The Schizophrenia Commission published its report this week. Entitled The Abandoned Illness, it looked into the care provided to patients with schizophrenia, concluding that provision is falling “catastrophically short” of what is needed. It found that care tends to follow a prescribed, narrow focus which treats many suffers as likely to have the same, often assumed to be violent, symptoms. It claims that too many patients are inappropriately admitted to secure units at a high cost to both the tax payer and themselves. Overall it suggest more appropriate care can be given which meets the individual needs of patients. The chair of the Commission commented that:
“If you have psychosis and your mind is disturbed, you need a period of respite and calm…But especially in inner cities, you get admitted to something like a madhouse. The nurses are often overwhelmed.”
The need for ‘a period of respite and calm’ is familiar to many of us with our busy lives. Yet these findings should not be surprising to many people who have sought mental health help through the national health service. From personal experience I know how it can leave you waiting at crisis point only for the prescription to fall short of what is needed for the best outcome. This is my story.
In September 2009 I went to the doctors. For some time things hadn’t been right: I’d lost interest in the things I liked and loved, I couldn’t take a photograph and I was having arguments with people (often work colleagues) in my head well after the event. I felt stressed, anxious and trapped. I didn’t look forward to the appointment but when I entered the doctors surgery I told him in a round a bout way what was going on. I was more honest than I had been and confronted with a questionnaire answered the questions in a painfully honest way. I spent 45 minutes in the doctors office, we talked openly, I thought that for once someone was taking this seriously. He offered me anti-depressants – a sign of things to come. I told him the week’s holiday I was about to take might do the trick. I left having been diagnosed with depression.
Things didn’t get better. The week away was a blur now and then. I took far too many pictures but rejected them all. And I remember sitting on a Northumbrian beach in tears not understanding why. This pattern got stronger. Back at work I was frantic, trying to do everything, never admitting I felt vulnerable and slowly sinking. By mid-October things were getting worse. I came home and MrsAB told me to phone the doctor, things couldn’t carry on like this. The following day I stood on the platform and waited for a train to take me to a meeting that I hadn’t a clue what I was contributing or doing attending. I decided I needed time out – a period of respite and calm. At that appointment I was signed off for 2 weeks and again offered the drugs. I took the former and decided to mull over the latter. It seemed like a release. But there was still a gap. I had previously spoken to a CBT counsellor at the health centre. I wanted to try it again. But the service had been cut and I was being referred to the community mental health team – and there was a waiting list.
Two weeks later I returned to be signed off for another two weeks. This time I took the prescription. Now the disinterest grew from the GP. I enquired about the referral for counseling and was told it might take some time. I felt like I was now part of the system, I’d ticked all the boxes, said yes to the right things and now I just had to sit on the conveyor belt and wait. Further trips to the GP followed, more prescriptions written yet no movement with the referral.
Then, the week before Christmas, I received a phone call. It was a mental health nurse from the community mental health team. He was phoning about my referral and wanted to know if it was good time to speak. Of course it was, this is what I had been waiting for. Only this was a triage interview. I felt crushed again, he sounded apologetic and throughout the interview it was clear we both hoped for something else. He listened, he noted but we both knew this was leading into another machine. We ended the conversation and he said a colleague would be in touch. I put the phone down and waited. In early January I received a letter, it informed me that I was being offered a computer based CBT course and that a member of the Community Mental Health Team would help me through it. The following week someone phoned and told me more about the programme and what it would do. I’ll be honest, I didn’t hold out much hope but I was willing to give anything a try by this stage. And so I tried it. The package was module based, not unlike an Open University course. You watched some videos and then responded to various questions about how you felt. It didn’t work for me. The scenarios didn’t connect with me and I didn’t have the motivation to sit typing answers to the questions. But importantly the feedback from the whole process just didn’t add anything constructive. The computer package offered generic but to me meaningless outputs. The counsellor phoned – irregularly and without warning, wanting to discuss things without giving me time to prepare my thoughts first. It was entirely unproductive and after a few months I decided to stop wasting all of our time and stop.
I was lucky, throughout all of this I had the means and support to find and see a counsellor privately who could offer me a service which met my needs in a way which made sense. Throughout it all my GPs seemed disinterested in how this was going, prepared to sign prescriptions and sick notes and grudgingly make the odd phone call early on to see where I was on their conveyor belt. Having begun with a positive consultation the process provided by the health service became formulaic, impersonal and increasingly frustrating. I went to the most obvious point of contact at a moment of crisis only to be told to wait for a treatment which ameliorated the symptoms but didn’t deal with the cause. So where physical complaints like heart attacks are treated immediately and with urgency and their causes addressed in the aftercare, the unseen illnesses of mental health are assumed to be something that can be wait to be possibly treated.
As the incidence of mental health problems grow in a society which is increasingly under an expanding range of challenges, stresses and anxieties this is something we need to address now.