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The Guardian
4 days ago
- Health
- The Guardian
As a long-term psychiatric patient, I've had superior care from the NHS
I read with interest the letters about psychiatric care in the NHS (11 July), prompted by Rachel Clarke's review of Bella Jackson's book Fragile Minds (A furious assault on NHS psychiatry, 30 June). I have not read the book but, as a long-term psychiatric patient, I would like to make two points. First, care naturally varies in quality, suitability and success. Following three years in unsatisfactory private care (after many previous years in NHS care), I have happily returned to the NHS. I find its care superior, but hamstrung by limited resources, which can mean waiting many months for an appointment. But I have never been treated badly, as Jackson suggests is common, even when in the worst state. Second, I was struck by what Jackson says a junior doctor said to her (as quoted by Clarke): ''Let's quetiapine them today!' And I asked him why quetiapine, and he said, 'They put you in the best hotels for conferences.'' As Clarke says, this is ludicrous, and certainly the only time I have heard 'quetiapine' used as a verb, which strikes me as improbable. Quetiapine has been a generic drug since 2012 (ie open to any company to manufacture and market, just as, say, paracetamol is). I cannot believe that a junior doctor would prescribe it in the hope of being put up in a 'best hotel' for a conference. It has long been the first-line treatment for psychosis, and for good reason: it works. I have been on quetiapine for 15 years. It's not an enviable position to be in, but I am glad it exists, and grateful to those who have – quite rightly – prescribed it to and address supplied I was disappointed to read that Cathy Wield was 'subjected to increasingly damaging interventions, including electroconvulsive therapy' (Letters, 11 July). I was treated with ECT for severe depression (with my full consent) in 2006 and it saved my life. In subsequent years when I had relapses, it again was highly effective as a treatment and I recovered fully, and have been well for the last five years. I would hope that patients won't dismiss ECT as a potential treatment for depression based on its negative portrayal in the press, but be guided by NHS professionals who prescribe what they believe is best for the individual and address supplied
The Guardian
11-07-2025
- Health
- The Guardian
Fundamental flaws in the NHS psychiatric system
I am disappointed to read such a scathing review of Bella Jackson's book Fragile Minds (A furious assault on NHS psychiatry, 30 June). It is a difficult read, and yet I thought that Jackson wrote about her experiences with compassion for both patients and staff unwittingly caught up in erratic and overstretched services. I am a doctor, with experience as a psychiatric patient and as a senior 'staff grade' doctor on an acute psychiatric ward. My memoir, Unshackled Mind: A Doctor's Story of Trauma, Liberation and Healing, confirms Jackson's claims that abuses do happen in these places. More subtly, there is a continued reliance on the disease-centred model of biomedical psychiatry without sufficient attention paid to the circumstances and adversities suffered by patients before they ever came in contact with psychiatry. As a result, my own early trauma was unaddressed for more than 20 years, while I was subjected to increasingly damaging interventions, including electroconvulsive therapy and even a cingulotomy. It is only since leaving psychiatry that I have been able to recover. Jackson's book is a reminder that despite the best intentions, many patients are failing to get the help they need in a fundamentally flawed psychiatric Cathy WieldAbingdon, Oxfordshire I am writing to congratulate Dr Rachel Clarke for her excellent rebuttal of Bella Jackson's assault on the failings of modern psychiatry. I have worked as the head of mental health law for a large NHS trust for 35 years, and as a frequent visitor to mental health wards, entirely agree that Jackson's views are at odds with my experience. I was last on a secure, forensic mental health ward just a few days ago – with incredibly challenging patients. All the staff I encountered were not only humane, but kind, compassionate and caring. I've also worked in roles where I visited many hospitals and have almost without exception experienced the same. Our mental health nurses and psychiatrists, as well as so many others, go out of their way to display the same values. I am far from naive, and recognise that there is a tiny minority of individuals who fail to live up to the same core values. Over decades I have witnessed interactions where psychiatrists, nurses and others are challenged to a degree that might seem almost impossible to cope with, but they rise to the challenge with great skill, kindness and compassion, in line with their respective professional codes of conduct. Kevin TowersHead of mental health law and data protection officer, West London NHS Trust I'm writing in response to the review by Rachel Clarke, especially the suggestion that the memoir is 'scaremongering'. I am a consultant clinical psychologist with more than 20 years' experience in the NHS across several London-based trusts. I train people, including ward staff and crisis services, in working effectively with people with personality disorder. Similar stories to those that Bella Jackson relates are reported to me and colleagues regularly. I don't doubt the veracity of Jackson's complaint, nor that NHS mental health is in a dire state; it is interesting that Clarke does, given her admission of relatively scant mental health and address supplied Have an opinion on anything you've read in the Guardian today? Please email us your letter and it will be considered for publication in our letters section.
Times
08-07-2025
- Health
- Times
Behind closed doors: what I saw as a nurse on a psychiatric ward
'My God, I hope I never get mentally ill,' says a doctor in Fragile Minds, an account of life on psychiatric wards in Britain. You can only agree with her. The book — by Bella Jackson, a trainee mental health nurse so shocked by what she witnessed that she left the profession — reads like a cross between One Flew Over the Cuckoo's Nest and Nineteen Eighty-Four. But as she says when we meet, 'This is now.' A rape victim is slapped with a diagnosis of personality disorder (PD) and called 'attention-seeking'. Her request to be assessed by a female is refused as she's 'manipulative'. A man dares to tell the consultant his medication is causing chest pain. He's threatened with 'seclusion''. He pleads, in tears, but is made to feel like nothing, bullied into meekly submitting. As he was as a child, you imagine. 'It's re-traumatising,' Jackson says. Jackson — now 41, a therapist in private practice and mental health mentor, in London — had worked in social care and in prisons for five years when she began training as a psychiatric nurse on NHS acute mental health wards and centres in the south of England 'within the last ten years', she says, vague to preserve confidentiality. She was stunned by the 'dissociation' of staff. She wanted to believe the doctors knew best, but instinctively felt something was 'very wrong'. Her university tutor agreed there was 'bad practice', but not enough for anyone to do anything. 'There are pockets of good care,' he told her, 'but there is a lot of this.' She thought: 'Can't we complain?' She's taken aside, told not to ask so many questions. 'I want people to see what's happening behind these closed doors,' she says now, so they can 'protect themselves and their loved ones, if they are involved in mental health services'. So they know what questions to ask. Too often, 'We assume the answers we are being given are the correct ones.' She says: 'You need to be curious. When it comes to mental health, the expert on us is us.' This affects us all. It's alarmingly easy for anyone to be locked away. 'There wasn't consistency — of diagnosis, of sectioning,' Jackson says. 'It was so bizarre to see this incredibly important decision-making be so haphazard.' She witnesses a middle-class student brought into A&E. A spiteful-sounding nurse judges her 'bipolar' and calls a psychiatrist who declares, 'She's totally psychotic.' Jackson says: 'Hasn't she just smoked a load of spice?' A clinician can argue that drug-taking has 'activated' an underlying illness. People aren't believed. The shrink says: 'She thinks she's a famous singer.' Jackson looks up the girl on her phone — she's a folk singer. Only her family turning up, refusing antipsychotics — and the lack of an available bed — avoid her being admitted to an acute psychiatric ward. • Read more expert advice on healthy living, fitness and wellbeing Once someone's in the system, labelled with, for example, schizophrenia, PD (often 'weaponised') or delusional disorder, anything they say can be paranoia. Racism features, a lot. An African woman insists she's been sectioned because her kids want her house. Crazy. But it turns out she's sane enough to get a diplomat from her country of origin to order her release. Another inpatient, in his fifties, characterised as sharp, witty — 'I understand you, I just don't agree with you,' he tells a patronising nurse — appears to have autism. His family's request for an assessment is refused as it's 'too late'. Jackson is told 'they don't want the stigma of mental illness''. She saw little understanding of neurodiversity, and cites research that finds misdiagnosis is common. Yet, if a doctor says, ''Oh no, it's not that,' how often do we push back?' Why couldn't his family get him out? 'The legalities around sectioning would mean that it was very difficult.' On a section, you're deemed unsafe to be outside. 'You'd have to go through a tribunal. Some people did really fight to get their family members out, but a lot of people didn't.' ('How do I argue with a doctor who says my relative is unwell?') Characters are composites to protect identities, but it all happened, 'all these things were said to me,' Jackson says. She carried around a tatty notebook, 'just writing everything down, because I could not believe what was happening'. Patients' treatment by staff is frequently callous. 'Some people have good experiences,' Jackson stresses — but Fragile Minds focuses on the worst. The mentally unwell are often traumatised, yet there's no attempt to understand the context for their behaviour. When people go into services, 'they really are hopeful for compassion. It's devastating when they don't get it,' she says. 'It makes me so angry. It can really destroy us.' Most are 'boxed into a diagnosis' and medicated, often oversedated. Jackson and another decent nurse question a young man being given four daily doses of lorazepam — a benzodiazepine — as he can barely stand. They're ignored until he nearly drowns shaving — collapsing unconscious face-down in his sink. 'These medications do help a lot of people,' Jackson says. But many have severe side-effects, and also they're used 'punitively'. She saw medication used 'as a restraint on wards, to calm people down, to shut them up, put them to sleep. It's used by force, it's used through coercion — very different to someone choosing, and saying, 'This helps me.'' • Our new health crisis — we're diagnosing too much, too early One nurse says: 'I'm all about a good injection.' To Jackson's horror that a woman prescribed the antipsychotic clozapine has undergone a drastic mental and physical deterioration on the drug, her doctor responds Orwellian-style: 'I think she's got better.' Soon after, the patient dies. Jackson hopes it doesn't come across 'that the staff are demonised'. She says they're exhausted, overworked, and don't receive adequate psychological training or support to withstand working with distressed, unwell people and remain empathic. 'You needed a shield, almost, an absence of feeling. And what that created then was very much an 'us and them'.' But it wasn't just no empathy — your book describes cruelty, I point out. 'I think there was some cruelty,' she says slowly. 'You saw prejudice and bias, and cruelty.' She suspects much of it comes from emotional burnout, 'and being asked to do things that feel morally dubious — if they're asked to restrain someone and inject them against their will, what does that do to a person?' You can't then be all chatty and empathic with that patient. It's upsetting to dig deeper. Numbing yourself is 'survival mode'. So, 'You almost become this jailor.' Plus, psychiatry is hierarchical. 'There's a cruelty that comes from unchecked power. It was easy to forget that it was a person in front of you.' Ideally — 'and these things are being fought for, in the wings' — there'd be more access to psychological therapy, family therapy, arts therapy and peer-to-peer support. We need to help people to find meaning in their lives, acquire skills, agency and self-esteem, she says. 'These are all parts of us that we need to rebuild once we break down, and we can't do that stuck in a ward where there's a TV screwed to the floor and some non-throwable furniture and there's nothing else to do other than take your drugs and sit still.' And yet, she stresses, it's complex. 'The need to think about what someone's been through, and emotional connection, empathy, is so important in recovery.' But crucially, 'There's all sorts of risk with mental illness and mental distress,' so as a psychiatrist you're assessing risk: 'Is this person going to harm themselves? Harm others?' • Six-day waits and security guards: the mental health crisis crippling A&E A key question. A recent NHS survey found one in five people in Britain have a mental health condition and in 16 to 24-year-olds it's 25.8 per cent. But for all those who think, this could be my child — there are those thinking, 'What about the likes of 'the Nottingham killer'?' This paranoid schizophrenic patient, repeatedly sectioned and with a record of 'extremely serious' violence, was allowed to stop his medication and go free (despite warnings from his family). He murdered three people. We've all seen their faces. Their grieving families. Many patients Jackson encounters exhibit disturbing, frightening behaviour. Some are misunderstood rather than psychotic, she believes — and some are dangerous and violent. Not everyone can recover, surely? 'I agree with that,' she says. So when does giving the benefit of the doubt put others at risk? Jackson stresses she's not denying that some people are very disturbed and need monitoring. 'And we can wonder about what happened to them.' Distinguishing between the dangerous and the harmless, 'figuring out what the dangers are and the risks', she believes, requires 'exploration and curiosity and needing to look at the context and seeing everyone as individuals'. Not, as she saw, 'a blanket approach'. She says: 'The 'how do we get it right' question is something I can't answer.' Having left the profession shortly after qualifying, she still feels some shame that she was 'too crushed' to stay within it. But she remains 'honoured' to help people with their mental health. ('I am not a 'silent therapist',' she promises, on her website, 'and will bring warm, gentle inquisitive exploration to our sessions.') Meanwhile, what Jackson is certain of is this: 'The system we have now is not making it safer for people. It's not reducing the number of suicides or violent crimes. What we're doing now isn't working.'Fragile Minds: Stories from an NHS Mental Health Ward by Bella Jackson (Doubleday £20) is out now
The Guardian
30-06-2025
- Health
- The Guardian
Fragile Minds by Bella Jackson review – a furious assault on NHS psychiatry
In 2018, Christie Watson's memoir about what it means to be a nurse became a publishing sensation, spending more than five months in the bestseller lists. The Language of Kindness: A Nurse's Story was tenderly distilled from the two decades that Watson had worked for the NHS, capturing the essence – and importance – of what it means to care for patients. Counsellor Bella Jackson will presumably be hoping that her account of two years spent training as a mental health nurse will resonate in a similar way. Jackson worked in social care for five years before embarking on her nursing degree. The book is 'pieced together from scattered notebooks and scribble'. But from the outset, it is not entirely clear what is fact and what is fiction. She explains that she has constructed three 'composite' settings from her contemporaneous notes: an acute psychiatric ward, an A&E department and a community psychiatric team. Although based on real situations, the stories she tells are also composites in which names and identifying details are changed. Similarly, the healthcare professionals depicted are 'generic'. The verisimilitude of what is described matters greatly because it is used by Jackson to mount a furious assault on the failings of modern psychiatry. The gross underfunding and understaffing of NHS mental health services is, she argues, 'only half the story. The other half is messy and confronting. It is philosophical and systemic. It is uncomfortable enough to make us look away sharply.' Without spelling out exactly what she means, she sets out to document the messiness unflinchingly. Entering the ward on day one triggers a powerful childhood memory. As a six-year-old child, Jackson accidentally locked herself in a bathroom while her parents hosted a raucous party. Recalling the overwhelming panic and powerlessness of being incarcerated causes her to reflect on the ward patients' plight: 'It's easy to walk in and out of a locked ward and forget the significance of that power. Does The Door protect the vulnerable people inside from an unkind world? Or does it protect our fragile society from the people who embody its failings?' Jackson's answer to this question is emphatically the latter. Seen through her eyes, locked psychiatric wards are bleak, punitive places patrolled by staff who are – with only rare exceptions – at worst cruel and at best indifferent. In the first few pages, psychiatrists are set up as uninterested, inhumane, work-shy pill-pushers. A patient spends hours hovering by the door, trying hopelessly to catch the eye of the consultant psychiatrist as he 'flitted in and out, always with somewhere else to be'. When another patient recounts a harrowing tale of homelessness and childhood beatings, the same consultant merely shuffles his papers as if the patient 'were absent'. Nurses are, if anything, even worse. A particularly aggressive nurse called Leon tells Jackson that he hates the ward because 'these patients get away with anything they want … asking what this is, what that is. What the fuck?' Two healthcare assistants laugh together about forcibly injecting patients with rapid tranquillisers. Amid the racist, abusive and offensive staff, who mock, belittle and chemically cosh their patients, are individual tales of heartbreaking social and psychological circumstances. Patients have experienced sexual assault, childhood abuse, domestic violence, poverty, exclusion and multiple suicide attempts. All of this is ignored by staff. High doses of antipsychotics leave the patients drooling and gurgling. One man has the face of 'a tired waxwork' while others 'remained shapes against the blank walls'. Jackson finds herself frequently intervening to stop a trigger-happy nurse or doctor casually slapping a potentially life-changing diagnosis such as psychosis or bipolar disorder on to a distressed patient. The problem with this account, for me, is that it doesn't really resonate with my experience. I spent my first rotation as a junior doctor in psychiatry at the same time Jackson was training. I simply didn't see the kinds of abuses Jackson documents – despite being a former current affairs journalist who was, and remains, highly attuned to the power dynamics inherent in medicine and potential injustices against patients. A particularly extraordinary moment is when Jackson describes a nurse telling her about a junior doctor 'who used to legit say, 'Let's quetiapine them today!' And I asked him why quetiapine, and he said, 'They put you in the best hotels for conferences.'' Really? That kind of pharma corruption was rooted out long ago – and I can scarcely imagine a junior doctor of my era using such a ludicrous phrase. Jackson has sacrificed complexity for polemic. The crux of her argument is: 'The medical world doesn't really know what to do with distress, so we drug the person, because that's what the medics are taught to do.' But the truth is not this simplistic. Psychiatrists do indeed have an almighty power to do things to patients that in any other context would be considered human rights abuses – restraining them, injecting them with drugs, depriving them of their liberty. Yet this is because the most seriously unwell patients often have no idea they are ill and will not engage with treatment voluntarily. Sectioning a patient is a last resort, not a cavalier act of malice. And though talking therapies are desperately lacking, this is due to endemic underfunding, not because psychiatrists regard them as pointless. Most of the psychiatric nurses and doctors I worked with were decent, run ragged, and longed to be able to offer their patients more. The truth is, we still understand very little about the root causes of serious mental illnesses and are painfully aware of what blunt tools psychotropic medications are. Jackson implies that treating serious mental illness is simply a matter of listening to, believing and empathising with patients. If only this were true for bipolar disorder and schizophrenia. There is much to be fixed in NHS psychiatry, but I'm afraid this book feels like scaremongering. Fragile Minds: Stories from an NHS Mental Health Ward by Bella Jackson is published by Doubleday (£20). To support the Guardian, order your copy at Delivery charges may apply. In the UK, Samaritans can be contacted on 116 123 or email jo@ You can contact the mental health charity Mind by calling 0300 123 3393 or visiting
