Poppy Shakespeare - Clare Allan

Set in a mental health hospital's day centre, Poppy Shakespeare is an enlightening vision of modern British mental health services and how they ultimately fail people. It shows how very thin and fragile the line between 'madness' and sanity and how the poor service itself can drive people over the edge.

It tells the tale of N, a young woman who has lost the majority of her family to suicide and has been a day patient at the Dorothy Fish hospital for 13 years. N is very happy in her world at Dorothy Fish, plodding along taking tablets for an impresive list of mental health problems she appears to have. N splits her life between the Dorothy Fish and her flat in the Darkwoods Estate. She knows the mental health system inside out, getting the most "MAD money" by playing her therapists in assessments and filling out application forms with creative and inventive lies.

N's life is changed when she is asked to be a tour guide to new patient Poppy Shakespeare, a young mum who insists she is not mentally ill and doesn't need to be at the Dorothy Fish. Poppy sticks out from the other patients. She is glossy, well-presented and eloquent, insisting she has been admitted as a day patient by mistake. Soon N becomes much more than a tour guide, assisting Poppy on her quest to prove she is sane.

Written in the first person using N's colloquial tongue, Poppy Shakespeare quickly draws the reader in to the life at Dorothy Fish, where patients are equally terrified of being discharged and being moved into 24/7 wards. The patients are categorised alphabetically, each assigned a seat according to the first letter of their name. New patients with names starting with the same initial are only admitted after the demise or exit of the last patient. They are constantly trying to outdo each other, without tipping over to the point of appearing too mad. They barter their pills for other medication and know when to join the queue precisely to ensure they don't miss out on their free lunch of fatty lamb.

Allan's writing is earthy and realistic, making Poppy's plight even more harsh. She is met with impossible conundrums and closed doors. She cannot fight her treatment as she doesn't receive MAD money, but she is refused MAD money because she isn't mad enough. Her presence at the Dorothy Fish isn't compulsary, but if she doesn't attend she will be made to attend.

As Poppy's quest to prove she isn't mentally ill becomes increasingly futile, we see her confidence and belief in her cause ebb away as N's strength and confidence flourishes. This contrast is shown most markedly in their physical appearances. Poppy slowly becomes unkempt and uncaring as N is transformed using Poppy's unwanted clothes and make up. By the novel's devastating end, they have swapped places and positions. N is discharged from the Dorothy Fish; Poppy is committed after seemingly descend into mental illness.

Like Nineteen Eighty-Four, Poppy Shakespeare is a terrifying vision of mental health services in Britain. The drive for targets and quantifiable results allows people to be used and slip through the net. Poppy is a guinea pig, a human yardstick used to measure the apparent madness of the hospital's patients. But in the process, she loses her life, her daughter and her sanity. Patients discharged throughout the novel commit suicide, unable to cope with being released for no real reason. And N, the patient so adept at showing others how mad she is, doesn't seem to be mentally ill at all.

Poppy Shakespeare is an angry and damning vision of how targets and efficiency can overshadow the real mission of mental health care: giving people appropriate care and support for their needs. A shocking yet oddly funny read, it uses traditional perceptions of mental illness to show how people can play the role of the "mad man" when the ones who really need help are sitting quietly in the sidelines.

My next read: The Visible World by Mark Slouka.