To think most people have a completely unrealistic view of mental health services?

[StHeathensGrammar]

...UK NHS services specifically (don't know about other countries!)

This isn't a TAAT but the deleted suicidal thread made me think of it. There just seems to be this "seek help" mantra without people realising that actually talking to a friend or even a bunch of strangers might be all you've got.

And "ordinary" kindness, a listening ear, could well be better than a recorded crisis team message or someone who's got 3 mins to talk to you before rushing off to the next patient. Or sitting in A&E for hours on end, alone, with the end result being sent away clutching a phone number for the aforementioned crisis team.

Plus people seem to have a very different idea of the threshold for hospitalisation than the reality! Funding aside, even a perfect mental health system surely wouldn't put people in hospital long term for relatively minor things? And a supportive social environment means a lot - it's not just whisking the person off to professionals, out of sight of the "normals"...

I wonder exactly what people think services will actually do? What magic help are people thinking of when they urge someone to "seek help"?

I think people woukd be horrified if they knew the restrictions placed on MH services due to brutal funding cuts. As a MH nurse I want to work with people when they are first becoming unwell, but I can't. I can only work with people if they are so unwell they are an imminent danger to themselves or others. So, not just suicidal, but suicidal with a fixed plan which will take place in the next 24 hours, for example.

It is a disgrace. Please don't think that this is how MH professionals want to work.

I get quite extensive support from MH services (CPN, long term CBT, fortnightly psychiatrist, art therapy) so it's not as non-existent as some people claim. I have been in the system for a long, long time though (20+ years) and been hospitalized several times. Our crisis team is pretty good and have always been available. I've had some long waits in A&E, but it's always triggered a higher level of support afterwards.

Everyone I know who has access to CMHT services has very severe MH issues though, almost all unemployed, a lot have had SS intervention. I think there is less help for those who are just feeling down or upset but who are managing to cope with work and daily tasks. But if I was in that position I'd probably seek help outside of the NHS.

It all depends. I doubt dd would be alive today if it hadn't been for CAHMS, and the support we got as a family was invaluable. Plus she absolutely depends on her medication to function.

I also had counselling through work when the whole situation got on top of me. It was precisely the opportunity to talk to a complete stranger that was so invaluable to me. With family, I always have to remember that they are as upset as I am, talking to friends again we are part of the same community and tied up with each other's lives in all sorts of ways. Having a stranger who simply did not care about either me or dd or our family as a whole, but who had experience of other people in similar situations, helped me to see the wood for trees.

So that's what the NHS did for me. Dd is still alive and I was able to process the trauma involved and get back to work.

I agree, there are too many gaps and often the bar set for accessing secondary services is too high.

CAMHS in particular seems very hard to access and there are problems with delays meaning that someone close to the upper age limit can end up waiting ages then essentially get told there's no point being seen as they'll just get transferred to Adult Services, so they go on a waiting list for that instead.

I wish I could do more to help the people who phone me, but all I can do is try and signpost them to someone who, may, if funding allows, be able to help. It's not getting any better.

I can only speak from personal experience. Last year, I self harmed (cut my wrists). I was arrested and charged by police for affray (causing someone to feel under threat). I was released after 36 hours during which time I repeatedly banged my head against the wall of the cell until my head was black and blue.
A week prior to that I was trying to get run over by cars. I was brought to A&E and released a couple of hours later as I told them I wasn't suicidal anymore.
After being released from police custody I had nowhere to go as one of my bail conditions was that I didn't return to my home (it was a flatmate who had made the statement that he was afraid for his life).
So I stood in front of a bus, was knocked down and spent 8 days in a psychiatric hospital.
While there, one night there was no bed so I had to sleep on chairs in the library room.
When discharged, I was homeless so they couldn't release me until they found me accommodation, so I spent 2 extra nights in the hospital.
It's a complete and utter fucking shambles.

My friend has had two suicide attempts that landed her in hospital. She has been self harming for years.

She has asd, she was offered telephone appointments by IAPT

I've just been to the doctors with her today and she has finally been referred to a psychiatrist as 'urgent'.

Remains to be seen if that happens though as she has been 'referred' twice but nothing ever happened about it.

I've asked for copies of the referral letter this time.

It makes me so furious, she is a vulnerable adult, in obvious mental distress. She should be being helped, not shunted around and ignored.

I don't blame the medical professionals or staff though. There is only so much they can do with their pittance of funding,

During my arrest and time in jail, I was not assessed by a doctor or medical professional of any kind.

YANBU OP.

There is scant evidence for many possibly most MH treatments.

It varies hugely by area, doesn't it?

I have a friend up near Lancaster who has at varies times been crying out for help, desperately in need, and given piss poor support. OTOH where I live now, I have seen people with far less serious - which is not to say undeserving - problems be offered far more extensive support, simply because there seems to be a budget and personnel to provide that support.

I can understand why people may have differing views on the service, because it does differ from place to place.

I think it's the expectation of the service the OP is questioning not the availability or even the quality per se.

Yanbu.

They will often just about keep you alive, but not necessarily heal you.

It depends on where you live and if you have a good gp. I've experienced amazing help, support and treatment, without delay, through the NHS for which I will always be grateful. However the interventions I experienced should be standard, not just me being lucky at where I happen to live.

eiffiels - sure, but they're related issues.

I know someone who became extremely upset when she wasn't provided with the level of service she deemed necessary - in fact, she'd been signed off by her GP as no longer ill - because her experience had been that there was ample availability of support.

By contrast, my friend in Lancaster would be quick to doubt that any support, even for people in the grips of a serious manic episode, would be easily come by.

So, people end up with unrealistic expectations because they experience different things.

I have various MH issues and regularly experience suicidal impulses, I get no support whatsoever. My Doctor refers me to the crisis team, the crisis team just basically smile and pat my head. My doctors practise has been rated as requires improvement by the CQC especially for those with mental health issues. Last time I saw my doctor he offered to put me back on the antidepressants I have been taking for nearly 3 years.

I have had very good experiences in Southwark/ Lambeth

I am becoming increasingly aware of the cuts directly affecting services. Spoke to one lady today whose daughter is having psychotic episodes for the last 7 years and she's been passed through the system with no therapy just drugs. It's having massive effect on entire family. She has no quality of life. Yet they pump money into cancer treatments for 80 year olds.

The difficulty is providing interventions that are proven to work, for a huge variety of mental health diagnosis which often have social and psysiological elements.

But perhaps our expectations arn't too high, there just isnt the right level provision? I feel for mental health professionals who's hands are tied by referral and acceptance criteriathat are basically crisis - surely this leads to a certain level of ambivalence and risk management strategies that may not be best for the patient.

I do think interventions and support for those with minor to moderate illness is hard to come by but I dont know how many of these people would go on to develop serious problems if not fully addressed. Ie do preventative methods work?

I do think that the barrier for secondary services is too high. I've been under CMHT my entire adult life (psychiatrist, psychologist, CPN, support worker, psychodynamic psychotherapy, DBT) and I'm now waiting on a referral to a specialist tertiary service but I'm acutely/chronically unwell and have been for many years. In contrast, I know several people who have struggled to get much support, if any at all. It seems rather inconsistent.

Scotland seems to be slightly better. When I lived in London I got absolutely nowhere and had to go private for psychotherapy. I'm in Glasgow now and after a bit of a wait (although not as long as I was expecting) I have been offered an initial 16 weekly sessions, with the potential for them to be extended.

I spent a few hours sat in a and e alone once. Everyone was kind to me, but they were very busy, they left me alone until I felt well enough for them to call someone to fetch me. They saved my life that night by leaving me in a quiet corner alone until the thoughts went away.

Sometimes you don't need anyone to do anything, and there is actually nothing they can do except keep you in a safe place until the idea passes.

I've phoned the crisis team sometimes too, they can't do anything specific but it is so comforting to know they are there and I can phone them.

Sometimes it helps to speak to a medical person not a friend.

My husband lost a lot of services which were good for him.

It was then down to only me to spot when he was in crisis and fight for help. I argued that I wanted a professional to monitor him so the pressure wasn't on me alone and they could spot an impending crisis before I could.

He now eventually has a care-co. We waited for 6 months for one after they said they would get him one urgently.

I also work in MH but only just started and I have already seen how lack of MH services have let people down left right and centre. I knew that from my own experience but it really hit it home.

I used to be able to call the crisis team for my husband and they would come out within a few hours. They know my husband so had no problem doing that. Now he has to see a GP first and they have to call the crisis team if they decide it is needed which is a bloody pain in the arse. The fact that he has been severely ill for over 25 years and only now has a care-co says a lot.

Up until a few weeks ago dh would have to go to his GP when he was really ill but not in crisis but the GP can't touch his meds so he would get a referral which would take weeks because he lost his psych when he moved out of the area and couldn't get another one. He has a new one now after 6ish years who he has only seen once.

The individual people have all been amazing. It's not their fault and they do the best they can.

It's not just the services but also the gp you first go to.
You take that huge step to seek help. You are either believed or you aren't. Believed on you go to a waiting list for further intervention and a prescription for meds. Waiting list time varies. You look at the side effects and think fuck this could make
Me worse. So not only will I be worse, but there's no help. Well aside from a number
For crisis team and the samaritans.

So your on the waiting list with your "happy pills" that make your suicidal thoughts worse. That the side effects ensure you can barely function basic life things never mind work.

So you go on sick leave. You either have the understanding boss or the arsehole. But either way you feel like a failure.

You finally talk to someone and find out it's not what you think. The help is just an assessment. You fill in a form and then talk it through with someone. Usuallly over the phone. So your back to that gamble but a bit happier beucase the pills are starting
To kick in. So you feel like a fraud. You are back on the waiting list for therapy. But still unable to function fully.
This can be a straight access to services or the same as above but in person. You question yourself further and try and push yourself but you make yourself more unwell.

You read people saying don't be daft
Your just a bit sad. How can you not work? Just what someone who feels like a failure already wants to hear.

So your help is still the pills. They not really working so the dose is increased and fuck me the side effects start again. Your still waiting to talk to someone aside from crisis team whose hands are tied and samaritans. Oh and of course the gp who keeps doling out pills and fit notes.

Then you get the arsehole of a gp who asks how's it going. Ask you if there's any triggers so you open up a bit. You say actually yes and talk about the feelings. The gp changes from nice to arsehole and your
Told you are a danger to yourself and others beucase you are fighting urges to self harm. And a referral fired to ss.

So now you have the "happy pills" that make you feel like shit. A gamble of which gp you will get because you no longer have a named one. A wait to see someone for another assessment. Still unable to work. Holding things together just about to ensure the needs of your child are taken care of, and ss sniffing around. Way to make someone feel like a bigger failure and of course the dark thoughts creep in. And you start to look at ways to harm that won't be seen even accidentally or if you need a medical examination or how to get a quick end. But even if it's just a thought you are scared to talk to the health people in case they refer to ss.
You don't want to talk to your family/friends because you don't want to burden them. After all you have this thought that you are already burden. Things that make sense to you seem illogical to others.

So you go online to talk anonymously. Like the gp this goes one of two ways. Either support or not. Support because others relate either through personal experience,
That of loved ones or even just empathy. Or no support and often made to feel worse when you just want to reach out.

It's that initial reaching that is hard. Saying to someone seek help elsewhere is crazy because that person doesn't think they will be believed. This is further endorsed by the ones that think it's all just attention. Through the fog you believe them. Which adds to the feelings of being a failure. Sometimes the thoughts pass because you know how to deal wit them and just need to talk to someone in a safe place whilst they pass.

And yes services have gotten worse. Last time I self harmed several years ago there wasn't an endless need to assess before treatment. It just seems like this process is to deter people to stop trying to access help and as a stalling tactic.

My expectations are just to be believed and not judged. To not have to go through a multitude of hoops to access help.

Sorry about the essay, it was very cathartic though.

I think that MH services in general are woefully inadequate. But the problem (speaking as someone with lifelong MH issues) is that, compared with physical problems, they are very difficult to solve.

For a broken leg, do an x-ray then put it in plaster until the x-rays show its fixed (I'm probably simplifying but you get the idea).

For self-harm or suicidal intent? Serious diagnosis requires a lot of time from a specialist. The actual diagnosis is to a large extent subjective and is focused on the symptoms, not the cause (for example depression in my book is a symptom of one or more underlying causes, not an illness in itself, just as a high temperature is a symptom of an infection, not a problem in itself). And treatments are based on containing the symptoms (drugs, hospitalisation, often even the talking 'cures') rather than treating the root cause because we don't really know how to tackle the root causes. So it rarely happens and generally only if you can afford to go privately at great expense over an extended period.

The underlying reason? There is no 'miracle cure' that someone can research, patent and manufacture then sell in vast quantities. Instead it requires a specific (and at present often highly idiosyncratic and unproven) therapeutic approach, usually delivered one-to-one over a long period. Where's the money in that?

Call me bitter, twisted and cynical (and a little disinhibited after several cls of very nice New Zealand self-medication) but I think the current state of medical MH science is equivalent to having a choice between paracetamol or ibuprofen or, in extreme cases, a morphine derivative.

We have a long way to go.

its not that hard

person goes in needing talking therapy after traumtaic events

dont tell them they are a waste of time, help them

people should be kind not abandon them to services

then they woudnt find themsleves knowing death is the only way out 15 years later

Difficult. My dd has been unwell. Self harming, anxiety, depression. GP referred to CAMHS saying they were useless and I"d be better off getting a counsellor off the internet. I was already in shock and there were 400 BACP counsellors within 15 miles of my home most of whom wouldn't see a 16 year old.

Eventually saw CAMHS who offered an inaccessible and inappropriate intervention and closed fhe case when if was declined refusing to offer an alternative. In the meantime having lost phone numbers , etc. The morning we went to CAMHS for a 9.30 appointment we arrived at 9.15 and it was locked up. A member of staff arrived at 9.32. It's a 9-5 service and so overworked staff don't even arrive in accordance with the opening hours.

We appointed a private psychiatrist and dd had CBT (not helpful), fluoxetine, at this stage she had taken three small od's that no health orofessional deigned to tell me about. Not the GP, not CAMHS, I found out about the third and we flew back to psych. More tests.

Last summer dd took another od (exam panic). Went to A&E who didn't know right arm from left. Reported us to SS and referred to CAMHS. CAMHS saw her 48 hours lateŕ and promised fast counselling. Assessed for this again three weeks later and didn't need it until three months after the od because "she was fine" well yes she would be in the hols with no pressure. NHD had resources for three assessments and an acutè overnight admission with an MH nurse but none for counselling or prevention. Meanwhile her psych says counselling essential and diagnosed ADHD ADD variant. CAMHS nurse saids you can't have ADHD at 17. Then wrote a spectacularly innaccurate report stating dd is a regular drunk. Refused to allow access to a qualified doctor for review.

The diagnosis helped hugely, the fluoxetine helped hugely, the private ounselling helped hugely once dd was on the mend.

DD is much better two years fŕom the first referral to CAMHS. The NHS has done nothing to help her whatsoever - in fact their misinformation at every turn combined with complete incompetence made things worse.

£5000 plus helped my daughter. Thank goodness we had it to spend.

I agree MH is underfunded but based on the quality I have seen the issues are far more than about just money. The system is rotten to the core with embedded excuses supported by a culture of incompetence and deceit.

Our local MH Trust is due to be sentenced on 22nd June for negligence relating to a preventable death.

MH provision and its quality is a national scandal and is why I am not voting Conservative tomorrow for the first time since 1979.