Dr Benji Waterhouse: 'I'm an NHS psychiatrist and my profession is endlessly challenging'

“There are not the beds to admit everyone with a diagnosis,” the psychiatrist explains – and that can mean delicate calculations around risk of harm when trying to triage patients. “You can’t square (the) numbers,” he says, “and so unfortunately hospital beds are reserved only for the most, most, most unwell people and everyone else gets discharged.”

Around one in four adults will experience at least one diagnosable mental health problem in any given year in England. Yet the share of NHS spending on mental health is just under nine per cent.

At the start of the 1980s, the number of hospital beds available in England each day for people with mental ill-health stood at around 80,000 – and today, that figure is around 18,000. That, Waterhouse says, is despite more demand than ever.

"I had this very idealistic idea that I was going to change the world,” he says, reflecting back to the start of his career. He had studied at medical school in Leeds before spending his junior doctor years in York and Hull and then moving to London to specialise in psychiatry.

The 40-year-old is still based in the capital as a frontline NHS doctor but he is also an award-winning stand-up comedian, a path he started treading at the same time as beginning his career in earnest.

“Humour does help to make things more tolerable,” he says. “I guess I saw this potential to use humour as a trojan horse to help people think about taboo subjects that they might rather not think about. Of course it’s a bit sensitive, (but) I’ve noticed if you add some lightness, people can tolerate these darker subjects.”

Without that mix, he’s almost certain that the book he released a year ago would not have become a Sunday Times bestseller. In You Don't Have to Be Mad to Work Here: A Psychiatrist’s Life, Waterhouse unlocks the doors to the psych ward, providing a fly-on-the-wall account of the medical speciality. Now, he’s on a book tour across the UK, including a date in Sheffield.

His show will be a combination of stand-up, storytelling and chapter readings followed by a question and answer session. “That will be people’s best chance to speak to an NHS psychiatrist without the 12 month waiting list,” he quips.

As well as touring, Waterhouse is working on the script for a television adaptation of the book, after the rights for You Don’t Have to Be Mad to Work Here were sold to the BBC Studios owned House Productions. He’s also writing a second book exploring psychiatric treatments around the world, all alongside his NHS work.

“There is this very welcome mental health conversation now but it does tend to focus more at the milder end of the spectrum,” Waterhouse says. “I want to give a voice to people with more severe mental illness, the people I try to help in my work, with things like schizophrenia. For those people, mindful colouring in and cold water swimming isn’t going to do a lot.”

Psychiatry is a profession that is “endlessly challenging”, he says. “There are no easy answers. We are still very much in the dark when it comes to understanding these mysterious things we call mental illnesses.”

Most of the (anonymised) cases in his book are Waterhouse’s patients. Some of them are family – and one of them is him. From both sides of the doctor’s desk, he explores questions such as why anyone would choose to be a psychiatrist and how vulnerable patients can receive the care they need when psychiatry “lacks staff, hospital beds and any actual cures”.

“There was a time when I was worrying a lot about my patients, struggling to get beds for them, worried that something might go wrong - the sort of tragedy that gets plastered all over front pages,” Waterhouse reflects. “In the context of that I was not sleeping very well and was having a lot of anxiety and getting quite dark thoughts myself.”

His GP diagnosed him with depression. But his therapist had a different view. “He said ‘no Benji, I think you’re an NHS psychiatrist’...I think there’s a bit of a trend in society nowadays of over-medicalising what are often just social problems.”

Waterhouse feels more could be done on the matter of prevention. “I think we often feel as psychiatrists that we’re at the bottom of a cliff trying to patch people up just wishing there were more protective barriers at the top.

"I think if we addressed more things like inequality, lack of opportunity, unemployment, (poor) housing and loneliness, a lot of the stuff that we end up calling mental health problems probably wouldn’t come through the door in the first place.”

A spokesperson for the Department of Health and Social Care told The Yorkshire Post that this government had inherited “a broken mental health system” and was “determined to fix it”.

“Our reforms to the Mental Health Act will ensure people with the most severe mental health conditions get the help they need and more personalised care. We are moving care out of hospital and into the community, so it is provided closer to home and keeps people out of hospital.

"Through our Plan for Change, we are also shifting the focus from sickness to prevention and recruiting 8,500 mental health workers to reduce delays, provide faster treatment and give patients the right support as they transition from an inpatient setting.”

- Dr Benji Waterhouse is at The Leadmill, Sheffield on May 11 with his You Don't Have to Be Mad to Work Here book tour.