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Stop forcing mental health workers ‘help’ police criminalise Muslim communities

Fighting for an alternative by Sarbjit Johal

Sarbjit Johal reveals GMMH Trust’s involvement in the development of Vulnerability Support Hubs (VSHubs) funded by the NHS, Home Office and the counter-terrorism police

A recent Medact report  (’Racism, Mental health and pre-crime policing, the ethics of Vulnerability Support Hubs’ May 2021) has highlighted the increasing securitization in mental health provision. Vulnerablity Support Hubs (VSHs) are being developed in three areas of the UK. These Hubs are ‘a secretive mental health – related project run by UK counter-terrorism police that disproportionately targets, impacts and ultimately harms racialised communities.’

Greater Manchester Mental Health Trust is involved in the Northern hub.

Thousands of individuals suspected of potential ‘extremism’ – a vague and racialised term which the government itself has tried and failed to legally define – have been assessed by the hubs, in which mental health professionals collude with counterterrorism police officers. Using a series of Freedom of Information requests the report highlights the increasing blurring of boundaries between security and care. The activities of the Hubs push mental health professionals into work that is beyond the health remit and encourage health workers to ‘monitor’ patients, and help conduct ‘combined’ mental health and terrorism risk assessments.

Muslims are at least 23 times more likely to be referred to a VSH for “Islamism” than a white British individual is for ‘Far Right’ extremism. Once referred to a VSH, based on the health officials gut instincts, suspicions or observations of what they perceive as odd behaviour in the patient, VSHs are places where the individual is now under pressure to consent to whatever is being suggested. They might have to agree to a mental health diagnosis or say yes to increased surveillance of their activities. Or they may have to agree to have their behaviour and speech observed and assessed or be questioned about their medication compliance if they are already a mental health patient. This is all to see if the person who has already been identified as showing ‘signs of extremism’ is now showing ‘signs of future criminal activity’.

Reframing

These Hubs are an extension of the Prevent agenda. Activists have shown that Prevent is a surveillance programme targeting and monitoring people primarily in the Muslim community. They could be people who are demanding their democratic rights for equality and justice, they may be people speaking out against government domestic, trade and foreign polices (upholding right wing regimes with leaders like India’s Modi, Brazil’s Bolsonaro, or Israel’s Netanyahu) or they maybe people organising against the racist scapegoating of migrants, refugees and asylum seekers. They could also just be  Muslim people resisting the welfare cuts to Nurseries, Youth centres and etc their communities or people just practicing their faith.

Vulnerability Support Hubs (VSHubs) started off as a pilot project funded by the NHS, Home Office and the counter-terrorism police.  Now we find this pilot project has become a national scheme and is being rolled out by the police via ‘Project Cicero’.

Altogether, there are three VSHubs. They are in Manchester (North), Birmingham (Central) and London (South). Greater Manchester Mental Health is involved in the northern hub.

In 2016, Vulnerability Support Hubs were just ‘helping’ the police in pre-criminal stages of the Prevent programme. But now they’ve become ‘spaces’ for health professionals to help police with their live investigations and prosecutions. This Medact report refers to a case study from the North Hubs which show that Hubs are now effectively ‘tools of intelligence gathering’ for active police investigations.

by Felicia Chand, reproduced from Inqilab, South Asia Solidarity Group’s  magazine, 1991

So, VSHs are not actually supposed to provide health care for people suffering mental health issues. They are designed to be centres for the police to gather information on people and especially from young Muslims, some as young as 6 years old and others are teenagers. The Hubs promote a mental health diagnosis and treatment within a conventional medical model. This encourages police and mental health workers to see Muslim communities through a ‘criminal lens’ rather than provide health care and address their health needs as ‘patients’. 

In 2015 the government made the Prevent programme a statutory duty for all public bodies including NHS trusts. Health workers were expected to report people they thought were showing signs of being “ vulnerable to radicalisation”. These signs can be anything from expressing a need for an identity or status, being excited or showing comradeship or just having a desire for adventure.  In 2020, Medact research found that Muslims were at least eight times more likely than non- Muslims – and Asians at least four times more likely than non-Asians – to be referred to Prevent.

These VSHubs also get referrals for the Prevent counter-terrorism programme from people living in precarious social and economic conditions. They maybe homeless and unemployed because they cannot access public funds. They are pathologised and criminalised. In the current racist hostile environment, as migrants with insecure immigration status, they are likely to be passed on to detention centres and face the threat of deportations. (Medact report, P41)

Sumayyah Ashrab, Humayara Tasnim, Tahyhba Ahmed, students suspended organising against the racism of Prevent policies, Newham <https://www.huffingtonpost.co.uk/2015/06/12/newvic-islamophobia-_n_7567992.html>  2015

Resistance movements have always highlighted the role of unequal power structures in the scapegoating of Muslim, Black, migrant and vulnerable communities.  Present government policies from health and welfare cuts, to foreign and domestic immigration policies and the erosion of workers rights have led to increasing anger at the social and economic conditions being inflicted on BAME communities. The criminalisation of protest can be seen from a school  student  in Manchester who was suspended recently for shouting ‘Free Palestine”. These VSHubs are part of the current government strategy to criminalise all those who dare to demand their rights and speak out against injustice.

Let’s not forget the racism experienced by students and teachers in Birmingham under the governments Islamophobic Trojan Horse operation. These Hubs are going to deter vulnerable communities from accessing Health and Care services through the distrust that they create. As these VSHubs are not designed to meet our health, welfare or caring needs, we have no choice but to support the campaign to close them down. With support from the 1.2 million workers in the NHS of whom 248 400 (20.7%) are from BAME backgrounds, I am sure we can win!

Health Services NOT Control and Criminalisation!

Stop state repression, Stop silencing of dissent!

Close down all Vulnerable Support Hubs! 

Stop Project CICERO!

Why aren’t patients being told truth about electric shock therapy?

Information leaflets about ECT comply neither with NICE recommendations nor the principle of informed consent. Patients are being misled about the risks they are taking and the limited nature of ECT’s benefits.

New research published today (15th June) concludes ECT Patient Information about ECT is misleading.

See full abstract here

See article in Daily Mail

How Accurate are ECT Patient Information Leaflets Provided by Mental Health Services in England and the Royal College of Psychiatrists? An Independent Audit
Harrop, Christopher, PhD | Read, John, PhD | Geekie, Jim, PhD | Renton, Julia, DClinPsy
Ethical Human Psychology and Psychiatry
DOI: 10.1891/EHPP-D-21-00003

The aims of this paper were to assess the accuracy of patient information leaflets about electroconvulsive therapy (ECT) in England, and assess compliance with National Institute for Health and Care Excellence (NICE) recommendations, and the principle of informed consent.
Freedom of Information Act requests were sent to 51 National Health Service Trusts for a copy of their information leaflet. These, and three Royal College of Psychiatrists (RCPsych) leaflets, were scored on a 40-item accuracy measure.
Thirty-six Trusts (71%) provided leaflets. The number of accurate statements, from a possible 29, ranged from four to 20, with a mean of 12.8. The most commonly omitted accurate statements included: that previous treatments, including psychological therapy, should be tried first (mentioned by 12 Trusts); cardiovascular side effects (6); lack of long-term benefits (6); patients’ right to take 24 hours to consider giving consent (1); memory loss higher in women and older people (0). The number of inaccurate statements averaged 5.8, out of 11, and ranged from two to nine. The most common inaccurate statements included: ECT corrects biological deficits (28); misleading claims of very low mortality risk (28); minimization of memory loss (23); claims that ECT saves lives (22); claims of very high improvement rates (19). The current (2020) RCPsych leaflet contained seven inaccurate statements and scored worse than two previous RCPsych leaflets.

Care Work, Crewe and the Deindustrialised Economy

For those who can afford it care is expensive, yet the work itself is usually poorly-paid, performed under increasingly stressful conditions and often contracted out to private providers. John Merrick outlines the effects the care crisis is having in his hometown of Crewe. 

John Merrick, Verso

A crisis of care grips British society. For those who can afford it care is expensive, yet the work itself is usually poorly-paid, performed under increasingly stressful conditions and often contracted out to private providers. Those who can’t afford to navigate the system of privatised care, or who the country’s strained public system will not stretch to accommodate, have to spend longer caring for their relatives and loved ones.

See full article here

Source: John Merrick, Verso, 21st June 2021

Implementing; Culture for Children’s Mental Health

GM i-THRIVE are holding a workshop on Implementing Arts & Culture for Children’s Mental Health on Thursday 1st July 10am-12.30pm.

The workshop will demonstrate the value of arts for children’s mental health, and explore on a locality level how arts and mental health projects can be implemented.

This session is for any Greater Manchester service leads and commissioners from across the children’s workforce, including all sectors (CAMHS, Voluntary sector, local authority and education)

The session will give you the opportunity to learn what options you can bring to your locality, to explore what offer already exists, and to understand how you can bring in a strong arts and cultural offer.

Sign up to attend now via Eventbrite: https://www.eventbrite.co.uk/e/implementing-arts-culture-for-childrens-mental-health-registration-158559043367

The session will be held online via zoom. Attendees will be sent papers and invite link in advance.

For more information contact Ashleigh Mutton, Project Co-ordinator, Greater Manchester i-THRIVE email: GM.THRIVE@mft.nhs.uk

Reshaping ownership within adult social care

Adult social care is broken. After years of marketisation and outsourcing we are left with a service where large market players dominate. Taxpayers’ money, and the savings of older people, are being extracted out of the system for shareholder gain. The Centre for Local Economic Strategies have published a report on the issues involved. 

Tom Lloyd Goodwin

New publication offers a number of recommendations for local policymakers.

The Meteor, Manchester’s Independent Media Platform draws attention to the issues facing Adult Social Care. The report’s author, Tom Lloyd Goodwin, reflects on how ownership models must be shifted to fix that broken system. He concludes:

In services such as adult social care, we should be building a resurgence of a public service movement based on new forms of democratic and citizen involvement. Nevertheless, communities should not be handmaidens to the continued marketisation and erosion of public services. We are in an era of political contestation, and we ignore the UK’s austerity addled political economy at our peril.

The report makes the following recommendations to local policy makers.

  1. Position adult social care as a key sector within strategic local economic planning.
  2. Support the development of alternative models of ownership through the use of community wealth hubs.
  3. Explore opportunities for more insourcing – particularly within nursing and residential care.
  4. Make greater use of ethical care frameworks – to in effect create a form of social licensing to influence the kinds of organisations that can gain access to local care markets.

See the full article Reshaping Ownership within adult social care

Stop Benefit Deaths Campaign

“People tell us that their experience in the welfare system puts them under a huge amount of pressure, that crucial payment and support is often delayed, and the assessment process itself can by highly intrusive and triggering. These characteristics of the welfare system can cause damage to people living with mental illness, but they affect everyone who relies on benefits.”

Rethink

This important campaign has been brought to our attention by the Rethink Manchester Group.

For more information go here

Eighteen leading charities and mental health organisations, including Disability Rights UK, Mind, Liberty and the Trussell Trust are backing a campaign by Rethink Mental Illness calling for an independent inquiry into the deaths of vulnerable people who rely on support from the welfare system.

Rethink Mental Illness has also written to the Secretary of State for Work and Pensions expressing deep concern about the welfare of vulnerable benefits claimants, following the emergence of evidence that people are being pushed to breaking point from their experience in the welfare system.

In many of the cases which have emerged mental health appears to be a significant factor, including in the widely reported death of Errol Graham, who starved after his benefits were stopped.

recent report by the National Audit Office showed that the Department for Work and Pensions investigated 69 instances where people receiving benefits have taken their own lives since 2014-15, but suggested it is very likely that there are more cases that could have been investigated.

The statement, co-signed by a wide range of charities and mental health organisations, is accompanied by the launch of a public petition.

The joint statement reads:

“As organisations that work with people who need support from the benefit system, we are deeply concerned that some of the policies and processes of the Department for Work and Pensions appear linked to avoidable deaths. 

“The National Audit Office reports that the Department has internally investigated 69 cases where people claiming benefits have taken their own lives since 2014-15.

It was also clear that is ‘highly unlikely’ that these represent the total number of cases that could have investigated in the past six years, and that there is ‘no tracking or monitoring’ of the status of the recommendations that have been made following the investigations that have taken place.

“We are therefore calling on the Government to establish an independent inquiry into those deaths where it appears that the welfare benefits system may have been a significant factor, with a remit to recommend changes to policy as well as internal DWP processes where needed.

“The clock is ticking. In November, the Government plans to begin a ‘managed migration’ of people from the current sickness benefit—Employment and Support Allowance—to Universal Credit.  It is vital that we properly understand the circumstances of these deaths before embarking on this change.” 

No systematic approach to supporting people with autism who are admitted to in-patient psychiatric units

A significant number of people with autism require in-patient psychiatric care. Although the requirement to adequately meet the needs of people with autism in these settings is enshrined in UK law and supported by national guidelines, little information is available on current practice.

A recent research study has found that there is no systematic approach to supporting people with autism who are admitted to in-patient psychiatric units. Significant concerns are highlighted of lack of professional training and skill sets resulting in variable clinical practice and care delivery underpinned by policy deficiency. This could account for the reported in-patient outcomes of longer stay and segregation experienced by people with autism.

Reference: Jones K, Gangadharan S, Brigham P, Smith E, Shankar R. Current practice and adaptations being made for people with autism admitted to in-patient psychiatric services across the UK. BJPsych Open. 2021 May 14;7(3):e102. doi: 10.1192/bjo.2021.58. PMID: 33988120.

See more here

Minimal Medication Alternatives for Psychosis Needed

Source: Mad in America:
http://madinamerica.com/2021/06/minimal-medication-alternatives-psychosis-needed/
By Ayurdhi Dhar, PhD, June 2, 2021

Researchers question the long-term use of antipsychotics and suggest increased research and investment in psychosocial interventions.

Mad in America

In a new opinion piece in Psychosis, psychologist Ruth Cooper of the University of Greenwich and her colleagues make a case against the long-term use of antipsychotic medication for psychosis and schizophrenia. They then advance their position that, given current evidence, the UK must explore psychosocial interventions and minimal medication approaches for patients.

Antipsychotic medication is the first line of treatment in the US and the UK. Criticisms have followed it through history and, more recently, become louder. Recent research has shown that people who stop taking antipsychotics tend to fare better in the long run and are more likely to recover. Others have focused on the numerous adverse effects of the drugs, especially their long-term effects. Most disturbingly, they have been associated with brain atrophy in children and causing decreased cortical thickness in adults.
Other criticisms have come from research on people’s experience with antipsychotics. Patients describe some benefits but also a reduced sense of self and agency. The biggest survey to date noted that most patients reported negative consequences of being
on these drugs. Resultantly, there has been a push to develop guidelines on withdrawing safely from psychiatric drugs, as withdrawal effects from antipsychotic medications can be debilitating.

Cooper and her colleagues begin by citing the 1979 WHO findings that, when it came to psychosis, people in poorer countries with less access to medication did better than those in rich nations. While antipsychotics help reduce symptoms for some patients, they can be ineffective in others and have significant adverse effects. New research suggests that for every 6 people treated with antipsychotics, 1 person has improved beneficial outcomes.
There are also numerous reasons patients stop taking antipsychotics. The adverse effects can include “significant weight gain, diabetes, heart disease, movement disorders and structural changes in the brain including brain volume reduction… sedation, lethargy, emotional flattening and sexual dysfunction which can adversely impact on quality of life”.
Patients can be coerced into treatment which can impede the relationship between them and the mental health system, closing down opportunities for psychological treatments.

The authors write that the UK’s NICE (National Institute for Health and Care Excellence) guidelines support shared-decision making between mental health workers and patients. As most patients retain their decision-making capacity, they have the right to choose alternative treatments if they desire. The authors write:

“Given the adverse effects of antipsychotics, ineffectiveness for some people, and further reasons for stopping described above, requests to stop or not take these drugs should be seen as a legitimate preference not, as some clinicians may assume, as ‘lack of insight.’”

The authors also note that antipsychotics became popular because they were thought to reduce relapse. Studies have also shown that stopping antipsychotics suddenly can lead to florid psychosis. However, while this was earlier confused with relapse, it is now hypothesized as a result of drug withdrawal caused by dopamine supersensitivity.

Thus, many patients want to get off their medications but have little guidance or help. Given the absence of national guidelines and pressure on mental health workers to discharge people, practitioners are often unsure about alternate interventions.
Under the pressure of service users who have developed their own resources to come off psychiatric drugs such as “The Harm Reduction Guide To Coming Off Drugs” and “The Inner Compass Initiative,” NICE has asked for further research into psychosocial interventions.

More recently, the Royal College of Psychiatry also published a set of resources and guidelines to withdraw from antidepressants, signaling building support for the deprescribing movement.

The authors explore the literature around minimal medication approaches to psychosis across the world. Historically there have been numerous places where minimal medication approaches and psychosocial treatments have been attempted – Soteria House in the US and Switzerland, Kingsley Hall and Villa 21 in the UK, and currently Open Dialogue in Finland (earlier need-adapted treatment).

These places have either not used antipsychotics, or minimized their use (delaying them by 6 weeks), or used benzodiazepines for a short period instead. They focus on providing emotional and practical support and sometimes on the process and experience of psychosis.

Cooper and her colleagues write that there are two major systematic reviews of these approaches, first by Calton and colleagues in 2008 and another by Cooper and Laxhman in 2020. Reviewing 9 psychosocial treatments in 2,250 patients, the analysis found that most treatments, when compared to the antipsychotic-using control group, were at least as effective as the control group – both in symptom reduction and improving functioning.

This was achieved via far less antipsychotic use and with no evidence of any greater harm in the minimally medicated patients. However, there are many limitations with these promising studies, such as the absence of high-quality research, small samples, and the exclusion of high-risk patients.

Recently an Australian trial compared, among first-episode psychosis patients, an antipsychotic group with another group that received intensive psychosocial treatment (care-coordination, CBT, psychoeducation, family intervention, and close monitoring). After 6 months, and then 1 and 2 years, no difference was found between groups. Drop- out rates were high in both groups. Cooper and colleagues write:

“Despite this, the study gives preliminary evidence that an intensive psychosocial treatment package, similar to what may be already available in early intervention services, could be a potential alternative to antipsychotics for some. A larger trial of this treatment package is certainly warranted.”

Currently, in Vermont and parts of Norway, institutions have established minimal medication approaches under pressure from service users. Formal evaluation of these initiatives has not yet been published.

The authors note that there are several approaches to alternatives to medication (or with minimal medication) that can be offered to patients who prefer them.

First, different types of psychosocial interventions can be used, such as “emotional and practical support, talking therapies and psychoeducation… ‘being with’ people who are actively psychotic, in a non-intrusive manner, practical, social, and creative activities such as exercise, art’ and animal therapy, and peer support from people with lived experience.”
Second, alternatives like The Hearing Voices Movement allow people to see their voices as meaningful and help incorporate them into their life experience by working with the voices.

Third, building a better relationship with family members and friends who are often concerned about relapse is important; this involves including them in appointments and giving them good information. They can provide essential support, and if not, then places like Soteria provide relief from difficult familial circumstances. Short-term use of benzodiazepines (less than 1 month because of their addictive properties) can alleviate some anxiety. Lastly, plans to manage deterioration and relapse should be made in collaboration with other services. A strong plan on how to deprescribe and get off antipsychotics is important. Research has shown that a very slow taper is most effective in reducing withdrawal effects. Tapering strips are also of use. This is the period when people might need extra support and close monitoring.

Some might benefit from completely stopping the use of the drugs, while others from maintaining minimal dosage. Good information on withdrawal symptoms and recognizing and dealing with them must be given to patients and their families.

The authors conclude by noting:
“We have an opportunity now to listen and respond to service users and, as in Norway and Vermont, governments could encourage the provision and further research of minimal medication services to provide people with a genuine choice about their treatment. Further discussion, in consultation with service users, of the key elements such a service should include is needed.”


Cooper, R.E., Mason, J.P., Calton, T., Richardson, J. & Joanna Moncrieff (2021) Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia

Psychosis, DOI: 10.1080/17522439.2021.1930119