Some thoughts on mental health services

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. 

Another research plug

http://www.volition.org.uk/audible-thoughts-research-project-mental-health/

Research website

If you are 18+ with lived experience of the NHS mental health system, please consider taking part in my research. Further details and instructions about taking part can be found here
audiblethoughts.org.uk

Everyone is a story

Health stories form part of our cultural landscape. We’ve all heard the tale of the Great Uncle who smoked 60 a day and lived to be 90 years old. It’s not always clear exactly whose uncle he was, but still, it's a great story! Families have these stories too, such as the time a relative absconded from hospital just before an operation, walking home in his dressing gown (this one is completely true, it was my Dad, but thankfully the operation was only a minor one!) There are mental health stories too and that's what my research is about.

We know that telling stories (narratives, in academic lingo) is an important way of making sense of the things that happen to us. They also tell us who we are. We are re-imagined in stories, a range of possible selves is within reach. Jerome Bruner said they’re often told when something important happens in or lives; it might be a danger or a challenge, or it might be something positive but we don’t tend to tell stories in which nothing happens. What’s interesting is that it’s not just a case of “stuff happens then we talk about it,” we actually use stories as a way to understand our experiences. So, in telling the story, we are also making sense of life events and ourselves. The plot will alter according to personal circumstances, mood, previous experiences and it will also be shaped by culture, family traditions and so on. A story can be told as a way to help us understand what’s happened, but each event could be 'storied' in a number of different ways. In this way, our experiences are something to be discovered, rather than concrete entities with one ‘official’ interpretation.   

My research work involves hearing people’s stories about their mental health. I’m no stranger to this; as a counsellor, I've listened to literally hundreds of life stories. At various times, I've been saddened, inspired, motivated, enlightened and entertained by what people had to say. I was already aware of the therapeutic value of story-telling and being heard and knew that the telling of a story could aid someone making sense of things. I acknowledged that the stories I was hearing might be rather different to the ones being told elsewhere in that person’s life; such was the privilege of doing therapeutic work. 

I also knew that often, someone would have pre-existing ‘stories’ in their mind, so their more recent experiences would take their place alongside the old. When someone has a number of pre-existing stories, they are liable to repeat old patterns because they make such intuitive sense; it’s just “how it is” for that person. As such, they can find themselves doing things that aren't always in their best interests. Part of the business of therapeutic work is to understand and possibly challenge these old stories by asking (in a variety of ways) "how’s this way of seeing your experiences working out?" And the response to these questions will vary, according to a person’s ability and willingness to introspect. It’s a difficult task to witness someone continuing with a pattern of behaviour that doesn’t exactly help them, but by asking the questions, the person is free to follow it up, if and when they want to. 

My research is, in a way, a continuation of this hearing people's stories. My task is to collect lots of stories (data) and put them together to create a kind of ‘collage’ of experiences. I'll then be providing some commentary, with a few psychoanalytic insights. It's more a mosaic than a collage, but my preferred way to describe it would be to say it's a bit like a kaleidoscope. A mosaic implies that the pattern is ‘fixed,’ whereas to me, human experience is anything but static. Just because we might think we see / think/ understand something now, it won’t necessarily look that way in a fortnight, or a couple of months' time. I want to reflect something of the dynamism of human lives in my work. Unfortunately I won;t be able to witness people's understanding evolve but I can take a snapshot of where they were at a given point in time and (hopefully) say something interesting about that. Just as it was when I did therapeutic work, it'll be such a privilege and I'm really looking forward to being part of it.