It is a philosophical truism that what any of us perceives is not necessarily what is actually there. I was once working with a thirteen year old who was hearing voices in his head. The voices were mocking him and telling him he was stupid, fat and lonely. He was visibly distressed and at times speaking back, as if in conversation. Periodically, a voice would 'interject' into our conversation and we would both have to address it. On speaking to CAMHS (child and adolescent mental health services) I was advised by a bureaucrat: 

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"the voices he hears are not external, they are part of his inner monologue".

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Yes, bureaucrat. All voices are. The child remained on a waiting list for a further two years and did not receive help until he had reached a point of crisis. A violent turn, a foster parent scared, another child institutionalised for what will most likely be the rest of his life - if not in a brick institution, then at least the draconian ones we create through the unspoken rules of societal power. 

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Why do we wait until there is a crisis before an individual with acute mental health needs is able to access help? What can be done to develop mental health triage and treatment?

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In the western world, schizophrenia and psychosis tends to be a story of anguish. As R.D Laing puts it, it is not possible to understand schizophrenia without first understanding the tenets of despair. In the east however, psychosis is often thought of as a transcendental experience, with religious and meditational connotations. So, societal value influences the psychosis experience. What if we could nurture it? 

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Relevant experience: 

 

Mind, Croydon (2019) 

Outreach: Caregivers of schizophrenia, support group. 

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Camden Hub (2015) 

Outreach: a safe space for people with acute mental health needs. 

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University College London (2014) 

Masters project: A consideration of the application of Self Concept Theories when working with adolescent schizophrenia.

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Guys & St Thomas NHS: Participle (2012)   

Organisational Behaviour Change project: Developing the way GPs work with individuals with long term/ chronic conditions, thus alleviating pressure on primary care services. 

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