Bedlam was one of the most talked-about TV series on mental health in many years. Here, South London and Maudsley NHS Foundation Trust’s Dan Charlton explains the decision to let Channel 4’s cameras in to film what happens at the Trust.
Inviting documentary filmmakers into your organisation isn’t a decision to be taken lightly. When you’re thinking about doing this at an NHS mental health trust, the risks, ethical considerations and complexities are particularly tricky.
What’s the risk that vulnerable patients will end up feeling exploited? Are people who are being treated for severe mental illness really in a position to give informed consent to be filmed? How do you avoid compromising the delivery of clinical care? What happens if your organisation’s reputation ends up getting trashed?
These are just a few of the issues we had to take into account when we first started talking with The Garden Productions more than two years ago about the idea of allowing them to make an observational television documentary at South London and Maudsley NHS Foundation Trust.
That said, from the very beginning of our time working with executive producer Amy Flanagan, I felt she and her team would approach the task with integrity, sensitivity and professionalism. We were prepared to take a risk working with them based on their track record for producing excellent television such as 24 Hours in A&E, which was filmed at King’s College Hospital. We were reassured when the producers described how they wanted to make the series: no rushed filming schedule, no short cuts and every care and attention paid to the wellbeing of the patients, family members and staff who gave their consent to be involved.
Promoting public awareness
An important part of our motivation for wanting to take part in the series was to promote public awareness and understanding of mental health. There is still much stigma and discrimination surrounding mental illness and our hope was that the Channel 4 series would go some way towards helping tackle this.
Another consideration was to show people what we do and how our services can make a real difference to vulnerable people’s lives. So much of the work our staff do is poorly understood by the public. Also, with the NHS operating in an increasingly competitive environment with diminishing resources available, we can’t afford to be shy and retiring about promoting our strengths, services and brand.
Having decided in principle to take part, we then spent more than a year discussing the ethics and practicalities of how filming could take place safely and sensitively. We involved some of our senior clinicians in developing a consent protocol and access agreement that would safeguard the wellbeing of any patients, family members and staff who gave their permission to be involved in filming. Importantly, this included a specific provision that gave people the right to withdraw their consent. All credit to Channel 4 for allowing The Garden sufficient time to plan things properly.
It took a lot of time to agree on the clinical areas in which The Garden would be allowed to film. Some clinical staff and teams felt understandably reserved about taking part, and we knew from the outset that it was important not to overdo the attempts to persuade people. It was particularly difficult for various reasons to set up any filming within our community services, yet we felt it was vital to do this because it is the area of our work that is probably least understood and most associated with misconceptions about ‘care in the community’.
In my view, the end result was a bold, unique, powerful piece of television that reflected the reality of living with mental ill health and trying to provide effective care and treatment. Interestingly, some of the feedback we had when we held a pre-broadcast preview of one of the episodes was that it was a little bit too positive. I have no problem with that. From the outset, I felt strongly about the need for a hopeful, positive portrayal about what it’s like to live with mental ill health and how vital it is to provide accessible, effective NHS care and treatment. To my mind, that is the best way of ensuring that mental health remains on the political radar.
The choice of Bedlam for the title of the series provoked concern and criticism because of what some people feel are the negative, stigmatising associations with the term. From our perspective, the working title of The Maudsley or Inside the Maudsley didn’t really cut it.
The practical problem was that most of the filming didn’t actually take place in the Maudsley Hospital, it was across our other sites and in the community. Deliberately, we had sought from the outset to try and show some of the areas of our work that don’t often get attention, a good example being the work of our adult mental health community services.
Another important factor was that Channel 4 wanted a title that would create interest and attract viewers. So did we. We took part because we wanted to try and help shift public attitudes about mental health. You can’t do that if nobody is watching. By their own admission, the channel has a liking for edgy titles that get people talking and encourage them to watch. But they were very clear they would only go with a title that we signed up to.
It was, of course, a really tough decision to make as no title is going to be universally acceptable, especially in the field of mental health. Language like ‘recovery’ that we are familiar within the NHS doesn’t lend itself to a snappy TV title. At the other end of the spectrum, we were clear that we would not accept a title with the term ‘mad’ in it.
Talking it through with Channel 4 and The Garden, we hit upon the idea of going “back to our roots”. The logic of the name being that South London and Maudsley can trace its origins back to the founding of ‘Bedlam’ in 1247. For television producers and commissioners, it’s a word that resonates with people who aren’t familiar with the world of mental health. And for those who are familiar they will know the significance of the word and how treatment of people with mental illness has evolved since the ‘Bedlam’ years.
And, yes, it is provocative. The history of treating mental illness has not always been a proud one. ‘Bedlam’ is often associated with the incarceration of the mentally ill within the walls of the asylum and charging people money to view the ‘lunatics’.
For us, there’s something to be said for making the contrast between the history of ‘Bedlam’ and the way in which mental health services are provided today – not perfect, by any means, but more focused on trying to help keep people well and out of hospital, and on providing care and treatment that helps people recover.
We were mindful that not everyone would see it that way and we did discuss the idea of canvassing opinion more widely. But we felt it would be nigh on impossible to come up with a title that everyone would be happy with. We can at times be guilty in the NHS of avoiding decisive action by trying to build consensus; whereas this was felt to be a call we should make and stand by.
The Garden asked the patients who had been filmed – they have kept in touch with all of them to ensure they remain happy to be included in the series – and nobody objected. On that basis, we gave the name our vote. It wasn’t imposed upon us and we weren’t strong-armed into agreeing.
From the feedback we’ve had to date, it’s clear that not everyone agrees. Far from it in fact; some people feel, very strongly and genuinely, that we’ve made a poor decision that reinforces stigma. We respect this perspective and are genuinely interested in discussing it. This is why we thought we should try and explain our thinking in a bit more detail.
Hopefully this Channel 4 series has provided a much needed, measured and powerful look at an issue that remains shrouded in too much mystery and misunderstanding. And we hope plenty of people watched who may not ordinarily have tuned in to a documentary about mental health.
Above all, we hope the series continues to generate debate and discussion – too much, too often is left unsaid when it comes to mental health.
For more information go to: www.slam.nhs.uk/ media/bedlam-on-c4
About the author
Dan Charlton is head of communications and media at the South London and Maudsley NHS Foundation Trust.