Depicting Severe Mental Illness Accurately

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*Warning: This article contains minor spoilers for Malpractice season 2.*

Originally, Grace Ofori-Attah didn’t foresee herself transitioning from a junior doctor to a screenwriter; however, her strong narrative talent eventually led her down this unexpected path.

Despite harboring aspirations to pen a novel amidst her scant free hours during medical school, it’s her real-world medical experiences that have ultimately shaped the compelling, heart-stopping narratives she’s committed to breathing life into on the silver screen.

Ofori-Attah acknowledges it all seems unbelievable,” she confesses, explaining that discussing her program via Zoom only heightens this strange feeling.

After transitioning from her role as a consultant psychiatrist to the realm of television, she is now bringing back her original series, Malpractice, for its eagerly awaited second season. The initial season was successful, with Niamh Algar’s character, Dr Lucinda Edwards, finding herself in a medical scandal following an unforgettable night in the emergency department.

In this new installation, the focus is on Dr James Ford, portrayed by Tom Hughes, who serves as a dedicated psychiatric resident. However, he finds himself in a complex situation, pulled between two patients. This internal struggle leads to outcomes that were not anticipated by anyone involved.

In this second part, I shared with Ofori-Attah, I believe it is more powerful and evocative than the first; a challenging accomplishment for any author. However, it undeniably demonstrates that Malpractice functions effectively as a series of anthologies, shedding light on various matters and aspects within the NHS.

According to Ofori-Attah, it was a thrilling prospect for her to transition from Emergency Medicine to the realm of Psychiatry, a field where she clearly possesses extensive personal insight due to her experiences.

She expresses her view that the field is more complex than people usually realize. Mental health, which isn’t typically portrayed on television, presented us with a unique chance to portray severe, long-lasting mental illness authentically and offer a genuine representation of what it’s like in a psychiatric healthcare environment.

Having held the same position as Dr. Ford herself, Ofori-Attah found it more accessible to construct the narrative. He describes the process as “making it quite straightforward,” because the numerous medical cases she’s handled over the years share similar themes and challenges that he wanted to delve into and intertwine, ultimately shaping the two primary stories of Rosie (Hannah McClean) and Tony (Seraphina Beh).

Rosie, who is caring for both a newborn and a toddler, visits Dr. Sophia Hernandez (Selin Hizli) for her regular post-natal checkup. However, during this appointment, Dr. Hernandeze suggests that Rosie undergoes a psychiatric evaluation by Dr. Ford. This sets the stage for a storyline in which mental illness plays a significant role and ultimately leads to a tragic ending.

What stands out to me most in Rosie’s story is the portrayal of how someone who appears ordinary can struggle with their health, and the effort they put into hiding it.

Ofori-Attah emphasizes that such incidents aren’t exclusive to certain individuals; they can affect anyone. He believes there’s a tendency to separate those with severe chronic mental illness, but the truth is, it’s a condition that can impact anyone, requiring understanding and support.

Writing the second season of Malpractice happened concurrently with the announcement from the Metropolitan Police about altering their approach to mental health emergencies in London. As part of the Right Care Right Person (RCRP) strategy, there are now fewer police officers responding to mental health incidents in London; however, this shift has sparked worries among charities and professionals within the mental health field.

According to Ofori-Attah, her psychiatrist colleagues expressed concern about handling their patients independently due to the nature of the cases.

It might seem surprising when the police say, “We’re not the ideal party to contact when someone is critically mentally ill,” but it’s important to understand that individuals in such a state can exhibit aggressive behavior.

In simpler terms, Ofori-Attah states that the actions aren’t violent just because they are labeled as such, but rather due to a deep fear within them which leads others to try to control them, and this can sometimes escalate into more intense situations.

Regarding Rosie’s narrative, it’s true that the police used what appeared to be a frightening mask and restraints on her during the initial episode. However, Ofori-Attah insisted on maintaining this escalation in the storyline.

Initially, there appears a petite woman who exudes tranquility and serenity. However, as the events unfold, her demeanor transforms drastically into one of extreme aggression, suggesting she could overpower everyone present. I made it explicitly clear to World Productions that this transformation should not be portrayed as an exaggeration in the depiction of her escalating in such a manner.

It might be beneficial for transparency to clearly illustrate the challenges and fears faced by hospital staff in emergency departments, as well as law enforcement, during these specific situations. This includes not only their heavy workload but also their apprehension about potential consequences of their actions.

From my perspective as a film enthusiast, I’d like to shed light on another tale – that of Tony, a woman grappling with psychosis, heavily pregnant, and facing the possibility of sectioning by Ford’s team. Like Rosie’s story, hers is heart-wrenchingly poignant, but in its own unique way.

It’s not accidental that Tony is a Black woman who has undergone an emergency hysterectomy without her consent, a situation that will likely stun many viewers. Her story serves to highlight a significant and pressing issue: the systemic racial injustice in maternity care.

In this rephrased version, I aimed to maintain the original message while using simpler language and making the sentence structure more cohesive and easier to understand.

In our conversation, Ofori-Attah mentioned that Tony plays a crucial role in the narrative. From the start, when we introduce the two patients, it’s clear that Tony often finds himself in difficult situations, as if he’s constantly on the receiving end.

In the opening scene, she finds herself in a distressing predicament, being manipulated by others. The manner in which the medical team addresses her is appalling and disrespectful. However, despite Dr. Ford appearing somewhat confident, he genuinely cares for Tony’s well-being. He stands out as one of the few individuals fighting for her rights. I hope the viewers will grasp this message: even though Dr. Ford may seem self-assured, his intentions towards Tony are noble and compassionate.

Despite being a contentious character within the series, Dr Ford’s portrayal as a psychiatrist, particularly his support for Tony, is a perspective that is frequently overlooked when it comes to representations of medical professionals, according to Ofori-Attah.

You may encounter patients who frequently lack decision-making ability, and it’s crucial to have a physician who is both compassionate and dedicated, willing not only to provide care but also to stand up for them. This goes beyond simply treating them and discharging them as quickly as possible because their hospital stay can often be prolonged.

It seems he’s making every effort to ensure she receives the finest care, but the obstetricians are wary due to bed-blocking issues. They’re worried about potential complications disrupting their schedules and records. They don’t want her admitted to their ward, so they propose a seemingly absurd solution instead.

As a film enthusiast, I can’t help but ponder about the reactions of fellow viewers when they learn about this fact. It seems astonishingly common in British hospitals, yet I often wonder if anyone questions its plausibility with a thought like, “That could never happen.” Yet, it does.

During my early career as a psychiatry resident, I encountered an unexpected situation: a heavily pregnant woman in a psychotic state on the ward. The strategy was to escort her across the parking lot to the main hospital. As you might imagine, things didn’t go as planned. This isn’t a sensationalized account; such incidents are more common than one might think.

Across five engaging episodes, we delve deeper into the individual stories of each patient while simultaneously revealing intriguing details about Dr. Ford, who was originally penned by Ofori-Attah as a female character.

Originally, Ofori-Attah intended for Dr Martha Ford to be the main character in season 2. However, a conversation with executive producer Simon Heath led her to reconsider this decision, as she wanted to introduce some changes to the format, deviating from the sole female lead role seen in season 1.

Initially, I found myself doubting due to the intriguing gender dynamic often seen in psychiatry. Typically, there are many female practitioners in this field, so a character like Dr. Ford stands out, making him somewhat uncommon in this context.

She elaborates, “As I pondered on it more, I realized that aspect indeed enriched the narrative’s intricacy, and you’ll notice its impact later. I must say, crafting that character has been particularly engaging for me since he mirrors my professional journey as a psychiatry registrar.

Jessica Layde’s character, Bernadette, serves as the junior doctor on Dr Ford’s ward. She bears a striking resemblance to Ofori-Attah in some ways. Although the show’s writer acknowledges that Bernadette shares characteristics with Ramya from Season 1 (played by Priyanka Patel), they note that Bernadette also reflects Layde’s personal experiences as a junior doctor when she was less informed about what was happening around her.

Primarily, Ofori-Attah aims to reveal an alternative perspective of being a doctor in the UK based on her personal experience. Typically, medical dramas are characterized by their glossy portrayals, steamy romances, and implausible plot twists. However, according to Ofori-Attah, working as a doctor in the UK is far from glamorous.

The situation is incredibly demanding and requires managing numerous tasks simultaneously, as even the busy night depicted in episode 1 was a greatly streamlined representation of what Ofori-Attah originally planned.

Drawing from my personal experience as a psychiatric registrar, I made sure to accurately portray the demanding workload I would have faced during each shift.

At first, Ofori-Attah was concerned about simplifying the presentation, fearing that viewers might not fully understand the hectic nature of Dr. Ford’s shift. However, this concern was effectively addressed in the final version, a development that has left her quite satisfied.

The initial episode maintains a consistent sense of tangible tension for the audience, portraying the hectic nature of an on-call night shift, a scene rarely depicted on television. In selecting what to feature, Ofori-Attah emphasized the importance of showcasing the disorder and the fact that doctors might appear scattered at times.

A doctor’s role, as taught from medical school, is to prioritize patients effectively. This involves assessing risks and determining who requires immediate attention and care. However, in practice, it can be challenging to make these decisions quickly. She emphasizes that there are doctors working tirelessly at night, trying to manage all of this on their own.

It’s clear that Ofori-Attah recognizes the unusual transition from being a doctor to scriptwriting for TV, yet, given her longtime desire to narrate stories, she sees this move as a fitting method to apply her medical expertise dramatically, captivating audiences about these subjects and themes.

While these programs primarily aim to entertain, they often delve into more substantial topics that keep viewers engaged; Ofori-Attah strives to maintain a balance, ensuring his message isn’t overly didactic.

With productions such as Malpractice, Playing Nice, and The Boiling Point already credited to her name, Ofori-Attah acknowledges that her passion for tales that delve into the depths of human psychology, suspense, and the thriller genre will undoubtedly influence her future projects.

Stories that feel real and relatable excite me, similar to ‘Playing Nice.’ The possibility of identifying with the story or even being in the character’s shoes makes it more captivating, enhancing both entertainment and immersion.

She expresses her hope that viewers will relate to ‘Malpractice’, understanding it primarily concerns doctors but knowing we all become patients eventually or know someone who has. She hopes the series portrays a familiar setting, making people think ‘This could be me’ or ‘This could happen to me.’

Speaking playfully, Ofori-Attah expresses an interest in taking on a romantic comedy or historical drama in the future, stating that she’d prefer a cheerful adaptation of Charles Dickens’ works, as opposed to the grim portrayal of his novels set in Victorian England.

Regarding the future of television, Ofori-Attah expresses her aspiration for an increase in varied narratives. Specifically, she hopes to witness a broader representation of minority groups not just in the UK, but across the industry as a whole.

This writer identifies as African-American, but was born in Glasgow and raised in Yorkshire. In her TV writing career, she has expressed an interest in setting certain shows in areas within the UK where Black families might feel isolated. She shares that such settings may not always resonate strongly with audiences.

I wonder why there seems to be an initial hesitation within the industry to share such varied local tales, I inquire from Ofori-Attah. She explains, “I believe it’s due to the nature of the business being quite cautious about taking risks.

Due to the positive reception of stories about London’s Black communities, certain themes related to Black families or young people in London are familiar and comforting. Investors seem content with these narratives, so I believe it won’t be too much of a stretch to envision similar success for families from other regions of the country. In simpler terms, since stories set in London about Black communities have been successful, it might not require much imagination to create compelling narratives about families from different parts of the country as well.

It seems to me that there’s a particular style of representation on TV that could benefit from being broadened. After all, there are so many different communities across the country who would find these diverse stories intriguing. I often encounter resistance from audiences who argue, ‘Why is every show focused on ethnic minorities? My community doesn’t look like that.’ However, I believe that a wider range of representation could help bridge those gaps.

Instead of exploring various areas, let’s zero in on a single African-American family and their surroundings. This narrative could be considered distinctly British.

Ofori-Attah expresses her preference for stories about people who find themselves in unfamiliar environments, like fish out of water. She points out that there are numerous ethnic minority families and communities scattered across the UK, yet they are often underrepresented in movies and TV shows.

The tales and predicaments depicted in them remain just as captivating, intriguing, and full of their unique difficulties. I’d be thrilled to read a story centered around a Ghanaian family living in a small village in Yorkshire, navigating through their experiences. However, it wouldn’t be an autobiography,” she chuckles.

I have a fondness for local matters. In our discussions while establishing ‘Playing Nice’, we emphasized diversity. We chose Cornwall as it is the least affluent region in the nation. Although it’s stunningly picturesque, it faces numerous challenges.

By shooting the production in that location, we can promote diversity through various means such as highlighting the area, employing a local team, and overall contributing to a broader spectrum of storytelling across our nation.

In the course of my creative endeavors, I’ve been weaving captivating narratives that shed light on crucial and frequently profound topics. It’s evident that the themes of representation and diversity are integral not just to the stories I tell, but also to the way I approach my craft as a writer.

The significance lies in the fact that the tales we weave and the material we produce serve as a chronicle of our era and its inhabitants. Moreover, it holds immense power; crafting a television program grants us an unparalleled ability to connect with people right inside their homes.

If you’ve grown up watching TV and don’t recognize yourself in the characters, it can be isolating not to identify with their experiences. On the other hand, seeing a few characters who resemble you can help others understand diverse cultures and lifestyles, thereby enriching and enlarging people’s perspectives, without imposing it upon them.

I believe that art holds significant potential for positive societal impact, carrying both the duty and the chance to make a difference, all while avoiding an overly aggressive approach.

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2025-05-04 14:36