Sunday 15 August

Last week’s news, much of it a continuation or repetition of what we’ve seen before, served as a timely reminder of what an uncertain world we’re living in, this naturally impacting on our mental wellbeing. As we move closer to the global climate change conference, COP26, experts and politicians deliver ever starker messages but often with no actual plan to reduce emissions as radically as global policies dictate. Boris Johnson wants to be seen as a world leader on climate change, but there’s a lack of urgency and the absence of a plan has partly been attributed to two opposing factions within the Conservative Party. There are the ‘blue environmentalists’, including his wife Carrie Johnson and there are the sceptics, including some climate change deniers, who worry about the cost to consumers. Other groups outside the Conservative Party with a powerful agenda are the ‘climate change warriors’ and the ‘Labour net zero pragmatists’. The dire climate emergency raises a conundrum which will surely test the capacity of COP26 deliberations – how much individual responsibility can governments expect their citizens to take when some regimes like China, Russia and Saudi Arabia at the G20 deliberately prevented a decision to end fossil fuel subsidies? And what can individual countries achieve when China’s emissions are 28% of the global total and are continuing to increase? There’s the intrinsic challenge that these forums like COP26 take place on the global stage, far removed from the localised government mechanisms which actually get things done. In the Financial Times Philip Stephens said ‘the gap between the soaring rhetoric of international conferences and policy inaction at home will have to be bridged, and soon…… Look at the weather’.  

Just before the release of the Intergovernmental Panel on Climate Change (IPCC) report, Business, Energy and Industrial Strategy minister Kwasi Kwarteng gave a car crash interview on Monday’s Radio 4 Today programme, consisting largely of sound bites and clichés which didn’t add value to the discussion. His perpetually languid and disengaged manner doesn’t help. Meanwhile, evidence of climate change is undeniable, many parts of the world experiencing unprecedented levels of flooding and wildfires. At least there’s a glimmer of hope that the IPCC report has been described as a massive alert that the time for climate action has nearly gone but crucially not gone yet.

The situation in Afghanistan is surely another lesson, as if we needed one, on the folly of Western intervention in such countries. More specifically, Western intervention without a genuine plan for sustained support for the Afghan government and the people. Having taken so many other cities and areas, the Taliban are now ‘at the gates of Kabul’ and unlikely to be halted now. It’s striking how hard some politicians and generals have been working to try to justify the last 20 years, whereas many, especially those who have lost family and friends there, feel it has been a waste. The main justification seems to be that during this time we have seen very little Al-Qaeda terrorism here but what about the Afghans? Those interviewed express despair about the return of the Taliban, pointing out the difference between their new propaganda and what’s actually happening on the ground. A sceptic tweeted: ‘The Taliban has changed – its PR is better’. Another said: ‘Western leaders are saying “but we educated millions of girls in Afghanistan” over the last 20 years. How does it help to now abandon 20m women to the Taliban and condemn them to a life in the Middle Ages’? It was heartrending to hear an Afghan woman say that the Americans had shown them a beautiful world and now President Biden had abandoned and betrayed them.

There’s also the key issue of the former interpreters: some have been welcomed to the UK but there are still many others there at risk of Taliban persecution and elimination. Shadow Foreign Secretary Lisa Nandy said there needs to be some genuine UK leadership on this (and what about the massive cut in foreign aid recently decided?), but it seems the complexity of the situation and the summer holidays are slowing down a considered response. At least Boris Johnson has recalled Parliament for Wednesday, though it seems he did initially resist this. The BBC also reported that Afghan students offered scholarships by the UK government won’t now be able to take up those offers because of paperwork not being completed in time by the British embassy there. Surely there must be a way around this.

Regarding the speed at which the Taliban has effectively toppled the Afghan government, one commentator interestingly attributed this partly to this government not being perceived as truly Afghan, having been built up from returning exiles. Former Tory MP and Afghanistan expert Rory Stewart tweeted: ‘At the centre of this is the most astonishing failure of intelligence + analysis from the US and its allies. The US presence was small, sustainable and vital to the country. It was removed in an utterly reckless fashion – as this shows with no understanding of the impact’.

As in previous years, there’s the usual August debate about exam results but this year, with two years of pandemic-related challenges, there’s rightly been a sharper focus on inequalities within the system, grade inflation and, because of teacher assessments, many more qualifying for university places than before. Labour has said that this makes Education Secretary Gavin Williamson’s position untenable, but needless to say, both he and Schools Minister Nick Gibb carry on regardless, not even acknowledging the problems.

‘Asked whether private school teachers had been too generous in their grading, Keir Starmer said the attainment gap appeared to be to do with a ‘lack of a coherent framework to do the assessment provided by the government. Some were testing very often and some not very often…It led to the widening and now yawning gap between private and state schools. The hallmark of this government is wherever there is an inequality they can make it bigger and they are very busy doing that’. It’s not only Labour calling for Williamson’s sacking – he’s apparently held in very poor esteem by Tory MPs and the Cabinet, but it’s not clear that   those touted as a possible successor (Vaccines Minister Nadhim Zahawi and Equalities Minister Kemi Badenoch) would be much of an improvement.

Meanwhile, as the gap between private and state schools comes under yet more scrutiny, an interesting article by Brooke Masters in the Financial Times, featured in The Week, aims to demonstrate how private schools have lost their grip on Oxbridge. Admissions tutors have moved towards a more inclusive policy, focusing more on state school pupils who have worked hard to overcome barriers, rather than simply privileging public school products from wealthy backgrounds who have also been groomed for the interview process. These parents who have shelled out thousands over years trying to ensure Oxbridge for their offspring find themselves in a new moral conundrum. Whereas many will publicly espouse the need for equality of opportunity, when it comes to this situation they see what they had assumed for their children as being under threat. One ‘grouchy’ father was heard to ask a school head to explain how he would protect the boys there from ‘social engineering’. A firm sense of entitlement accompanies this level of spend over years. ‘I feel genuine sympathy for anyone concerned for their child’s future, but complaining about a loss of privilege comes across as tone deaf’.

We’re told that since 1981, annual applications to Cambridge rose from 5,000 to 20, 426. It’s now four times harder to get a place than when these parents were applying and the pandemic has exacerbated the situation because of teacher-assessed grades leading to hundreds of extra students. I feel sorry for the children of these parents who went to Oxbridge themselves, expecting their sons and daughters to follow suit but without understanding what has changed. But rather than parents engineering their children’s futures, a healthier approach is for those students to determine their own future. One sixth form college principal has long tried to convince parents that Oxbridge entrance isn’t the be all and end all: ‘Things have changed very dramatically in 30 years… for parents it’s about learning to let go a bit and learning to let students drive the process… our job is to walk alongside them. It’s not to go in front and drag them’.

The shocking shooting in Plymouth raised a number of issues which need closer scrutiny, such as what seems a dereliction of duty in the police reissuing the gun licence to this disturbed man after it had been removed following Jake Davison’s involvement in an assault. We know how depleted police forces are but this is surely an area of their work they cannot afford to carry out negligently. Three other key issues are Davison’s association with the incel movement (which not everyone is yet familiar with), whether this should be treated as a form of terrorism, and yet another situation in which inadequate mental health services have played a part.

‘Davison had shared hate-filled views on Reddit forums used by incels – men who express hostility and resentment towards those who are sexually active, particularly women. Earlier this year, authorities in the US warned that attacks linked to the incel movement were on the rise, and authorities around the world have begun to treat the ideology as a more serious terrorism threat.

‘The condition of Davison’s mental health has been questioned, with one person familiar with his family claiming relatives had requested help from mental health authorities. Writing on Facebook, the neighbour said: “His family [pleaded] for help to the mental health team, the NHS basically said that they are short-staffed and that was it. The family even asked for the police to come out to see him as he was talking and acting strange but they didn’t do a welfare check’.

A useful article describes what ‘incel’ culture is and how it could be on the rise. ‘Incels are men who describe themselves as “involuntary celibates”. Laura Bates, author of Men Who Hate Women, said: ‘In other words, they’re not having sex and they want to be. They see women as completely commodified and dehumanised sex objects [that] are there purely for male sexual pleasure. And they blame women for the fact that they’re not having sex’. Bates estimates that the incel community in the UK could be as large as 10,000, with hundreds of thousands more worldwide and that the movement is actively grooming and recruiting young men.

The policy of ‘living with the virus’ is being manifested in various ways, especially the normalisation of substantial numbers of new cases and of daily deaths (around 90 each day). One of the key disillusionments of recent times must be the realisation that vaccination doesn’t prevent us getting Covid and doesn’t prevent hospitalisation. When the vaccines were first developed we didn’t have the lethal variants to contend with, but now we hear that the double jabbed only have a 59% protection, down from 83% earlier this summer, due to the Delta variant. The decline in protective antibodies after the second job has strengthened calls for autumn booster jabs, although no decision on this has yet been taken. This and related decisions must be taken soon since experts are advising the government that vaccine-resistant variants could ‘set us back a year’. Various scientists and commentators (including Dominic Cummings) have urged the government to produce a Covid risk assessment strategy relating to contingency plans, but so far we’ve mainly seen reactive short-termism.

‘Stephen Reicher, Professor of Psychology at the University of St Andrews, said: ‘It very much makes sense to be prepared. Scotland is setting up its standing committee on pandemics. It will be interesting to see what emerges on a UK level. In the longer-term we need a systematic inquiry into what went wrong (and right) so we are prepared and also so that we can institute systemic changes to protect us. The pandemic has been like a barium meal which has exposed so many deficiencies in our society. We can no longer pretend we are not aware of them. This has been a deafening wake-up call. Let’s make sure we don’t press the snooze button’. Government sources have said Public Health England and other bodies are monitoring the situation ‘through rapid surveillance and genomic sequencing of the virus’ but it could be argued this already doesn’t reflect the urgency of the situation.

We heard this week that Baroness Dido Harding will be stepping down from her role as chair of NHS Improvement in October in the wake of her unsuccessful attempt to become the next NHS England Chief Executive. Well overdue, some may say. In another embarrassing but not surprising revelation, the government has also admitted that it had the data on deletions and disabling of the NHS Covid app amid the ‘pingdemic’, but refused to release the figures. The Department of Health and Social Care again demonstrates how it takes us for fools, in trying to suggest that the release of such information was not yet in the public interest, also declining to say when this time might come.

Meanwhile, for those travelling abroad, there’s been increasing disquiet about profiteering by the companies (over 400 according to Transport Secretary Grant Shapps) offering PCR tests. The Competition and Markets Authority has now entered the fray, concerned about pricing and test results being delayed or not returned. The CMA is providing data for the Department of Health and Social Care to act on. As a reminder and to see the contrast with other countries: ‘PCR tests are needed to travel to some overseas holiday destinations and on return from amber and green-list countries. Similar tests for days two and eight after return to England listed on the government’s website can cost more than £300 or as little as £20. On average, prices in the UK are £75 for a single test, compared with about £40 in France and Greece’. Some travellers have found that the cheaper tests listed on the website aren’t available when they come to book them, prompting questions about the authenticity of the apparently low costs. This situation again throws up inequalities, with only those able to afford these tests able to go abroad. Even a Tory MP observed: ‘It’s almost as much as the holiday that they’re having to fork out in Covid tests which means for a vast majority it’s a no go. I couldn’t afford to with a family of five’.

Meanwhile, the ‘staycation’ industry continues at pace despite the UK’s unpredictable weather and amid complaints about crowds, inflated accommodation prices, shortages in shops and queues for restaurants and cafes. But not everywhere – after this summer there will no doubt be positive accounts of less popular holiday spots, some quite off the beaten track. Anonymous street artist Banksy is also doing his bit for the British seaside, as he tours the UK in his campervan, his works already appearing in Lowestoft (Suffolk), and Gorleston and Great Yarmouth in Norfolk. I wonder how many media outlets already have a team combing the roads and resorts for the elusive artist.

‘In one work on the concrete sea-defence wall of a British beach, a rat lounges in a deckchair, sipping a cocktail. In another, sticking to the seaside theme, a mechanical claw dangles above a public bench – as if anyone who sits there is about to be plucked up like a prize in an arcade game. Another shows a giant seagull hovering above a skip full of oversized “chips”. A fourth shows three children in a rickety boat. One looks ahead while another is busy bailing out water with a bucket. Above them, appears the inscription: “We’re all in the same boat.”On the roof of a bus shelter, a couple also dance to the tune of a flat-capped accordion player, in a black and white painting evoking the faded, down-at-heel feel of many of the country’s once-prosperous seaside resorts’. It will be exciting to find out what further works appear and in which resorts.

Prince Andrew is once more in the news since his legal team has not responded to lawyers representing the woman accusing him of sexual assault when she was a teenager, Virginia Giuffre. The main lawyer, Daniel Boies, has said that Andrew cannot ‘hide behind castle walls’ and that his client had ‘tried every way she can to resolve this short of litigation’. Apart from the hiding not being good for the Prince himself, it gives a poor impression of this country and of the Royal Family.

 ‘The lawsuit seeks unspecified damages. Giuffre accuses Andrew of sexual assault and intentional infliction of emotional distress. The lawsuit said that 20 years ago, ‘Prince Andrew’s wealth, power, position, and connections enabled him to abuse a frightened, vulnerable child with no one there to protect her. It is long past the time for him to be held to account’. If he doesn’t respond to this current request, he will anyway be drawn back into these accusations because the delayed trial of Jeffrey Epstein consort Ghislaine Maxwell will take place in the autumn.

Again, mental ill health hits the news, from several different sources. Besides the failure of services in Plymouth to respond to the alerts regarding Jake Davison, the Guardian tells the story (and this will be the tip of the iceberg) who had to give up their jobs to care for mentally unwell children because of service failures. One mother had to give up her work as a much-needed ITU nurse to care for her daughter. ‘Leese is one of many parents who are the collateral damage of the funding crises in children’s mental health services (Camhs) and the special needs education (Send) system. The Observer revealed last month that up to half of all children and teenagers referred to mental health, learning disability and autism services in 2019-20 were left without proper support. But the effect on parents is often overlooked – forced to abandon their careers so they can look after their children full-time and fight endless battles with cash-strapped bureaucracies for the most basic support’.

One of the shocking things is how much money these parents have had to spend on assessments and legal fees in order to get their children’s needs met. ‘Ruth Cliff has spent £20,000 in two years on legal support and private assessments for her 17-year-old adopted son, draining her savings and sending her into debt. Her son, who has ADHD, hasn’t attended school since March 2019. She had to go to her GP three times just to get a Camhs referral’.

But on top of all this what a lonely place for the parents to be in, their own mental health also compromised. ‘As a parent of a child who struggles with mental health and with special educational needs you basically have to become the expert, not only of your child and their needs, but also of what needs to be put in place to support them..It doesn’t seem that services that are supposed to help will willingly help – you literally have to fight every battle to get them to help you’. Needless to say, Department of Health and Social Care issues statements about how much it’s ‘invested’ but it’s never enough or in the right places. A distressed and sceptical parent said: ‘I watched them in the Commons saying by 20-whatever year it was they’re going to have this, this and that done, and how much progress they’ve made. And it was like, if you think you’ve made progress for the pathway into assessments then come to my house and see the state of my child, because I can tell you that you haven’t. I would welcome any of the health ministers into my house to look at my child, to spend a day in my shoes, so they can see they’ve not changed anything. Nothing has changed’.

 Meanwhile, counselling and therapy, which many initially seek through their GP, have moved substantially online and via apps, a trend reinforced by the pandemic but one which started with the ill-conceived (in the eyes of some) IAPT (Increasing Access to Psychological Therapies) programme, which privileged short-term work and Cognitive Behavioural Therapy when what many need is relational therapy which goes to the roots of difficulties. There’s no doubt the programme has broadened access to therapy but it has also unhelpfully removed elements of the special relationship between client and therapist. It was appealing to politicians and policymakers because it appeared to deliver ‘treatment’ at much lower cost and achieve success rates, but now we know how these figures have been fabricated.

‘Elizabeth Cotton, a former psychotherapist working in the NHS, is an academic based at Cardiff Metropolitan University whose recent research is focused on the “Uberisation of mental health”. She carried out a series of surveys (including three about the impact of Covid on working life in mental health) and has published them under the title The Future of Therapy. We speak on Zoom, of course, and I marvel inwardly at how we have taught ourselves to communicate in this new land, our own faces hovering meanly to the right. “Essentially,” she says, her argument is that “an industrialisation has taken place, a downgrading of therapy, which opens the doors to digital providers, and what is emerging now is the Uberisation of mental health services.” Cotton shows how the original intentions of IAPT have been undermined and explains how figures are manipulated.

She stresses that there are still good therapists and services. ‘But the model is designed in a particular way, to downgrade the service. To shorten the interventions, to reduce the number of highly trained clinicians that you need to take on a supervisory role rather than a direct clinical role. To reduce expectations. To reduce what people think is a treatment’. The NHS has a major conundrum to wrestle with, on top of very inadequate investment in mental health, despite what some disingenuous ministers maintain: it tries to help a greater number of people, though waiting lists are often still long, but often at the expense of choice of treatment and work which can genuinely help them, resulting in revolving doors and people having to seek help privately, which not everyone can afford. ‘The gold standard of therapy remains two people in a room, one talking, the other listening. In Britain right now, that level of care is reserved for the very wealthiest and the very sickest, while those in between have traditionally relied on luck and compromise’. While the new digital approaches will help some, many will not experience them as helpful, leaving patients to finance the work themselves or continue as best they can. The frustrating irony is that for years counselling and therapy professional bodies have been urging the NHS to recruit their qualified and experienced members to meet the need but this hasn’t happened.

Finally, on a positive note, related to the earlier piece about addressing educational inequalities, it’s good news that another 30 black students will get £20k a year scholarships to Cambridge, thanks to rapper Stormzy. Having started with two students a year in 2018, it’s now ten for the next 3 years, enabled via a partnership with HSBC. The star said: ‘I hope this scholarship continues to serve as a small reminder to young black students that the opportunity to study at one of the best universities in the world is theirs for the taking’.  

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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