Around 630,000 people in England and Wales live with severe mental illness. SMIs are a range of illnesses in which psychosis, a frightening and isolating loss of a sense of reality, is likely to occur. Cliff Prior, chief executive of Rethink, a membership charity for people with SMI and their carers, believes that the reclassification of cannabis next week masks a mental health crisis.
"For people with mental illnesses, street drugs have a devastating effect. We have woken up to the problem, but we don't yet know the solution and people are being locked up rather than treated," says Prior.
As well as being a leading campaigning organisation, Rethink is also the largest mental health service provider in the voluntary sector. It provides services such as home treatment, day centres, helplines, housing and training to around 7,500 people each day, and is growing all the time, operating 370 services and 120 support groups across England and Northern Ireland.
Rethink changed its name from the National Schizophrenia Fellowship in July 2002. This was partly because the name was too condition-specific, and the charity represents 7,000 members with a variety of conditions, including bipolar disorder, personality disorder and autism. This extensive membership allows the charity to conduct surveys that are highly credible with policymakers, as well as making the charity more responsive.
"Our services are very grounded," says Prior. "Our members say what works because they know, first-hand." It was also felt that a 'friendlier' name would encourage people to contact the charity at an earlier stage. Prior says that people do ask for help in the early stages of psychosis, but are often turned away, until they reach the point where the state has no option but compulsory sectioning.
Rethink aims to ensure that service users retain as much control as possible over what happens to them during their treatment, and ultimately recover a meaningful life. This principle extends to the charity's media presence.
Media volunteers are Rethink members who receive training and support for speaking to groups such as police and benefits officers, as well as dealing proactively with a media that is quick to link severe mental illness with violence.
"It's better to have 100 people telling 100 different stories, than quoting the chief executive of Rethink 100 times," argues Prior, "because there isn't just one story to tell about mental illness". He admits that this creates a fundraising challenge because brand recognition is lower, but says the charity's principle of members speaking for themselves is absolutely core to its values. "If one of our media volunteers mentions Rethink in an article, that's great, but the important thing is that people get to hear the story."
Relations between mental health charities and the press hit an all-time low last September when The Sun ran the headline "Bonkers Bruno Locked Up" over a story about former world heavyweight champion Frank Bruno being sectioned. The headline was changed in later editions to read "Sad Bruno in Mental Health Home", but the reader backlash against the tabloid's gaffe was extraordinary. "It's a real breakthrough that a discriminatory and prejudiced headline was changed almost immediately because of pressure from readers," Prior says, "but you have to ask yourself how much that was due to Bruno's immense popularity."
Prior talks of "profound pessimism" surrounding mental illness, and criticises the widespread assumption that mental health services fail. "The Government has stated three priorities: cardiac disease, cancer and mental health. The improvement in cardiac and cancer care is there to see in lower mortality rates, but mental health is way behind. The money just keeps slipping away. Why? Because we don't put the same value on improving mental health. Our message is that recovery is possible, but many policymakers don't believe anything works."
The current pattern for managing severe mental illness dates back to the 1950s. Although the best models of treatment are recognised, the leap forward in understanding is not reflected in service provision.
"What we're seeing is in fact the recreation of the old institutions with more high-security beds," says Prior. "Treatment has improved vastly in the past 10 years, and it's a scandal that people don't have access to it. For example, cognitive behavioural therapy is highly effective, yet the majority of people who would benefit just can't get it."
Mental health organisations have called for an overhaul of legislation, but the Government's 2002 Draft Mental Health Bill was widely considered to be a retrogressive bill which effectively criminalised mental illness.
Although the Mental Health Alliance, of which Rethink is a member, has secured pre-legislative scrutiny on the bill, Prior says that the hard work is in front of them.
"This legislation will affect a generation and (charities) have to speak with one voice, however difficult that is."
As head of the mental health sector's largest service provider, Prior has a cautious welcome for the proposed Voluntary Finance Initiative.
"Our members say that their worst experiences are in hospitals," he says.
"There's a high level of trust involved in what we do, between the NHS, our staff in non-NHS settings and the people using the services.
"We need the long-term funding arrangements that allow you to build up that kind of trust, because you can't do it on a year-by-year basis. We're interested in VFI for people, not buildings."