Trying to solve the many riddles of the NHS is like playing whack-a-mole. Fixed A&E? Then say hello to GP waiting times. Solved the junior doctors’ strikes? Crumbling hospitals would like a word.
While a sense of despair now envelops every aspect of the NHS, mental health services have been neglected to the point of total dysfunction. Newspaper headlines about “hospitals in crisis” are now as regular a feature of the festive period as mince pies. But unacceptably long waits for talking therapy or a sustained fall in the number of mental health beds don’t capture the public imagination in the same way.
Dr Benji Waterhouse’s superb memoir You Don’t Have to Be Mad to Work Here could well be the moment that the NHS mental health crisis explodes into the public consciousness. The book recounts Dr Waterhouse’s early experiences of training and working as an NHS psychiatrist at an unnamed hospital in London. Like many doctors in the NHS, he begins his career full of wide-eyed ambition and idealism before being worn down by a broken system. “I had never imagined I’d query the legitimacy of people’s suffering, use phrases like ‘bed blocker’, and only offer them help if jumping from a certain floored window would create a big enough splat,” he writes after his first few days on the job. It is a book that should really prompt a public inquiry but is also, somehow, hilarious.
Much of the book focuses on Dr Waterhouse’s patients, who suffer from a range of disorders including schizophrenia and borderline personality disorder. Barbara has flown to London from the US in the belief that she is going to marry Harry Styles at St Paul’s Cathedral. Femi believes he is a werewolf and bites a nurse while in hospital.
Dr Waterhouse’s work is overseen by the steely, cynical consultant Dr Glick, who is dismissive of his holistic approach to his patients. While he frequently muses on the deeper societal causes of mental illness, she believes in “brain defects and chemical imbalances”. This is the “tongue of ‘proper doctors’ ” but a source of constant frustration for Dr Waterhouse, who describes patients as being treated “like fruit on a processing line” given the “little sticky labels that go on apples, oranges and bananas”.
In one particularly shocking exchange, a psychiatrist colleague on Dr Waterhouse’s ward recalls a bed manager asking whether the suicide of a patient will free up a bed. The system has degraded to the point that human life is seen merely a statistic, the opposite of the values that the NHS was founded on.
If this book does not serve as a wake-up call that serious change is needed, I don’t know what will
The blurb of the book made me worry that it would inadvertently stigmatise psychotic patients by poking fun at their “madness”. Campaigners have been fighting for decades to stop the “othering” of psychosis patients, who are often falsely portrayed as violent and dangerous. As someone who interviews doctors for a living, I have occasionally heard gallows humour cross the line when the microphone is off. But Dr Waterhouse is full of love for his patients; he does not laugh at them nor encourage us to do so.
A great deal of the book examines Dr Waterhouse’s own mental health journey and his experiences of therapy. He reflects on the darkness lurking beneath his “idyllic” childhood in rural Northumberland and struggles to face the reality of his anxiety and depression. It is tragically ironic that the talking therapy that helps Dr Waterhouse is unavailable to most of the public, due to decades of underfunding and mismanagement.
Comparisons will be made between this book and Adam Kay’s 2017 medical memoir This Is Going To Hurt, which chronicles the horrors of working in the NHS as an obstetrician. That book, along with the first set of junior doctors’ strikes in 2016, was the catalyst for a profound change in the public’s perception of the health service and the people working in it. Britain does not worship at the altar of the NHS anymore. If anything, we mourn it.
You Don’t Have to Be Mad to Work Here could well have a similar effect on psychiatry. Britain is currently in the grip of a post-pandemic mental health crisis that stretches across generations, with diagnoses for anxiety, depression and eating disorders soaring in the past five years. While it is clear that the capacity does not exist within the system to cope, the reaction in Westminster is a collective shrug. If this book does not serve as a wake-up call that serious change is needed, I don’t know what will.
You Don’t Have to Be Mad to Work Here by Benji Cape is published by Jonathan Cape (£18.99, out now)
