You’re not nutting me off, are you, doctor?

I was not in the least surprised that the Equality and Human Rights Commission came to the conclusion that patients detained in psychiatric hospital have five times the risk of preventable death as psychiatrically ill people in prison.

Having worked in both types of institution, I had long suspected as much. The prisoners in knew were in general far more afraid of psychiatric hospitals than they were of prisons. One of their most plaintive cries was, ‘You’re not nutting me off, are you, doctor?’ i.e sending them to the local bin. Only one thing was more to be feared by them than being nutted off, and that was being ‘lifed off’ by the judge, which is to say given a life sentence. Many prisoners quite like prison for a time, but not for years on end.

In my experience, prison officers were kinder and more astute than many of those called ‘mental health workers.’ (I speak, of course, grosso modo, I do not mean in every last case.) They had not had their heads filled with psychological jargon and rubbish. When they came to me to tell me that a prisoner was not himself, or was acting strangely, or that ‘he’s not your typical con,’ I soon learned to take their observations seriously. And prisoners sent to hospital usually begged to be sent back to prison as soon as possible. Among other things, the food was better there.

Whenever one reads official reports of disastrous cases in psychiatric hospital, one soon recognises certain phrases such as ‘lessons have been learned’ and ‘errors of communication.’ In fact, one could write almost all reports on disastrous cases before they have occurred. By ‘lessons have been learned’ is meant ‘It will be exactly the same next time:’ and the reason for this is simple.

The lesson that has been learned is always that a new form, longer and more complex than the old, should be introduced. The problem is that the form filling gets in the way of genuine contact with or concern for the patient. The form-filling is the work itself.

Of course, there is the same tendency in prison, but the very nature of imprisonment limits it more than in psychiatric hospital. Of course, conditions should be equalised between the two great institutions, equality being so important to us. By far the easiest way to achieve this would be to raise the death rate of the mentally ill in prisons, to equal the rate in hospitals.

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