Navigating the maze of mental health treatment (part 1)

April 16, 2018

I had the good fortune to grow up in a family which knew a thing or two about mental health. Like many, mental ill health runs through my family history and unlike quite so many, I’m also surrounded by doctors (something of a bonus in the circumstances, but not much use if you fancy a day bunking off school – thanks Dad!).

 

Anyway… in my family, mental ill health is acknowledged as a ‘thing’. So, when I first became unwell not long after my 16th birthday, we were able to put our finger on what was going on reasonably quickly. My parents have an intricate understanding and of how the NHS worked and so I was in a privileged position. But I can say unreservedly that there have been some clear shortcomings to the point that I have given up on using the NHS as my main source of care. I basically use my GP as an administrator to hand me a prescription on a bi-monthly basis and do the rest privately, these days.

 

This is not the way I’d prefer to be doing things and it is not certainly not cheap ‘taking care of things for yourself’. I don’t think this is the fault of some of the wonderful nurses, doctors, counsellors and psychologists I have come into contact with – it is more systemic than that. But first, here is my journey through mental health services:

 

Episode 1, Anxiety & Depression, aged 16.

I was provided support by my local GP who helped me to learn some simple CBT techniques, and I was prescribed antidepressants. I took a turn for the worse after about 3 months and had my dose doubled, as well as being referred to an adolescent Clinical Psychologist whom I visited twice. He told me things would be OK and I was a normal kid. In the short term, this helped, but in reality, I think it was a miss. And I was told I probably wouldn’t have another episode – if only...

 

Episode 2, Anxiety & Depression, aged 18.

I had just arrived at Uni at this point and went straight for the GP to get back on the antidepressants. I tried to wait it out for a while but eventually turned to the University counselling services for some ‘person-centred therapy’. This helped me to explore and accept the situation I was in, but once I started to feel better, I stopped going. Again, probably a missed opportunity, but I thought I was ‘fixed’ so why would I bother? I kept taking antidepressants for a couple of years after this episode and regularly checked in with my GP. At the time, I still thought of depression as related to a ‘chemical imbalance’ which I couldn’t do much to control. This isn’t fully bollocks, but it is mostly bollocks. Reliable sources tell us it is much more complicated than that. 

 

Episode 3, Anxiety & Depression, aged 22.

This time, I had just finished Uni and was back at home. I worked in a crap temp job in a bank with no semblance of a future in front of me. I took another nose-dive and went back to the doctor, again. This guy was local and very, very good (Big shout out to Dr Drummond Begg. Fun fact - he is also responsible for the permanent amputation of the big toenail on my right foot). He was the first person to tell me that being a depressive is not always a bad thing and that intrusive thoughts about suicide are actually not all that unusual. A big part of dealing with these kinds of thoughts is ‘normalising’ them and understanding that you’re not weird or losing your mind, so this was incredibly helpful.

 

Back on medication I went, and without taking too long to do it, got lined up for some therapy with a nurse counsellor. She was pretty good to be fair. She was helpful and taught me a more detailed understanding of CBT. The only problem is, looking back, that my problem was more complicated than that. I don’t think she was to know, but the basic form of CBT used at the time was not the right treatment for me. I eventually went travelling with a good pal, which was a bit sketchy at first, but seemed to fix me up good and proper. Meanwhile the nurse counsellor retired, I felt better, and everyone was happy. I was ‘fixed’ again. Hooray!

 

 

Episode 4, Anxiety & Depression, aged 27-28

At the beginning of this one, I really thought I was fixed. I thought I had all the tools, I exercised regularly, and so on. You don’t need me to tell you about this – I have already done it in this blog. What I haven’t told you about was the absolute debacle I became embroiled in when trying to get proper treatment.

 

You can imagine that, when you start to slip into depression and anxiety for the fourth time, it might start to register that you’re in the shit again. This took a while to sink in since I had thought I was ‘cured’ and had to prove that I was ‘strong’. So, I delayed getting treatment and for that I take full responsibility. This was a real problem, especially when I hit the floor as hard as I did. But when I did realise I had a problem, I really didn’t get the help I needed, and nobody in the caring professions seemed to take note that this was a recurring problem which needed to be addressed in a different way. Here is what happened instead:

 

August 2012

I went to my local GP in Highbury and saw a relatively junior locum doctor after starting to feel down in late July. He prescribed me some antidepressants and I understood we had agreed to put me on the waiting list for CBT, while I figured out if that was something I wanted to do.

 

October

I went back to my local GP 6 weeks later as things started to tank, and found out that I was NOT on the waiting list. I had to self-refer. I started seeing a different doctor who was lovely, and reassured me with a lot of empathy that she wasn’t going to have to section me. However, the waiting time to get CBT was a minimum of 6 weeks. This was not OK. In the meantime, she would call me and we would keep talking regularly so we could monitor how I was doing.

 

November-December

Things started to get worse but I did have access to my work’s Employee Assistance Programme. The kinds of therapists available on EAPs vary enormously so I demanded a proper clinical psychologist and they found me a lady by the name of Barbara. She was most certainly edging towards retirement and was quite forgetful. But she did help me to get my shit together when she realised what sort of sorry state I was in. She was VERY WORRIED about me. She sent me back to the doctor to get my prescription bumped up and told me to walk into A&E if I was in any serious trouble and demand to see the consultant psychiatrist. She helped me to survive the worst of it and I owe her that credit. But the downsides: Barbara was old-school. We didn’t really ‘click’ and the EAP limited me to 6 sessions, so we finished up by Christmas

 

January

Just in time for my last session with Barbara, I started seeing a CBT practitioner through the NHS. This turned out to be mostly an online CBT programme called Beating the Blues. This produced a LOT of paper. It was supported by perhaps 2-3 meetings with the practitioner and a phone call or two. By this point, I was very fed up and I understood that I had a long-term problem. I would need something more than front-line CBT to help me with that. I was just starting to heal but I still I couldn’t get access to a clinical psychologist until I had stuck out this programme, and I kept getting referred back to my doctor who would only refer me back to the regional mental health services.

 

April

I finished the online course and was still not entirely better – I was living life a lot more normally but still experiencing a lot of wobbles and was determined to get proper help this time. I was referred to a clinical psychologist to assess whether I was right to go on a mindfulness-based programme.

 

May

I met with the clinical psychologist and based on my current state (still up and down but not in the pits) she referred me for high-intensity therapy with a clinical psychologist. I was told the wait could take 3-6 months.

 

June

Finally, I got to see a clinical psychologist on a cancellation. She started talking me through some of the reasons why I might be suffering from the problems I was suffering from. We immediately started to make progress. However, as I had moved across London recently, she wasn’t able to support me on a sustained basis. I needed to find care in Wandsworth, instead.

 

August 2013, onwards.

By this point I was still experiencing intermittent ups and downs. It was a year since I had started feeling depressed. I was still discussing treatment options with the Wandsworth NHS trust (who had put me back to square 1) and was reassured that it would be some wait before I was able to access face to face therapy. The alternatives were online therapy or access to a website called Big White Wall which basically seemed like a giant echo chamber for people to complain about how awful they felt. I didn’t think this was at all useful.

 

As you might expect, I gave up at this point and went private. I sought immediate access to support from a local clinical psychologist called Terry who was great. We talked through a range of techniques based around Mindfulness-based cognitive behaviour therapy (M-CBT) and acceptance and commitment therapy (ACT) which really helped with a number of challenges I experienced. I continued to work with Terry for some time, until such a point as I felt ready to support myself. He eventually moved to Jersey but always made himself available for a skype call should I want it.

 

OCD Diagnosis - May 2016

In 2016 I started to experience symptoms of OCD. This wasn’t the sort that relates to tidiness or hand washing or anything like that, but a more obscure form known colloquially as ‘Pure O’. With this, I experience ‘compulsive doubt’ about things which matter to me – in this particular moment, relationships. Looking back, this has been a major feature of much of my anxiety going back to the beginning. A bit of research on the internet helped me to realise what was going on and I contacted a local psychology clinic and came to meet Martin, who I have been working with since. I can’t recommend him, and the clinic, highly enough.

 

 

Both Martin and Terry have helped me to learn an enormous amount about myself and how I deal with difficulty in life, and I am now in the fortunate position to be able share some of those lessons for the benefit of others. I still see Martin from time to time and it’s fantastic knowing that I can see someone if I’m feeling a bit off or worried. I can now be proactive about seeking support and not have to worry that I’ll get put on a waiting list for months before I get to see someone. This is how mental health support should be, except I shouldn’t have to pay for it. I did try to get private medical insurance to pay for it, but since I had a history of mental health problems before I had cover, they refused to pay out for it and I was on my own. Either way it’s the best money I’ve ever spent.

 

I am incredibly lucky in that I have a job which pays enough to cover paying for the support I need (although at times it’s been a little tight). I’m also incredibly lucky that I’ve got a family who are educated about mental health and people around me that recognise and offer the support I need when I need it. That includes the company I work for and the people I work with who are genuinely supportive, too. But you can see how hard it’s been for me to get the right care.

 

Now...

 

Imagine I came from a culture which has a very limited understanding of mental health problems and where there is huge stigma attached to seeking therapies, getting support or taking medication.

 

Imagine I didn’t have a job which offers an EAP (which in my opinion is not sufficient anyway) and imagine I worked with people who didn’t really understand what was going on or provide support.

 

Imagine I didn’t earn enough to have the luxury of being able to pay for my own care.  Imagine I had no idea how to approach the NHS or what sorts of treatments were available.

 

I would have had no chance of living the life I live today. Absolutely none. It would be a disgrace. And mark my words, there must be hundreds of thousands of people in the UK alone who live in those circumstances and suffer from this kind of disadvantage. This must change for such a wide range of reasons I don't even feel a need to justify it. 

 

Going forward

I recognise that in this post I’ve offered up a story which looks like a giant whinge about the NHS and this is not my intention at all. I will re-state my position that THIS IS NOT THE FAULT OF THE CARE STAFF WHO WORK AT THE NHS. And in my next post, I will offer some ideas about the key problems and what needs to be done to drive change.

 

In the meantime, please keep talking about this, sharing these stories and offering your comments - as I will mention in my next post, dialogue is the key!


Until then,

Andy

 

 

 

 

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