The UK’s Mental Health Crisis
By Myles Cook
THERE is a crisis regarding mental health in this country. It is wide spread and wide ranging in the various elements of the subject. It is also getting worse rather than better.
Despite their claims to be giving the mental health service an injection of much needed cash, the Tories have simply robbed Peter to pay Paul by syphoning some cash from physical health services meaning that a cash-strapped physical health service is losing money at a time when it needs it the most. This smoke-and-mirrors approach to looking like the Tories give a damn about mental health is laughable and, unfortunately, gullible voters, most of whom don’t know the first thing about mental health, are falling for the ploy. It also shows that the Tories are only paying lip service to their claims that they are giving mental health parity of esteem with physical health.
Mental health services have always been notoriously underfunded, even during the last Labour administration, but the Tories have gone one better than that since taking power in 2010 – they have actually cut mental health funding whilst trying to convince everyone that they have increased it. At a time when mental health services are even more in demand than in the past, thanks to the global financial crash in 2008 which caused many job losses that, in turn, caused an increase in depressive episodes amongst the usually mentally healthy members of society and the increase in ever more desperate breakdowns in mental health brought about by the cuts to the welfare budget, dressed up as welfare ‘reforms’, courtesy of the Tory austerity agenda (a seemingly innocuous terminology for the process of social engineering leading to the early deaths of thousands of claimants), this cut in funding to the mental health service is at odds with the mental/physical health parity that the Tories have supposed to have brought.
To take a local example, before its merger with the North Essex Mental Health Trust, SEPT’s psychotherapy team was cut by 50%, leading to even longer waiting lists than they previously had. Group therapy, which was once offered in durations of 18 to 24 months, was reduced to ‘intensive, focussed’ six-month offers, which is barely a sticking plaster to people with long term mental ill-health or complex mental health conditions.
I enter into evidence at this point a quote from a letter from the therapist who ran my group therapy group that shows the point I just made about the sticking plaster approach being forced on the local mental health service:
“Mr Cook was a reliable member and tried hard to participate in the process but was often hampered by his over-riding disposition of deeply embedded anger outbursts and inner state of depression.
“I have met with him after a three month gap for a Post Review. He was appreciative of the time spent in the group but still feels that he has not resolved his long term history of mental illness. He continues to try but he feels that his lack of social skills prevents him from socialising freely and making strides to move on. He continues to try.
“His physical health and mental health have left him frustrated because he feels stuck which feeds into morose feelings of despair.”
The last therapy I was offered was in January 2016. It lasted six months. I have been on the waiting list for one-to-one therapy for over two years. There is no sign that I’m any closer to getting it or even being offered another load of group therapy.
Even before the merger with the North Essex mental health trust, SEPT was struggling to provide a consistent service in South Essex, leading to a postcode lottery as to whether you got a good service or not. However, after the merger, resources were diverted to North Essex which was failing prior to the merger, making the service in South Essex even more inconsistent and stretched to breaking point. Part of the problem was that a former Chief Executive of SEPT was an empire builder and stretched out his hand to take on mental health services in Bedfordshire and Luton and community physical health services in other areas rather than concentrating on providing a consistent service in South Essex like he should have been. His failures were compounded by his successor who ran the trust like an accountant rather than concentrating on the quality and consistency of the service provided.
To bring the discussion back to my own personal situation for a moment, as a means of providing some fact-based evidence from my own experience, I will offer the following fact – I should be seen by my consultant psychiatrist (or one of his team) every three months at Grays Hall Outpatients Department; my last appointment was over a year ago.
Grays Hall is also the focal point of another problem with the consistency of mental health services – a high staff turnover. SEPT, prior to its merger with the North Essex Trust, had posters boasting that service users would see the same doctor “as usual”. At Grays Hall, some people were lucky enough for that to be a fact but many were not due to the high staff turnover. Being so close to the boundary for London weighting, staff tended to view Grays Hall as a stopping off place before they could get a more lucrative job closer to London. They were ideally placed to keep an eye open for those more lucrative jobs which was fine for them but wasn’t conducive to building the sort of client/doctor relationships that people with mental ill-health rely on. It is counterproductive if a person with mental ill-health is forced to re-tell their life story to a new doctor each time they go to an appointment because the doctor doesn’t know the patient and, more often than not, hasn’t read the copious notes written by their predecessor.
The statutory mental health services aren’t the only problem, however, as so much funding for voluntary organisations is dependent on getting their service users into work that a schism has opened up between service users. On the one side, there are those whose mental health allows them to do some kind of work and get a lot of help and, on the other side, are the people who are left dependent on the table scraps left to provide services for them. There seems to be no middle ground to provide services that would actually help people suffering with mental health issues live more independent lives with a modicum of support. You are either completely dependent on the services provided or you barely need help because you are able to work.
The sticking plaster approach forced on the statutory services also tends to build a dependence on the services they provide because they get a patient well enough to be discharged but not well enough not to fall back into crisis.
Another problem with mental health services, both statutory and voluntary, is the lack of empathy for sufferers and understanding of the realities of living with a long term mental health issue. Psychiatrists see mental health issues as simply a list of diagnostic criteria and nothing more which is understandable in a way as there has to be an objective measure of what is or is not a mental illness but leads to a lack of empathy which, in turn, leads to them not asking the right questions to get a full picture of the sufferer’s mental health. To take myself as an example for a moment, it took me eight years to get my consultant to actually believe that I had a long term depressive illness because he asked the wrong question at the outset of every appointment I had. I became so fed up with him not addressing the issues I wanted to speak to him about that I wrote down how I felt every day of my life on just over a side of A4 paper and refused to talk to him until he read it. I came out of the appointment with a diagnosis of recurrent depressive disorder, a secondary diagnosis of dysthymia and a brand new diagnosis of a previously undiagnosed personality disorder. I have since been diagnosed with another personality disorder.
However, just let this fact sink in for a moment – it took me eight years to convince my local psychiatrist that I had a long-term depressive illness despite going to him with a diagnosis of depression from a psychiatrist in London following my breakdown at work in 1997. Is it any wonder there’s a mental health crisis when even the experts don’t know what they’re doing?
This lack of proper mental health training with an emphasis on empathy is a major problem that doesn’t look like being addressed any time soon.
Another problem is the lack of what I call ‘collaborative practice’, the method of encouraging a mental health service user to become as much a part of creating the solution to their mental health issues as being a recipient of services.
There are places in the UK where mental health service users are actually running services themselves with only minimal back up from mental health professionals. Leeds has a crisis service run by service users and it is enormously successful and there are other examples including a ‘crash pad’, a place where service users can stay when they are in crisis rather than going to hospital, taking them away from the source of their problems but not giving up total control of their lives to statutory services. There were no examples of this in Essex when I was involved in the mental health service user community so this might have changed in the last couple of years although I haven’t heard of any such projects. In fact, I proposed a service user led organisation myself back in 2012 that the Essex mental health commissioners seemed to love the idea of but they wouldn’t even give us some funding for some public meetings to drum up support in the service user community so the idea died on the vine.
Yet another contributing factor to the crisis in mental health in Essex, at the very least, is that the mental health commissioners put funding into the services that are the least successful in helping the service users, starving potentially helpful projects of funding. “Making Involvement in Essex” was a three year project that trained service users to go out and do research for the mental health commissioners. We came back with a surfeit of information from across Essex on what service users would find useful in coping with their mental ill-health, most of which would have been relatively cheap and would have fed into the ‘collaborative practice’ method I outlined earlier. Everything we came back with was ignored by the commissioners and they ended up funding the same old services that were already failing to produce the best results.
Finally, a major factor in the mental health crisis engulfing the UK is the public perception of mental ill-health. This is characterised in two ways – 1) a general ignorance of mental health issues due to an unwillingness to learn the true facts about the different illnesses and how those illnesses affect a sufferer, and 2) the well-meaning but, in some respects, counterproductive testimonies of celebrities who suffer with mental ill-health that gives the impression that such conditions are only suffered by certain types of people – creative types, etc. – or that mental health conditions aren’t as disabling as they can actually be.
It might be best for mental health awareness training to be made mandatory to all non-sufferers and that the training should be provided by sufferers themselves and for celebrities to start to take a back seat in the arena of public debate on mental health so that people with more disabling conditions can provide a more accurate picture of mental ill-health. Having real people with disabling mental ill-health talk about their conditions might help remove the myth that people on benefits due to psychological disorders are fakers, scroungers or “parasites” (as one commentator calls us). It is a vain hope, I suppose, but one I would like to see happen.
To digress for a moment – if anyone would be interested in reading an article on what it’s like to have severe depression from the perspective of a sufferer say so in the comments section and I’ll consider writing one. Or, better still, if you have a group of people who’d like to know more about depression from the perspective of a sufferer, feel free to pay me to deliver the training session I created and if I get enough bookings I’ll be able to come off benefits and have a chance at some self respect.
Given the crisis within mental health and, specifically the local problems with the mental health services, one would be forgiven for thinking that Thurrock is especially lucky to have as our MP the Minister for Mental Health and Suicide Prevention but Jackie Doyle-Price just stands around doing nothing, not caring about or understanding her remit or championing the cause of mental health. She simply goes about trying to find her latest photo opportunity and ignores the concerns of the people she is supposed to represent, both her constituents and the UK’s millions of mental health service users. She stands in eerie silence regarding the effect of welfare cuts on the suicide rate which has seen a dramatic increase since 2010 despite being responsible for suicide prevention.
We should be lucky to have access to the Minister for Mental Health and Suicide Prevention but we aren’t because she just doesn’t care.
One of the things that I liked about Jeremy Corbyn when he became Leader of the Opposition is that he democratised PMQs by including questions he received from the public. In that spirit, given that we have the Minister for Mental Health and Suicide Prevention as our MP, I asked a mental health group on Facebook if they had any questions for Jackie Doyle-Price, below are the questions and comments I received (all of which are direct copy-and-paste quotes including any errors in spelling, punctuation, etc.):
1) What measures are being put in place to stop people ‘slipping through the net’?
2) Do you think it is acceptable to make a joke about Beachy Head considering the number of suicides that occur there?
3) If someone is threatening suicide what is going to be put in place to prevent it?
Case study: “patient told psychologist several times that on a certain date they were going to attempt suicide…patient was referred to crisis team on the date the patient had stated yet was not seen in a timely manner, stating they could not be seen for 5-8 hours later despite patient asking for earlier time.” Patient then ended up in ITU due to severe overdose.”
4) My question would be ‘are you here to promote suicide? Is that your real agenda? Is Universal Credit a developed nations’ form of genocide, using economic means instead of physical ones to force the poor and disabled – particularly those with mental health problems – into suicide, thus saving the government money as they don’t even have to spend on a bullet or rope?’
Forcing disabled people onto universal credit, where they have no money for rent, heating or basic sanitation and no food to take their meds with, is not going to make them magically cured and able to work. It would make a healthy person sick with depression never mind someone with mental health problems to start with.
5) Please ask her why she is unwilling to answer emails offering help from myself that she has read and then not responded to in any way. Since then my MP has sent the discussion paper to her boss Matt Hancock Secretary of State for Health. The plan involves investment which will be self-funding as Mental Health is proven to be costing the country up to £99B in lost output. (Alastair Deards)
I’ll leave the final word to this poster whose comment sums up the situation beautifully – “do us all a favour and resign your post. as she is one of the most inappropriate appointments to a ministerial position since Tony Blair”.