Room to breathe in defence of the NHS

Failed by the NHS aired last night as part of a BBC 3 season on mental health. The programme followed Jonny Benjamin, a 26 year old with schizoaffective disorder, as he met other young people who have had to struggle to access NHS care for their mental health needs. The programme was quite timely for me, as it touched issues my family are experiencing right now, and reflected the frustration and desperation we’ve been feeling while trying to navigate a system that seems determined to ignore us.

As the young people featured in the programme spoke about how hard they and their families have had to fight to be heard by GPs and child and adolescent mental health services (CAMHS), I knew these were not isolated horror stories. Each example of being dismissed and mismanaged by A&E, GPs, specialist services matched my own experiences as a CAMHS service user, CAMHS professional, and carer. As the programme aired, the twitter hashtag #failedbytheNHS brought even more voices together describing the myriad ways mental health service users have experienced vastly inadequate and neglectful “care” from statutory services.

This isn’t the place to give a potted history of anti-psychiatry, or the ever growing and inspirational initiatives led by those who experience mental distress to challenge mainstream models of mental illness and mental health care, from R.D. Laing to the Hearing Voices Network, Mad Pride and beyond. Nor is it the place to give a history of the oppressive nature of psychiatry and its history, its role in social control, its gendered, racist, and classist treatment of those who come into contact with it. That psychiatric care is inadequate and problematic shouldn’t be a controversial point to make amongst anarchists or the radical left.

But criticising the NHS while the government is undermining it and selling it off is a dangerous move, but not one we can never make. It wasn’t long before those of us using the #failedbytheNHS hashtag were politely informed that we hadn’t been failed by the NHS, we’d been failed by budget cuts, a point that I thought barely needed raising, and one that the programme itself made pretty clear. We were also reminded that NHS workers themselves were not to blame, that some people have good experiences of the NHS, that some NHS staff are fantastic on mental health issues, and that while the NHS may not be perfect, it’s better than privatised healthcare. All valid points, none of which I’d disagree with, nor would most of the mental health service users whose blogs and tweets I’m familiar with. The implication being that the programme and the hashtag and the vocal criticisms of the NHS are all lending legitimacy to the destruction and privatisation of the NHS, which of course will exist for as long as there are people left to fight for it etc etc. And soon enough, #savedbytheNHS appeared, with heartwarming stories of NHS doing its job well.

So we end up with a really frustrating and immobilising false dichotomy, where you can either get behind the NHS 100%, or you’re more or less an unwitting propagandist for neocon privatisation. There is no room, it seems, for those who have undeniably been failed by the NHS to speak out, group together, and imagine models of mental health care that actually work. That would be divisive, it’d be giving points to the opposition, it’d undermine the movement, we’ll deal with that after the revolution. Sound familiar?1

And of course, those in favour of undermining and privatising the NHS will point to the various ways in which the NHS doesn’t really work and argue that privatisation will make that better. And even though the privatisation of the NHS is such an unpopular move that it’s being carried out in piecework behind closed doors, it’s still happening. We cannot keep countering the anti-NHS arguments with “but at least it’s free!” and “the NHS is great, shut up”, because the NHS, as it stands, is not perfect and beyond criticism. As our opponents find faults throughout the NHS, it’s not enough to tell them those faults aren’t there.

We need to be brave about this, and start making the case for why the NHS as it stands fails us, and linking this to austerity. We need to convince ourselves and everyone else why the NHS would be better under patient and worker’s control – not in a decentralised, free-school, Tory kind of a way, but in a revolutionary, for need instead of profit, directly democratic kind of a way. We can and must be able to think critically about mental health care without reverting to “spirit of ‘45” nostalgia, or endless repetition of the same losing arguments. We need to engage with the already existing, vibrant user-led movements and NHS workers challenging conventional mental health care and think about what these movements could offer for health care as a whole. It’s perfectly possible to argue for free health care at the same time as arguing for better healthcare. We can be brave enough to criticise a mental health model which is all too often experienced as coercive and shit as well as making the case for why privatisation would be worse.

• 1a clue: women, queers, black people, trans people, we’ve heard all this before from various corners of the left and beyond