Friday, 14 October 2016

Mental Health in Britain

On Monday 10th October it was World Mental Health Day and many charities involved in mental health care and research took the opportunity to spread the word of taking mental health more seriously. Research charity MQ released figures showing a large discrepancy in research funding for mental health versus more "popular" medical campaigns like cancer research: mental health research receives 22% less funding than cancer. With funding and continued research cancer, HIV and AIDS are all no longer the life/death sentences that they once were: while people cannot shake the illnesses completely they can, with appropriate medication and support, continue to live their lives for many years. The mental health community is urging the public to invest in mental health research with a similar passion and enthusiasm in the hopes of seeing similar success.

As a society we have become more accepting of mental health conditions, we are becoming more understanding of them and more vocal about supporting people who have them. But who are the people who have them? Pretty much everyone!! Mental health conditions are becoming much more prevalent. Statistics suggest that 1 in 4 people have bi-polar, 1 in 5 people have depression, 1 in 100 people will experience schizophrenic episodes. Perhaps mental health problems are becoming more prevalent because as a society we are becoming more open and more accepting and it's actually just a case of more people seeking help and opening up about what goes on in their heads, rather than continuing to maintain the British "stiff upper lip" or perhaps mental health conditions are becoming more prevalent because the environments that are most conducive to mental breakdowns are becoming more wide spread.

Back in 2013 Dr. Ed Mitchell, a clinical fellow to NHS England's Director for Long Term Conditions, wrote that "Mental illness causes almost a quarter of our burden of disease (22.8%), yet receives only 11% of NHS funding. (For comparison cancer causes 15.9% of that burden).  Whilst 92% of people with diabetes are in receipt of treatment, only 28% of people with mental illness get treatment for their problems. Yet we know that people with serious mental illness are at risk of dying 25 years earlier than those without such illness." - see the rest of his article here.

Those are some pretty big discrepancies! And not much has changed in the past three years; in 2014, Heidi Ledford wrote this for where she explains that "more than 350 million people are affected by depression, making it one of the most common disorders in the world." She goes on to say that "two thirds of people who commit suicide have the condition." Despite this there is a continued lack of funding. If this were a physical condition there would be, understandably, huge public outcry. Yet the silence surrounding the lack of facilities, care, services and research funding for mental health is deafening. For years in western society we have dismembered our minds from our bodies. Our medicine is reactive rather than preventative. We live in a state of exertion to the point of collapse both physically and mentally but when we collapse mentally we are told to "pull it together" and "carry on".

In 2015 the BBC reported that mentalhealth services had their budgets slashed by 8%: a reduction reportedly worth £600 million, while at the same time referrals to community mental health teams had increased by 20%. It's not hard to see, with figures and numbers like that, why so many people with mental health crisis's are falling through the cracks and not receiving the treatment and care that they need. If we, as a society, aren't taking mental health seriously then the doctors in our society aren't going to either. I spent Monday in the Accident & Emergency department of Whitechapel Hospital with a friend who has been depressed for almost two years and has been steadily falling into suicidal thoughts yet when she approached her GP months ago and cried in his office while telling him about how suicidal she was he merely handed her a leaflet and told her to refer herself. After a rejection like that it was weeks before she was able to pluck up the courage to call the people on the leaflet, only to be told that someone would call her back within 24 hours and no one did. Later we discovered that instead of calling her back they had called her GP as they had deemed that she needed more immediate help and they had told her GP to call her and provide that support. Her GP never called her. Once again faced with a rejection from the system she spent another few weeks battling suicidal thoughts and fighting with herself to prevent her from cutting herself (so that she could "prove" she needed help). Feeling that what she was dealing with wasn't "serious" enough to warrant a visit to A&E she instead went to her local walk-in clinic who had to tell her that they weren't equipped to deal with such things... At what point does it become "serious" enough to visit A&E? The minute you feel suicidal. That's it. There's no wiggle room or 'maybe I'll feel better in the morning.' If you're feeling suicidal you need to talk to someone about it and you need to talk to them about it then and there. That's why we have the emergency walk in services for mental health. And the more people who use them the better; because talking to someone there and then in that precise moment in time may prevent a suicide or a suicide attempt; because it may circumvent a full-blown mental health condition from occurring later down the line; because the more people who use them the more the need for them will be recognised and the more funding can be secured for them.

Throughout 2016 the BBC have been reporting on various aspects of mental health including diagnosis, care, facilities and underfunding:

We need to start changing the conversation around mental health. Yes, being in a depression is horrible, but it's not the end of the world and you do come out of them. The more you focus on how horrible it is and how much you'd like it to stop the less time you are spending on having a conversation with yourself about why it's happening in the first place. You and only you are responsible for your mental health, if you don't tell people you're struggling they're not going to have any idea and they can't help you. It's not like having a fever or a broken arm - people can't see into the mind and witness all the twisted things that are going on inside. They'll either think that you're having an off-day/week/year if it goes on longer they'll just assume that you're a moody person, that you're an introvert, that you like to keep yourself to yourself. The longer you leave matters of the brain undiagnosed and untreated the worse they become. Imagine you have a broken leg; you splash a bit of cold water on it, maybe go lie-down in a dark room for an hour, cover up the pain with some paracetamol and hope for the best. Eventually the wound is going to become infected, the bone is going to set in the wrong place, walking is impossible, you're in constant discomfort, pain, irritation. You stop going to work, you hide in your room, you don't want anyone to see the horrible mess that is your leg. Eventually you drag yourself to your GP's office and they make an appointment with a specialist and tell you to go home and wait for the letter, they don't know how long it's going to take. It takes 2 months to arrive. You see the specialist, they ask you to make notes about the changes in the colours of the bruising and the weeping of the wound and keep a diary of what your range of motion is with the leg on a daily/twice daily basis... You come back two months later with your diaries and notes and they tell you: you've broken your leg, it hasn't set properly, it's hideously infected because you didn't get it seen to sooner, they make an appointment with another specialist and you have to wait for three months to meet them just to find out if there's something they can do to help you, they say no they can't actually help you but they can send your file to another specialist whose remit you do fall under. You wait another three months to meet this next specialist, they say they can help you but they're very busy and they don't have any spaces available to fit you in at the moment and they'll send you a letter in nine months to one year with the details of your first treatment appointment. They promise that if an opening comes up sooner they'll be in touch. All this time your leg is growing worse and worse, it's a dead-weight latched onto your body that gets heavier and more grotesque with each passing day.

How much easier would your life have been if you'd gone to A&E to begin with? How appalling was the service that you received? Would you stand for it?

Now imagine that instead of a broken leg, an illness has taken root in your mind. Now take yourself through the exact same stages laid out above. That's what using mental health services is like for too many people. This has been my experience of using mental health services over the past eighteen months. I'm still waiting for that last letter outling the details of my first therapy appointment. On average it takes 10 years from initial mental distress for a person to seek help, by the time they have sought help the problem is already deeply rooted. We need to make a change in the way we think about mental health, we need to stop side-lining it and saying "it's okay, it's just in my head, I'll be fine." The longer you leave it the bigger it grows, the deeper it sinks in its claws, the weaker your grasp on reality becomes, the longer it takes to find the right treatment for you, the longer your healing process takes, and, the more likely it is that you will harm yourself while waiting for help.

Seeing the world in a different way to other people is nothing to be ashamed of. I think that that is the biggest hurdle for people with burgeoning mental health problems. They don't want people to think they're 'crazy.' They're afraid they'll get locked up in an insane asylum and that their lives will be over. That they'll be injected with drugs and abused by staff and turned into zombies. So they keep quiet. A lot of us have been raised to believe that there are things that are polite to talk about and things that aren't. Financial and emotional crisis's fall into those categories. It's not 'nice' to ask how much someone makes, or what their turnover is, or if they can afford to feed themselves and their families tonight. It's not 'nice' to pry into people's minds and really and truly ask them how they are coping after the loss of a loved one, or their job, or their house. Being 'nice' basically equates to ignoring your fellow human beings and pretending like we're not all in the same boat, that we don't all have the same issues and struggles. Being 'nice' basically also means that we make everyone around us feel worse because while they're struggling to maintain a façade of wealth and happiness they believe that for you it's not a façade, they believe that you've got it all, that there's some kind of secret to success and that if they work hard enough and put in enough hours they'll find the secret too.

There is no secret.

Everyone is struggling with something. None of us have achieved total health, and by TOTAL health I mean:

1) Nutritional
2) Emotional
3) Mental
4) Sexual
5) Physical
6) Social
7) Spiritual
8) Medical

How healthy are you in these eight areas? What changes do you need to make to your life to make you as healthy as you want to be in the areas that you most want to be healthy in?

Are you currently depressed or do you ever gets bouts of depression? Think about why? What part of yourself are you ignoring or suppressing? Why are you doing that? Keep asking yourself why. And if asking yourself isn't enough, get other people to ask you why. Volunteer as a patient to psychology students, ask your GP to refer you for therapy. Do something about the way you feel. Don't buy into the "Keep Calm and Carry On" mantra.

It is your life and only you can be in control of it. Don't give that control away and don't wait till it's almost or too late. Do something about your mental health now.