Awareness is not enough, and here’s why | mental health

Mental health is one of the social issues most important to me, but I struggle with the awareness week and days. At an individual level, people do as much as they are able – there is talk of parity of esteem and telling people to reach out, and sharing of helpline numbers. Those are all important things, don’t get me wrong, and I’m sure those things are enough to save some people’s lives. There is absolutely nothing wrong with those actions. But what is wrong, is the complete lack of care by the state for the mental health crisis; overstretched services seeing no extra funding, and those with mental health issues being left to their own devices.

The government recognises Mental Health Awareness Week each year, tweeting about it and lighting buildings up green. They mention it vaguely in speeches and in the budget. In 2019, it was found that compared to 2017/18, the amount of planned spending on mental health services had gone down by £34 million. But the mental health crisis is worse than ever, and after this period of isolation it is almost certain to get worse.

Those suffering with mental health issues spend months waiting to be seen, and are often discharged on first meeting. They are told they do not need therapy or medication, they are given worksheets and recommendations for apps. They are sent home from A&E because no-one knows what to do with them. They are sent to inpatient units hundreds and hundreds of miles away, and most experience trauma whilst there. The transition to adult services at 18 is difficult. None of this is acceptable.

Today CAMHS is trending, halfway through Mental Health Awareness Week. There is tweet after tweet of negative experiences, for example here and often with added memes, like this one (TW). It is no surprise to me at all that young people up and down the country have had bad experiences with mental health services. Last year, the Children’s Society estimated that over 100,000 young people aged 10-17 were turned away for not being a “serious enough” case – 60% of those referred. Those who do get support find it is not soon enough, or is not good enough.

In the most part, I do not blame the staff, and I have to emphasise that. They are pushed to their limits and doing their best in an underfunded system. And 6 weeks of Cognitive Behavioural Therapy (CBT) is rarely enough for anyone dealing with mental illness; both in terms of it not being enough time and the fact CBT isn’t a one size fits all therapy like it is made out to be. Dialectal Behavioural Therapy or art or drama therapies are often better placed to support patients, but they are rarely offered.

I was very lucky to have a great psychologist, but I’ve had a lot of issues with other parts of the service, particularly when I turned 18. The main mental health service here is now Forward Thinking Birmingham, which runs from 0-25 so I didn’t have to transition to a different place, but I had to move to a different psychiatrist. When I had issues with this doctor, they couldn’t get me a new one because the service didn’t have another 18-25 one available, and I was told to wait until I got to university and to try then. I was left without psychiatric support for 10 months, aside from one emergency appointment with my old one before my A Level exams. I was and still am on a medication that should be closely monitored, as well as at the time my insomnia being severe because the melatonin I took for years was taken away the minute I turned 18.

I say I was “lucky” to have the psychologist I did, and the emphasis has to be on that word. I had friends who had psychologists who worked for the service in the exact same building who did not support them at all and discharged them quickly with nowhere to go. Luck should never come into it, and support should never be a case of probability.

The statistics show how significant the issues within CAMHS and the wider mental health service are. YoungMinds found that in 2017-18, there were over 27,000 A&E attendances by under 18s with a psychiatric diagnosis – almost double from the 13,800 in 2012-13. This is because there is nowhere near enough crisis support available, nor is there proper long-term care. In 2015, an extra £1.4bn was pledged for CAMHS, but it still account for only 0.7% of NHS spending. A report in 2018 said that NHS England admitted that only a quarter of those under 18 with a diagnosable problem received treatment after triage.

Yes, we’re in the middle of a pandemic, but we’re refusing to talk about an epidemic across our country. Thousands of people in this country suffer with mental illness and are not receiving treatment, and this is rarely because they aren’t trying to access it. Most of us are are talking, we are speaking up – we know it’s “okay not to be okay” and we want to get help. The problem comes because the infrastructure is not available to support us.

Three quarters of young people who seek support become more unwell during the wait for treatment, and further thousands aren’t given the support they need once they get there. The standards of mental health support across the country vary massively. We cannot allow this to continue.

COVID-19 will only make this worse. After weeks and weeks of isolation and loneliness, it is only inevitable that many more people may experience agoraphobia, or develop mental health issues due to bereavement, or have dealt with significant anxiety or depression due to the situation. Autistic young people will struggle to go back to their normal routines and may struggle with their mental health because of this. This pandemic will only feed the silent mental health epidemic.

The lack of care given by the government for mental health funding is, ultimately, disgusting, and I am tired of mental health being a buzzword. I don’t want awareness, I want action. I want proper support, better training, and true parity of esteem. Mental health issues aren’t actually the same as a broken leg, because that is an acute issue – we need long-term support and inpatient beds that aren’t halfway across the country, and services that aren’t so overstretched that they have to turn people away just because someone else is slightly more severe.

I am not ashamed of my mental health issues, and I know that I deserve help. Awareness is not always the problem, and there are major stumbling blocks before we get to the next stage.

Why medication is not the enemy | mental health / chronic illness

Disclaimer: as said towards the end of this post, I am not advocating for the use of medications, I am only discussing my personal experience and the stigmatisation of such medications.

A couple of days ago an opinion column was posted in the LA times, discussing one man’s experience with attempting to come off anti-depressants. As a community, many people have written threads on the issues there are within the piece such as this one by @coffeespoonie including his use of addiction and dependence as interchangeable terms, as well as implying that an anti-depressant is not a prescription drug. Whilst these threads have taken apart the piece very effectively and better than I ever could, I wanted to talk about my own experience of long-term medication use, why it isn’t the enemy, and how much it annoys me that medication are continually demonised in traditional media.

I’ve been on some form of mental health medication since I was fifteen. Originally, for six months beforehand, my GP placed me on a beta blocker as a measure until I could see a psychiatrist, who put me on my first of many tries at an SSRI. I was very unlucky and had a major reaction to it, but it does come down to being unlucky – what happened to me would never happen to more than a couple of people. When I then went into inpatient care a month later, I was instead placed on another form of anxiety medication and, although I’ve tried several others over the last four years, it is the one I am still on today. I couldn’t imagine life without it.

Actually, that’s a lie, because I know what my life is like without it, where there have been periods off it, as well as my life beforehand. I was in Year 9 at a grammar school when I started having panic attacks and they quickly became daily, and often twice daily, occurrences which meant I was out of lesson after lesson and often unable to even make it through the gates. I moved school, and though my anxiety was reduced they were still happening. Fast forward two years of therapy, I attempted to come away from my medication, and it just wasn’t sustainable – my brain moves at a pace that I often can’t even explain; I have five trains of thought running at once, most of which aren’t even relevant and causing unnecessary levels of panic, at such a fast speed I can’t focus on them.

I’m at the best I have been for four years at the moment; those two years of therapy had a huge impact, and in the last year I have had my chronic pain management programmes which were quite holistic and focused a lot on my anxiety. Apart from during exam season, my panic attacks have been increasingly rare. But with my move to university, I don’t know how I am going to be. Often, doctors question me as to when I’m going to come off the medication as if it’s simply for an acute illness. Mental health medication is often seen as the last resort, something avoided if at all possible, and whilst I am a big advocate for therapy, I don’t think it should be demonised the way it is. Therapy got me out of crisis, but my medication is what keeps me afloat. If anything, it was my medication which meant I could get the most out of therapy.

In a similar vein, I’m also on a long-term painkiller, which are equally as demonised in the time of the opiod crisis. It began with 6-8 tablets of paracetamol a day, before endless different painkillers that were all completely ineffective or gave me side effects. Eventually, I found an NSAID that seemed to at least take the edge off the pain and I was on that until I finally saw a specialist rheumatologist who recommended the one I have been on for the last two years. I could probably survive without it – but could I live? Could I have done my A Levels? Almost absolutely not.

I am not advocating that people turn to medication before therapy, whether that be talking therapy or DBT or physio, or even advocating it’s use at all. I’m not a doctor, and I will never recommend a certain medication or slander those which have caused me issues, because everyone is different. All I want is for it to stop being so stigmatised, particularly by people who have never experienced the trauma and issues that mental health problems and chronic pain can cause.

Am I dependent? Or even an addict, as David Lazarus implies in the LA Times? Perhaps I am dependent. But I am no longer constantly frozen by anxiety and out of action due to pain and panic attacks. Is that such a bad thing? Those who say that my age means I should not be depending on medication are correct, because no I shouldn’t have to be – I don’t want to be either, but I have chronic and mental illnesses.

And yes, there is significant irony in the fact that I have been sat writing this piece for two hours and have only just realised that I didn’t take my meds this morning, but here we are. Let this be your reminder!