A Mental Health Service in Crisis

Way, way back when the pandemic began (& yes you can singalong if you know the reference) I predicted that the pandemic would expose the mental health epidemic which was growing in the UK

There was an inevitability to this prediction, after all, I'm no mental health expert, I'm a mere musician who happens to run a drama college, and that drama college happens to be one of the most progressive in the way that we acknowledge and support people in our industry learning how to live with mental illness.

I was mindful that so many people manage the symptoms of their mental illness and indeed trauma too, by putting their heads down and cracking on with the task in hand, keeping busy in order to ignore them.  However, in our industry, all those 'tasks' disappeared overnight. Theatres closed, rehearsals stopped, auditions stopped, the hospitality industry shut down - Muggle jobs and theatre jobs disappeared overnight removing the need to crack on with anything. We were all left in our own spaces (and for many, those spaces were quite isolated), and left in our mind space. For the people that had been quietly fighting an insidious mental health battle for years, they were suddenly confronted with a harsh reality.

I got angry when people started weaponising mental health as part of their despair with how the government were handling the pandemic. As for so many people, the pandemic simply left them emotionally vulnerable - with nothing to do to mask their feelings, they weren't ill because of the lockdown, they were ill before, but prior to lockdown life were not confronted with the real state of their minds

I've seen a lot of people acknowledge this 'new' reality, and many jumped to utilise IAPT  which I have to say appears to have run rather successfully for the numerous people that I know personally that have needed to utilise it.

However, this has been successful for people dealing with illnesses such as anxiety and depression, for those dealing with the lesser publicised illnesses such as eating disorders, bipolar, PTSD IAPT just isn't equipped to deal with those in a time-sensitive way. Those illnesses tend to need more specialist medical interventions, psychiatrists who are able to diagnose and then sort out a treatment - but again the treatments for these sorts of illnesses are not straightforward either.  You don't solve an eating disorder with a tablet (though that might be part of the treatment), complex illnesses require complex treatments.

The waiting list for these sort of illnesses appear to START at 18 months, and for children requiring a CAMHS intervention, it can be much longer. Now I mention children as the key to a successful outcome for nearly every sort of mental illness is 'early intervention'. Catch the thing at the start, treat it, and then regulate it all leading to the successful management of an illness. I mean it makes sense, doesn't it?  You break your leg - the more you use the 'damaged', untreated limb, the worse the injury gets. You're straight to the hospital, getting an X-Ray, getting that cast put on, thereby ensuring that your recovery time is as little as possible. Well, mental illnesses are no different. 

This sort of early intervention though needs a robust, joined-up, mental health service in order to operate successfully, and as much as I'm a massive fan of the NHS, a joined-up service it is not. The gatekeepers to the specialists - the GPs are STILL hit and miss when it comes to mental health.  Amazingly some of them still dismiss mental illnesses in young people, and STILL put clear MH symptoms down to 'growing pains'. 

On The MTA's Instastory series 'In Conversation', I chat with a few of my graduates who were diagnosed with illnesses whilst at college, and all of them tell the story of going to a GP when they were younger, stating the same symptoms that they presented with at college, and the GP dismissing them and effectively putting it down to teenage angst.  All got treated whilst at college, and all are now thriving. Had they not come to the college, and had they not happened across a clinician who recognised the symptoms that they were discussing, they too would have been entering the pandemic about to be confronted with their own mental illness.

The purpose of this blog though is actually to offload guilt. The guilt of knowing that somebody is very ill and highly vulnerable. Having a vague idea of what sort of treatment they should be having in order to get well and 'balance' the chemicals in their brain, but hearing day after day how that treatment is not being started because the system can not do joined-up thinking. However also hearing day after day how much worse that person is getting, and yet there is absolutely nothing that I can do other than listen.

If I had a spare cash I would, without a shadow of a doubt, get them to another psychiatrist in order for them to receive the treatment that has been suggested to them - but psychiatrist fees range from £350 right up to nearly £1000 for a consultation and then you're potentially adding on numerous tests on top of that. One person that I know has already forked out hundreds for the initial diagnosis, but now they're back on the NHS waiting list waiting for a doctor to approve their treatment, and because of the complexity of the diagnosis. . . you guessed it. . . the GP can't prescribe the necessary treatment, it has to be approved by a psychiatrist!

Where the pandemic really hasn't helped is this idea that you can't go to an appointment or present at a hospital at the moment with a plus one. You have to go to all appointments on your own. Well if you're mentally ill, the chances are quite strong that you'll be unable to really talk about your maladaptive coping strategies, as you'll see them all as perfectly 'normal'. Whereas if somebody goes with you, they can highlight the difficulties. eg if you're awaiting an appointment to get diagnosed with an eating disorder, there's a strong chance that you'll not want that diagnosis, as you're happy lying to yourself saying that your current relationship to food is just fine. However, your loved ones are far more likely to recognise that your habits are not fine, and indeed you're effectively self-harming with your relationship to and around food. They will be able to name that in the room.

The solution to this requires the government to properly fund the NHS, a thing that we've seen time after time they refuse to do. Throw some money at the early intervention stage and you won't need to spend so much in the continuing care stage.  Throw money at the educators to ensure that they're able to spot the early signs of mental illnesses. Ensure that GPs are trained to acknowledge that mental health is every bit as important as physical health, and should not be dismissed in young people.

Until that glorious day comes then we also need to really train up effective mental health crisis teams, as I've yet to speak to anyone that's had a good experience with one. You need your top people on that team, not the work experience guys just filling in because you're short-staffed! I mean - I know that they're not really 'work-experience' guys, but honestly judging by some of the people that I've met whilst supporting people in crisis you'd agree with my description.

So as you're shouting about the ever growing suicide rates in the UK in a bid to weaponize the pandemic, let's get some other facts out there tool Facts like the rates have been growing year on year for at least a decade, facts like early intervention could prevent a whole load of those people becoming statistics, facts like better education around mental health would allow people to access help earlier, and facts like even when people are looking for help, that help comes complete with a waiting list, the timeframe for which for many, might be too long to even contemplate.

There IS a mental health crisis in the UK, but the mental health services are also in crisis, thanks to years of underfunding by successive governments. Weaponise that and try to make a difference..