Removing the pain

The suicides of people with mental illnesses, assisted or
otherwise, reinforce the need for an overhaul of the system. Yet
many commentators seem fixated only on making assisted suicide
legal, writes Peter Beresford.

My father committed suicide when I was four. He left a note,
which I have in front of me now. Written on a scrap of paper, it
says: “The pain never stops. Now it is more than I can bear. All my
love.” On the back is a child’s drawing of a castle.

One of my best friends hanged himself after trashing his home.
Other mental health service users and survivors I have known, have
taken their lives or had their lives taken because of the distress
they experience or the “treatment” they have received. I never know
when I might need to make the same journey.

Therefore I believe in the inalienable right of individuals to
end their own life. But I have a problem with ideas of “assisted
suicide” and “euthanasia” for mental health service users. I know I
am not alone in this among mental health service users and
survivors. We wonder what interest in these ideas says about public
perceptions of us, as well as about the inadequacies of mental
health services.

I don’t intend to comment on the particular case of Sarah Lawson
– may she rest in peace. It will be a sorry day when I or any other
mental health service user or survivor starts offering a kind of
long distance diagnosis or analyses of people and situations that
they have no direct knowledge of, like Doctors Raj Persaud and
Oliver James. But this sad story does raise some big questions.

It has mainly been presented in the media in terms of the issues
for carers and family. The emphasis has been on putting her out of
her misery as you would a cat or dog and on the suffering and
distress of her parents. The worrying subtext seems to be that it
may be best for mental health service users (and the rest of us?)
if they were dead. Certainly in terms of news values, we now know
that for mental distress to make tabloid front pages, it must
either involve homicide, assisted suicide or the royal and
famous.

The press, in its coverage of this story, has criticised
psychiatric services for not maintaining support for people like
Sarah Lawson. But what about the problems when services are
provided? She had already been through the mill of ECT and chemical
treatment, with things apparently only getting worse.

There is longstanding evidence of the poor quality of acute
services particularly in large cities like London. Another close
relation of mine committed suicide because he couldn’t face the
prospect of going back into the psychiatric hospital that had been
so painful and damaging on a previous occasion.

The professional press and mental health charities have also
raised concerns about the failure of psychiatric services to access
and include young people.

But do we really want to extend the psychiatric processing of
young people and put them through this stigmatising and often
damaging gateway? Wouldn’t it make more sense to follow the route
pioneered by the late and much lamented Dr Steve Baldwin (killed in
the Hatfield train crash), who campaigned tirelessly against the
widespread prescription of Ritalin to children, and develop
non-medicalised alternatives?

Interest in assisted suicide for mental health service users is
emerging in a climate of greatly increased political and media
concern about the threat, danger and nuisance that mental health
service users are seen to pose, as well as the pain and anguish
they are seen to cause. It also comes at a time when there is a
growing research and political interest in bio-chemical and genetic
explanations and responses to madness and distress.

As the search goes on for an imagined schizophrenia gene the
goal seems to be to edit out mental health service users even
before they are born.

When her husband stood trial for the manslaughter of Sarah, her
mother said: “The people who should be in the dock are the people
who refused to keep my daughter in safe care.” Perhaps an even
larger dock is what’s really needed, which could hold to account an
outmoded psychiatric system that still frequently fails to see the
person and only sees the illness. In doing so, it misses both
people’s strengths and their difficulties.

Sarah Lawson’s story is a grim reminder that mental health
service users’ rights must be protected in death as in life. Let’s
hope that the long-term lesson that is learned from it goes beyond
mental health service users’ right to death and instead is to
prioritise their right to a life. Then at least one death may not
have been in vain.

Peter Beresford is professor of social policy, Brunel
University, a long term user of mental health services and actively
involved in the psychiatric system survivor movement.