The first time I visited the Maudsley Hospital was as an outpatient. More recently I was there as a visitor after a friend had been sectioned. The experiences were very different, but each strengthened my consciousness about the fragility – and strength – of the human mind and the extraordinarily different work done by those in the so-called Cinderella ervice of the NHS, psychiatry.
Back in 1986, I was slowly recovering from a psychotic breakdown. I had assumed that new-found teetotalism would mean an end to my problems. But my ongoing depression was having a dreadful impact, not just on me but on my partner Fiona, who asked our GP to help. He referred me to the Maudsley.
Sitting there, waiting to see two doctors, surrounded by people visibly more disturbed than I was, got me off on the wrong foot. And when the doctors refused to believe the details of my breakdown – I really had been arrested by Special Branch, a claim they clearly felt to be a classic paranoid delusion – I said, “Sod this for a game,” and walked out. Inadvertently, the doctors had given me the strength to feel strong again.
More recently, as a visitor and researcher, I was struck by how safe and secure it felt, the high quality of nursing care, and the sheer volume of people and conditions being cared for in the world’s oldest and the country’s biggest psychiatric service, in the London postcode with the highest rate of psychosis.
Now the public will get the chance to take a close look too, because the South London and Maudsley NHS Foundation Trust has opened its doors to TV and a remarkable series for Channel 4, Bedlam.
“It was a risk,” admits medical director, Dr Martin Baggaley. (He was in the news last week saying that a shortage of beds meant the service was “in real crisis… inefficient and unsafe”.) “But we got the sense the C4 team making it were really serious, and driven in part by the same reasons for doing it as we were – to break down ancient fears and myths surrounding mental illness. I’m not pretending four hours of television can wipe out centuries of stigma and we have a long way to go, but we just have to keep chipping away.”
It’s gripping, dramatic, often troubling television, but also uplifting in the way it shows people can and do get better. “I’m glad I’ve been diagnosed young,” smiles Katrina, 22, a drama student previously seen in full-on manic mode. She has schizoaffective disorder. “I’ve got the right medication, I can get a job, go to uni, whatever.”
There are four episodes: on the residential centre for people crippled by chronic anxiety and OCD; the triage unit at Lambeth Hospital; services for older adults; and finally the fantastic work of mental health teams in the community.
“There is definitely more pressure on services,” says Baggaley, “and the same thing is reported across the country. Referrals are up 20 per cent over the last 12–18 months. Whether that is more social pressures, the economy, falling living stand- ards, a squeeze on social services, population changes, it’s hard to tell. It means there’s constant pressure on beds and of course you do feel some- times you’re pushing people back out into the lives that gave them their problems in the first place.”
The series follows patients in real detail and at length, and they and their families were consulted at every stage about what could be broadcast. Unsurprisingly, many refused to give consent. It is therefore astonishingly brave of Helen, a British Museum librarian hopefully back at work by the time the films are shown, to be so open about her clearly irrational fear that she has been putting strangers in bins.
Or James, a patient who’s now back at university after four months of residential care, talking about his obsessive fear of having faeces inside him, which means much of his life is spent on the toilet: “As long as I can remember, I’ve had a difficult relationship with it. It sounds ridiculous, it’s just a toilet. I’m just going to be stuck with OCD and not be able to do anything. I really don’t want to be a sort of a waste of a human.”
Or Dominic, 44, a middle-class, Oxford- educated, professional father of four who’s twice tried to end his life – “I feel as though there’s a murderer inside my head, trying to kill me,” he says. Dominic was of particular concern to Dr Baggaley, who heads a team of more than 300 psychiatrists. “I was frightened at one point whether this was some long, elaborate suicide note on film. But I was delighted to see him the other day, seeming so well. It’s astonishing really.”
Not every case ends positively. Knowing when to discharge a patient is crucial, but there are no certainties. “I’ve lost a couple of patients through suicide. It’s always what you dread and you do your very best to stop it. My point in the film is that you can’t prevent it entirely, because it’s ridiculous to assume that, however clever or skilful you are, you can predict people’s behaviour.”
And what of public reaction to the films? Are there any dangers there? “You do worry about the patients and their families because they really are exposing themselves,” says Dr Baggaley. “And remember back in the ‘Bedlam’ days, people paid to visit the asylums and watch the patients for entertainment and a part of me was always worrying about making sure this is not like that. That’s why it was so important the people making the film really understood why we were doing it and all the issues involved.”
As Aaron, an OCD patient, says about why he agreed to talk so openly on television about his illness: “If it can help one person know that they have a problem, it’s a good thing.” There’s much that concerns Dr Baggaley about modern psychiatry; the potent form of cannabis, skunk, and “designer drugs” GBL and GHB that add to his caseload. The “scandal” of patients with schizophrenia whose life expectation is 20 years lower than average – “if that was happen- ing for anything else, there’d be an outrage” – and misconceptions about the role of psychiatry.
There’s still a feeling,” he says, “that therapy is what middle-class neurotics do, as opposed to what people need. A private-sector psychiatrist told me that every day he sees teenage girls from very well-to-do families whose parents wouldn’t even think of going to a GP because it’s so stigmatising. But actually having your own therapist at 17 is fine.”
He hopes the series will lead to the medical profession and pharmaceutical industry ceasing to put psychiatry at the bottom of the pile. “Psychiatry isn’t given the priority is should by governments and health services. The pharmaceutical industry doesn’t invest enough in research in this area, because it isn’t where the money is.” But despite the often acute difficulties, there are successes – many, many successes – and moments of “you couldn’t write it” absurdity that make his job so rewarding.
“We had a patient admitted who, unbeknown to me, had a long-standing delusion that she was being followed and filmed by Channel 4. So there she is, poor woman, turns up at the door and there’s a big sign saying, ‘Warning: Channel 4 Are Filming.’ So, probably regrettably, we decided we should stop filming while she was in. But in fact, thinking about it from a psychotherapeutic point of view, it would have been quite helpful to say: ‘Well, actually Channel 4 are filming you, but they’re only filming in the ward and no great harm has happened.’ But it still makes me smile, the curiosity and bizarreness of life.”
See Bedlam tonight 9:00pm on Channel 4