“Without dignity, identity is erased.”

Dignity is the theme for this year’s World Mental Health Day, tomorrow, Oct 10th. It is a topic that is worth exploring…

In talking of dignity in mental health, it is easy to assume that we have come a long way and that we have done the majority of the hard yards in our recent strides forward in public and professional attitudes and understanding.

To challenge this easy assumption, I propose to take the above quote out of context for the moment. It bears repeating, “Without dignity, identity is erased”. Broadly, the subject matter is the imbalance of power. Power imbalances are the basis of much of dominant culture, and to a certain extent are a societal inevitability as we organise ourselves as communities. They are not however of course, desirable. Moreover, when they are conducted on the basis of sexuality, race, gender, disability or mental health, they need to be examined and rooted out as they are emblematic of historical attitudes of which we have cause as a society to wish to put behind us.

In some ways, dignity in mental health is a misnomer. To talk of dignity in the context of a specific health condition implies that there are grades of dignity. That for some important people, dignity means one, high status thing. For people with mental health conditions, it means another, lower grade of dignity. I would argue that it is better to talk of universal dignity and the respect for the individual that it requires.

To put the quote in context, it is from “Unbroken: A World War II story of Survival, Resilience and Redemption” by Laura Hillenbrand. The section it is from covers the treatment of prisoners of war. It goes on; “In its absence, men are defined not by themselves, but by their captors and the circumstances in which they are forced to live.”

The unspoken assumption behind this statement, and one with which I wholeheartedly agree, is that it is a human need to define oneself, and in respecting dignity, this is a need that should also be respected. We all have a narrative of self that we tell ourselves, and its continuity and precedence above others’ narratives about us, are primary universal human drivers. They are drivers that are currently disrespected by the mental health system. The official records on mental health service users and their methodology have not fundamentally changed since Victorian times. Like the sepia images that fill mental health archives, with single word diagnoses under them – ‘mania’, ‘hysteria’ – my record, which is a bulky one, can be summed up in one word; ‘Bipolar’. At no point have I been invited to contribute my own narrative to my records. I think this is wrong, and that it conflicts with my understanding of myself as a person of dignity.

With this in mind, this summer I called a small group of service users together over a series of months to contribute to an idea for a venture to address this. Mental Snapp is a proposal for a simple, intuitive app, for mental health service users to contribute video to their mental health record. Short clips can be uploaded, to monitor mood, to contribute to care planning, to engage in peer support or evaluate services in closed groups, or to contribute to research. Service users can choose for each clip they upload whether they wish to upload as an individual, part of a group, or contribute to national level research.

As a mental health film maker, I have seen time after time the therapeutic value of the listening ear and the seeing eye of the camera. As a way of recording narrative and rich material, video is a highly accessible and intuitive medium, which circumvents barriers of literacy, crisis or complex needs. It is also becoming more and more acceptable among service users to self identify on film. In the 15 years that I have spent working in the field, I have seen vast changes in the accessibility and acceptability of film as a feedback and narrative medium among the service user community. The technology is there, the digitisation agenda is in place, and now surely the time is right for service users to be enabled to co-produce their digital archive.

In Mental Snapp, we hope to move the mental health agenda far further along the route of partnership between provider and user, towards true co-production, away from value judgements and towards narrative medicine. We need partners, pilot sites, people to help us drive the agenda and lead thought to get to the NHS kite mark of excellence and roll out nationally. We see a true shift being possible, and that being entirely along the lines of supporting the identity of the individual, without which dignity is impossible. Join us. www.mentalsnapp.com.

By Hannah Chamberlain www.about.me/hannah.chamberlain

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