Openmind 148, November/December 2007
Those times when I need others to help me to do ordinary things that I can usually do for myself - shopping, cooking and travelling around - are among the things I find most difficult about having mental health problems. I suspect that in this I am not alone.
Always being on the receiving end of help doesn't exactly make you feel good, does it? Being the beneficiary of the 'good works' of others does little to boost your confidence and self-belief. Over the years I have met many people who find it demeaning and diminishing to need the help of others to cope with what we have come to regard as the basics of life.
But I have been thinking about this a bit more recently. And this has led me to asking myself, 'What is the difference between Prince Charles and a psychiatric patient?' No, I am not thinking about any unusual ideas he may possess. I am thinking about all the help he receives to live his life. He has people who drive him everywhere, cook his meals, organise his day and advise him on what to wear, what to say and how to behave. Forgive me if I am wrong, but I have also heard tell that he has someone to put his toothpaste on his toothbrush in the morning and someone who sorts out his socks (I sometimes feel that I could do with one of them!).
In short, it seems to me that Prince Charles has a great deal more support to live his life than does even the most severely disabled psychiatric patient. I'll bet he does not feel demeaned by this help. On the contrary, I am certain that he feels privileged and important. So what is the difference between Prince Charles and a psychiatric patient?
Well, from where I sit the answer would seem to be choice and, more importantly, control. Prince Charles employs the coterie of people who assist him in all facets of his life. He can sack them if they do not do what he wants or if they do not treat him in the manner he feels he has a right to expect. If there really is a person who puts toothpaste on his toothbrush, you can bet they always ask, "How can I help you, sir?" (or whatever the correct form of address - forgive my ignorance but I don't move in such exalted circles) I wonder how many psychiatric patients have ever heard the words, "How can I help you, sir?" No, public servants behave in a very different manner from private servants.
Back in the 1940s when the NHS was established there was a sense of doing the masses a favour - free health care for the great unwashed. As the NHS Plan says, despite exhortations to tailor services to the concerns, wishes and convenience of those whom we serve, 'Too many patients feel talked at, rather than listened to' and the 'convenience of the patient comes a poor second to the convenience of the system'. (1)
How many times have I heard said of inpatient wards things like, 'If we make it too comfortable we'll never be able to get them out of here', and 'This isn't a hotel, you know'. Well maybe we should think of our wards as hotels, or maybe those health spas and clinics frequented by the rich and famous (who I'm sure are asked, like Prince Charles, "How can I help you, sir/madam?").
It seems to me that one of the biggest challenges we face in mental health services, whether they be voluntary or statutory sector, is to move away from a culture of altruism - you get what you are given and be grateful for it - to a culture of customer service - "How can I help you, sir/madam?" How can we ensure that public servants become more like private servants?
1. Department of Health, 2000.