Saturday 14 November

Of all the eventful weeks we’ve had recently, this one must be a record, including the aftermath of Biden’s victory, Trump’s ongoing refusal to concede amid allegations of fraud, the second predictable government U-turn on free school meals, the relief (despite the hard work to come) of the Pfizer vaccine announcement, the defeat of the Internal Market bill in the Lords and the turmoil inside no 10, culminating in the sudden departure of arch-fixer Dominic Cummings. ‘That’s the last time he walks down the road like Kim Kardashian, preening for the cameras like the spoilt lord of Barnard Castle. In future advisers will go round the back and let the elected prime minister use the front door’, said one commentator, yet others suggested that this dramatic exit was staged for an orchestrated photo shoot and Cummings will still be there in the background. The most memorable photo must be the unstaged one, the lone and forlorn figure standing in Whitehall, with the box at his feet, staring at his phone. Not everyone is glad to see the back of him, though – one caller to Radio 4’s Any Answers said he’d ‘done a lot of good’, and another, seeing his iconoclasm as a good thing, said he’ll probably ‘go to Silicon Valley’ and what a loss this would be.

In The Independent, former Labour Director of Communications Alastair Campbell questions the ability of the government to ‘reset’, which some Conservatives (Bernard Jenkin, David Davis and others) seem to be taking for granted or at least think possible. It does indeed seem far too late for that. Campbell argues that there are three important assets a prime minister has that should ‘never be underestimated and should always be carefully managed… diary, authority and goodwill’. Our PM is struggling with all three now and, it could be argued, has done for quite some time. Campbell suggests that the resources necessary to deal with the UK’s current challenges have had serious inroads made into them because of this time-consuming ‘personnel crisis’, attributed to ‘his inability to set a clear strategic course or to be a commander of events inside Downing Street rather than a responder to them’. It’s argued that the authority and goodwill assets come with a full tank when a PM enters office, but the way they’re managed (or not) will determine whether those tanks are kept topped up or their contents allowed to drain away. We now know that fiancé Carrie Symonds sees herself as ‘a seasoned political operator’ and that she was heavily involved in the turmoil leading to Cummings’s departure.

‘But if the narrative of an all-powerful adviser having already drained Johnson’s authority is replaced by the narrative of an all-powerful, controlling partner, that will drain it more, as will the televised briefings by Stratton. Scrapping them before they start would be a sensible part of the reset….. In the end, this is about Johnson. Diary, authority, goodwill: get a grip on all three. Or, if you can’t, just Leave. Leaving, after all, seems to be the one thing this lot know how to do’.

The US election has thrown up a number of concerns about the American electoral system: it seems to me that constitutional change is way overdue, enabling more federal control of the process to prevent further time consuming and costly disputes but apparently this will never happen as the individual states cling tightly to their power and changing the Constitution requires a two thirds Senate majority. It’s likely that our joy at Biden’s victory will be dampened considerably by the continuation of Trumpism in some shape or form and the likelihood is that this vengeful narcissist will stop at nothing to undermine the new administration. He’s already posing a security risk by excluding Biden from intelligence briefings. The refusal to concede and the undignified accusations of fraud without evidence are undermining America’s international standing, not to mention Donald Jnr calling for ‘total war’ and threatening to run for President in 2024. A week after the result we finally hear that Trump Snr has admitted that he ‘may not’ be President in January.

How Trump Senior must have regretted treating his niece and her family in such a way that she felt the need to write such an attacking and exposing book – Too Much and Never Enough. Mary Trump gave her verdict last weekend: ‘This is how the most colossal and fragile ego on the planet deals with losing the US election: he does not deal with it at all….. My uncle’s speech late on election night wasn’t just entirely mendacious from beginning to end. It was also deeply dangerous. It’s one thing for random Republicans to call a legitimate election into question, but this was the head of the government. The consequences of that action should not be underestimated’. Trump believes her uncle will be having ‘meltdowns upon meltdowns’,  seeing poetic justice in the lies and cheating now coming back to bite him.

Many have wondered what possessed so many Americans to vote for Trump and the answer, depressingly, seems to be that despite his divisive policies and failing to deliver on many of his objectives, he was seen as ‘authentic’, ‘telling it how it is’ because he didn’t speak or come across like other politicians, and somehow this engendered a kind of trust in some voters. As one commentator put it, they saw him as ‘a self-confident guy who took no shit and had moved beyond the rhetorical niceties of politics’, somehow managing to discount his catastrophic management of the pandemic and to overlook his damaging antics and absurd posturing.

Although the Internal Market bill was roundly defeated in the Lords last week, the government wasted no time in saying it would re-introduce the offending clauses when the bill returns to the Commons, including the one enabling the breaking of international law ‘in a limited and specific way’. It seems extraordinary that only days away from the Brexit negotiations deadline, there’s still no sign of real progress and resolution. ‘Lord Clarke, the former home secretary and chancellor, told the House of Lords there was no evidence for the supposed EU threat to the Good Friday agreement – describing the Brexit clauses as a “Donald Trump like gesture” born of “panic” by a government acting like a dictatorship’. It seems the government is determined to press ahead with these clauses, seeing them as ‘a vital safety net’, even though such legislation would damage relationships and trade negotiations with the US, Ireland and the EU as a whole.

After months of doom and gloom, many of us would have experienced a marked uplift in our spirits at the start of last week, the vaccine news following hot on the heels of the Biden victory. It was a jaw-dropping moment hearing immunologist Professor Sir John Bell, interviewed on the BBC’s World at One programme, giving a resounding ‘Yes’ to three questions including ‘Could life be back to normal by spring?’ Nevertheless, it was made clear just how much work this will involve, especially for the NHS, ‘tasked’ by Health Secretary Matt Hancock to get the rollout organised within the next few weeks. Typically, media interviews with high profile NHS figures, such as GP Clare Gerada and former chair of the Royal College of GPs, Helen Stokes-Lampard, talked up the level of preparedness within GP practices, confidence not echoed by all GPs. Some expressed misgivings about the manpower problems (additional staff yet to be recruited) and vaccine storage facilities, since it must be stored at below -70 degrees C. Numerous commentators and members of the public have also voiced concerns about transporting the vaccine from its manufacture base in Belgium after a No Deal Brexit, but during Thursday’s Question Time, Matt Hancock was adamant that it was manageable. This is likely to be as much of a ‘mammoth logistical operation’ as the vaccine rollout. Given the already existing backlogs in non-COVID treatment and urgent procedures, many are concerned that regular NHS work will have to be scaled back in order to resource the vaccine rollout.

Wouldn’t you just know that such a key development couldn’t emerge without the usual taint of corruption? The PM’s vaccine tsar, Kate Bingham (married to a Tory MP) was lambasted for spending £670m on PR and having received a government investment in her company of £49m. Interviewed on Tuesday’s Today programme, Matt Hancock said (in relation to the PR bill) that he will go out of his way to thank her and the vaccine task force for stepping up in the national effort, alluding to such people as ‘giving up their lives’ to carry out this work. Palliative care doctor Rachel Clarke tweeted: ‘First Boris Johnson appointed Kate Bingham his vaccine tsar (a venture capitalist, no health experience, married to a Tory minister, schoolmate of Rachel Johnson). Then her firm received a £49 million investment – funded by the UK govt. Obscene cronyism’. It was somewhat galling to hear Hancock archly reproving presenter Mishal Husain, hinting at churlishness for not ‘thanking’ these armies of people when what’s glaringly obvious is their incapacity to do a job without lining their pockets. Perhaps the most striking aspect is the bizarre perception that it was the cronies who’d given up their lives for months, rather than the many clinicians who’ve given up months and, in too many cases, their own lives.

This week Business Secretary Alok Sharma became the hapless target of Guardian sketchwriter John Crace’s blistering pen. Sharma was the latest minister selected to conduct the press conference which the PM was too tied up with no 10 intrigue to do himself. ‘Not even the business secretary is entirely sure how he came to be business secretary. He doesn’t even seem to have much interest in politics, let alone business. Rather it was a case of one thing leading to another. He had seen which way the wind was blowing in the Tory leadership contest, had declared himself a huge fan of Boris Johnson, despite never having knowingly declared any great enthusiasm for Brexit, and was rewarded – to his and everyone else’s surprise – with a place in the cabinet’. Crace details one failure after another in the Business Secretary’s performance. ‘Fair to say, Sharma is not a details man. The trouble started with a question from the BBC about reports that Brexit could disrupt the supply chain for the Pfizer-BioNTech vaccine. Rather sweetly, Sharma didn’t even seem to sense the danger in the question’, admitting that yes, Brexit would cause massive disruption to businesses and that he’d produced a series of webinars to help them prepare.

‘From there, it all went downhill. Asked about the current infighting within Downing St and the resignation of Lee Cain, all Sharma could manage was that everyone was working hard to protect lives and livelihoods….. You could hear the cries of despair coming from what was left of the Downing Street communications team. They had counted on their man not to mess up, and he had just let them down. It was turning into one of those days. Or, as the rest of us call it, one of those years’.

Meanwhile, the lockdown in England, hard to detect in some areas, plods on, not helped by anxiety that it could well be extended beyond 2 December. An interesting analysis in the Guardian describes how the second wave and lockdown have more clearly exposed the country’s socioeconomic divisions, as the instructions to stay at home and ‘do the right thing’ are given by those with decent-sized properties, gardens and laptops, with the ones suffering the most being young people, the low paid and the self-employed.

A similar pattern is seen across Europe, where violent protests have broken out in some cities, and in the US. ‘The biggest victims of lockdowns and curfews have been blue-collar workers, the self-employed and those whose livelihoods depend on servicing the better-heeled in the metropolises of early 21st-century capitalism….. If you have to leave home to do your job, you are probably in trouble. If you are securely ensconced in the better-paid knowledge economy, and able to retreat to the virtual world of Zoom, you’re probably still in business.’ Worryingly, the article describes how anti-lockdown sentiment is being weaponised by populists in order to further their own agendas. ‘After too often demonstrating a tin ear for the preoccupations and perceptions of the post-industrial working class, the liberal left cannot afford to make the same mistake again. In the short term it must lobby for far greater social protection for those worst hit by the economic fallout of Covid’.

Mental ill-health continues to feature in the news, and no surprise, since pre-existing difficulties, especially anxiety, will be significantly exacerbated by the shambolic management of the pandemic besides cuts to mental health services making themselves felt more keenly. We’ve known this for some time but recent research suggests that mental health should be added to the COVID pre-disposing risk factors. The study by the University of Oxford and NIHR Oxford Health Biomedical Research Centre showed that nearly one in five people who have had COVID-19 are diagnosed with a psychiatric disorder such as anxiety, depression or insomnia within three months of testing positive for the virus. Furthermore, they found that those with a pre-existing mental health condition were 65% more likely to be diagnosed with Covid-19 than those without, even accounting for known risk factors such as age, sex, race, and underlying physical conditions. ‘A particularly concerning finding was the doubling of the diagnosis of dementia – which is typically irreversible – three months after testing positive for Covid-19, versus the other health conditions’. If such research doesn’t help make a cast-iron case for better mental health funding, I don’t know what would.

There hasn’t been much in the media about the government’s Winter Mental Health Plan and I hadn’t been aware until I saw news from my professional body, the British Association for Counselling and Psychotherapy (BACP), that Nadine Dorries has been Minister for Mental Health, Suicide Prevention and Patient Safety since 2019. Not exactly a high profile. BACP tells us: ‘We’re pleased the UK government is set to announce an evidence-informed Winter Mental Health Plan, which will include improved access to talking therapies at its heart. The plan, which was raised by Mental Health Minister Nadine Dorries MP during questions in the House of Commons on the mental health impact of the pandemic, will also include a campaign to help people access the support they need when they need it. These were key elements of our Covid-19 campaign and we’re writing to government to offer our support in bringing this plan forward as well as pushing for greater funding for counselling and psychotherapy to meet the growing demand’.

Brave talk, but as so many have found out, support is often not there ‘when they need it’, because of long waiting lists and poor choice of treatment in primary care services. The government’s Plan doesn’t seem to amount to much and seems rather technocratic in its approach, for example ‘piloting a national surveillance system to monitor suspected suicide and self-harm by collecting data from local systems in near real-time…… This will allow us to identify patterns of risk and inform national and local responses. [But, given the cuts made over the years, what can these ‘responses’ amount to?] I can also announce we’re developing a winter plan for wellbeing and mental health, and I hope to return to the House with more information on this shortly’. BACP acknowledges the statement and thanks its 27 campaign partners but is clearly on the government’s case: ‘But the government needs to get this right and we’ll be continuing to make the case that the plan must provide adequate funding and draw on the expertise of our skilled and professional members if it’s going to support the growing number of people whose mental health has suffered during this challenging year’.

Meanwhile, we learn that out of area psychiatric in-patient placements have more than doubled over recent years, causing considerable distress to patients and families, patients often being sent far away, with the attendant difficulties involved in organising visits. An NHS spokesman said: The NHS and psychiatrists remain committed to reducing the numbers of out of hours placements’. I wonder how many will be reassured by that.

Finally, you might like to explore two interesting kinds of audio output. The latest of Radio 4’s very topical profile programmes features the husband and wife doctors who developed the Pfizer and BioNTech COVID vaccine.

New to me is slow radio podcast producer Radio Lento, which produces beautifully meditational pieces consisting of natural sounds like water, the forest at night, an afternoon in the Essex countryside, and so on. This kind of content is so good for our mental health, especially if we feel rushed, stressed or it’s difficult to access natural spaces. I hope they get a good following.

Published by therapistinlockdown

I'm a psychodynamic therapist in private practice, also doing some voluntary work, and I'm interested in the whole field of mental health, especially how it's faring in this unprecedented crisis we're all going through. I wanted to explore some of the psychological aspects to this crisis which, it seems to me, aren't being dealt with sufficiently by the media or policymakers, for example the mental health burden already in evidence and likely to become more severe as time goes on.

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