Be Wary of Buildings (AS)

It seems appropriate to have written and thought about this on borrowed time from work. Now I'm finishing it and I am sticking to the injunctions about writing fast. I'm not sure there is a cohesive point here, and if I stop to try and form one, I'll collapse into self-doubt or contradictions or infinite regress. Just come a few steps down the road with me, and we'll see where it takes us, I can't promise it'll make sense or help, but everything on the news is making me feel sick right now and I needed the distraction.

I remember Jow and I discussing my work, my actual work, and the ambivalence I felt towards the business of working for a public sector body. Jow told me that if I remained clear-eyed about what I was taking from it, I'd probably be okay. I've finished with local councils for now, so this is a first stab at something.  

One long-time lesson I learnt from being in local government was people really care about what happens to buildings. Less so what happens in them. 

Prime examples are hospitals - crumbling Victorian buildings will see people out with placards protesting closure. Obsessives get wrapped up in whether there will be less beds or more beds, more spaces or less spaces. Never mind that the whole point is to get you treated, out and away from hospital - it's a place where people mostly go to die. I remember a chief executive of a hospital in Surrey telling me once that no-one would argue for taking funding away from hospitals to earlier intervention social care, as hospital was the place everyone "went to in the end". 

For balance, the same man also told me he had been involved in the closing of a cluster of antiquated psychiatric hospitals that ring greater London, one of which was the one my grandfather spent time in. The shift to "care in the community" had failed, in his view, because the issue of long-term disabilities and mental health conditions had gone from being one collectivised in big institutional buildings to one where individual need and destitution are largely concealed within the community. It is notable that experiments with collectivisation and communal living seemed to emerge out of the psychiatric movement in the sixties and before (for instance, take a look at The Man Who Closed the Asylums by John Foot). He didn't actually say anything about that last bit, just that the whole thing had failed.

The closure or defunding of services, more abstracted than a building, will rarely garner the same groundswell. In 2019 the child and adolescent mental health services (CAMHS) in north east London declared they were not taking any more referrals for six months, unless it was the most "acute" circumstances. By which they meant serious hospitalisation due to self-harm or attempted suicide. It was an open secret in schools, who had received an email to that effect, but only the most diligent reader of trust board papers would have spotted the reality on the ground. Its impact was hidden by a RAG rating, that was marked amber, not red, because they changed the performance measure at the same time as closing the doors.

That's not to say don't fight for the right to have local services, or preserve communal spaces and what they represent, it is more that you need to guard yourself against that being the totem on which everything hangs. Boris Johnson's popular promise to build 40 hospitals, or whatever the hell it was, only worked because the building forms the simplest representation of investment. There's not much point having a new hospital if you haven't got the workforce, equipment and services they require.. There's not much point putting care in the community without a serious consideration of what that care entails, how it is funded and how we don't lose that spirit of collectivised, mutual support that occasionally fosters in  long-term hospital care settings.

I don't know what I'm saying. I don't know what I learnt. All I am trying to say is be clear eyed about what you are getting in any given circumstance. Don't become too attached to the shell of a feeling, at the expense of its interior.

With love,

A