The Snake Pit Remembered

Back in 1998, I started teaching medical sociology and cultural anthropology to nursing students in Finland. These were students undertaking their nursing degree which, predominately, they were doing speaking only the English language. The university valued natural English speakers as teachers. I have to say it was a unique experience, and something I was privileged to do a once or twice a year for five years. I have many fond memories and have maintained the friendships made during that time to this day.

Now I was prompted to think about these memories by an article I read last week about Bartley Green School in Birmingham, and its attempt at providing mental self-help advice to its pupils. It was generally good, except one of the pieces of advice was to suggest struggling pupils smoke a cigarette to help them deal with their mental health issues. My heart went out to whoever was responsible for developing the self-help leaflet.

The connection with Finland? Well one of my anthropology sessions was built around the 1948 film, the Snake Pit. It was a black and white film, based upon the semi-autobiographical book by Mary Ward and tells the story of a woman, Virginia Cunningham, who finds herself in a psychiatric hospital, with no idea how she got there. The hospital is organised around a series of wards that reflect a patient’s progress and response to treatment. The Snake Pit is the ward folk go to when they are deemed to be beyond treatment and help. They become the forgotten and invisible population within the hospital system.

It is a fascinating film, and amazingly you can still find it for sale on eBay. It is a film with so many levels of human interaction and behaviours to observe. One of these is the fact that the nurses and doctors offer the patients a ‘therapeutic cigarette’ at the start of any conversation. These days, we would find this totally unacceptable. However, when I trained as a mental health nurse back in 1975, it was a very common part of the way we built and sustained our relationships with service users.

Things really are different now and, despite the unfortunate advice being provided to the Bartley Green School pupils, looking after our children’s and young people’s mental health remains critical. Late last year, NHS England published The Mental health of Children and Young People in England Report 2023. The report found that one in five children and young people in England, aged eight to 25 had experienced a probable mental health problem during 2023. In response, nearly 400 Mental Health Support Teams have been set up to work within schools and colleges. The purpose of these teams is to provide early support to children and young people experiencing common mental health issues.

Some 200 new teams are in development, and due to come in line in early 2025. When this happens over 50% of England’s schoolchildren will be able to access mental health care and support. Of course, 50% is distinctly better than where we are now, but it remains vital that any child or young person experiencing mental health issues should be able to access the help that they, and perhaps their families, might need.

Post-pandemic, the world has become a lot more difficult for children and young people. Many families continue to struggle with the cost-of-living crisis. This gets played out in choices over what family money should be spent on. Nearly three million people used a food bank in the last 12 months. For many children and young people there is the lockdown legacy, where the pandemic isolation and virtual education resulted in limited opportunities for them to socialise and develop self-confidence and resilience.

Additionally, what is happening across the globe - the conflicts in Ukraine, Palestine, Israel and now sadly Yemen - raises everybody’s anxiety, but I guess, even more that of young children. These days, children and young people have much greater access to unfiltered news and it’s all available in almost real time. I guess there will be some young people who will equate the pictures from last Thursday’s jets taking off with their missiles with the Top Gun Maverick film or their latest Ace Combat video game. Other young people, however, might rightly wonder how safe they are from the reach of other people’s warfare.    

Looking after the mental health of children and young people is one of the five clinical areas of the excellent NHS CORE20 +5 approach. The approach was originally focussed on healthcare inequalities being experienced by adults, but it has now been adapted to apply to children and young people. The CORE focus is on the most deprived 20% of the population in terms of the Index of Multiple Deprivation. The seven domains cover all social detriments of health and wellbeing – you can see these here. Tackling these inequalities will take time and effort.

Virginia’s battle to move out of the Snake Pit and receive the treatment she needs is eventually facilitated by a pipe-smoking and kindly psychiatrist, Dr Kik. He believed with the right person-centred support, everyone could recover and live a healthy and worthwhile life. Perhaps thinking about our children’s future, and finding ways to tackle the inequalities they might face, we might all need to be a ‘bit more Dr Kik’ (minus the cigarettes and pipe of course).