Review: Don’t Call Me Crazy

A still picture of a young woman sitting on a bed with her knees up and her hands over her face, behind a heavy lockable (but unlocked) doorRecently a series called Don’t Call Me Crazy, set inside an adolescent mental health unit in Manchester, the now-closed McGuinness Unit, was screened on BBC Three, apparently the first time cameras had been allowed to film inside such a unit. They were given access to patients and staff, although some of both declined to be featured (or were unable to give consent) and their faces were disguised in the programme. The most prominently featured was Beth Whittaker, who had an eating disorder and was in the unit for six months, much of it on a section as she failed to comply with the treatment, but other patients had OCD, depression, psychosis and one had suffered a nervous breakdown. All three episodes are currently available online in the UK until next Monday (Episode 1, Episode 2, Episode 3) and you can read an interview with Beth here and some interviews with Beth and three members of staff on the programme’s website here. (More: Ilona Richards @ Mind [1], [2], [3], Secret Schizophrenic, And Then She Disappeared [1], [2], [3].) Also, Katy Gray published a very critical comment on this programme on TwitLonger, relating to consent issues.

I have a few friends on Twitter with recent experience of (adult) inpatient mental health care, and some of them raised serious issues about the consent given by some of the patients. The executive producer, Jane Merkin, told people on Twitter that not only the patients’ consent was gained before both filming and transmission but also the parents or guardians and the clinicians. However, one patient, I was told, had not given consent to be featured, but she was so thinly disguised in the programme (her face was blurred, but the rest of her body could be seen) that she was recognised by people she knew (a scene with such a thinly-concealed patient appears in the opening scenes of every episode, at about 1min 5secs).

I was also concerned about one of the younger patients, Kristal, who had been suffering hallucinations which were probably the result of abuse in her early life, before she had been adopted, and complicated relations with her birth family (it seems some of her siblings were still with them). Her hallucinations featured ‘numbered’ characters, and there has been some gossip online with people claiming that she was pretending and that these characters were ‘lifted’ from online reports about January ‘Jani’ Schofield, an American girl with schizophrenia featured on the Oprah Winfrey show. Personally, I did not think she was faking at all; she seemed very frightened by a lot of it. She was discharged when her hallucinations were found not to be psychosis or schizophrenia, but I still think she was too immature and vulnerable to be featured. A third patient was released from section during filming but is now in a different unit, and there was a conspicuous lack of further information about this person which would have led viewers to form their own conclusions. I raised this issue myself on Twitter and was assured that this person had been “in a good place” when “key filming” ended.

I have no such qualms about the other patients featured, though. All of them had been discharged by the time the programme went out and by the end of the series, were well over the worst of their difficulties. Another complaint was that there were scenes of distressed patients, alarms, locked doors, restraint and other harsh features of life in a psychiatric unit, and some people found themselves unable to watch more than the first five minutes because of this. Worse, these opening scenes were repeated in all three episodes. The first episode heavily featured the “acute corridor” where some patients were kept under strict supervision, including one girl (Gill) with a history of self-harm, violent behaviour and absconding. This featured much less in the second and third episodes, so if you found the first too upsetting, you might find the second less so as the patients most prominently featured are further along the road to recovery.

Besides Beth, the programmes featured Emma (about 13 or 14, with OCD, only in episode 1), Gill (16, with depression, in episodes 1 and 2), the aforementioned Kristal (with hallucinations thought to be psychosis, only in episode 2), Matty (with psychosis, in episode 3) and George (with a nervous breakdown, featured in episode 3). With the exception noted above, all had been discharged by the end of the series, and a couple spent only a few weeks in the unit, which suggests that the unit favours quick turnarounds and enabling people to manage their condition, if possible, at home rather than getting them used to being in hospital and on the strength of the few featured here, seem to do it quite well. However, I found some of the staff’s behaviour questionable, including the scene where the staff ‘inspected’ Emma’s room and turned things upside down looking for forbidden items (mostly sharp objects, but in this case they took a mobile phone). It caused her considerable distress that they did not put things back the way they had previously been arranged; she was convinced that her family would die if she did not follow this ‘régime’. They may have thought that going along with it would not do her any favours, but you don’t just go into someone’s house and rearrange the furniture or the books on the shelf. It must have felt very invasive for the poor girl. It made me wonder if a unit run on a lock-down basis is the right place for a young girl with relatively mild difficulties, but a less secure therapeutic environment probably was not available.

A second disturbing trend was that isolated incidents of self-harm were answered on two separate occasions (that were shown) by cancellation of home leave. One of the girls was refused leave for Christmas (after staff had got her hopes up) and a second for a weekend home, in both cases not long before their sections were revoked. In both cases they were devastated, a feeling I can well identify with from boarding school days when I counted the days until the next trip home (to their credit — a phrase you won’t hear me say often — they never used weekends home as a weapon or cancelled one when it was due). These incidents were accompanied by ominous tone in the voice-overs that made these incidents sound horrific (and there were scenes of staff meetings where staff talked in “very sad” tones that told the audience what was going to happen, as if this wasn’t their stock reaction). In fact, self-harm is a widespread problem and the majority of young people who cut themselves never see the inside of a psychiatric unit.

So, was the programme exploitative? As far as I can tell, all of the people who featured on the programme are, right now, happy to have done so and seem to be happy with the outcome of the programme. Recently I commented on an entry by Carly Findlay criticising the Channel 4 series Embarrassing Bodies, which despite doing some good in raising sexual health awareness and the like, mostly trades on the “yuck factor”, offering speedy fixes (surgery, if necessary) to people with embarrassing problems that perhaps could be fixed on the NHS, but would entail a long wait. In this case, there was no question of anyone approaching the production company out of that kind of desperation, but the “yuck factor” seems to have been provided with close-ups of recent self-harm wounds, something some people with mental health problems have found distressing or even triggering, as Ilona Richards mentioned on her review on the Mind website.

Mental health units in the UK are very strict about security: they do not allow patients to keep mobile phones and recording equipment on the ward and very often do not allow them Internet access. A friend who spent more than two years (in two bursts) in different wards told me that this was for confidentiality reasons, to prevent patients taking pictures of each other and circulating them. I would question how much of a distraction the presence of the cameramen was in the life of the people in the unit, particularly when patients were seriously distressed and staff were trying to calm them down or comfort them. How much of the time were they there? And while they can stop patients accessing the Internet while in the unit, they cannot stop them talking once released, gossiping and revealing sensitive information about each other. (I have known people to tweet from adult wards after being sectioned, however, so perhaps things have changed since her last discharge or, as she suggested, phones were issued as and when needed and then taken away. The matter of Internet access, or lack thereof, was never discussed in the programme, despite how important it is in modern life, including among the young.) In such an environment, it’s very unacceptable that someone who did not consent to be filmed be exposed so as to be recognised, but for the most part the company have taken pains to make sure that consent from all parties was sought, including at a time when the patient was not under section and thus able to consent; surnames were not divulged and the programme will disappear from iPlayer within a week.

The programme makers had a fine line to tread here, and the lapses already discussed aside, they seemed to have handled this mostly quite sensitively. The patients are shown in a pretty good light, as decent young people working their way through some problems, not as “trouble” or as “crazy”; they are never shown bullying or otherwise being cruel to each other. To a certain extent any TV based on people’s real lives, especially in crisis, is exploitation as the production company (and broadcaster, if it’s a commercial one) profit and the subjects are, if anything, paid a small fee, but in terms of what it exposed of the patients, I think this was as sensitive as it’s possible for this kind of programme to be.

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