For the sake of sanity

nhs_threatI sincerely hope people read this article in full. Morag and Ulrich Fischer provide an insightful and informed overview of Scotland’s mental health services. It’s by no means an entirely favourable review. It is clear that much remains to be done. Overall, the article conveys a distinct sense of hope and confidence. But there are also evident concerns.

These concerns relate, in some measure, to the fact that Scotland’s mental health services are under serious pressure. But such pressure is an inherent characteristic of a genuine public health system in which the overarching principle of universal care free at the point of need must be fully honoured while striving to resolve the intractable problem of potentially infinite demand chasing severely limited resources. That is what our health workers do. All of them. Doctors and managers and nurses and cleaners and all the rest. They cope with the demands. They manage the resources. They deal with the pressure. That is their job. And, whatever the British politicians squatting in the Scottish Parliament say, they do that job remarkably well.

When elective and/or non-critical procedures are postponed in order to free-up capacity to deal with some extraordinary demand, this is not a failure on the part of health service workers as those British politicians would have you believe. This is just them doing their job.

In order to do this job; in order to cope with the pressure, there is one thing that the people who run Scotland’s NHS absolutely require above anything else – even money. They need control. Without an appropriate level of control, normal workaday pressure becomes intolerable stress. It is not pressure that breaks systems or people. It is the stress of responsibility without authority; expectation without capacity; aspiration without hope; pressure without control.

There are striking parallels between factors affecting the mental well-being of individuals and those which impact on the functional ‘health’ of groups, organisations, communities and even nations. Lack of control is one example. Insecurity is another. When an individual is under pressure to perform (or conform) but is deprived of the relevant choices, that individual will experience stress and suffer a deterioration in their mental health. This will always be the case. Only the degree of deterioration will vary from person to person.

Similarly, when an organisation, community or nation is under pressure to achieve defined goals while being denied the decision-making power that is required, that entity too will tend to become dysfunctional.

Insecurity arises when such ability to choose as the individual may possess – or believe they possess – comes under threat. Or when whatever limited decision-making power exists within the organisation, community or nation is perceived to be in jeopardy.

Morag and Ulrich Fischer recognise the threat. They feel the insecurity. Having described the successes and ongoing efforts and continuing progress in Scotland’s mental health services, they issue a stark warning.

All this might be under threat should we allow Westminster to ride roughshod over devolved powers.

That warning must be heeded. We must not allow Westminster to strip powers from the Scottish Parliament. We must cease to tolerate the withholding of powers that rightfully belong with the Scottish Parliament.

We must categorically reject the British state’s asserted veto over Scotland’s right of self-determination.

We must loudly and vehemently denounce the anti-democratic British Nationalists who would deny us the opportunity to choose a different way.

We must dissolve the Union!


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