Before I even get started I want to make something perfectly clear.. I am NOT having a dig at the NHS. I know plenty of people out there have their issues with the service, some quite rightly so, others just over expectational of what the service exist for, and what medical science is actually capable of.
Contrary to believe, not all lives can be saved, no all conditions resolved. Of course it is sad to lose a loved one, but blaming a service as mighty as the NHS is not always the right way to vent that feeling.
Mistakes have been made, lives lost for sure, and no that is not right. But on the grand scale, if we frown on the bad, then we should also celebrate the huge achievements of the NHS every day. But as usual, we are quick to complain, but slow to commend.
Right, now to what I started writing this whole entry about. Not sure about its direction just yet, so lets see how it pans out. In short, I want to address the mental health service offered by the NHS. Obviously this is something I am quite familiar with, having been treated for depression and anxiety a number of times now, so I am not just grasping at straws here, and want to use some of my own experiences, and stories of others I know to try and put across a balanced opinion, so lets try this.
The first time I suffered from a bout of depression was long before I was ever treated for depression. In the late 90's, losing touch with my daughter drove my to the brink. And thinking back about that now, reminds me very much of my most recent experience. Both dealt with by me with irrational amounts of physical activity, training twice a day 6 days a week at the gym. Good for the body, terrible for the mind.
Back then I was a lost soul, still in my 20's seeing my daughter torn away from me, and worst still, seeing my child move forwards in her life without her father, just like I had. Something I had vowed no child of mine would EVER go through. And there is was. One afternoon I found myself in casualty with a large gash on my hand, as a result of punching through a laminated screen in frustration. A scar I still carry today, and a reminder that physical reactions to feeling unstable mentally need to be limited and controlled. I didn't intend harm to myself, but ended up doing so. I never recognised what I was going through as being a mental health issue, so plugged on for the next year, finally slowly returning to my old self.
It would be another 10 years before I would see depression again, properly at least. As the condition of my mother worsened, and her need for a carer grew, I took on a new lifestyle. Combined with the recovery of a recent operation and a bad time at work, my mental condition dropped, and I soon realised I was in a very dark and desperate place, struggling to sleep, socialise, or even care about my own well being. On seeing a doctor I was prescribed Citalopram 20mh, soon rising to 40mg. Thankfully work provided some one to one counselling for me, and with the help of Peter my brilliant counsellor, I made a strong recovery, again, after about a year or so. Meds were reduced and phased out.
Move on another 5 years or so, and there we were again. A huge slump in mood drove me to possibly the deepest and most desperate point I have ever been in, long term. I have had huge lows, but never stayed this low. Seeing a new GP, I was back on Citalopram, and referred for counselling. This is where it really begun.
I was phone assessed by what felt like a very robotic and uncaring person, who decided my condition was mild and I should go to Cognitive Behavioural Therapy (CBT) For those not familiar with it, the only way I can summarise it is like this. You are taught to identify points from early life which may have shaped your behaviour today, then to concentrate on what triggers your depression, and the cycles you go through which perpetuate the depression. Learning coping mechanisms, how to isolate each component, and on ways to avoid the spiral of depression. It sounds a bit hopeless and complex, but I must confess by the end I was understanding myself a lot better. In short, CBT isn't as bad as I first thought it was, but still don't believe it is for everyone.
As I was first introduced to the CBT service, I started to understand why some people were so frustrated with the NHS for their MH provisions, or at least the way they manage it. A few weeks after my somewhat uncaring phone assessment I received a letter to go to the Jenner Health centre for a one to one, with some vague information about this CBT thing. Having looked it up on the internet I was curious but not convinced.
On my arrival there I realised that not only was there no reception for the CBT dept (as noted in the letter) but there was barely a sign that I was even in the right place. Bad start for anxious people. My appointment was for about 12.00, but by about 12.30 I hadn't seen a single person on the floor or in the waiting room. Finally someone did come in, and was swiftly collected by a post natal class person. Now I am wondering if I am in the right place, anxiety levels rising. Eventually someone came out to get me, apologising as we walked down the hallway. Little comfort for the way I was now feeling.
I was briefly asked about what brought me there that day, then pummelled with piles of papers about CBT. Being told that the things I was talking about were not of consequence, and that CBT only looks forwards. The past can't be changed. Tell that to someone traumatised by their past!
The following week, after finding peace with myself and realising this was the help I was getting and to go with it, I arrived at my appointment to be told I had been referred elsewhere, and was now to join a group therapy class. Anxious and depressed, great, lets go sit in a circle and talk about it. I was told this was NOT the case, but on arrival it was just like that. A circle of chairs and two counsellors.
At this point I was feeling hopeless. Speaking to the counsellors about how I felt, I was told nicely just to stick with it, but with no real foundation to it.
So I guess this is where my concerns first start. As humans we are capable of compassion and empathy, to a degree at least. But the line "I know how you feel" is used all too freely. If you have never been bound by the ropes of depression, or had your thoughts suppressed by the worry and voices in your head. If you have never just wanted to spend the next week in bed, and not wanted to see ANYONE face to face for weeks on end.... Then you certainly should not tell a depressed person "I know how you feel", you really don't.
I applaud anyone choosing a career in mental health. As far as the NHS goes it is hardly financially rewarding, and to some degree it isn't an easy role to fill either. It takes a strong mind to deal with such matters day in, day out. However I do sometimes wonder what the criteria really is for getting such a role, and how many sufferers of depression actually work in the service. Maybe it is counter productive to have sufferers working in the field, but from my perspective, I am in my element working with people suffering, as I feel I have more ability to understand what they mean when thy express how helpless they feel. Rather than replying with the "hmmm, hmmm, yes" I seemed to get a lot of the time.
So before I go on anymore, thank you to anyone who seriously takes on a role to help sufferers of mental health issues, not just depression and anxiety. You DO make a difference for sure. But I wonder would more funding, training, or better selection of staff, and a better understanding of the conditions make a bigger difference.
Do I think I could do better? Well that is a very good question indeed, and a fair one. I don't have any qualifications in anything, let alone psychology, I have no further education either. So academically I am useless. But is that what counts? Who can lead you through a forest at night the best, an expert map reader who has never been to this forest, or a local who lives there, but can't read or write? I think the answer is obvious. Sometimes qualifications and certificates are not the be all and end all. Sometimes its more about understanding and empathy to the situation.
Obviously there is some information required. Not every experience is the same, and not all people react the same way. Understanding the mechanism of the mind is pretty darn important too of course. So there is a balance to be found for sure. The right level of input from sufferers, the correct level of understanding of the situation from a psychological perspective, and carefully planned academic coursework and structured action plans. Question is, is this being achieved?
From my experience, possibly, in fact probably not. Counsellors arriving late to groups, not understanding the impact that has on the recovering mind. Mixed up piles of photocopied coursework sheets, sometimes not enough to go around. Depending too much on patient participation to get the course moving. Without solid contribution of stories from those attending, sessions sometimes stalled. In my instance I was happy to share deep and past experiences, but it was quite clear to me that many others were less comfortable (rightly so). Counsellors unable to directly answer questions on the subject matter at times, with others in the group having to fumble for answers til it was decided one of them was right.
It is not all negative of course, I came out the other end feeling better for it. My question is, who did what for me. Did I get back on my feet myself, did my sharing and helping others inspire me to fight back, or did CBT save the day? Honestly, I think it is a combination, but not a very balanced one. CBT put me in a room with people, something I was uncomfortable with, but willing to try. It also gave me the opportunity to tell my story. However the coursework was mainly thinks I have been through on my own free will. Identifying triggers, identifying drops in mood, coping mechanisms, understanding how society makes me feel. So the actual learning side was lost on me.
That said, helping others in the group identify with their own demons, and give my own examples to help them better understand their own, that was something. By half way through I was looking forwards to each week, to see what impact I could have, and getting people smiling or sharing was a powerful drug for me.
This in turn enabled me to help myself. Both understand myself a bit more, give me a purpose and some self worth back. All in all the right combination was found, for me at least.
As the course went on, and people showed up from time to time, it became obvious that some people were back for the second or third time. That part was lost on me. Learning about yourself, understanding the functions of the mind, and the cruel tricks it plays is one thing. But re-learning over and over.... I don't get it. If you need help after completing the first course, surely you need a different approach. In this respect the MH system is a bit lost and misguided. I wonder what it feels like to be re-sent on a 12 week course just because you have become depressed again. While the lessons learned are powerful and enlightening, they simply cannot stop the body and mind from throwing your life into turmoil, it's just not that simple.
Now the elephant in the room. Medication!
Having grown up watching programs with mental health patience receiving mind numbing sedation drugs to keep their minds rested, I have long thought that all anti depressants are of the same nature, making you sleepy and non functional, and silencing the issues, rather than helping tackle them.
However it turns out they are not. They all do different things, some indeed are sedative style, but others help the body produce more of what is needed to balance your moods. Apart from some strange side effects during early days, life after that, once on the right dose becomes pretty darn normal. Apart from remembering to take a tablet each day, you are just you again, certainly with Citalopram.
I know quite a few others who feel exactly the same way about the meds.
Being serious for a second, look at it this way. In most cases you can come off them when the depression and risk of it reoccurring has passed, reducing the dose, until none is needed. I have done that successfully myself after my last bout of depression 5 years ago.
Think of it this way, if you have something important to do which requires your full attention, and have a headache, you grab some ibuprofen, wait 45 mins, and you are fit to do the task at hand. There is no stigma attached to ibuprofen, so it is socially acceptable. With mental health, it is the same, but sadly its going to be 45 days or more rather than minutes. Once the levels in your body start to level out, and you are able to think straight again, you can help yourself understand what the issue is, and how best to overcome it. Sometimes without clearing the fog, you won't be able to see the path out of the forest.
So I don't see them as a negative thing at all. And I really wish society would see this too. Alcohol alters the mind, so does tobacco, but somehow they are both social and acceptable drugs to use. "Overdosing" on them is common place, and abuse of them is an epidemic. But society seems to say that is ok. And yet at the same time frowns on simple, controlled, monitored medication taken by those needing that little tweak of the mind. I don't get it, not for one second. But then I don't drink or smoke, so how would I. Just as those who frown on medication for mental health don't get it, but still judge.
The drug side of the mental health treatment on the NHS seems to be aplenty. Churning out prescriptions many times a day, no scheduled reviews once prescribed. The face to face part, which in some cases is critical however seems very hit and miss. I felt that the whole process took far too long for me to get facetime with anyone. However it seems that this waiting time varies radically from borough to borough, just in London alone, so nationally, I dread to think what the variations are.
One example. I was referred in November 2015, and finally got face time in Jan 2016. To me, that was an eternity, and waiting for it was both scary and painful. Thankfully by that time I had started to find my own circle of support from a great group of friends.
For someone else I have gotten to know, they were referred at the same time as me, and here we are in August, coming on for a year later, and they are STILL waiting. Same are, different borough council, so different MH team and ethics it would seem. This is fundamentally where it all starts to fall apart.
I have all too often heard the term "NHS postcode lottery" and again wondered what the hell people are on about. But it would seem this is one example of this phenomena.
I just don't get how there can be differences in urgency, treatment, assessment, and over all ethics towards mental health from postcode to postcode. Surely the NHS as a whole, all the trusts combined have agreed a strategy for treating mental health. Moral codes of conduct, tiers of urgency and treatment nationwide. I don't understand how one body, overseen by one government, can be so fragmented, first into trusts, then into boroughs, and each fragment having its own ideals on treatment for a condition.
It also leaves me wondering if the same is true for others branches of the NHS, other fields of medicine. Should I move house to get considered more important by another boroughs health team?
Thankfully for me, in South London, under Lewisham, I cannot complain about any of the medical attention I have received over the years. Ultimately it has all worked out for me, and I am here writing annoyingly long blogs like this. But I has me now wondering about how different things are, and what can be done to make a change to the whole system.
I have read news reports for years which say the mental health section of the NHS is desperately under-funded, and spiralling out of control. I have also read reports of how people have been let down by the service, resulting in vulnerable people committing suicide, or harming others.
Somewhere in amongst that all is the answer. The right direction to take.
So my questions.
Why are counsellors photocopying literature for a course with a fixed program of learning. Buying paper,making thousands of copies on a photocopier, making a mess of things, and fumbling by. Is it not easier to have these put into booklets and handed out by every borough, every trust. Ensuring that everyone is receiving the same education on their condition. No missing pages, no topics accidentally overlooked. Surely it is cheaper to put it out to tender once, and print them all and distribute throughout the UK. Procurement for such things should be centralised. One of the faults maybe of the NHS being so top heavy and fragmented?
How many people working in the field actually have first hand experience of depression and anxiety. Statistically it is likely that most people working with cancer in the NHS no someone who has experienced cancer, so empathy is far easier to give.
However while depression and anxiety is at epidemic levels now, firstly it is in the shadows. Not discussed, never admitted, and sometimes denied by those diagnosed. So getting people to speak about it, let alone help in the field is really tough, I get that. But I am still curious to know how many are in the field, helping others understand. After my CBT course was done, I was hungry to help others, and as it turns out when I look back over my life, I have been doing this for ages.
I was shocked by the number of my friends who have suffered or still do, and touched by the positivity I received about my honest and open blog entries about the matter. I really didn't realise how wide spread it was, nor how secret it was.
I really wish I had the know how to start digging for information and understanding how things could be done differently, not only from my experiences, but from others too. If I had the time, I would dig deeper, and push harder to get heard, but for now I will carry on doing what I feel is right, and keep reaching out to others who are fighting their demons. Struggling every day against the voices in their heads, and the lack of understanding from the world around them.
I have more to say on this matter, watch this space. But in the meantime, if there is any official organisation I can lend my mind to, just call :)