Left Waiting at Crisis Point

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.

A Mental Coach

At last, back to some sort of terra firma with the blog and an opportunity to combine the Tour de France with mental health*. Argos-Shimano’s Koen de Kort has been writing a diary for the Financial Review during this year’s Tour and in his latest entry looks at the imminent loss of his “mental coach” from the team. What is a mental coach? de Kort eloquently explains the role Merijn Zeeman has played in his cycling. The way he describes Zeeman as a friend underlines the importance of having the right fit of people around you to support your psychological well-being.  So is de Kort weak or fallable? As he says:

I’ve found that a lot of people think that a mental coach is only beneficial for athletes with mental weaknesses, but I’ve come to realise they can help all athletes at any level.

Which just goes to show how none of us should be complacent about our mental well being and how letting others in can be beneficial.

Koen de Kort’s article can be viewed at http://www.afr.com/p/lifestyle/sport/cycling/koen_de_kort_diary_second_rest_day_PnGx0GOE6chenddGeslRrO

* Thanks to @melaniebbikes for bringing it to my attention.

Admission is more than half the battle

Dealing with the inner gremlins first requires self recognition, though preferably before the problems get too big.

On firing up the computer this morning I noticed this tweet from Adrian Timmis

Every athlete should read this, male as well as female RT @Hollie_Avil: I’ve decided to end my career as a triathlete.. http://t.co/OpFpzCdf

Out of curiosity I took a look. Although Adrian’s tweets are always informative and interesting I had my suspicions it would be about training, coaching or worst still saddle positions. So I was even more pleasantly surprised to read Hollie Avil’s story of how the pursuit of her sporting dreams led to misery. As she says herself

Don’t get me wrong. I have had some amazing experiences in triathlon. I leave the sport as an Olympian, a double world champion, a national champion and also someone who was once ranked world No 1.

But those great times do not outweigh the miserable times. I don’t want to risk my health again, not just my mental health, but my physical health.

I want to be happy.

For me this article is important for three reasons. The first is that, again, it highlights the role that expectations – and especially the expectations of others – play in shaping who were are and what we become. The second is the feelings of isolation that are brought on by both the cause of the problems (in this case the expectations of coaches as well as the feelings of lack of control) and . But the third, and for me the most poignant, is the role that self admission plays in finding a way out. Whatever the problem, without owning up to it yourself there are few ways to let others in who can help, especially when the problems are often locked inside your own head. But with alarming familiarity Avil admits that her cry for help cam, if not too late then at a point which made dealing with it harder.

In February 2011, I finally made a cry for help, admitting everything to Joce[Brooks]and my parents. This time I was too far gone and we had to work so hard to get me better.

Admission is much more than half the battle. By the time you’ve reached that point the problems feel ten, maybe a hundred times worse and the way out seems so hard. It can feel like you’re being attacked from all sides. But in admitting to these problems yourself you open up a world of possibilities even if they don’t seem so clear at the time. I know, I’ve been there and some of you have been with me on all or part of the journey. So here are some words of encouragement:

I believe life has chapters and this is the end of one of mine.

Although I am sad to be hanging up the race shoes, I’m proud of what I’ve overcome.