casual tweeting hides unpleasant truths

A couple of bipolar-related issues caught my eye on twitter today.

The first was a reported exchange at a senior management team meeting of a mental health trust.

One consultant suggests empowering staff to advocate for patients. HR director replies: “This is a mental health trust, not Amnesty International.”

I tweeted the person who’d reported this and suggested that the HR director should be sacked. Back came the reply, “No, they’ve been promoted”.

This would be bordering on the unacceptable for the HR director of an acute NHS trust, but for someone working in a mental health trust surely there can be no doubt that this displays a callousness and lack of understanding that is quite extraordinary. I can only wonder who was responsible for promoting this person, and what criteria were considered important.

Unfortunately similar attitudes are becoming more common in today’s NHS, as compassion has given way to financially driven decisions. Phrases such as ‘the NHS is not an employment agency’ in relation to job cuts, and ‘writing letters to support a patient’s request for housing/ application for disability benefits is not part of my clinical role’ have replaced a holistic approach to patient care.

In mental health trusts, always the Cinderella in the hierarchy of hospitals, disproportionate financial cuts have cut clinical resources to the bone. Staff are overworked, underpaid, and spending compassionate time with patients is often sacrificed for the cold bottom line of maintaining safety. Even this fails – a recent MIND survey detailed physical and sexual attacks on mental health wards, not isolated incidents but distressingly frequent occurrences. A mental health hospital is meant to provide sanctuary, a safe and healing environment. This requires adequate staffing levels, with all staff both clinical and non-clinical subscribing to the goal of patient-centred holistic care. In order to do this staff must be cared for and feel valued and nurtured – something that is far from the case in 2014.


The second tweet that I saw related to weight gain with psychiatric drugs. The tweeter had essentially been told that she could be ‘well and fat’ or ‘unwell and thin’. I suppose that at least there had been some sort of acknowledgement that her medication was associated with weight gain. It is surprising that many doctors still seem unaware that a number of commonly used psychiatric drugs cause weight gain. If they do realise there are two common responses. The first is the one my fellow tweeter had – put up with it because it’s the price you’ve got to pay for staying well. The second is ‘you’ll only get fat if you eat too much.’ (There is a possible third, which is denial – ‘these newer drugs don’t make you put on weight.’ This was a myth peddled by the drug manufacturer, a myth now shown to be untrue. The new drugs are just as bad as the old.)

This is yet another way of shaming and disempowering people with psychiatric illness. There is a disturbing lack of awareness about the side effects of drugs prescribed (the weight gain is a metabolic effect, which is also associated with an increased risk of diabetes), about the importance of it to the patient (there seems to be an unspoken belief that if you are mad you’re not going to be worried about whether you are fat and unattractive), and about whose responsibility it is to discuss the problem of weight gain. ‘Eat less’ and ‘go on a diet’ are singularly unhelpful directives, not least because they are unlikely to work. The  patient tries to eat less, still gains weight, is likely to find it difficult to exercise (because lack of motivation is part of depression), and returns to her GP feeling a failure.

Both tweets upset me because both show a complete lack of understanding and compassion. They buy into the narrative that madness is some sort of lack of moral fibre, that it can be overcome by sufficient willpower. Such attitudes are readily conveyed non-verbally to patients, who in turn may become passive victims. As we know, victims invite bullying, and certainly this cycle of behaviour deters people from seeking early diagnosis and help for mental illness.

These tweets show that stigmatisation of people with mental illness is alive and well in the UK at the end of 2014.

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