Yesterday I spoke on a panel with a psychiatrist who used an example of their patient who died from anorexia almost as though this was a good outcome. That it was at least inevitable.

I found some of what they said frankly disturbing. Buckle up…🧵 Highlights include framing the patient wanting to try treatment in terms of their “willpower”. Sure it takes willpower to try treatment. So does existing with severe illness.

Privileging willpower in this way suggests that patients who don’t want treatment lack willpower

🧵 Last year the GP told me I was “being manipulative” when I said I didn’t feel safe to leave & asked if it was at all possible to have a blood test that morning

I was threatened with security

Within hours I collapsed with extremely low potassium trying to get to hospital

1/8 My experience as a patient with a severe eating disorder is that MY security has often come last

My safety has been a lesser priority than safeguarding the tight parameters of service provision that’ve been unbelievably hypersensitive to even a perceived sense of challenge

2/8

🧵 My doctoral psychology course said the adjustments I requested for Ehlers Danlos Syndrome, autism and ADHD were “unreasonable” because they’d create a “slippery slope” and undermine course rules. My complaint was upheld. This narrative wasn’t just wrong though -

1/4 The slippery slope concept - whereby misfits are assumed to create a degeneration of the status quo - isn’t just stigmatising. It misses the possibility that the status quo might NEED disrupting, that what may seem disruptive or destructive can actually be creative, fruitful

2/4

It's #TimeToTalkDay tomorrow, so instead of telling mentally ill people to ask for help, here are 10 things to talk about instead:

1) the UK Government has scrapped their 10-year strategy for #mentalhealth

2) people with serious mental health problems die prematurely worldwide 3) mental illness is the leading cause of days off work in the UK

4) the number of mental health beds in the UK is decreasing, but demand for them is increasing

This year with my yoga business (Cambridge Yoga Project) we have a dedicated charity of the year for the first time! It had to be @MQmentalhealth - research is the future of #mentalhealth.

Read more about why I’m so pleased to support MQ including as an ambassador below 👇🏽 Our first event is on Tuesday 7th Feb 6-7.15pm and is called MOVE for MQ, a super fun movement/dance class fusing music, movement, yogic philosophy, embodiment theory and more- to create something good together!

In my experience, the idea of being "held" has not been seen by #mentalhealth services as a part of their remit.

In fact, my need to be held or saved, at times, has been seen as a part of my pathology, and something for which I've been shamed.

https://twitter.com/AAJDeVille1/status/1582349131955441664

It's a clinical need to be held in safety or saved from danger. It's not a need-to-feed some kind of a pathology/ a shameful part of yourself / a need you should have met elsewhere. But it can seem like services have given up on the ideas of holding in safety or saving from harm

One of the greatest problems in #mentalhealth care is how intensity of care is overlooked. You may have needed far more than an hour of therapy a week, but you're described as having had treatment. As though it was somehow automatically enough and appropriate for your needs
1/ But the evidence isn't there that 1hr of therapy/wk is the right intensity for all outpatients. It's arbitrary - reflecting service design & capacity more than patient need. It feels cruel when people will misunderstand you as being adequately supported because "in treatment"
2/

(Possible) explanations for when patients with #eatingdisorders “aren’t engaged”, which don’t rely on stigma and assumed character defects:

1) their prior experiences of care give no reasons to trust

2) they were ready to engage years ago but help wasn’t available

Continues👇🏽 3) healthcare systems were “unprepared to change” with the patient

4) services were “not ready” when the patient was

5) treatment options and delivery format are “not engaging”

6) their clinicians are not trained

👇🏽

My experiences of #mentalhealth emergencies have been many and varied, but they have ALL been made worse by a huge fear of being misunderstood or not heard. The absolute terror of being dismissed or ignored when in a crisis has been worse than the crisis itself. The fear is not irrational. For me it became embodied through experience - experience of being denied care, being completely misunderstood, being hung up on by 111 & 999 because unable to stop crying enough to say your date of birth. Of being left without a support net at all.

I never counted calories until I was told that people with anorexia are fixated on calories

When I was last in #eatingdisorders treatment it was suggested to me to count calories even though I'd been a healthy weight & not calorie-counted for over 5 years

This is a problem 🧵-> At what stage to we stop and think about how treatment might actually introduce people to harmful behaviour/thoughts/beliefs by imposing pretty fixed understandings of what it is to have a particular condition? I think this happens in #eatingdisorders

One of the problems I’ve experienced with thought-based therapy is that rarely has a therapy/therapist offered me a thought I haven’t already had.

Sure, some thoughts might be emphasised over others, but I don’t think we can always debate ourselves into feeling better ...🧵-> Of course anyone who knows me will know I hugely value talking therapies, the power of articulating an experience, being heard. But other approaches are also valid, or necessary.

And I think sometimes it’s even actively unhelpful to combat language with language.

🧵It's perfectly valid to criticise a government that opts for a #mentalhealth ambassador over a proportional response to need in its funding of services. It's not to say an ambassador is bad or can't do good work, but it's no substitute for investment to actually meet need. For some context, c10% of department for health budget (pre-COVID) is mental health, but mental health is 26% of the economic "disease burden". We see more money going into services than before, but nowhere near enough to meet demand never mind catch up with historic harms