Bedlam – Do we need stories to understand?

I watched Bedlam, a documentary based on the work done in the South London and Maudsley (SLaM) NHS Foundation Trust last week and this week. I was reassured by last weeks’ episode, titled “Anxiety” which followed some people who had obsessive compulsive disorder so I was looking forward to the episode broadcast last night titled “Crisis” which was based in an assessment ward (which they called a Triage ward) where, the programme makers told us, decisions were made about whether to admit over longer periods or discharged home.

The “story” aspect of the programme focussed particularly on four people – two men and two women who had found themselves in situations which had necessitated (or where they had chosen – in the case of informal patients) to be admitted to psychiatric inpatient wards.  Fashionable documentary style is very much in the ‘story-telling’ vein. We like stories. We like stories with ‘happy’ endings and as the programme finished, they made sure we had the resolution we required but I was left uncomfortable by a number of aspects and details in the programme. Maybe I was more critical this week because it was an area I had more experience of but I didn’t walk away from the programme thinking it had necessarily reduced stigma and instilled a greater understanding of the mental health system as it is. Of course, that’s not the purpose of TV programmes at 9pm. The purpose was entertainment and perhaps that’s where some of my discomfort lies.

I saw a lot of the positive waves of support for the programme, helpfully tweeted out by NHS Maudsley through the programme. Interesting (but of course, unsurprising) that they didn’t deal with some of the criticisms. I know the issue of capacity to consent to filming has been raised and the programme makers have addressed it.

The producers state

One of the complex questions for filming on the ward was that of patients’ capacity to consent. We’d agreed a rigorous consent protocol with the Trust which included getting an initial steer from a lead consultant in charge of the patients’ care before even approaching an individual. At times we just got a patients’ consent to film them, we had to return to them at a later date to get consent to broadcast the material. We filmed with one lady, M, for a number of days while she was on the ward and then when she was discharged home we met her for lunch and she decided not to be involved further. Central to the filming was a respect for people’s right to privacy and we respected M’s decision.

Clearly they have covered themselves legally but some of the situations presented made me wonder how much thought had been given to the future impact of the broadcast on recovery in the long term and a full understanding of the implications of being filmed at your most unwell “in the public domain” for perpetuity – and the effect on yourself and your family of this. Of course, I’m sure these issues were covered but I was uncomfortable in the same way that I was with the ‘much lauded’ Protecting Our Children series. I’m not sure that seeing people at their most unwell or disturbed is ‘entertainment’ and now ‘educational’ it is. Do we need to ‘see’ crisis? Do we need to see a psychiatrist telling a patient he is going to use section 5 (2) of the Mental Health Act to demand that he remains on the ward when he has asked to leave? Are some things necessary to film and show on the television with real people to understand?

Perhaps I’m too sensitive because I’m thinking that for me, the thought of being filmed if I were to be restrained and forceably medicated by a team of staff is abhorrent personally. And thinking about the shots of someone being ‘persuaded’ to take their medication and forceably injected, I wonder how much it was necessary to see it. It reminded me of Panorama where the abuse at Winterbourne View was shown – not because there was abuse, clearly, but because I wondered at that point too, how much needed to do shown on camera and whether we were indulging voyeurism too much. Of course, legally, the Trust and TV production company had consent tied up but I can’t say it didn’t leave me with unease at the way we view entertainment and couch it in ‘education’ and ‘attention raising’ to make us feel better.

My other discomfort, and I’ve been criticised for raising this, was some of the racial undertones and stereotypes that I felt were perpetuated by the ‘storytelling’. Dominic, the white middle class man who would be someone who could be ‘identified with’ by many at home, was a ‘danger to himself’. Rupert, a black man, was presented as having been a ‘danger to others’. I felt distinctly uncomfortable not with the people telling their own stories in the context of the programme but with the narrative of the documentary makers that ran over it. The sequence with Dominic and Rupert singing together, seemed particularly focused on the viewer ‘empathising’ with Dominic – possibly at Rupert’s expense. Dominic was someone who was ‘like us’ – at least, until he got his ‘new’ diagnosis of having a personality disorder which immediately ‘othered’ him. Rupert was presented differently. Perhaps I am too sensitive to these things but having worked in mental health services in central London, it’s hard not to attune to race as an issue – particularly when we look at compulsory admissions.

Lots happens on admissions ward but in terms of staff, we only saw doctors and nurses. It’s a shame that there was a missed opportunity to see some of the multi-disciplinary work that happens on inpatient wards constantly especially as people move towards discharge but perhaps that’s an unfair criticism, after all, it isn’t an ‘entertaining’ as seeing people in distress. The ‘follow ups’ we got intimated that hospital admissions were successful. If that’s the case (and it isn’t always although obviously, we hope it is), I’d have liked to have seen some of the ‘why’ that we saw last week. Apart from seeing someone medicated, what other ‘tools’ are used to help prepare someone to move out of crisis. In my view, that’s an opportunity that was missed.

Early in the programme, I heard the documentary makers mention that patients who were ‘informal’ needed to see the doctor before they could leave the ward. This, I have to admit made me bristle. I hope it was a misunderstanding on the part of the documentary makers as it is veering dangerously close to ‘de facto detention’ on the part of the Trust. Someone asked me, during the programme to explain this better so I’ll give it a go. An ‘informal’ patient is a patient who chooses, willingly and with capacity understanding the implications of their actions, to admit themselves to a psychiatric ward. They are free to leave whenever they like. They are not under any compulsion to stay. If staff feel they are making a clinical decision that there is a need for someone to  remain on the ward, or ‘see a doctor before they leave’ they have to ensure they have the legal authority to do so so as not to breach article 5 of the Human Rights Act – either by a detention under the Mental Health Act (known as ‘sectioning’) or by using immediate short term holding powers under section 5 of the Mental Health Act (5(2) is where a doctor can compel someone to stay on the ward until an assessment is carried out and 5(4) is where a nurse can do so for a much shorter period). Leave cannot by restricted for an informal patient. If they need to stay, or if their leave needs to be restricted there are legal processes which need to kick into place. Detaining someone is a massive infringement of human rights and needs to be considered carefully. It cannot be a flippant comment by a member of staff on a ward about ‘staying to see the doctor’.

So Bedlam this week, definitely not leaving me feeling that it was waving the flag for stigma busting. It’s a shame as the opportunity was there but the need for stories and entertainment were paramount. Personally, it compounded my view that fly-on-the-wall wouldn’t be my personal format of preference for gaining insights into worlds that might not be apparent to others. I am of the view, and I am aware I’m probably in a minority on this, who thinks that created drama without ‘real’ people on camera – at least during their moments of crisis – would be a better way to achieve this. Drama created by people who have understanding and experience, absolutely,  but I’m not sure how much seeing the ‘real time’ distress and illness is a help to those who are experiencing it. Is that my inherent paternalist nature creeping out? Perhaps it is. Perhaps I overthink things and should let people get on with it but frankly, after last week, I was disappointed with last nights’ episode – as a rather sad epilogue, I am also thinking, thank goodness the Trust I worked in didn’t agree to TV cameras. Stories are good. Stories are necessary. But do we need every part of a story to understand? Do we need to see the needle being injected, the distress and confusion, do we need to see all that in ‘real time’ to understand? Maybe we do now. I accept I probably don’t  hold the majority view on this, judging by the waves of praise for the Trust and the TV production company  but it doesn’t shake off my general unease.

11 thoughts on “Bedlam – Do we need stories to understand?

  1. Thought it was only myself who was not happy with this episode. As a ‘frequent flyer’ psych patient who has not had a happy ending and gone off into the sunset fixed by medication or indeed got immediate access to therapy – lucky Dominic I did not feel it was representative of the real world. I feel guilty now that I have not recovered.

    It was uncomfortable viewing and maybe it has done some good in that it has shown the outside world what it is like to be locked in a madhouse. Me also getting upset about the informal patient attitude not really knowing their rights but that is how it is. I usually am an informal patient and always have to fight and have similar conversations to those shown on Bedlam about being able to leave the ward.

    The worse bit was that there was no attempt to understand Dominic’s side of the story to understand the despair etc that drove him down the path of suicide just the family’s take that he was a bad father to even think of leaving his children behind. Suicide is just not like that. It left a feeling of he must be selfish which continues that stigma associated with suicide.

    Thanks for writing this blog.

  2. Brava FM and thank you for articulating my unease with the programme so eloquently. I look forward to finding out more about what is said about these issues.

  3. I too was uneasy and repelled by the psychiatric treatment and drugging, shown as being civilised when in fact it was coercive and disabling. Very difficult to watch. There has to be a better, more humane way of working with mentally distressed people.

    Bedlam demonstrated the bankruptcy of present day psychiatry. In my opinion.

  4. Great to read this. I identfiy with much you have highlighted as universal issues with story sharing and sensationalising trauma ; the entertainment and anti-stigma balance, especially in tv format seems to elude producers and campaigners alike. Good stuff, if it gets made at all, is not commissioned or promoted as it it seems not to fit with entertainment standards….perhaps this just reflects the stigmatising climate we are in. Although i feel Bedlam is definately more useful than previous programming I’ve seen in this time slot. Progress- but perhaps behind the standards we’d prefer to see.

    I’m particularly passionate about clarity in ownership of a story; who edits, who decides on audience and format etc. Because of this I created a document on Storysharing Guidance with the scottish recovery network ( to help support both creaters and those sharing their personal experiences. I wish more would read it with the hope it would increase discussion, awareness and ultimately support better programme making.

    If you read it id be interested in hearing your feedback.

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  6. Picking up on the bankruptcy of present day psychiatry comment I couldnt agree more… From Bedlams portrayal that is…

    What we saw was the old school medical model in action wasnt it?? Dominating. And even described as the ‘answer’ to recovery. What we didnt see is the considerable multi-disiplinary, holistic and empowering approach adopted by many psychiatric hospitals and how this feeds into a recovery model.

    The programme, in my opinion, is dangerous for this very reason.

    What must the general public feel and beleive about psychiatric inpatient units after viewing this? And what message does it give a potential Patient experiencing a mental health crisis for the first time and thinking of voluntary/informal admission?

    Not good enough Bedlam. Its time we celebrated the work that is done which this most certainly does not do.

  7. I have major issues with informed consent being sought from individuals at a time when they are clearly distressed,unwell ,vulnerable and lacking mental capacity.I also feel disappointed that healthcare professionals have been complicit in this when they should be protecting the people in their care. I fear for the privacy and dignity of mental health service users if this breach in their human rights has somehow been deemed to be legally ,morally and ethically acceptable.I feel strongly that this programme is wrong on so many levels.

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  9. Totally agree with this review – glad it wasn’t just you. I was especially uncomfortable with Dominic / Rupert compare and contrast. The happy endings seemed very artificila and there was no explanation about why or what treatment had been successful.

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