‘It took running my car off the road and digging holes in my ceiling to get me sectioned’

The best-selling author on his own breakdown – and why changes to the Mental Health Act are long overdue

The lowest point came when the young policeman walked me across that rainy hospital car park into the psychiatric ward. I was crazy, there was something very wrong with me, and now I was being taken away.
Mental breakdowns are strikingly horrible and surprisingly common. There are 60,000 people in British psychiatric wards and hospitals, a population the size of Margate, many detained – or “sectioned” – under the Mental Health Act. 
Thousands more are waiting for a bed. And there are many thousands besides them, suffering from burnout, anxiety, disordered eating, self-harm, suicidal thoughts or depression, which can also be thought of as forms of breakdown. 
It is not a medical term, but an accurate description of the depression, mania, psychosis and other episodes of mental illness requiring help and treatment. 
As I found, breakdowns are terrifying to go through, but after years of researching them, and what we know about the mind in crisis, I have learned three wonderful facts. 
First, we know more about breakdowns and their best treatments than we ever have. 
Second, although our knowledge of recovery is far ahead of how our system works and the outcomes for sufferers, we are close to knowing enough (and, as a society, we are desperate enough) to make serious changes. 
Third, the upcoming reform of the Mental Health Act is the moment that will make all the difference, if it is done right. If the Government fluffs this chance we will remain in our current overloaded, ineffective mess, and more of us will suffer, terribly and avoidably.
The story of my breakdown set alongside the findings in my new book, Your Journey Your Way – How to Make the Mental Health System Work For You, about recovery, shows how mental health can go catastrophically awry, and how we can transform it. 
A breakdown can be the first step to a better life. Like many others, my own story is evidence for it. 
Breakdowns can come out of the blue, though their causes, often in adverse childhood experiences, tend to be laid down early. “We all have attachment issues!” a leading psychotherapist said to me, meaning we all carry needs and vulnerabilities into adulthood. She was my therapist before my breakdown, when I knew there was something wrong but I did not know then how to stop it. 
My childhood was magical in many ways but it left me with profound doubts about my self-worth, traumatised at some deep level about my parents’ divorce (and the role of the mini “man of the house” I took on when they split, aged seven); and an unwillingness to reveal or explore what troubled me. Perfectionism, hunger for intensity and risky situations, and a longing to convince people all was well, by lying and hiding if necessary, were eating me inside. 
I had a pattern of elevated mood in summer, and suffered depression in winter – an underlying tendency to cyclothymia, a milder form of bipolar, I know now. I often pushed myself too hard, by publishing two books while starting a new job, working and travelling in a whirl until my feet bled and my voice died, fuelling myself on cannabis, sustaining an unhappy relationship with lies and affairs, until my fuses blew. 
In our last session my therapist said I needed a psychiatrist. Manic, and in the escalating grip of a mental illness which tells the sufferer you are just fine (it’s everyone else who is crazy), I ignored her. When my family took me to doctors, psychiatrists and crisis team workers, I pretended I was fine. 
Like many of us, I thought mental hospitals were frightening, stigmatising places to be avoided. Secretly I thought my history of ups and downs meant there was something wrong with my brain, some sort of defect or chemical imbalance, which shamed and terrified me. 
Now I know differently – there is no defect we can find, no chemical imbalance and there are no biomarkers for most mental conditions. It took running my car off the road and digging holes in my ceiling to get me sectioned. I rose through hypomania (elevated mood, talking too fast, a feel of bursting, unfocused energy) to mania (racing thoughts and speech, grandiose fantasies, no sleep) and thence to psychosis: I looked normal, but I was now fully in the grip of mad delusions about spies and aliens.
In the new system we must have, if Mental Health Act reform is to be meaningful, I would have been given early intervention open dialogue therapy. Open dialogue treats your whole network, so my family, close friends, a doctor and a peer supporter would meet, share their worries, and decide on the best course for all of us. 
Given a choice between being sectioned and taking anti-psychotics at home with a friend or family member supervising, I would have stayed out of hospital – only a tenth of those treated with open dialogue become in-patients, so it is much cheaper, as well as being many times more effective than our current system. At the moment, we medicate symptoms away. But a functioning system must address causes.
Instead, I was escorted into a locked ward by a policeman.
“How long have you been a stand-up comedian?” I asked him.
I honestly thought we were going to perform together on stage. In psychosis, while you may appear crazy, ranting in the street (I was found naked on top of a gamekeeper’s Land Rover after I crashed my car), to the sufferer, your mad world makes complete sense. It is reality. I was working so hard to bring about world peace that I barely had time to sleep. 
The delusions, as false beliefs are called, are crazy in themselves, but psychologists and open dialogue practitioners now understand them as a kind of language for and a way of coping with an actual world the sufferer can no longer bear. 
It was easier to be a mad B-movie Bond saving the world – and more real, to me – than to be a mentally unwell middle-aged man suffering mental and relationship breakdown in a small northern town. 
We in our ward were lucky. It was well-run and safe, a new wing with kind, caring staff. Many wards are much worse. I was given quetiapine, an antipsychotic. Two doses drove the madness out of me. But there was no treatment available to us except for pills and rare cognitive behavioural therapy. As one man said to me, “I don’t want ways to cope with the future, I need help with what my father did when I was a child.”
Like tens of thousands of patients, we were effectively warehoused – dosed with medication and locked up. Many of us would be released, break down and be readmitted. The only “treatment” available was trips to the gym. We felt ashamed, defective and isolated. Psychiatry judged us all to have lifelong, incurable conditions. 
In the system we need, which has been shown to work in New Zealand, a peer supporter meets me on admission and tells their story: how they had a breakdown, and how they got better. Peer support – working with someone who has been through a similar experience, and recovered – has been shown to be wonderfully effective. We must expand training and funding for it: a new career path for former sufferers, and a life-changing treatment. 
In this system, a peer supporter and a psychiatrist will explain there is nothing physically wrong with me, apart from exhaustion and rampaging stress. My brain is not broken: I need feel no shame or stigma, I am suffering in normal and understandable ways, and I can and will get better. My medication will manage the crisis and trauma therapy will promote recovery. 
And they will give me the really exciting news: the worst is over, my recovery journey has begun, and now I can look forward to post-traumatic growth.
Studies in the United States found that people who have been through a breakdown can experience growth in compassion and self-care. Our values change, our self-knowledge widens, leading us to more meaningful work and activity. But you need to know about post-traumatic stress and you need to change your habits. 
In my case, sleep, nutrition, exercise, my relationship with my now ex-partner and my approach to work all changed. 
This is a “recovery model” of mental health care, instead of what we have now, an “illness model”, which dooms thousands of us to miserable misconceptions about our chances of living a balanced life and fulfilling our potential. 
Upon discharge from the ward I began years of research into mental health. I am not on medication, and technically “in remission” from the bipolar diagnosis I was given. Understanding that mental health labels and diagnoses are merely language, language that is currently changing, helps you remember that we are not our labels. Everyone’s condition is different. 
For example, imagine being told you have a “personality disorder”. In the future, this will be referred to as “complex emotional needs” or “complex trauma”. Language matters. In recovery, you own it, not the other way round.
We cannot cure everyone, but we can switch from an illness model to a recovery model, and replace medication for everyone (our current practice) with trauma therapy for all who need it. Open dialogue will save money; money that we can put into psychiatric wards. New kinds of personalised, therapeutic, hugely effective psychiatric wards are an NHS speciality, but they are currently only available in mother and baby units for women with postpartum psychosis. They work. We should aim to have no other kind of psychiatric ward.
New treatment trials, including on psilocybin and ketamine, are finding evidence for tremendous hope. We just need ministers and clinicians to make courageous and informed decisions. Tens of thousands of us are not just praying Britain makes these changes. We are betting our lives on it.  
Horatio Clare presents the acclaimed BBC Radio 4 series Is Psychiatry Working? His new book, Your Journey, Your Way is published on August 29 by Penguin at £18.99.