Many people knew Claire Greaves, if not personally then from her campaign work. She was a mental health activist who ran the blog Mental Illness Talk and tweeted on @mentalbattle. From her latest blog post, the last before she died:
"I’m in a scary place right now and de-escalation has become the place where I spend most my time. Sad really to think that life has come to this."
I usually link to stories and then use a quote from the family about the deceased and say nothing myself, but the report of the inquest into the death of Claire Greaves has come at a difficult time. BIGSPD 2019, an annual conference about personality disorders for the UK and Ireland, has come to a close and with it a report of yet another death in the hospital of one of their sponsors. While many of the clinicians express issues with the diagnosis of borderline personality disorder, and there are many talks about the problematic issues around language and stigma, for many people diagnosed with a personality disorder it seems a shallow gesture.
Cygnet Health Care is a private healthcare company who has been called out for their appalling care (Cygnet Sheffield: MP urges NHS to break ties with private hospital and
A Chain Of Private Psychiatric Hospitals Has Been Accused Of Failing Vulnerable Young Patients), but remains very profitable. From the buzzfeed report:
The attraction of the UK’s psychiatric hospital market for foreign investors is clear: As in the US, this is a big-money opportunity.
BuzzFeed News examined 12 months of financial records and found that over the last year NHS England paid Cygnet £101 million for young people’s acute psychiatric services. This money, plus payments from local NHS bodies for adult mental health services, makes up the bulk of Cygnet’s £131 million turnover. Cygnet made a healthy £6.3 million annual profit, according to its latest accounts.
Cygnet’s top director is paid £469,000 a year. UHS, Cygnet’s American owner, has an annual turnover of $9 billion a year. Alan Miller, the American multimillionaire founder and CEO of UHS, said in the firm’s latest annual report that Cygnet had been expanding because it views "the U.K. market as increasingly attractive”.
Of course, it is easy to be profitable if the care you provide is merely to isolate patients and keep a skeleton staff. In the death of Claire Greaves, the long term seclusion was found to be directly tied to her deterioration in mental health, and that staffing levels "probably caused or contributed" to her death. It is cheap to keep somebody in a room with no furniture save a mattress that is brought in at night, with little oversight from staff. It is profitable to take patients into a hospital that then offers no meaningful treatment. People who don't know better think we have moved past the days of locking disturbed loved ones away, out of sight out of mind, moved past the days of asylums, but the experiences of those who are confined to psychiatric hospitals makes it clear that we have not. Claire's own post describing her experiences in a secure unit (prior to her move to the Cygnet hospital) is aptly titled "My Nightmare At The Secure Unit".
Cygnet runs 13 private wards specifically for service users diagnosed with personality disorder. 11 of them are for women. All of them, I'm sure, are profitable or work to establish a monopoly as a superior healthcare provider that will eventually make them profitable. This gender discrepancy is much highlighted by feminists and activists and other critics of borderline personality disorder, but for other personality disorders like narcissistic personality disorder and anti-social personality disorder which are mostly diagnosed in men the wards are usually literal prisons. Whether medical or criminal, people with personality disorders are profitable when detained by private institutions. The neglect that is justifiable by the stigma surrounding the diagnosis and the associated criminality and moral judgement is profound.
A key criticism of BIGSPD and personality disorders as a concept is the conflation between survivors and perpetrators. Discussions have been had about whether, for the sake of survivors, it would be beneficial to hold a separate forensic conference. Most agree that it is in poor taste to have talks about the needs of violent abusers alongside those who are survivors of such violence.
However, perpetrators, as a term to denote any violent individual, especially if the line drawn is forensic, criminal, is a poor way to attempt to divide people diagnosed with personality disorders and speaks to a greater failure in the framework.
A focus on individual psychology neglects much of the context that feeds violence. It neglects that physical violence is just one way to exert power somebody else, and not all violence holds the same impact. The inability to distinguish different types of violence, inability to acknowledge how power intersects with violence makes this forensic approach to dividing people inadequate in understanding both trauma and abuse.
If clinicians cannot meaningfully distinguish between people who are violent in ways that are self destructive or lashing out, and those that target people who are vulnerable it will remain insufficient at addressing the true harm and real cause of traumatic violence. Most importantly, if clinicians cannot recognise that abuse comes from systemic power, the iatrogenic violence against people diagnosed with personality disorders that many of those attending BIGSPD 2019 seem so concerned about cannot be addressed from within the system.
If clinicians cannot see the bigger picture and meaningfully stand against those who would abuse and neglect service users, especially against those that profit greatly from such abuse, they are enabling this abuse as an active part of the system of power that creates it. They are complicit in the suffering and death.
Though Cygnet gets a slap on the wrist for it's systemic issues, the wards are still open and profiting from the suffering of the vulnerable and it continues to sponsor events like BIGSPD. Smiling representatives promoted their specialist personality disorder services from the Cygnet booth as the BBC published an article about how the inquest found Claire Graves died from the gross negligence in one of their hospitals.
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