There’s been a run of programmes about different sorts of mental health problem recently, and different ways of helping. I had a week where I watched lots of them: Louis Theroux on experiences of postnatal depression and psychosis, Alistair Campbell on depression, Nadiya Hussain on anxiety and David Harewood on psychosis.
Just as mental health is a spectrum, so is its coverage. The purpose and filming practices of these programmes are in stark contrast to reality TV shows that have also been in the news lately, in relation to their effects on participant mental health: Jeremy Kyle’s show in particular, but also Love Island.
Similar ethical conundrums underlie the whole range of telly programmes though, and hopefully similar principles can be used to help navigate what is best to do. New British Psychological Society (BPS) guidelines came out this week aiming to help programme-makers know how to responsibly cover issues relating to psychological distress and to support people taking part in programmes so as not to induce or worsen a mental health problem. I was happy to have the opportunity to play a small part in advising on those guidelines, which you can find here.
There was much I thought was good in all the programmes I watched, and also some areas of concern for me: the ability of people to properly consent being the biggest one. I’m normally a big fan of Louis Theroux, but the many of the people he interviewed either seemed to be saying they felt uncomfortable but were ignored, or seemed to be unable to consider all implications of having a camera crew around. In the David Harewood documentary, which otherwise I thought was great, one of the people filmed was in hospital and was clearly terrified of being possessed, and it was her family who had consented to filming on her behalf. I’d question what extra we learn from scenes like this and at what cost to the person being filmed.
Concerns aside, programmes like these documentaries do an important job of getting different difficulties out into the light. This in itself can be helpful: to allow people to feel that others are experiencing something similar, to demystify what happens in treatment, and to increase the language that we all have to describe and understand our internal lives.
I was particularly pleased, in these recent programmes, to learn about Nadiya Hussain and David Harewood’s experiences. As many have compellingly argued, including Reni Eddo-Lodge, Jacqui Dyer, and the team responsible for writing the new BAME IAPT positive practice guide (due out soon), communities of colour are under-served by many mental health services, and often face multiple inequalities: more stressors which can increase risk of mental health problems and at the same time often greater stigma around mental health problems and their treatment. The David Harewood documentary included conversations about the role of difference and how that may have impacted on David’s experiences of psychosis, and the programme highlighted the statistics around how black men are ten times more likely than white men to be diagnosed with a psychotic illness and four times more likely to be placed under a section of the mental health act.
These issues are debate-provoking, and quite rightly so, although many of the conversations I saw on Twitter about the programmes came from different factions of mental health professionals rather than people with experience of the mental health problems or people who were curious about the issues shown. Debates were around how much diagnosis should have been used or not in the different programmes (the age old anti-psychiatry debate continues in its different forms).
My own view is that diagnosis can be useful, both to know how to approach a treatment and sometimes as a relief, that there is a ‘thing’ which can be described and which others experience too, even if that thing is socially constructed. Diagnosis shouldn’t need to preclude a wider understanding of why a problem has come about or is being maintained, and should definitely be discussed with whomever is experiencing the difficulties to see if they find it useful.
Really though, my view on diagnosis is irrelevant to whether the people in those documentaries used it to tell their story or not. There is always power at play in these debates, and often the most power is held by the mental health professionals. Perhaps we should sometimes try to be the ones who are the quietest in the conversation. If we did then who else might speak up? And what might we learn from what they have to say?