In my last post I shared my personal experiences of trying to access proper support for my mental health. In short, during several very difficult periods in my life when I was really quite unwell, I have found the mental health services provided by the NHS to be lacking. As a result, I have since made the decision to seek support privately. This I have found to be an expensive but worthwhile investment which I am lucky to be able to afford. But this is not how it should be. This post highlights some of the key challenges and offers some suggestions both for what needs to change, and what you can do to support it. Here goes:
So where does it all go wrong?
I think the challenges I have faced in accessing adequate treatment in the past have had little to do with the capability, or at least intentions, of the care staff I have worked with over the years. Even the people I have worked with privately both trained at, and continue to work part-time for, the NHS. It seems everyone in the system is aware of its shortcomings but they are powerless to do anything about it. I can’t pretend to have an intricate understanding of the inner workings of the NHS. But the main problems I’ve run into are far from being a one-off (1):
Waiting lists were too long and there was a lack of availability of the right support when I most needed it
The system seemed to lack awareness of what support I would need and what would help for the long-term. I suspect most front-line mental health workers in the NHS are targeted on getting patients ‘back on their feet’ – not on ensuring people can support themselves on a sustained basis over their lives. This short-term focus is likely to exacerbate the situation in the long term as people keep coming back into the system.
There is a serious lack of ‘joined up-ness’ of services. Every time I ended up in trouble, or moved house, I have had to go back to square one. I have been passed around from pillar to post while different services diagnose the problem for themselves. It should have been evident from my medical history what methods and interventions have been tried or not. Instead, it was left to me to push this agenda for my treatment. I doubt very much whether you’d see this issue on a widespread basis for people who suffer with a history of heart disease or Parkinson’s.
I have continually run into the ‘one-size-fits-all’ approach provided by the NHS which is designed to have the maximum impact on the largest number of people with the least expense. The guidelines from the National Institute of Clinical Excellence (NICE) direct services toward provision of an inflexible combination of antidepressants and cognitive behaviour therapy (CBT) (2). These treatments do have a positive impact en masse, but treatment needs to be more carefully mapped to individual needs. The particular brand of ‘straight up’ CBT which I've been provided with hasn’t really worked for me. Both myself and many people I speak to find that certain aspects of CBT have acted to exacerbate some of the problems we have experienced. The NICE’s approach is still at odds with the ‘We Still Need to Talk’ coalition’s recommendation in 2013, of “considering a more flexible approach and valuing a wider range of evidence types … in developing future clinical guidelines.” (3) In fact, NICE are doing quite the opposite (4).
We also need to recognise that the challenges the NHS face are part of a broader societal problem. In general, people lack an understanding of how to recognise mental illness. They also lack knowledge of how and where to access the best support. The NHS is doing the best it can with limited resources in a societal climate which does not value or invest in the Nation’s mental health. To put this in perspective, The Donkey Sanctuary received more than twice the amount of voluntary donations in 2017 than Mind, the UK’s biggest mental health charity (5).
I mean, everyone loves a donkey. But this is utter madness when the statistics around mental ill health show that it is prevalent, damaging, costly and there is a clear economic case for investment:
1 in 6 people have experienced a mental health problem in the past week (6).
There is an increasing prevalence of mental health conditions across the UK population (7). This increase is most notable among our millennial generation (8).
Poor mental health costs UK employers £33-42 bn each year (9).
For every pound invested into mental healthcare by employers, they would get a return of £4.20 (10).
So, it’s a no brainer then? We should invest more money, right? Even Theresa May seems to say so…
“One of the reasons I've made mental health a priority is precisely because I think that there are issues …we're putting record amounts of funding into mental health in the national health service"
What is both interesting and alarming, then, is that there are now at least 6,000 fewer mental health nurses and doctors than there were in 2010 (11). Mental Health services have received lower increases in investment than other areas of medicine (12) and the Royal College of Psychiatrists report that current spending on mental health is, in real terms, £105 million less than it was in 2012 when inflation is taken into account. (13). The picture begins to look rather less rosy when you take a harder look, then.
So why is it that funding for mental health is so lacking? My hunch is that there simply isn’t enough noise around mental health. Mental health problems are not nearly as ‘visible’ as other widespread physical problems – for example arthritis, dementia, cancer or diabetes. Mental Health problems are not cute or fluffy and they are not particularly sympathy-inducing. They are difficult to understand and can be quite scary. And so, they become a little easier to ignore. Not only that – the stigma that prevails around mental ill health prevents those who live with mental health problems from speaking up about it. Perhaps it is a generalisation, but I hardly imagine that most people in the midst of a serious bout of anxiety, depression or most other serious mental health conditions are going to have the energy to start writing to their MPs, organising rallies or shaking tins in the street.
What do we need to do to help?
Well – we need to start consciously participating in a growing movement. We need to create a greater level of discourse and dialogue around mental health and wellbeing. We all need to speak up on the behalf of people with mental health problems and we need to support those people to speak up about their own experiences. We need to show that it is OK to be living with a mental health problem, and that it is OK to talk about it. We need to be curious and ask people to share their experiences. And we need to drop the need to pretend we’re “OK” all the time. Let’s be real. Life isn’t always great – and feeling vulnerable isn’t a sin. It’s just normal.
We also need to speak out about how unacceptable it is that the government and our society don't provide adequate care for people with mental health difficulties. We all have mental health, and we all need looking after from time to time. There is a good chance that you will need treatment for a mental health problem in the future, if you haven’t already. It is an inevitability that one or some of your spouse, parents, children or best friends will experience mental ill health. So, if you care, the minimum you can do is start talking about it. Talk to your family, friends, neighbours and colleagues. It doesn’t have to be a big deal. If you care a bit more, write to your local council or MP. Demand a proper mental health and wellbeing policy at work. Tweet, Facebook or Instagram about it. Give money to charities like the Mental Health Foundation, Mind or Rethink. Vote depending on it.
Trust me, it will be words, time and money well spent.