As you know, I've begun the data collection phase of my research and I wanted to write a little about a consistent theme that's emerging. It's to do with expectations versus reality when it comes to mental health care. What I'm seeing is a real sense of disillusionment among many people who enter the secondary mental health system (that is, they're referred by their GP to a community mental health team or CMHT). For some people, unless they are hospitalised, it seems that 'care' equals medication and a brief chat once every couple of months with a psychiatrist. Possibly a brief intervention with CBT. If someone is deemed to be in greater need, they might receive some nursing support from a CPN or get to see another mental health professional, such as a psychologist or an occupational therapist. In some cases, a mental health social worker might be involved, often to co-ordinate practical matters (such as to do with caring for children, dealing with housing problems and so on). But for many people, the story seems to be that they are given medication and then feel as though they are 'parked' on drugs, with very little ongoing support, other than being advised to see their GP in between psychiatry appointments. In a sense, this mirrors the experience of physical health problems - if you're 'well' enough not to be in hospital, then you're sent home to get on with things and advised to see your GP if you have any problems.The difficulty with mental health is that all too often, the problem ('illness' if you prefer to see it as such) tends to have its origins in the complexity and difficulties of life, so in sending people right back into that life, unchanged save for medication, how can they ever hope to get well?
If a person's problems lie in relationship breakdown, difficulties in coping with being a lone parent, anxiety around housing and money worries, or they have a background of abuse and neglect, multiple trauma and losses (some people are managing all these things and more), then how can medication with nothing else help? It's a fundamental problem in mental health and one to which I don't pretend to have easy answers. I realise that the remit of the NHS is not to extend itself into people's private lives but it strikes me that just medicating people and leaving them to it is only storing up problems for later - whereas some may recover or their circumstances improve, others will become 'revolving door' patients.
What has struck me during the course of my work so far is the disappointment that people feel when they realise that for some, diagnosis and medication is as good as it gets. Perhaps the disappointment lies in the belief that the mental health services can, and sometimes do, offer more. As one person pointed out, in some cases, people simply don't receive any 'care.' Services are patchy and all too often, it depends on where you live, which CMHT you're referred to, which consultant you're under and so on. Only a minority are referred for NHS psychotherapy and speaking from experience as a patient, you have to jump through a lot of hoops to get that, it's not routinely available. But when you're unwell, do you really want to have to jump through hoops? For those who are very unwell, it may be impossible.
I realise that in-depth psychotherapy may not be everyone's taste; it involves a long term time commitment, for a start. But the CBT offering that was promised to transform the lives of many has proved disappointing. Again, some individual therapists are brilliant but others rely too heavily on the manual and ignore the real person sitting across from them. Many people are deemed unsuitable for IAPT on the basis they have more complex needs (I was one of those people). So what do they get? In my case, it'll be psychotherapy but as I've mentioned,for a variety of reasons, that isn't an option for everyone.
Some people say they need help with emotional problems, others need more practical support to help them get on with their lives. If it's not the remit of the NHS to act as a counselling or advisory service, or to do the work of social care,who fulfils those roles in our increasingly atomised society? The voluntary sector is already overstretched, with many services affected by cuts and needing to scale back (that's where they aren't having to close down altogether). NHS mental health services are organised in such a way as to discourage 'dependency, ' but the question is where else can people turn when there is genuine need?
It seems that there's a gap between expectations and reality when it comes to mental health services and what you get is whatever's available, which is, in some areas, not a lot. A diagnosis, a prescription and told to see your GP in case of any problems, now go away and get better. It's nowhere near enough.
Having just returned to my GP to become reacquainted with medication following an almost disastrous dip in my mental well being your post was timely. Some years ago I had CBT which at the time was extremely helpful and I still use the skills learned at that time to this day. My disappointment has been with subsequent times of need when I was told I had to do the 6 weeks of CBT before anything else would be considered as support (other than medication), when it was clear the 6 weeks was entirely inappropriate for my needs I was offered 13 weeks of CBT as if having twice as much CBT would help. I was quite clear in my own, rather sad mind, that twice as much CBT was not what I required. The counsellor to whom I was allocated entirely agreed that she was not able to help me given the parameters under which she was allowed to work and so the sessions with her ceased after only three or four sessions.
ReplyDeleteAt breaking point again I have discussed with my GP my options and decided that medication is the only real option in the current system as a referral for psychotherapy which is what would probably benefit me most will not be available for at least twelve months, even an assessment would most likely take several months. I'm afraid I can't wait that long for help, so medication it is. My GP said, very sadly, of course if you can afford to seek and pay for therapy yourself that would be much quicker, but I can't. I have drugs which I know will take the edge off the world but it will take the edge off the whole world and that is just a plaster over a cut, and is not dealing with the open wound beneath.
It seems sad that more easily accessible and flexible support is not available. As I try to hold down a job as well as deal with all that is going on outside of work. It is very sad that there is not something other than medicating myself to numbness to help me get through until I feel able to cope unaided. Worse still is that until I can afford to seek more lasting help then it is unlikely that the NHS system as it stands will be able to help me.
Dear Anonymous, Thank you so much for this thoughtful response. I'm so sorry to hear that about your experiences within the mental health system. I agree, whether a person recovers or the speed of that recovery really shouldn't be determined by their ability to pay for a private therapist. It's unacceptable. The waiting lists are ridiculous; I was told to expect a six month wait for the assessment alone. I've been referred and now I must wait, so I do understand something of your frustration.
ReplyDeleteI agree with what you say about the drugs too - they help, as you say, but at a cost - emotional numbness and not forgetting the side effects, which are often brutal. I had a shock when I glanced at the leaflet that comes with my meds! I do hope you are able to look after yourself and best wishes for your recovery. Ali