give young people opportunities, leisure and transport infrastructure – and when we use open dialogue to slash hospital admissions and expensive medication – then we will have that money.
And when our mental hospitals become recovery houses, with peer supporters and effective therapy to set us on the way to healing, those of us who have had breakdowns will not need to be readmitted – and you, dear taxpayer, will save a fortune.
But perhaps the greatest secret of recovery, the key to our future mental health system, is called post-traumatic growth.
Mike Slade, a professor of mental health recovery and social inclusion at the University of Nottingham, explains that after a mental health crisis, sufferers can actually experience benefits.
‘You may find that you are more compassionate with yourself and others, more aware of both your needs and theirs, and more able to help others,’ he says.
Discovered by research in the US, post-traumatic growth means your values may change, Professor Slade explains. In other words, you might find your ‘tribe’, people with similar interests and talents, and spend more time on creative and healthy activities and meaningful work.
‘The most recognised system for recovery is the CHIME framework, which stands for connectedness, hope, identity, meaning and empowerment,’ he says.
Everyone, from the Prime Minister to every clinician, parent and child leaving school needs to know about the CHIME framework and post-traumatic growth. Because even if the coming reforms to the Mental Health Act – as yet to be revealed – give us the world’s best system, life will still hit many of us with trauma, the way life just does.
And if we can learn to see ourselves, even in the fires of suffering, as not medically damaged, but reacting to trauma in natural ways – and if the whole system understands that, too – then our lives will become journeys of recovery and growth.
And our lives will not be wasted, as so many are now, in long and desperate struggles against untreated pain.
- Your Journey, Your Way: How To Make The Mental Health System Work For You, by Horatio Clare, is published on August 29 (Penguin Life, £18.99). To order a copy for £17.09 (offer valid until September 2, 2024; UK P&P free on orders over £25), go to mailshop.co.uk/books or call 020 3176 2937.