Many thanks to the author, Bella Jackson, NetGalley, and the publishers Random House, UK, for an ARC of this book, which was published on 3 July. It’s a passionate inditement of public mental health services in the UK (the author doesn’t write about private mental health services, apart from a passing comment from a psychiatrist to note that they are “often worse”).
The book paints a picture of spaces where patients are rarely listened to; are forced to take medication against their will, with life-changing, sometimes life-threatening, consequences; where diagnoses are made more on impressions than any formal process - and which patients aren’t allowed to question; and where there's a culture of polypharmacy, without any understanding of the effects the combinations of drugs might have. Staff are also shown to have generally dismissive attitudes.

It took me a while to write this review, as I read a sceptical review in the Guardian by a junior psychiatrist who questioned its accuracy, and I wanted a little time to think about whether that was fair or not. Overall, however, I’m inclined to agree with Jackson’s picture, which accords with what I know of hospitals in general, and mental health services in particular. For instance, Jackson describes the psychiatrists as “flitting in and out [of the ward], always with someplace else to be”, and the difficulties patients have in getting time to talk to them. I think anyone who has ever tried to speak to a hospital consultant on behalf of themselves or their loved one will recognise that description.

As for diagnoses being made on first impressions, I once attended a training session in Edinburgh with an eminent psychiatrist who stated, “I always say to my students, ‘If you’re not making a diagnosis within five minutes of meeting the patient, you’re not doing it properly.’”Jackson also shows psychiatrists who aren’t interested in what students like her might tell them - and who hasn't encountered a senior member of staff who has no interest in listening to their more junior colleagues?

If I have a criticism to make of this book, it’s that while the author ends with an exhortation from a patient to “do better”, there isn’t a single chapter at the end summing up changes that could be made to the mental health system. The author mentions the psychiatric survivor moment in passing, but I felt more information could be included about their work, or maybe referenced in a “resources” section. Still, I’d recommend it to everyone - we all need to be more aware of how mental health treatment works.

This book shocked me but didn’t surprise me. The treatment of mental health is very complex and needs time and resources - both of which seem to be a luxury in today’s climate. It’s a reminder to everyone to fight for the NHS and to treat people with kindness, empathy and compassion; and to listen.

Thanks to NetGalley and the publisher for the e-ARC. This was a harrowing look at mental health services and the treatment of the mentally unwell. It was an uncomfortable but important read.

A very powerful read that shines a light on an almost hidden area of our healthcare (unless you've experienced it directly) that still impacts everyone in ways not so recognised but still there. The strain on mental health services and the way these services operate is having an increasing effect on our children, our homeless people, the workforce, the disabled, and the people trying to work in these systems. It is ever clear from reading this well presented and astute account that the author is delivering a message as a warning, of what is happening and what is to come if nothing changes. There have been a number of tragic news headlines regarding mental health and incidents involving those known to mental health services, I think this book delivers answers as to how these people slip through the net, and the background to causation. There is a correlation here with how the NHS is struggling also; the lack of funding, overworked and overwhelmed staff, a hierarchy of influence that is near impossible to challenge and frequent missed opportunities to correctly help people to recover because of a lack of attention and curiosity beyond the perceived. I am left shocked, angered and changed from reading this book and urge everyone to read it to understand the seriousness of what needs to change.

I was drawn to this book as my career has been based around mental health, for the first eight years working with patients in psychiatric hospitals, mainly preparing and enabling long term patients to move out into the community. It has not escaped my notice that all the hard work I, and many others carried out has been taken apart and those who we advocated for are worse off than they were before. During my time in these hospitals I observed many distressing practices and the institutionalisation of not only patients but staff. I’ve also advocated for several people who were friends who had been sectioned and were not being listened to. And others who were desperate to access mental health support, and had to fight for years to get it. I would suggest that this book is essential reading for anyone who has any interest in or connection to mental health. It’s heart breaking that it’s exactly the same as it used to be, possibly even worse. Fragile Minds is creatively and sensitively written, and quite lyrical, which makes it a joy to read, despite the distressing content. It seeks to not only chronicle what goes on in psychiatric units, but to humanise those who are ensnared there, to challenge their disempowerment, to ask you to imagine yourself in the position of patients. It should not be possible to take away the agency of those who have mental health conditions, or who are in distress due to various abuses against them, but here we may see and feel what it’s like when that happens. Instead of the sort of gentle empathic listening that should be offered, to enable patients to feel they’re in a safe place where they can find sanctuary to heal, to understand their condition and to find empowering ways to address them, they often find themselves in the hands of a system that seeks to control and manage them, to disempower them further. That is not to say there aren’t some excellent practitioners out there, but they are few and far between, and unless you have the capacity to keep going until you find them (rare when in mental distress), you are at the mercy of a largely broken system. Fragile Minds beautifully describes this in a way that is comprehensible to anyone, with or without experience. I can’t recommend it highly enough. I hope some who read it are in a position to make a difference, to begin a change for the better.