Saturday, 6 August 2016

We Need To Talk About The Failures of the Mental Healthcare System.

"When you have mental illness society tells you your only power is invisibility. Tells you that they would save you if only they could see you, but of course, they cannot see you. Of course they will not save you, no matter how bright you sew your cape. Invisibility is not a superpower, it is the best weapon of a broken system desperate to make their streets look clean." - Brenna Twohy

I woke up this morning, to find that #MentalHealthcareSoPoor was trending on twitter. As a long term member of this club, I've been made fully aware of the pitfalls of the mental healthcare system but to see it all set out in that way, to see people talk about what they've been put through as a result of the stigma attached to mental health, is heart breaking. But more than heart breaking, its infuriating. The reality is that mental health services are so poor because the illness isn't as visible as a physical illness, you can't take an x-ray or see it in my blood, and therefore it's treated as subjective. 

The reality is, no mental illness is invisible, it just requires one person to pay enough attention in order to notice that there is something clearly wrong. You cant have an active untreated mental illness without presenting symptoms and behavior changes, even if, like many, you keep them as secret as you can. I couldn't hide my disorder even if I tried. The issue with doctors and health care professionals is that there just aren't enough around to provide sufficient time and care for a person suffering from a mental illness, meaning most are written off as "teenage hormones" "stress" and "overreactions". GP surgeries are set to a 6 minute appointment target, and that's just not good enough when a person needs to explain the full painful workings of their own mind. 6 minutes wouldn't even scratch the surface of what a doctor needs to know about me. I'm fortunate enough to have had a GP who has set aside time to work with me, and gave me full control over my own treatment. I have no doubt that I am one of the lucky ones. 

In 2014 the We Need to Talk Coalition, carried out a survey and found that, out of 2,000 people who tried to access talking therapies, only 15% were offered the full range recommended by the National Institute for Health and Care Excellence (NICE). For many, especially in the poorer, lowest funded areas of health care, the full plethora of mental health treatments is not offered, only medications and the lowest level of talking therapy. 

There is such a high demand for growth in mental health services, and yet it's still so under funded and under represented. The Care Quality Commission found that in 2011-2012 16% of wards visited by the Mental Health Act Commissioners were over capacity and about half of the wards were nearly at capacity, with occupancy level of 90% or less. These statistics represent only hospital wards, where mental illness suffers have finally ended up. I have no doubt that if there was more concern and attention given at the first appointments, and more suitable and effective treatment given immediately, the numbers of patients having to be hospitalized would be so much lower. I'd like to clarify that hospitalized patients aren't limited to those who are suicidal or have attempted. These wards will be filled with those suffering from a whole variety of disorders, who just need immediate care. Due to the overcrowding of wards and GP surgeries, emergency departments are regularly overflowing with those concerned about their mental illness, because it is the final place where someone might listen. 

The estimated global cost of mental health problems is £1.6 trillion, which is greater than the individual cost of cancer, respiratory diseases or heart disease. Yet still, investment in prevention is so limited. Currently research into mental illness is only receiving 5.5% of the total UK health research spending (£115 million). 

I often can't help but wonder where I would be, had I have been relying on the NHS and had be left with a GP who didn't have the time or empathy that I needed. I was first sent to a free "talking therapy", where the specifics weren't on my illness, but on my general well being, and while this was a good enough experience it wasn't sufficient when I developed full blown Agoraphobia. I am forever grateful that I am part of a family who were financially stable enough to get me into private Cognitive Behavioral Therapy when I needed it most. I was seen within a week of inquiring and have been in continuing treatment ever since, for 18 months. In start contrast, pursuing mental health treatment via the NHS is torturous and extremely inefficient. After an initial consultation with a doctor, you will be put on a waiting list for therapy for about six months. Usually, to tide you over for those 6 months, you will be given medication. While I was fortunate enough to choose medication on my own accord, for those treated by the NHS, it isn't an option. In 2012, Avivia's Health of the Nation Report surveyed 202 GP and found that 75% had prescribed medication even though they felt psychological therapies would be more effective. After those 6 months are up, you will receive a letter informing you that you are close to the top of the list. When you finally get your place in treatment, you only get 6 months of treatment provided. I know for certain, that if I had to wait 6 months for treatment, I wouldn't have made it to 18. I regularly hear stories of people, who were made to wait those months out alone, and subsequently took their own lives in the meantime. There has to be a better way. 

I feel as though I could talk about this for hours, the statistics are shocking and utterly terrifying. To know that I live in a world where, if for some horrendous reason, I was left without the financial support I have now (touch wood), I would suddenly be alone without treatment for 6 months straight is harrowing. I've got enough anxiety to worry about. I don't know how to approach the idea of budgeting, but I am certain that if we have to start somewhere then we ought to start with understanding. It is shocking how few medical professionals have satisfactory knowledge on all the various mental illnesses. And while no one person can be flawless when it comes to understanding these things, it is a core reason why so many patients are left without the support and treatment they require, because the doctors they see aren't aware of the signs or severity of what they're dealing with. I went un-diagnosed for an entire year, despite seeing multiple doctors. If a single one had simply asked the right questions, maybe I would be in a better place today. Looking back now, it's almost humorous how obvious it was that the symptoms I was presenting with collectively added up to anxiety. 

The most important factor in making a change here is understanding the medical severity of mental illnesses, and accepting that just because you consider them to be invisible does not in any way mean they can be made to feel lower in importance. You wouldn't postpone the treatment of a chronic physical illness, and mental illness should be the same. In many if not most cases, it is still a life or death situation. The national healthcare system in place pushes mental illness aside, because they cannot see the damage done, they cannot watch the illness spread. There is no sense of urgency, all through a lack of understanding, and that is exactly where change needs to begin. 


  1. I don't know how to comment a nod of understanding, but that's what I'm doing. I was in the public mental health system for years, and while I'm lucky enough that I never had to be hospitalized in the county (I received a grant for a private hospital), I did experience being written off, diagnosed within minutes, medicated with no follow up, and much more. Mental health isn't even in the backseat to other health problems. It's in the trunk. It's still in the garage. It's sad.

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