“Mental health is about us. That’s what I’m always passionate about — mental health is about everybody” — Sandra Vaughan
Trigger warning: this article mentions suicide. Chapter: “Who supports the support? A sensitive case”.
Black Country Mental Health (BCMH) is a charity which operates next to Bushey Fields Hospital in Dudley, serving surrounding communities — but it is separate from NHS services. Vaughan emphasises this when a patient looking for the hospital rings the bell. Deadpan, she turns to me and states:
“We’re not connected with the hospital, which, to be fair, is a good thing because that’s a classic example of the NHS.
“You know, he’s got an appointment.
“He doesn’t know where to go”.
As NHS services reach capacity, with staff, working environments and patient facilities under stress, external services and charities are seeing an influx of ‘service-users’. As waiting lists and stigma persist, organisations such as BCMH are encouraging a more hopeful narrative — for England’s discourse around mental health, from talking therapies to conversations at dinner.
We sit around a table, Vaughan to the right and Turner, 15, to the left. Turner is on work experience and particularly excited to sit in on group counselling sessions. She talks of her plans to work in psychology and reflects on last night’s sessions, a women’s trauma group and an anxiety and depression group:
“It was nice to see when other people were sharing their stories, how other people were chiming in saying ‘you took the right step, you’ve done the right things’”.
The landscape changes all the while
Vaughan has spent over 30 years working in mental health, spanning Birmingham, Sandwell and Dudley. She has managed a psychiatric unit, taught mental health first aid training and taught in the classroom. Reflecting on her career so far, she says:
“Mental health is fluid — the landscape changes all the while. So you can never say there is one way of working in mental health”.
Vaughan mentions the shift from drastic institutional practices of “locking people away”, only to later “put them out on the street”. Now, practitioners are taught to adhere to least restrictive options.
Considering the negative image people may think of when they think of those in touch with services, Vaughan reflects:
“Some of the women who come to that [trauma] group, they work and they’ve got high-power positions”.
Covid, a lack of human care and an increase in male-focused support
Since Covid-19, there has been a notable change in working habits, particularly an increase in hybrid working. Vaughan suggests this has made services less accessible.
“A lot of people can’t now contact a Community Psychiatric Nurse (CPN) or a mental health worker, because people ring and they hide their number.
“We never hide our number, you know – why would you?”
Often, men don’t access NHS Talking Therapies, making up only 33% of referrals.
Vaughan emphasises an increase in male-orientated services, opening up avenues such as working with The Guardian’s Guild, a local men’s support group. They will help run a male trauma group at the Hub on weekends.
Attributing to Covid more men coming forward, Vaughan relays:
“They felt they’d lost their place in the family because they’d been furloughed or they’d lost their job, and their wife or partner was working”.
The additional factor: social media’s impact
Turner reinforces:
“The bar is way too high for people, especially with young girls and body image and young men navigating mental health — especially with the idea ‘boys don’t cry, they’ve got to be strong’— but that’s not the case at all.
“I’d much rather see a boy that I know cry than bottle it all up because it’s just going to make it worse”.
Challenging labels and prejudice
“The main thing with mental health is the word mental, isn’t it?” — Vaughan
People may forget that we all have mental health — it does not disappear and reappear but is always there, working in synergy with physical and emotional wellbeing.
Vaughan explains: “Mental health is not about having a diagnosis or an illness. It’s about a state of mind at the time”.
She describes that this perception that people must fit a set criteria and label prevents people from feeling comfortable to access help, leading to greater deterioration in mental and emotional wellbeing. She dislikes the tendency to “pigeonhole” people:
“We need labels sometimes… but I’m not keen on labels…”
Vaughan emphasises the need for sensitivity when referring to peoples’ diagnoses, describing it as a characteristic rather than their whole identity.
“On training I tell people not to call people ‘schizophrenics’. That’s a terrible label — say someone’s ‘got schizophrenia’ — but not ‘schizophrenic’.
“But the main one I don’t like is ‘Borderline Personality Disorder’”.
According to the NHS’ 2023–2024 Survey of Mental Health and Wellbeing in England, 1.9% of adults aged 16 and over screened positive for Borderline Personality Disorder (BPD). Women were almost twice more likely to screen positive for BPD (2.5%) than men (1.3%).
According to Rethink Mental Illness (RMI), “Borderline”, rather than the clearcut “Personality Disorder”, was included in diagnoses from the mid-20th century. “Psychiatrists noticed that some people didn’t fit neatly into the categories of psychosis (where someone loses touch with reality) or neurosis (where someone experiences distress but remains in touch with reality)”.
Vaughan challenges the label:
“Who’s to say my personality’s okay and yours isn’t?
“We’re all a mix of personalities, so sometimes I know that can make people behave in certain ways.
“And people get frightened of certain conditions, particularly psychosis, schizophrenia. People feel because they’ve got that label, they can’t work, for example — but I know people who have really good jobs and have paranoid schizophrenia”.
“Labels are for boxes – they’re not for people”.
Labelling children
The issue also lies in peoples’ agency, considering who may apply labels to those who are vulnerable. Vaughan says it can be “counterproductive”.
BCMH have a contract with Child and Adolescent Mental Health Services (CAMHS), taking on referrals for talking therapies and sometimes working with children as young as six years old. Vaughan says the contract has been implemented because of the “colossal” CAMHS waiting lists.
“A mom wants to try and get her child diagnosed with bipolar disorder. That’s a massive label to give a child in primary school.
“Parents are saying ‘we need medication to emotionally regulate them’ but sometimes it’s just normal adolescence and teenage angst, you know?”.
According to BBC analysis of NHS England figures this year, about 70,000 under-18s are prescribed antidepressants each year.
Media and disconnection
Vaughan points to the simple value of spending quality time with loved ones and family, without the presence of a screen.
“I always ask, ‘do you eat as a family?’ and there are very few. A lot eat in their room. So you’ve lost all that connection”.
Asking Turner her perspective, including her thoughts on England’s new social media restrictions for under 16s, she says:
“I think it’s all well and good but it should have been inputted ages ago, especially during Covid. We’ve become more dependent on phones and social media — we find it a comfort.
“But social media is a scary place. There are things that you can’t rely on. It has a massive input into how daily life is affected, especially children’s mental health.
“There are real people out there, like Black Country Mental Health, who are here to help you rather than you resorting to self-harm or speaking to strangers on the internet”.
Fostering synergy and connection
“What is your biggest challenge at the Hub?”
Vaughan swiftly replies:
“Our biggest problem is time. You can’t get more — it is what it is, time”.
This is largely down to the hours the service is available. Vaughan continues:
“If my phone goes at night, I will answer most of the time because in the back of my mind is always a thought somebody might be feeling suicidal. And I might make a difference”.
This fragile sense of time is reinforced when service-users do not make the most of appointments offered, seemingly underestimating the time needed to make real progress. There are also limitations to how many staff can be allocated those needing support.
“Some [service-users] don’t realise they have to come every week — the whole point of counselling is turning up every week”, Vaughan reinforces.
Investing time into their services, organisations such as BCMH are able to build long-lasting connections with people, and as Vaughan suggests, work out a sense of “synergy”, finding things which staff and service-users have in common. This connection contributes to better understanding states of mind.
This also relies on staff caring about their work.
Reflecting on her experience, Vaughan suggests: “A lot of the problem is people”. Hesitant, she proceeds: “I don’t think people care in a way. I think a lot of people working in mental health don’t care”.
She talks of a man who has bipolar, who she met on a ward whilst working in Sandwell. Vaughan talks of the fact that “people didn’t know who the staff were because we called patients ‘members’ — they controlled the whole thing. We had meetings — they controlled that”.
Having thanked Vaughan for her helping to save his life — to which Vaughan assured him he saved himself — he went on to pursue a career in health and social care.
“He was told he was most unsuitable to do it — and I got in touch with Dudley College to come and help.
“He got a placement in one of our residential units, became a support worker and took his clients to see the psychiatrist that he used to see, which I thought was fantastic”, Vaughan says, smiling.
Who supports the support?
For Vaughan: “I always say there’s something wrong with me — but somebody said I’ve probably got high resilience.
“I just say I do what I do”.
Turner, who confides in her mom, recalls a difficult moment from the women’s support group the night before.
“It’s hard because it made me upset to see someone else upset — knowing the reason why she was upset hurt even more. You don’t want to get upset when the conversation’s happening as that’s just going to make it worse for them.
“So I think it’s mainly about reassuring someone, resonating with them, sharing personal experiences of similar situations. Tell them the steps they’re taking to navigate the situation are the right things to do.
“We never know what’s going to trigger somebody or what’s going to trigger us”.
Photo: Daisy Bourne. A bridge in Quinton: worn ribbons.
A sensitive case
Vaughan reflects on this sentiment:
“During COVID, we phoned people. I phoned a guy who was in his early 40s and he’d been furloughed. He started drinking and we talked every week on the phone for about an hour.
“He got back into his running, cooking — he’d tell me what he was cooking on Sunday night as he was doing batch meals.
“He thanked me for all my help and I spoke to his dad and everything.
Towards Winter time, Vaughan had a phone call.
“It was from his sister and she said, ‘could you tell me what you used to talk to him about?’ and I said, ‘well, I’m sorry — what we talked about was confidential’.
“I said, ‘why are you asking?’
“She said, ‘he’s taken his own life’.
A pause.
“I look back, I remember everything, the notes and everything.
Talking to a friend at the time, Vaughan opened up: “I keep feeling now, I should have — could have — done more”.
“It’s been several years. I’d never met him. It was all telephone.
“The ripple effects are massive”.
Photo: Daisy Bourne. A bridge in Quinton: fresh flowers.
Refreshing the system
Vaughan emphasises:
“I think health and social care needs a shake up.
“I think people see it as a lower level and not something into which they could move from something else.
“It could be a stepping stone into loads of things”.
You’re not an outsider
Travelling home, a man watches something loudly on his phone — along the lines of a 999 documentary. The narrator describes a person of interest, “a man acting strangely”, and mentions the man has schizophrenia. Not knowing the resolution of this episode, I step on my bus and think of Sandra and Lexi’s insights, wondering if this man would have received the right help, avoiding merely being exploited.
“Talk to somebody: there is help out there; there is support out there” — Vaughan.
At a point in our chat, Turner hesitantly turns to Vaughan before answering — to which Vaughan chuckles, asking her why she’s looking to her. Turner shifts in her seat, thinking. She concludes:
“Mental health, for me, like Sandra said, is not the minority. It’s not the majority. It’s everyone.
“Be kind”— Lexi Turner
The hub awaits a “massive” event this September, organised by Kay Hinton, Sir Lenny Henry’s sister. Additionally, as the new Prime Minister, Andy Burnham, has announced the Autumn opening of new mental health ‘A&Es’ across the country, perhaps mental health will be better viewed as equal to physical health.
If you are struggling, you can contact Samaritans free on 116 123. If you are in immediate danger, call 999.
Article by Daisy Dilys Bourne – Data journalist based in the Midlands