Friday 24 September

Just when you think the government can’t get any worse, it does just that and in spades this last week. As our Prime Minister undermined the climate change message by jetting off to New York with what seemed a sizeable entourage, giving the most embarrassing performance to the UN General Assembly, back at the ranch his colleagues tried to wrestle with rocketing energy prices, shortages of petrol and other supplies (very carefully not attributed to Brexit) and growing opposition to the imminent cut in the Universal Credit uplift. The forever languid and disengaged Business Secretary, Kwasi Kwarteng, gave an unconvincing performance in media interviews to the effect that ‘the lights would not go out’ despite massive energy price hikes which coincide with National Insurance increases and the Universal Credit uplift disappearing, but many will be desperately worried at the prospect that they could be choosing between heating their homes and feeding their families. Several energy companies have already gone to the wall and Kwarteng was oblivious to the irony of his assertion that this ‘responsible government’ would not bale out companies which were not well managed. Pots and kettles.

What this and the Co2 shortage have brought to the fore, however, is the mythology propping up neoliberal economics: ‘the market’ cannot be relied upon as the sole determinant of a nation’s wellbeing. Unfortunately, many are now finding that the longstanding ‘advice’ since the privatisation of utilities to switch providers to obtain a better deal is pretty threadbare – the large ones have a much better chance of surviving than the smaller newbies purporting to offer a good deal when they’re little more than call centres. What these problems also reveal yet again is the government’s lack of planning and sense of urgency: so often ministers say they’re ‘looking at a plan’ when a ‘responsible government’ should have contingency plans to ensure continuity of supply. Relying on an overseas company for a large percentage of our CO2 supply is just reckless. As a Radio 4 listener tweeted: ‘I think the main problem is a shortage of competent leadership. Which is also due to Brexit.’

Having stuck to their guns about not making special provision for recruiting HGV drivers, petrol shortages and long queues at petrol stations have now driven ministers to consider changing their minds regarding relaxation of immigration rules for lorry drivers. A very breezy Grant Shapps, in media interviews, said that he would not rule anything out, including deploying the army to drive petrol tankers, but played down the idea that loosening border restrictions would fix labour shortages. I wonder if army bosses tire of being expected to step into such situations when some contingency planning would have made such a drastic step unnecessary. Finally, a sense of urgency: as ministers met for talks, Sky News suggested that they’re likely to sign off on temporary visas for HGV drivers to ‘avoid a full blown crisis’. Not surprisingly, ‘U-turn’ is trending on Twitter.

Brexit is clearly in the frame despite the government’s sidestepping of it and the media’s collusion in not citing it as a cause. Apparently the shortage is 100,000 drivers but even before Covid it was 60,000, though Covid contributed because of a large backlog in HGV driver tests, making recruitment impossible. The BBC helpfully detailed the reasons for the shortage, effectively including wage suppression and (yet again) lack of ‘succession planning’ as many drivers were over 55. The situation we face today has clearly been building up for some years, another issue not anticipated by the ‘hindsight’ government.

Besides dismissing French umbrage at the Aukus defence and security deal, demonstrating his statesmanship by telling them to ‘prenez un grip’ and ‘donnez-moi un break’, Boris Johnson embarrassed himself and the UK by his ridiculous stance at the UN General Assembly and coming away with  little from his meeting with President Biden.

The BBC obediently colluded with the Johnson pots and kettles narrative, without irony reporting his urging of world leaders to take action on climate change, that COP26 was a turning point for humanity (his personal reputation staked on it, of course) and that it was time for the world ‘to grow up’, also trying to suggest that the US had made concessions to the UK. This prompted a volley of tweets from sceptics, eg: ‘Biden didn’t just lift travel ban for UK, it was for all Europe. US not interested in a trade deal, we are deluding ourselves about that importance…. way overblown by the government to excuse lack of post-Brexit progress’.

 The Guardian’s John Crace lampoons the PM’s humiliating performance (‘Prime minister’s bluster meets real world as promised post-Brexit trade deal fails to materialise’) in which his ego was well and truly punctured: ‘When the highlight of your first trip to the US as prime minister is an awkward minute-long conversation with the president about a shared interest in trains, it’s probably fair to say that things haven’t gone quite as well as hoped. Boris Johnson may feel himself to be the unassailable world king in the UK, but on the other side of the Atlantic he’s pretty much a nobody. Come Wednesday morning, Johnson wasn’t even pretending to put a positive spin on things…. The previous day he had tried to hang on to the veneer that some kind of trade deal with the US was in the offing. Or failing that, a deal with the US, Mexico and Canada that Liz Truss had found knocking around somewhere on the floor when she had been minister for international trade. Though that last option didn’t survive the night before Downing Street dismissed it. Presumably because by then someone had started reading the small print’.

A useful Guardian article attempts to read between the lines of the PM’s UN climate change speech, interspersing what he actually said with what he really meant, or more often, what he unconsciously reveals about himself. ‘He quickly swerves into far different territory, revealing far more perhaps of the preoccupations and psyche of the prime minister himself than of the aims of Cop26 and the task the world faces’. For example, in the bit about humanity being the age equivalent of a teenager, he lambasts our alleged irresponsibility, citing philosophy (to add authority?).  ‘In the words of the Oxford philosopher Toby Ord, ’We are just old enough to get ourselves into serious trouble.’ We still cling with part of our minds to the infantile belief that the world was made for our gratification and pleasure and we combine this narcissism with an assumption of our own immortality’.

This is dissected thus: ‘Name-checking a moral philosopher is a shortcut to signalling high seriousness, and Ord is noted for his work on existential risk at the Future of Humanity Institute in Oxford. But perhaps a psychologist rather than a philosopher might have been more appropriate – Johnson has frequently been accused of narcissism, and what better way to deflect the charge than extend it to the whole of humanity? With its extensive references to mistakes made in the name of gratification and pleasure, and a new willingness to reform, this is definitely the speech of a man on his third marriage’. This article goes on to cite further examples of hypocrisy and disingenuousness, for example excusing his earlier forays into anti-climate change rhetoric, the PM says ‘the facts change and people change their minds and change their views and that’s very important too’. But as the journalist says, facts do not change: ‘The facts, though, have not changed: the IPCC was set up in 1988, to investigate the clear likelihood that human actions were causing changes to the climate. The scientific evidence was forceful enough even then to bring Johnson’s predecessor, Margaret Thatcher, to the UN the following year to call for urgent action’.

In contrast to some newspapers calling this speech ‘a triumph, this article’s conclusion summarises the various disconnects between the PM’s theatrical talk and reality. ‘The rhetoric may soar between Greek tragedy and the Muppets, but the decisions the government has taken – cutting overseas aid; continuing the expansion of oil and gas, and perhaps a new coalmine, in the UK; dropping references to the Paris temperature goals from the Australian trade deal; forming the Aukus defence pact with climate rogue Australia, and so offending ally France and the pivotal player at the Cop26 talks, China, in doing so – will do far more than any words of the prime minister at UNGA to set the diplomatic tone for Cop26’.

As if all this wasn’t enough, at this critical time Boris Johnson refused to say whether he could live on the basic Universal Credit (£118 a week for couples), and the unfortunately named Environment Minister George Eustice (often billed ‘Useless’ in social media) had the nerve to suggest that Joe Biden is wrong about the Northern Ireland Protocol because he does not understand the complicated nature of the post-Brexit trade deal. Interviewed on Sky News, Eustice said: ‘He is probably at the moment just reading the headlines, reading what the EU is saying, reading what Ireland might be saying, which is that they would like the Northern Ireland protocol to work in the way the EU envisage’. Seeking to distance himself from his minister’s comments, Johnson fibbed again by saying the subject of Northern Ireland had not come up in their meeting, when it was widely reported that it did.

As more misgivings continue to be expressed regarding the appointment of Nadine Dorries to the Culture brief, there’s yet more evidence of failing mental health services, which was her previous brief. Last week I said she had been disingenuous in the Commons by implying that problems were due to the shortage of people ‘coming through’ to work in mental health, when thousands of counsellors and therapists who trained at their own expense could have been recruited. Therapy Today, the journal of the British Association for Counselling and Psychotherapy, also reports that BACP wrote to her to correct erroneous statements in the Commons and on social media about deficits in counselling for children and young people. It’s a shocking state of affairs when professional bodies in any field feel compelled to write to government ministers to point out their misinformation, which many through no fault of their own will just believe.

Hardly a week goes by without there being some reporting of mental health service deficits. Now psychiatrists have said how desperate the need for additional funding is. ‘There were 1.5 million people in contact with English mental health services in June, 12.4 per cent higher than the same time last year. About 1.6 million people are waiting for treatment. We need the right resources and decisive action on the long-term challenges to help stretched services that are struggling to meet demand. This means building new mental health hospitals, transforming outdated infrastructure and training more specialist doctors’. This situation doesn’t just impact on the patients themselves, hard enough though this is: for everyone who is waiting for treatment many others including their friends, families and employers will be negatively impacted. I’d just have to disagree with the argument that we need more ‘specialist doctors’: what’s really needed much more is many more NHS psychotherapists to help patients get to the root of their difficulties, rather than going down the short-term medical model road of cognitive behaviour therapy and (often) dependency-inducing medication.

From its alternative universe the Department of Health and Social Care said that its ‘NHS long-term plan would provide mental health services in England with an extra £2.3 billion a year by 2023-24.In addition, our £500 million mental health recovery action plan will ensure we offer the right support over the coming year to help people with a variety of mental health conditions. The government is determined to ensure the NHS has the funding it needs to support those whose mental health has suffered during the pandemic’. As we well know, it’s not just about putting more (but never enough) money in – it’s about the right kind of help and not wasting resources on short-term ‘revolving doors’ pseudo solutions.

It’s also been reported that the ongoing shortage of mental health beds has meant children being inappropriately placed on acute medicine wards, not only unsuitable for them but also preventing those needing those wards getting the beds. A paediatric consultant said: ‘Over the last five years there has been a gradual increase in the number of children admitted on to our acute paediatric unit who don’t need the kind of medical treatment we offer. Consistently this summer, 20% of our beds have been occupied by children who need either a specialist mental health bed or a specialist residential placement in the community…. Many of these patients are not getting the care they need because neither I, nor my colleagues or the nursing staff are trained to provide the level of psychiatric care they require. We are trained to deal with medical problems. The mental healthcare teams don’t have the capacity to provide the level of daily input that these children need’.

A director of children’s social services, while absolutely acknowledging that these aren’t the best places for these distressed and traumatised children, explained that they effectively have very little choice because of lack of provision of the right facilities. ‘We know a hospital is not necessarily the right place for them, but there is a real gap in specialist provision between a “tier 4” psychiatric bed or welfare secure placement, which are both in short supply, and existing residential or foster care provision, where these children can receive bespoke, wraparound support’. The cost of the government ignoring these mounting problems can be seen in this director’s fears for the children concerned: ‘The consequences of nothing changing are stark – an increased risk that children seriously harm themselves or worse, or them harming other people and ending up in the criminal justice system’. Apart from the immediate distress to children and their families, not to mention those trying to help them, failing to fund these services effectively is yet another false economy which will have much heavier long-term costs.

Further proof of the dire situation is that it’s estimated there could be around 4,000 illegal detentions under the Mental Health Act because of sufficient beds to send the patients to and a record number of young people are waiting for eating disorder treatment in England (207 waiting for urgent treatment, up from 56 at the same time last year and many more waiting for ‘routine treatment’). Yet the then minister, Nadine Dorries, insisted that mental health provision is working.

If the government continues to ignore this situation, perhaps some funding at least could be freed up if results of a Public Health England report are implemented. This report showed 10% of the drugs people are prescribed are a waste, can be clinically ineffective and, moreover, increase the likelihood of medical complications and hospital admissions. This is a pretty shocking finding, likely to have been exacerbated by very busy doctors over-relying on prescribed drugs. ‘The landmark review, ordered by the government in 2018 and published on Wednesday (!!), concludes that overprescribing is a “serious problem”. As many as 110m medicines handed to patients each year may be unnecessary and even potentially harmful, it suggests’. Instead, the report recommends doctors doing much more social prescribing, including exercise, gardening, walking and volunteering, which have huge benefits without the unpleasant side-effects some entail. Obviously, some medications are necessary but repeat prescriptions are in the frame and it definitely sounds as if stringent medication reviews are called for across the board. We’re told that Health Secretary Sajid Javid has enthusiastically accepted the report: how long before the recommendations filter down to a GP practice near you?

Positive news, related to the above, comes in the form of the rise of community gardening, a development also facilitated by the pandemic, perhaps. It’s significant that the Royal Horticultural Society has now set up a Community Awards scheme as these gardens become more common. Such places have the capacity to boost mental wellbeing and tackle loneliness through the mutual sharing with others and the well-known therapeutic benefits of growing things and of connecting with nature, the passing seasons and the soil. ‘Where groups like this existed, communities seemed to be more resilient when it came to a crisis [like Covid] because they had a pre-established network of volunteers and people already knew each other so they could easily offer support (Kay Clark, head of the RHS community gardening programme)…. With wellbeing and nature connection becoming top priority during lockdown, we had this massive surge of interest in gardening and the community groups were there to help people learn how to garden, teach skills, share knowledge, plants, tools and all sorts as well as inspire people and cheer them up’. It will be interesting to hear who wins the awards at the end of this month.

On a related theme, several projects focus on rewilding and its benefits for the environment. A vast ‘stretch’ of the Scottish Highlands is to be rewilded in an ambitious 30 year project to restore nature. ‘The project has been launched after two years of conversations and meetings between local communities and conservationists from rewilding charity Trees for Life. Similar to the WildEast project in East Anglia, it is a community-led effort to restore nature over a large area, which organisers hope will be a catalyst for social and economic regeneration’. One of the most challenging aspects of such projects is bringing stakeholders together (in this case over 50) and winning over sceptics. At least Brexit doesn’t seem to have invalidated the UK’s access to Rewilding Europe funds: it helped fund the work with a €300,000 (£250,000) grant and it will be the organisation’s first UK project, so a bit of a flagship of which might be expected. There nine RE projects underway, including those based in Romania’s southern Carpathians, Croatia’s Velebit mountains, Italy’s central Apennines and Bulgaria’s Rhodope mountains.

Again on an environmental theme, it’s very interesting, given the city’s increasing discontent with excessive numbers of visitors, that Venice has now bitten this bullet and imposed an admission charge on visitors, who will have to book time slots in advance. Residents and their relatives will be exempt, as will tourists staying in hotels, so this is clearly aimed at cruise ships, which disgorge thousands of tourists every day who mainly spend nothing to support the local economy as everything they need is provided on board. The scheme isn’t starting until next year, though, so locals will have to put up with the strain on services a bit longer.

Museums and other cultural institutions (as per the Belgian project described last week) also have their part to play in enhancing mental wellbeing and now we know the winner of this year’s Art Fund Museum of the Year. It’s Firstsite, described as a ‘Colchester contemporary art venue’, now it its tenth year and, importantly, focusing on relevance to local communities. ‘Firstsite supported people during the pandemic by lending its building to the Community 360 charity to run a food bank. It also created activity packs that went on to feature 50-plus artists and were downloaded by more than 92,000 households….. Award presenter John Wilson described Firstsite as the “Marcus Rashford of museums” pointing to the fact that it had turned a lobster restaurant into a canteen serving free school meals’. The £100,000 prize should certainly be a further shot in the arm for the museum.

Finally, the highly calorific cronut (croissant and doughnut combo) is at risk of being displaced by a new pastry du jour. A Breton speciality called kouign amann (meaning butter cake in Breton) and pronounced ‘kween ah-Mon’ is now becoming an international phenomenon, according to the Financial Times. It’s been described as the ‘fattiest pastry in Europe’, consisting of 40% flour, 30% butter and 30% sugar, and you could wonder why it’s so popular at a time when people are becoming more health conscious. The answer comes from a Singapore bakery owner, where they’re a bestseller. ‘It’s the texture people crave…it’s heavier than croissant, it melts in your mouth but it’s also crunchy and chewy’. How soon before they appear in a cafe near you?

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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