Thursday, 10 October 2013

My experience of the Medical Model of Mental Health

As it's World Mental Health Day I took a moment to read some documentation I had been sent by UCU, the trade union for which I was a Learning Rep, Branch Secretary, and Equality Rep when I worked in Further Education. It was an interesting read, discussing the differences between the medical and social model of disability as applied to mental health. It led me to reflect upon how Canterbury College treated my mental health condition, as well as my understanding of the outcomes of that process. 

When I worked in the pre-16 department at Canterbury College, the contract we had with KCC was being routinely ignored. This contract stated that there would be a staff to student ratio of 2:8, when at times it was 1:14. I had often wondered why this was never discussed as part of my return to work (after being signed off for two months due to work related stress and depresssion). I had wondered if it were being "swept under the carpet". 

Upon my return I felt aggrieved that I'd received a letter stating I would return in a teaching role, having been told by the OH doctor that I could teach again with the right support, but instead was demoted because the College felt I couldn't cope. I felt this to the point that I never signed the new contract and sought voluntary redundancy at the end of the academic year, convinced I was about to lose my job anyway.  I felt I was being punished for not being able to cope in that one situation after ten years of dedicated service.

Since then I've often felt that I was completely mishandled by those in management at the College, but have felt unable to gain any redress for what I view as inflicted suffering. This is due in part to the fact that I am keenly aware that I do suffer from anxiety and depression, and that doing so has an effect on how I percieve even the most basic events. I'm clear, however, that even after a year away from the College, I still feel unhappy with my treatment at the hands of two individuals in particular (I'm not here to name and shame).

The nature of that treatment, and the reasons behind it, are now that much clearer to me. I believe the managers in question viewed my mental ill health as something which reduced my ability to cope in the environment in which I worked. They did not view it as being exacerbated by, or a result of, an unwillingness to adapt the environment to suit my particular needs. They even suggested that I hadn't done enough to inform them of my issues.

On that particular matter, they couldn't have been further from the truth. Before I was signed off I was in regular communication with the HR welfare officer, and I had repeatedly emailed my manager about my concerns. On the day I was signed off I had sought to inform both my senior manager and HR that I felt unable to return to the classroom and had told my line manager the same thing. I was, however, cajoled back into a classroom by that very same line manager.

The result of all this was ten stitches, two months of wasted public money, and the end of a potentially decent career. The reason for this is, perhaps, that mental health is viewed by Canterbury College from the medical model standpoint and not the social model standpoint. To be clear on this, I'm not suggesting that Canterbury College is unwilling to deal with mental health issues, I'm just suggesting reasons why I think it did so incorrectly in my case. 

So what could have been done differently? Essentially, the College's basic assumption was that my anxiety and depression were a result of my disability and by inference were therefore my barrier to fulfilling my duties. This meant that in considering reasonable adjustments they considered what roles existed that a person suffering from anxiety and depression might be able to cope with, which seems fairly sensible on face value.

What this ignores though is the transient nature of my ill health, the potential effects of the change of role on my self esteem (and its link to my mental health), and the specific reasons why my existing role effected my mental health condition. The key point here is that a reasonable adjustment under the social model should look first at adapting the existing role to the person, rather than assuming that it is the person that needs to be adapted to the role.

I will, of course, never know for certain that I could have returned to teaching. I will also never be certain that the College made no attempt to find adaptations to my existing role that could allow me to continue to complete it. I am convinced however that the use of language, and the actions taken, by two of my managers confirmed that they viewed my mental health from a medical model standpoint and that they in turn contributed to my leaving the College. 

I believe Canterbury College failed to adequately safeguard my mental health, and thus by inference to safeguard my students and colleagues. Moreover, the College then failed to carry out reasonable adjustments, instead seeking to remove the problem (me) rather than address the true problem (the role's effect on me). My reason for this assertion is the behaviour of the pre-16 management team, which includes a senior manager. In essence, I believe their behaviour and viewpoints reflected the culture of the College as a whole. 

My hope is that I am wrong.

Monday, 29 July 2013

Why I'm not a Whinger... on the Arch anyway

Most people who know me will know that I do love a good self-righteous moan about the state of the world. For a committed Social Liberal I can moralise at the drop of a hat, dropping emotive phrases by the dozen and leaving objectivity in the dust. It is, ironically, this kind of moralising that has been used in response to my petition regarding the Step Short Arch. 

All criticism of the Arch has been met with cries of "won't somebody think of the children" and "don't you care about the sacrifices". Beyond that, phrases like "it makes me sad" and accusations of being one of the "whingers" have exemplified the level of informed debate on the issues I've raised. I've even heard of an "unfriending" on Facebook as a result of a signature.

The sad thing in all of this is the complete failure by Step Short, Step Short's supporters, and Shepway's Tory Cllrs, to engage with the debate I'm trying to start. If they had actually taken the time to think about it they might even have had some sympathy for my view (or not). As they haven't taken that time, I'll write it here so that it is at least recorded for posterity.

I support the Step Short Arch. I think it is a fantastic idea and I really hope that it goes ahead. I want Folkestone to be a beacon in remembering our war dead and I wholeheartedly agree that it is vital that we teach, and learn from, the lessons of World War I. I think every student in the land should have a grasp of the horrors of trench warfare, and should understand the feelings of terror that the Mark 1 tank would have inspired when it was first unleashed against the enemy.

I want the Step Short Arch to be funded by Central Government grants and/or individual donations. I believe that the Arch at the top of the Road of Remembrance is important enough to be included in the Government's plans for the Centenary. I believe they should cover the costs of any funding not already secured, by donations or grants, at the time that construction begins. I believe that, up until that time, we shouldn't be able to move on social media for requests for donations to the project.

The only thing I oppose about this Arch is Shepway District Council supplying £200,000 to help build it. There is a simple reason for this. Shepway's job is to support local people and deal with local issues, not to fund national memorials. With incomes and welfare support being squeezed left, right and centre, as well as local government budgets being hit, Shepway's role in supporting those in need and improving quality of life for every local person is more important than it ever has been. It is for that, and only that, reason that I set up my petition.

There are people who oppose building the Arch in the first place, and I am sure they have sensible arguments for their position. It isn't a position I share, but I applaud anyone who takes the time to form a position rather than relying on off-the-cuff responses (I wish I did it more at times). To those, however, who support the Arch (with or without a Shepway grant) I say this. Wouldn't it be better if this national memorial was nationally funded?

I've been pondering the best response to the Shepway grant, beyond my petition, and it hit me the other day that the best response is actually rather simple. I urge everyone who doesn't support Shepway funding the Arch to donate as much as they can afford to the project as well as encouraging others to do so. I'm not saying this to be hypocritical or back track on my views. I just hope that maybe, if Step Short no longer need the money, Shepway might just spend their reserves on what they are meant for.

Lads' Mags - Know your place!

In an example of perhaps foolish bravery for a man (stereotyping much), I'm going to comment on the news that Co-op want packaging on lads' mags, and the growing call to have them banned from supermarket shelves. To be clear on this, I used to read lads' mags when I was a teenager (read into that what you will) but have sinced moved on to reading publications like Private Eye when I get the chance (Yey for me).

So what can a (probably lower) middle class white male, who is fast approaching middle age, bring to the issue of objectification of women, one wonders. There were certainly no men interviewed on BBC news this morning, and the one argument put forward in favour of lads' mags was that the men on exercise magazines are half naked, an argument put forward by a woman with a vested interest in the market.

When I watched the coverage on this issue I found I had two major problems with the debate, which I'll attempt to outline for you. The first issue was with the emotive language and lack of scientific rigour in the discussion around effects on children. This is a common theme for all "moral" crusades in our society, and often leads to bad policy. 

The suggestion that a magazine can be harmful carries with it a lot of assumptions that don't really help the debate. If lads' mags increase the likelihood of individuals committing acts of abuse, this is a serious matter, it should be presented in a way that makes that very clear, and in doing so it shouldn't rely on emotive slogans that can be easily dismissed due to lack of evidence.

My second issue was with the use of the term objectification. I'll allow a moment for the assumption that I'm about to launch a defence of lads' mags to set in. My point here is that men and women view each other a sex objects on a daily basis. This is a genetic imperative, if one that can be consciously mitigated in a truly modern society. The problem with the use of objectification in this debate is that it isn't a precise enough definition of the true issue, in my view.

The true issue for me is not with viewing other human beings as objects of desire and as opportunities for sexual gratification, the problem is when this becomes a reason to think of those we desire as only fit for that purpose and as lesser beings than ourselves. This is the potential difference between the lads' mag and the exercise mag. 

The half naked men on an exercise mag are being lauded as perfection in manhood, they are inherently better than the average bloke (not saying I agree, but that is the impression). The half naked women on a lads' mag are there to perform sexual services and, frankly, if they did so in silence whilst washing the undies then more power to the man who breaks them (again, not agreeing, just describing).  What I've just described may be a little cartoon-like, but it isn't that far from the truth. 

The central issue, therefore, is how do we prevent young men from conflating images that offer sexual gratification with the assumption that participating in those images somehow makes women subservient. In other words, how do we move away from a societal view that female nakedness is a sign of weakness and male nakedness is a sign of strength. 

The first start to this is perhaps to examine the very arguments that the media engages in about the topic. The debate on the BBC this morning could almost have served to perpetuate the view that female nudity is based purely upon male power and that in order to feel empowered a woman must hide her body (to be fair it might also be seen by some as suggesting that men are too weak to control themselves in the face of female nudity). This hardly moves the cause of gender equality forwards.

Hiding, or not selling, lads' mags does very little to combat this issue. It doesn't strengthen the position of women with regards to sexism or nudity, and it doesn't encourage men to move beyond the assumption that the ability to penetrate another individual makes them a better class of person with the right to behave as they please. 

A picture may speak a thousand words, but it is our thought processes that need to be changed here. Removing lads' mags from the shelves isn't going to remove sexism from the male psyche. In some ways it may even strengthen it. It's improved education and respect for others that will tackle this issue, not moral crusades against female nudity.

Monday, 22 July 2013

Reflections on policy and the state of play

I keep finding myself muttering at the TV and having internal conversations about things like the welfare system, education and the coalition. Occasionally I've tried to verbalise some of what I'm thinking/feeling to colleagues, family, and friends, but now I'm going to take the perhaps foolish route of trying to put it into writing in some vaguely coherent way.

The more I think about it the more I become convinced that there is a disconnect in our society between how we view people, how we treat them and how we are as human beings. For want of a better way to put it, it is as if we all lack Theory of Mind. For anyone vaguely interested, Theory of Mind relates to the Three Mountains Experiment. This purportedly shows that people with Autism cannot visualise a situation from the point of view of a toy policeman viewing a scene from a different angle. I'll try below to put into words how I think this applies to society.

There are, depending on your belief system, various things that contribute to who and what we are as individuals. The existence of Fate, a God, or Gods, could be relevant to (or negate) this, but for now let me stick to the ones that I think Science alludes to. In a sense, the list below is my list of things that, I think, directly effect whether or not I will get up in the morning. They are:

My genes
My physiology
My upbringing
My heritage
My experience
My situation 
My social/familial network
My self

When I came up with this list, or subconsciously stole it, I found it very difficult to pin down. Each item bears a great deal of explaining and pondering, not least because each item could be split into hundreds. It is probably something that a decent philosopher could make their life's work, but I'm going to try to do this from left field, as it were, by relying on a couple of pseudo-parables.

The politician versus the benefits scrounger:

Gary comes from a good family. His parents have money, have status, and they have a good work ethic. He rarely gets ill and he has a great deal of support from family and friends. His teachers instilled in him the importance of success and he is mentally driven. He eats well, exercises and works hard. He gets up in the morning and approaches every new day positively. He didn't get where he is today by feeling sorry for himself or relying on luck, and he didn't need handouts from anyone, including his parents. He can take the stresses and strains of everyday life and he doesn't crumble in the face of adversity. He only wants a family when he can afford it and he saves for a rainy day so that if things go wrong he has something to fall back on. He's well educated and he helps out in the local community.

Gary comes from a work shy family. His parents have never had any money, they've never bothered working and they live off the state. He's always getting ill and his parents just can't be bothered with him. His teachers have always told him he'll amount to nothing and he just drives them round the bend. He lives on takeaways, and plays games or watches telly all the time. He gets high, or has a drink (or both) most nights. He looks around and he sees those lucky sods with their BMWs, holidays, and big houses and he wonders why he's so unlucky. He's had a couple of jobs but couldn't be doing with the stress. He sees his kids now and then, but they're better of with their Mum as she has a bigger place and he's busy reducing the pensions bill by smoking 20 fags a day. He doesn't have any qualifications and most days he can't be bothered to do anything.

So what was the point of hauling out both of those rather awful stereotypical representations? The point is simple. The list I produced above loosely represents the factors that helped make me into a combination of Gary the politician and Gary the benefits scrounger. Which one I more closely resemble varies from day to day, minute to minute. This closeness is affected by everything from what I had for breakfast, through to the pills I take for Anxiety/Depression, through to the amount of Dopamine my brain releases at any given nanosecond. There is no one policy, or political assumption that can possibly fit me perfectly and/or make me into the "perfect" member of society.

It is this very realisation, however, that I find completely lacking from our national political system and our society as a whole. It is as if we all assume either that the things in life that shaped us are the same for everyone or that we can somehow pre-empt or understand fully how any one person has been shaped based purely upon our own unique experiences. Perhaps it is fear that understanding a behaviour is the same as completely absolving a person from any responsibility for that behaviour. Perhaps it is an assumption that free will completely trumps every other factor affecting our lives. Who knows.

Whatever the reason, as long as this unwillingness to truly accept individual differences continues, we will not succeed in creating a truly "Fair" society. On a basic level, we have begun to understand that differences in gender, ethnicity, culture, sexuality and disability should be celebrated and that discrimination should be eliminated. We've begun to apply this to mental illness and, through the Equality Act 2010, we almost began to apply this to socio-economic groups. Until we accept, however, that the massive complexity that goes into the actions and character of every individual cannot be fully predicted, controlled, or contained we will continue to blunder around applying false absolutes to every policy decision where none can possibly exist.

They say every rule has an exception. They've got it wrong. Every exception has a rule. When we finally accept this, we truly can, and will, move forward as a race.

Sunday, 14 April 2013

Reflections on social housing

Before the end of "New Labour", when the then Govt was gleefully sycophantic towards the media and the banks, there was a trend in social housing. I'm not talking of a Thatcherite trend in depleting stock, but a trend in rents.

Towards the tale end of the Noughties rents were rising. The Govt felt that social housing rent should "reflect the market rate" and so was slapping above inflation increases upon rents wherever possible. If memory serves the target was 90% of market rates, though I'm not sure where it is now. Pondering that trend, I wonder, do social housing tenants get 90% of the service of private tenants? My impression is that this isn't the case, though I am happy to be corrected.

In private rented accommodation you can expect certain basic rights or starting points when you move in. The property will generally have flooring in the form of carpet or laminate. The property will have been cleaned and will have had a lick of paint. You will get to choose where you live, finances permitting, and you can expect semi-regular contact with your new landlord including basic repairs (mostly without a call to environmental health).

Presumably, therefore, you can expect most of that in social housing. My experience is that this isn't the case at all. For the recent increase in rents the only thing that seems to be in line with the private sector is choice. Of course this choice is based on priority, rather than finances, but no system is perfect.

Flooring, is often paid for by the tenant. Cleaning and initial painting is the same. Getting anything done is a gauntlet of faceless Managers all gleefully passing you sideways until you involve the media or one of the sometimes all too distant Cllrs. Even after fundamental issues are sorted, you may be expected to make good paintwork, shoddy workmanship or get rid of excess rubbish.

There'll be a certain amount of the above in private rented accommodation and there will be many who think, "So what. Social housing isn't meant to be as good as private rented". That's a debate I will steer clear of for now in the current "rush to the bottom" culture being engendered by David Cameron's Conservatives in an effort to justify their efforts to dismantle the welfare state. The question I have today is simple. If social housing is coming into line with the rents in the private sector, why aren't tenants getting the same level of customer service (shoddy though it is for some).

Answers, or disagreement, on a postcard please.

Monday, 25 March 2013

Making it more difficult to get something for nothing

Today David Cameron told us that immigrants would no longer be allowed to get something for nothing. Strangely I didn't find myself rejoicing at the public money it would save or the strong message it would send etc...

The initial reason for my lack of joy was simple. Our circumstances as human beings are created by four things in my view. Genetics, our environment, history and the decisions we make (I'm leaving the Will of God to greater minds). With this in mind, it is difficult for me to resent people whose history and environment encourages them to seek a better life in a place where, to most, being poor is not having access to Sky Sports.

The other reason for my lack of rejoicing was relative. Namely, when one compares the "something"  that any benefits claimant gets, whether a UK national, working, or not to the "something" that bankers got for doing nothing to help our economy and the "something" that genetic accident can confer at birth on the children of the historically rich I'm frankly horrified that David Cameron thinks he has any right at all to comment.

Rant over. Back to sponging off of society as a Cllr... wait a minute... I don't even claim expenses that I don't need...