How Geoffrey’s story reveals reality of frontline mental health care in Yorkshire - Nuwan Dissanayaka

Why? Because although mental health problems affect one in four of us, too many of us still feel too ashamed and stigmatised to open up about them.

As an NHS psychiatrist I’m glad that we’re talking about mental health but I wish we were talking a little more about mental illness.

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In the barrage of memes about mental wellbeing and mindfulness it’s hard to make out the stories we really need to hear.

Of course we do hear about the psychological struggles of royals and celebrities and I applaud their courage for speaking up but their worlds don’t resemble the reality faced by the patients here in Leeds who I support.

I work for the Leeds Assertive Outreach Team and we support people with severe psychotic illnesses who often have a long and turbulent history of hospital treatment. Their journeys are marked by unimaginable adversity and inequality.

Geoffrey is one of my patients. I first met him during my time as a junior doctor at High Royds hospital, Leeds’s local asylum.

Vital work of Yorkshire’s mental health providers

When it finally closed its heavy doors, the myth of “care in the community” became all too apparent and for Geoffrey there followed years of breakdowns in the community which led to him being “sectioned” countless times.

That’s when our team became involved. It took some time to get him to open the door to us but now he values our support.

The odds are stacked against people like Geoffrey. He’s too paranoid to have a smartphone or use a computer so we have had to help him navigate the digital mazes of benefits and housing.

He is suspicious of his mail so his money was stopped and, not for the first time, our nurses had to access food banks.

He really needs supported housing but there is very little on offer so he lives in a flat. His place was barely habitable and his vile voices warned him not to accept the scarce support available.

But over the years he has come to trust us and he now accepts a little help with his cleaning. He’s an easy target for predatory drug dealers who use his place and take what little money he has.

The police call it ‘cuckooing’ and they would help but Geoffrey’s too scared to make a complaint. But he is still luckier than some.

He has remarkable resilience and an optimism that’s contagious. And these qualities have helped to save him from the downward spiral into the darkness of homelessness and hopelessness that we witness far too often.

Not everywhere has an Assertive Outreach Team. They were rolled out nationally during the 1990s to meet the needs of those patients with severe mental illness who struggle to engage with services but over the last decade most have been disbanded along with other services specifically designed for those with longer term mental health needs.

The backdrop for this has been wider ranging cuts to psychiatric hospital beds, social care and longer term supported accommodation.

And the consequence?

In my view it is no surprise that as these cuts have been inflicted we have witnessed the emergence of a burgeoning industry of private-for-profit units which warehouse patients who can no longer be supported in the community often hundreds of miles away from their homes and families.

Thankfully in Leeds we have managed to keep our Assertive Outreach Team. The reason is that we have been able to show that we can help people like Geoffrey break the cycle and stay out of hospital.

Our data over a decade shows our team in Leeds massively reduces the time patients spend in hospital.

Stigma is much more than the taboo that surrounds mental illness.

It is the exclusion of those with the more severe illness from those aspects of living in our society which most of us take for granted.

So, if our city is serious about challenging stigma for all, then we need to safeguard the support we offer to those most vulnerable and make sure that we include those with the voices that are hardest to hear in the mental health conversation.

Dr Nuwan Dissanayaka is a consultant psychiatrist at Leeds and York Partnership NHS Foundation Trust.