Mental Health Services : A Clients Experience

Today, there is a much greater awareness and, to some extent, acceptance of mental health issues. It is as wide a spectrum of syndromes, disorders, disabilities,....as light. And as with light, some are clearly visible, some are only visible under certain conditions, while others are invisible. Just a glance at the Table of Contents of the DSM (The Diagnostic and Statistical Manual of Mental Disorders) or the ICD (International Classification of Diseases) section on Mental Disorders, gives an insight into the amount of, what I'll call, mental disorders. In combination, there are almost infinite diagnoses, for instance Post Traumatic Stress Disorder leading to High Anxiety related Substance Misuse causing Psychotic episodes.

Now, not holding a PhD in Psychiatry or Psychology, my lack of knowledge of terms and causations may be obvious. But having suffered with higher and lower levels of Depression, Anxiety Disorder, Paranoia, along with Alcoholism and Substance Use since my late teens, I do have the lived experience of these disorders, and of the treatments offered. At University I was offered low level anti anxiety/depression medication and a course of psychotherapy and hypnotherapy. From there I was prescribed Propranolol and Paroxetine. Then Fluoxetine, Venlafaxine, Mirtazapine, and back to Fluoxetine, with added Quetiapine and Diazepam. I've been referred to my Community Mental Health Team, their Crisis Team, Improving Access to Psychological Therapies (IAPT), private counselling, charity group therapy and addiction services.

Services have become much more accessible over the years. But it is very hit and miss. Waiting times for an initial assessment seem to be dropping, but after that, the wait to actually start therapy can be months. And depending on where you live will determine what therapy is available. Different Health Trusts have different priorities for their funding. At the start of IAPT, which is what is usually offered from a GP, along with medication, clients are filtered through any number of therapy channels until the right one is found. This can be a frustratingly slow process. Even if you know a certain therapy is not right for you, you are advised to finish it before you are filtered to the next channel. If you move from one trust to another for any reason, you are expected to start their IAPT programme from the beginning. At each level of therapy, there seems to be a 'Gatekeeper' system that decides which filter you take next, what you are suited for, what is available or whether you qualify. The client's pathway is usually decided for them, rather than them being asked.

I understand that this is how the NHS are dealing with the nation's mental health issues. I know that the NHS is being stretched beyond breaking point. My local IAPT service offers initial assessment, then 6 to 9 weeks of counselling. Clients are then signposted to peer support or charity groups. And that is, sort of, that. Now, for some clients, this is just what they need. It gives them the support they need to negotiate difficult periods, introduces effective coping strategies and tools to work through their issues. However, I found myself needing more. I had understood the mainly Cognitive Behavioural Therapy (CBT), but what I needed was to talk. A lot. I had ideas of long term "lay down on the couch and tell me of your childhood" kinds of therapy. But this just wasn't available on the NHS, and I understand why: the cost, and no assurance of efficacy. I was left with my CBT tools and an ever changing cocktail of medication. I levelled out for a while, coping but making no headway into actually solving my problems. Eventually I spiralled down to the point of suicidal thinking. I knew where, I knew how. Luckily, I saw my doctor and he referred me to my Community Mental Health Team (CMHT). They assessed me but because I hadn't acted on my plans, they offered no further help. In short, I had to actually try to kill or harm myself before they could help. When I asked why, they said "...resources...". Instead they referred me back to IAPT to start the whole cycle again! The only way I could access the therapy I wanted was to go private.

Now, finding a counsellor/therapist wasn't hard. There are lists of local practitioners online. What was difficult was the price. Most in my area charged upwards of £40 an hour. Way beyond my means. Some offered concessions, but this was still £25 an hour. I did, though, find a local counselling college whose final year students practice in order to gain experience. And it was here that I was first asked what I wanted from my therapy. I said "I just want to feel comfortable in my own skin." I was given an initial course of 12 sessions and then a further 12 after re-assessment. This was provided on a 'pay what you can' scale, and I paid £10 per session. Here I was given the time to meet, get to know and, most importantly, trust my therapist. Loosely structured, I was allowed to lead the therapy, let my mind (and my mouth) find its own way. I was given time to think, to find the right words and expressions. Here I didn't feel as is I was being channelled or filtered, no-one was imposing a therapy onto me, I was choosing my own, with guidance of course.

The NHS only has the resources to offer this type of open ended therapy to its most critical clients, those most at risk. My issue is not with the providers who are constrained by lack of resources. I have spoken to some who say they have often had to sign clients off but wishing they could give more time. There is a heightened awareness of mental health issues these days and this can only be a positive thing. But with this increase come higher numbers of clients to cater for. The IAPT method, my local one, allows clients to be seen quickly. This means numbers don't pile up on waiting lists, which is always good for Department of Health and Social Care audits. But what matters is the service offered after this assessment. To the general public, numbers of people with mental health issues are being dealt with and managed. But to the service user it can be a frustrating, impersonal and, sometimes, futile experience. To have to try to take your life being a condition of entry into psychiatric care is inexcusable. Clients need more say in their care pathways. Trusts need more resources to deal with mental health. The State needs to stop using broad brushstrokes when dealing with a matter that is intrinsically individual. And, perhaps, societal outlook needs to change so that fewer people need mental health services to begin with. Throughout this Coronavirus campaign we have been reminded again and again the prevention is better than cure. Maybe there's a lesson to be learned about mental health there too.