Mental Health Services on the NHS

Right, okay. I wasn’t sure whether to write any more on depression, because it isn’t easy and I don’t want to bang on and on and make people bored. But over the last week since I put up my post on depression and suicide, I’ve had several people get in touch to let me know how much they’ve enjoyed reading them personally, and how accurate they’ve been to their own experiences, or just to offer me some support. I am so incredibly touched that people have taken the time to get in touch, and it’s made me want to write a little more.

The other prompt for me to write this post is, again, the general media’s sway into pieces on depression and the state of mental health services, particularly in England, in the wake of Robin Williams’ death. Many stories are very negative (see here and here), emphasising cases where people have not been offered enough help, or not enough help in time. Although my own experiences aren’t perfect, they do show that help is there and that if you are lucky, or just very persistent, you can get help even among England’s overstretched and underfunded services. I’m also aware that many people might not be sure if they need to speak to a doctor, or be frightened of what would happen if they did. This blog is for you, to show you what can happen and what you can expect.

Several people in the medical profession were involved in my eventually going to a doctor and getting some help when I was at a very low point. The first was a pharmacist. I was at my parents’, had been taken ill with a stomach bug and wasn’t getting any better because every evening the thought of having to go back to London and to work made me nauseous again, so I couldn’t eat, and my stomach is ridiculous and makes me throw up when I get overhungry, meaning I stayed weak and queasy. I was waking up at 5 or 6 and lying there feeling too sick to do anything other than lie on my back- the kind of nerves you get before a major event, only I wasn’t due to do anything. My Dad went to a local pharmacist to see if they could suggest any anti-nausea pills. All they could give him were Kalms, but they did say the waking early could be a sign of depression and I should see a doctor. My parents were very concerned but trying not to show it. They didn’t realise how unhappy I was until they saw how destroyed I was at the idea of having to go back and carry on. I made a doctor’s appointment, and went back to London.

Thankfully for me, the doctor I saw was the absolute best of her profession. I told her about the stress and the early mornings, and she disappeared to get me a questionnaire they give patients to ascertain if they are just a bit down, or if it’s something worse that needs to be looked into further. This is the questionnaire:

Over the last two weeks, how often have you been bothered by the following problems, on a scale of: Not at all (score 0), several days (score 1), more than half the days (score 2), nearly every day (score 3):

Little interest or pleasure in doing things?

Feeling down, depressed or hopeless?

Trouble falling or staying asleep, or sleeping too much?

Feeling tired or having little energy?

Poor appetite or overeating?

Feeling bad about yourself- or that you a failure or have let yourself or your family down?

Trouble concentrating on things, such as reading the newspaper or watching television?

Moving or speaking so slowly that other people could have noticed? Or the opposite- being so fidgety or restless that you have been moving around a lot more than usual?

Thoughts that you would be better off dead, or of hurting yourself in some way?

Add up the total. Depression Severity: 0-4= none, 5-9= mild, 10-14= moderate, 15-19= moderately severe, 20-27= severe. (Source: http://www.patient.co.uk/doctor/patient-health-questionnaire-phq-9)

Probably this isn’t a perfect questionnaire, but if you are reading it and scoffing, take your scoffing elsewhere. It helped me enormously, forcing me to evaluate my own feelings and how often I had them, and I don’t want to hear that this may not be positive proof of depression. If you are suffering from several of these things, the majority of the time, chances are you’re depressed.

I came out of the questionnaire as moderately depressed. We talked about my situation, and it was the most in depth conversation with a doctor I’ve ever had. She typed everything I was saying into my notes, and it was during this conversation that I told her things that had been troubling me for a long time and which persuaded her that, depression or not, I needed to talk to somebody.

But before that, she wanted to make sure there was nothing else wrong with me that might be contributing to the low feelings and the stress. She sent me for some comprehensive blood tests, and booked me an appointment for the following week- even walking out with me to the front desk so she could make sure I was booked in, and booked for a double appointment so I wouldn’t completely screw up her appointment timetable for the rest of the day (I’d been with her for 20-30 minutes). She is an extraordinary doctor.

The blood tests showed that I had an underactive thyroid which can cause low moods, lethargy, and weight gain. She put me on some thyroxine and told me to come back in two weeks to see if it had made a difference to my mood. I think at this point she had also already referred me to see a counsellor. The way the system works, the counselling services are meant to call you soon to book an initial assessment, within the next week or two, and then after that you should see a counsellor within about 6-8 weeks.

The thyroxine made no discernible difference so I was put on Citalopram, a very common antidepressant. I hadn’t had a phone call from the counselling services so my doctor called them, and when they didn’t respond to her call, she wrote. Thanks to her persistence I got an appointment for my phone assessment easier than perhaps I would have done. It was the run-up to Christmas so very likely they were even more busy than usual.

If you have one of these phone assessments, brace yourself. They are not fun. You’re talking to a stranger, albeit a lovely and sympathetic stranger, but still a stranger and, in my case, you’re sitting in the office while you’re doing it hoping the door is soundproof. They ask you a lot of personal things, perhaps things that you never normally speak about but which you would want to work through with a counsellor. It’s a bleak experience and I felt drained, exposed and tearful afterwards. Happily my office was very close to an excellent bookshop, so I went out at lunchtime and bought a beautiful hardback of Sense and Sensibility to cheer myself up.

That phone call is the first major flaw I came across in this system. Difficult as it is, it would be fine as long as it served an obvious purpose. But when I got to see a counsellor, the contents of that phone call had not got through to her. I had to tell her all over again why I was there. So why do they do it? I’m not really sure. Presumably it is necessary for some reason, but I would love to know what is if any of you know. Perhaps it’s necessary if you’re referring yourself for counselling, rather than through a doctor? I don’t know.

The six to eight weeks waiting time to see a counsellor turned into about three months. By the time I got to see someone I’d already fallen (metaphorically) flat at work and gone on sick leave. I was living at home with my parents. Thankfully, as I still had my London flat at that point, I could stay registered with my doctor and travelled to my counselling sessions. Otherwise I would have had to take myself out of the London system, register with a doctor in Suffolk and get put on their counselling waiting list instead.

I’ve already said that the antidepressants didn’t work for me. They made me nauseous and stopped me getting hungry, so I started taking them in the evening but they disturbed my sleep and gave me vivid, strange dreams which were difficult to throw off the next day. I was eventually told you shouldn’t take them right before bed because they contain something or other that is bound to disturb your sleep. But by then I’d made my mind up to come off them anyway. I was feeling better but I knew it was because I was taking a break, and talking to somebody every week. The counselling was excellent and I was lucky that the place they sent me to also did a concession for students and the unemployed, so you could get a session for £15, meaning I could carry on after the ten weeks the NHS gave me for free. For many the ten weeks would have been enough, but I needed more. Unfortunately without the concessions it would have been prohibitively expensive.

So that’s how it all worked for me. There is a system but it took me going to the doctor just to talk about the stress and the sleeplessness for the doctor to act. I had been once or twice before and tacked on at the end that I wasn’t quite right. One doctor did ask me if I thought I was depressed, to which I could only say I really didn’t know. Another flaw, I think, in the GP services is that since then, I’ve registered with a new doctor in London and although they have access to my (comprehensive) mental health history, they haven’t asked why I stopped the antidepressants or how I’m feeling. I think the patient has to go willing to talk, but many doctors seem to think if you’re not bringing it up, you’re okay, and clearly that isn’t always the case. The waiting times for counselling are clearly too long, and more money needs to be put in to that. The pills work for some people but if there’s an underlying reason why you’ve ground to a halt, then pills aren’t going to solve that for you.

Although there are flaws in the system, I did want to tell a story which isn’t just about despair and nothing working, frustrated patients and overtired doctors. There are many people who helped me to get better, and I want to thank them all. I hope this will help some people to know what to expect, and what they need to put in themselves to get the help they need.

Another place which is very good for personal support is the charity SANE. You can talk to people over the phone or on email, and they offer a text messaging service so you get sent supporting messages at times you think you’ll need them. It’s a lovely online community and very useful to help you feel you are not alone. Depression is a phenomenally isolating illness but you can get help, and you can get better. http://www.sane.org.uk/

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