Here is a list of just some of the many problems I’ve experienced using (NHS and council led-social care) mental health services:
1. Astronomical waiting lists. I don’t know if you can use that adjective in that phrase but I’m sure regardless everyone will understand the meaning I’m trying to convey! Some examples: The first time I was referred to counselling I had to wait around 3 weeks and that was fast-tracked by CAMHS as I was viewed as being at-risk, otherwise it would have been at least 3 months. In Leicester I had to wait 2 months for an assessment by the Open Mind service and then a further 4 months for my first session, which was with a different therapist so was basically a repeat of the assessment as this therapist had no idea of my history etc. It was around 8 months after I was first diagnosed with depression (including the acknowledgement that I was at-risk of severe harm to myself) until I was first prescribed anti-depressants. I’ve also been unable to see a GP on the day when I’ve suddenly become particularly ill which includes being therefore unable to get a prescription of something if I’ve ran out of a medication – it is very difficult for someone like me to go to an unfamiliar setting like a walk-in centre to be seen for medical care and absolutely impossible to go without chaperoning which further limits my independence with regards to trying to manage my health.
2. Lack of continuity in care. You get passed from one person to another constantly. Sometimes this genuinely cannot be helped (e.g. a member of staff actually leaves entirely, or someone is off sick etc) and I do understand that but it doesn’t make it any less of a problem for service users. Over the last few years I have seen about 6 different therapists, 3 different psychiatrists, 3 different psychologists, 1 psychiatric nurse, 3 social workers, a bunch of nurses and healthcare assistants in hospital, and I’m not even going to attempt to count the number of GPs. Every time you have to repeat your entire story which is painful and exhausting. Your treatment becomes fragmented, you can’t build up trusting relationships with your healthcare providers, the uncertainty of everything makes you more ill.
3. Medication. Where do I even begin? I’ve only ever been on one anti-depressant. It was what was offered to me, and I agreed and went on it. There was no discussion about different anti-depressants/different classes of anti-depressants so I could make some kind of informed choice, there was no talk about specific side effects. I have also found that if you do your research properly beforehand, go in to see the GP and request a particular medication, if you sound authoritative enough they will generally just write you the prescription (albeit warily) to see the back of you. I’ve had to do this with diazepam as tentative efforts to get a benzodiazepine described were getting nowhere and I knew that was what I needed and what would benefit me. However GPs often weren’t even willing to have a mature conversation about this class of drugs, their benefits and risks etc, just didn’t want to be ‘that GP’ that puts a young woman on a benzo. Also sometimes it’s difficult to get your medication on time when you have poor management of your stock as a result of your ill-health, then you ring and are told that it’s your responsibility, the GP has no time to talk to you today so you just have to wait and call up early the next morning. Not disastrous in most cases but definitely harmful. Now this latter wouldn’t be a problem if my drugs were put on a repeat prescription for me as some of my medicine is – I then get a text from my pharmacy to tell me when it’s there and ready to be collected. My old surgery used to have my anti-depressant on repeat so I could call up and order it every month. My new surgery however will not allow that, same with the diazepam, so I have to remember to book at least a telephone appointment with a GP every month just to ask them to print out a prescription. I then have to go to the surgery, and then the pharmacy, both of which are in completely opposite directions from each other. It usually takes me like 3 days to fill this process: Day 1), Order the medicine from the GP surgery. Day 2) Collect prescription from surgery – sometimes I need chaperoning, sometimes I absolutely can’t and my partner will have to go alone himself. Day 3) Go to pharmacy to collect medication (same conditions as above). Anyway this all leads me to the next point:
3. Lack of medical consensus. I know there are loads of people who go in to see a GP about feeling low and sheer coincidence of who they are seeing determines their treatment. Some GPs are strong believers in anti-depressants (particularly SSRIs) and that is their first port of call, with nothing else. Others are simply more interested in “come back in another few weeks if you feel the same and in the meantime read up about stress and try to exercise more”. Other people believe more in therapy and want the service user to try that before medicine, still others think the medicine is useful at least until the therapy begins because of waiting lists. Some doctors will happily hand out benzopdiazepine prescriptions like sweets and others will absolutely unconditionally refuse them. This lack of consensus, does not exist with regards to physical health or at least not to such a ridiculous degree. It is truly baffling to me why this should be the case if all GPs are taught to practice evidence-based medicine. Obviously individual circumstances need to be taken into account and definitely the person’s wishes however I’m sure I would have benefited from some kind of medication when I first started presenting to my then-GP with extreme anxiety instead of having to wait 3 months to re-start counselling. I could very rarely leave my house yet was refused medication and had an agonising 3-month+ wait until anything started to improve. In my opinion this was poor clinical judgement driven by personal beliefs about when psychiatric medication is appropriate rather than evidential medicine.
4. Lack of follow-ups. I know GP surgeries are busy and with the recent healthcare reforms they are generally getting worse at doing EVERYTHING not just mental-health related things. However I think follow-ups are particularly important for known mental health sufferers. It surely can’t be too difficult for GP receptionists to have an alert system on their computers to alert them when a known mental-health sufferer misses a GP/therapy appointment or is discharged from a service for non-attendance, or fails to request their prescription on time etc. This could be dealt with quickly by the receptionist calling the service user to just ask if they are ok, if they would like to speak to a GP about anything and if so they can be booked in. I don’t think people realise how beneficial this could be for us. It is really difficult for some of us to keep appointments. I’ve missed loads of GP appointments, therapy appointments, or cancelled things at short notice, I was discharged from physiotherapy last year which I really needed for 2 consecutive non-attendances. It always makes me feel insanely guilty, but then I usually forget or don’t feel motivated enough to reschedule them. Any treatment I need then gets delayed, problems can therefore get worse etc. However nobody ever calls or inquires as to why that might be, as to whether I am just health now and no longer need the appointment and can’t be arsed to cancel – or as to whether I’m holed up in my room, crying my eyes out and sedated by misusing medication feeling that nobody is interested in aiding my recovery.
I could go on but I’m getting a headache so I’ll stop here for now. This is my lived reality and I can only really speak for myself but I do know many other people who have reported similar issues.