To think the NHS mental health system is a shitshow?

[ChaoticGouda]

This is probably going to turn into a bit of a whingey rant, sorry

Disclaimer that I'm not talking about most nurses, doctors and staff, who are lovely and doing their best in unfair, overworked and underfunded circumstances.

However in my years of going into and out of the doctor's office for help and support, the feeling of being pushed out of CBT because I hadn't made enough improvement during sessions, the dismissal both I and loved ones have had when going to GPs about any issue other than depression/anxiety...

Plus the fact that specialist clinics for things like ADHD, EDs, etc (especially for adults) are still hard to access and shockingly underfunded despite these issues becoming increasingly talked about amongst the general public...

Of course I'm grateful we have an NHS, grateful that I'm not forced to pay for everything like in some countries, and grateful that I'm safe and relatively comfortable enough to be complaining about this. I'm definitely luckier than a lot of people on the planet, and I know it's a less-pressing issue to complain about, on the grand scale of things.

Still not going to stop me from complaining, though!

Presumably, the only people who receive help are those who are causing a problem for the authorities or who are violent towards others.

No, it depends where you are it seems. My sister has genuinely never been in trouble or violent, the first time we called 999 and she was taken to A&E and assessed and sectioned. Her subsequent ones have been because she is 'in the system' and the crisis team referred her for assessment. Other places and people have huge issues accessing any sort of care.

I was referred for CBT under the NHS. 6 sessions, which was nothing (mental health issues tend to be very complicated).
After my sessions I felt no better so made the decision to go private. So, so much better.
I still think there is a huge stigma surrounding mental health unfortunately.

Haven't read the whole thread but do you think there is something we can do about this? Something one person can do to make a change?

I briefly did some temping in an NHS mental health centre. It was awful, every day patients would phone up screaming or crying down the phone. I had to ask the nurses or psychiatrists to ring the patients back and they hardly ever did (probably because they were snowed under with patients) and the patients would keep phoning getting angrier each time.

The staff in general seemed extremely fed up and tired and none of them actually seemed to care about the patients.

It also struck me that there was very little talking therapy. It was all about giving patients medication. There was one counsellor I think and she was off on long term sick. There were therapy groups but funding had been cut back and some of the services were provided by charities.

Lots of counselling that doesn’t work. CBT is like some sort of joke therapy.

I feel the same but I think that's because CBT was not the appropriate treatment for my condition. (And a mere four sessions is unlikely to help anyone very much, in my opinion.) I don't think it's the "one size fits all" treatment it is touted as.

@JalapenoDave

I was referred for CBT under the NHS. 6 sessions, which was nothing (mental health issues tend to be very complicated). After my sessions I felt no better so made the decision to go private. So, so much better. I still think there is a huge stigma surrounding mental health unfortunately.

CBT is a quick fix for one acute problem, no use for someone with longstanding, chronic depression and anxiety.

I too was given six sessions on NHS but was told at the fifth it wasn't working so didn't bother with the sixth. I had tried so hard, did all the homework; it was like being told you are getting the sack at the end of a trial period. However I honestly didn't think much of the therapy and prefer proper psychotherapy.

This is my first post here. Long time lurker but this resonates with me.

I'm 30 now, and have struggled with my mental health for most of my adult life. I've been to my GP on probably 5/6 occasions in the last 5 years. Initially prescribed antidepressants- perhaps to my own detriment, I never committed fully to a course.

In the last few years my mental health has deteriorated further. This peaked last December- I got to the point where I ended up drawing on my face, the walls of my bedroom, and was convinced I was hearing voices.

After withdrawing completely for a few weeks, I managed to visit my GP. They offered nothing other than a phone number for a self referral (which I had to obtain from their reception) to 'healthy minds'.

Every time I've reached out for help I've felt dismissed and ignored. Its difficult to find support in my experience.

Heartsonacake

Excuse me, but l did engage. I did every single thing l was told to do. I wanted it to work so much. I worked really hard at it. 3 rounds made no difference.

I have several friends who it didn’t work for either. It works for some, but not everyone. But trying to access any other talking therapy on the NHS is like the Holy Grail.

I was told by a psychiatrist that l needed a referral for pyschotherapy. To access this on the NHS you need to have 3 rounds of failed CBT first.

My last round, the therapist missed a couple of appointments. Therefore l have not ‘completed’ 3 full rounds. So l have to have another round before l can access other therapies. What a waste of money...

CBT is a quick fix for one acute problem, no use for someone with longstanding, chronic depression and anxiety.

jessstan2 Also not true.

I had severe anxiety for a decade before I had CBT on the NHS; in a matter of months over 20 odd sessions I went from housebound to holding down a full time job. I recovered fully.

I've been back and forth the system for ten years and am currently at absolute rock bottom and it feels like nobody cares.

I've told the same things to numerous therapists over the years, most recently a physchaitrist who suggested changing medication and more CBT (which did nothing for me in the past), and it turns out nothing she said even got passed back to my surgery.

I don't want to be alive but every time they ask me if I have a plan to end my life and I say no they think, ah its okay then. Because honestly I'm not the planning time. If I'm gonna do it it'll be on a whim. It could be this afternoon for all I know. But they don't care.

'Depression and anxiety' is a go to diagnosis. What about all the other mental health conditions out there?

Also once I was on medication that I thought may have been helping. So for that reason they increased the dose. Likewise when I've said medication isn't working, they increase the dose.

My mother has been ringing the surgery in desperation to get me help because it feels like I'm shouting at a brick wall and each time they give some twee response and try to shove responsibility on someone else.

It's at the point where I feel like the only way to get the help I need is to go through with attempting suicide.

I also hate how they always treat it as a period of depression whereas for me it's not a fucking period it's my whole life. I do feel like the same response (medication and cbt) is dished out for everyone despite all of the different issues people experience. For me it's not just one thing, I found that when I went to CBT they focused on one thing which wasn't even a big problem it all my other issues were still there. Alot of the therapists I've seen have picked up on a random thing I've said and decided to make that their focus and I spend the whole sessions talking about something completely irrelevant.

It took me two years to get seen and that was because I phoned up and chased a referral. Mental health here is a joke. I attempted suicide twice and self-harmed a lot during the period while I was waiting to be seen. I've got a fantastic therapist now and changing meds helped, but it was a slog.

Hearing these stories makes me so grateful that I am waiting for EMDR not CBT. I hope for good outcomes for all of those going through so much distress.

To the poster saying you just need to try harder with CBT, it has never been claimed that CBT will work for everyone. When it was first developed it had a high success rate, but it was never claimed to be the appropriate treatment for everyone. Over time the success rate has declined. One of the reasons why is that the basics of CBT have become part of popular culture, so people have already tried these techniques and failed before they even get to therapy. There is also a problem with CBT that success rates are not as high as recorded because CBT is particularly prone to patients exaggerating improvement to please the therapist.

CBT is particularly good for people whose emotions are a consequence of certain patterns of thinking, but that isn’t the cause of everyone’s mental health problems.

I have Schizoaffective disorder which is treated by my NHS psychiatrist with high doses of anti psychotics & anti depressants. I take Promethazine prn if I get anxiety caused by paranoia.
I see my Psychiatrist 3 monthly (obviously with Covid the appointments are now over the phone but I don't mind). I think he's very good at his job & he's generally popular with his patients.
I can get breakthrough symptoms of hallucinations, & paranoia at times of stress & when I'm tired.
When I feel unwell between appointments I have to phone the CMHT (this is 9-5 mon-fri).
I find that the response varies depending on the Nurse I speak to.
The most reliable person there is actually not a Nurse, she's a Support Worker & she's really caring. She always does what she says she will do, such as emailing my psychiatrist.
Some of the Nurses are not reliable & don't email my psychiatrist & don't call back when they've said they will.

The out of hours Crisis Team is now known as 'Connections' but is the same thing.
I find them to be a bit crap actually & have politely told this to a nurse at my CMHT who actually agreed!!
Given that I've only phoned when I've been desperate they are useless. I would be better off phoning 111.
One time I felt my neighbour had put cameras in my house & I was very worried so I phoned & was told to 'listen to music' by this male nurse who also made a slightly inappropriate 'jokey' comment.

I was very ill in 2012 with untreated Psychosis (before my diagnosis & before I met my current psychiatrist) but no one from the CMHT or Crisis Team bothered to help me although I was under their 'care'
Then the Police got involved. Can I say the main Police officer who was involved at the time was lovely.
Finally I got the help I needed. I'm lucky I'm still here but I lost the career I loved.
Apparently I never got help early enough because the 'Early Intervention in Psychosis Team' only intervene with people aged 35 or under & I'd just turned 36.

The problem with mental health provision is that ironically you often need to be 'well' to get the help you need. To chase treatments & appointments for example.
Or you need a carer or advocate to do it for you.
You also need to be willing to be a 'good compliant' patient which luckily I am. I will do what it takes to stay well.
But I've met lots of individuals with schizoaffective disorder & schizophrenia etc who don't take meds, who self medicate with cannabis & alcohol, who get into the conspiracy theories & get ill then are repeatedly arrested & sectioned, it's really sad.

Also the PIP is hard to get for Mental Illness. One girl I know who's schizophrenic works as a prostitute.

One good thing is that I now see an Occupational Therapist from the CMHT whose job it is to keep me in work. He keeps in touch with me & can report back to the psychiatrist if I'm unwell.
It was the caring Support Worker who put me with him as I've been struggling with work.

Sorry for the essay

I know it's cliche, but thank you again for all your replies! I have sat and read through them all but unfortunately ran out of steam to reply to them personally I hope you're all doing the best you can in your individual circumstances. I appreciate you taking the time to let me know your thoughts, whether we agree or not.

Now back to the ranting (This is long, you'll probably want to skip to the TLDR)

I find myself with another hill to struggle upwards. After paying for my assessment and getting a diagnosis, I was told I would need a blood test and ECG to rule out any risk factors for medication. "But don't worry", the psychiatrist assured me, "The NHS should be able to perform it for you, and we'll send them a letter with more information."

A week for the letter, and another to work up the bottle to make an appointment with the GP. Phone appointment is another week, which is fine. It's not an emergency and it will all be worth it in the end. But, hold on...

The GP tells me very sorry, she needs to look over the letter again and confer with her colleagues to see if it's something they can actually carry out. They say it isn't normally a service they provide. I'm a little confused, but hopeful and accepting, and say I'm happy to wait. They assure they'll call me back.

Another Week goes by. No contact, no call, so I find the nerve again to give them a call. Appointment is given for next Wednesday. Fine. I'm struggling more with work and the anti-depressants I have aren't doing much to take the edge off, but that's fine. Finally get that call and am told, very definitely, that there's no way they can perform the tests.

"It just isn't a service we provide here!"

So here I am, almost a month later, trying to find a private clinic that can do the tests for me. The assessment centre recommended once but as they're England-based and I'm in Och-Aye-The-Noo land it isn't going to do much good. So that's pretty shit.

TLDR; GP says they can't do the blood tests and ECG that I need in order to start the ball rolling for my medication. I now need to find a clinic that can do this for me before I lose motivation entirely

What medication do you need where you need an ecg?
Im on antipsychotics and mood stabilizers and didnt need an eccg

It's been awful for years. I don't think counselling is really available these days. Just a sticking plaster of CBT.
I don't bother any more and just stay permanently anxious and miserable 🤷‍♀️. I had a few £40 sessions with a lovely counsellor but I'd need a year or two to get better, and I don't have that money.

@Showandtell1 ADHD medication. Psych said it can potentially affect the heart so they need to rule out risk factors beforehand.

Someone told me that if you go to a psychiatrist privately and start treatment the NHS has an obligation to fund it going forwards? Is that true? Would that be a way to fast track some help?

Yes the nhs mental health system is shambles but it’s not the fault of the people who work in it. It needs more funding but obviously it’s government dependent rather down to individuals.

I think we are lucky to get medications and therapy free on the NHS

Medication is only free whilst you are in hospital. Prescription medication is only subsidised when you’re at home.

Yes, the whole NHS is a mess.
Not the doctor’s and nurse’s fault.
The system is f’ked.

@Shubsy

The short answer is it depends. In general a private psychiatrist gives a recommendation for primary care and its up to the NHS if they want to continue that.

In general a medication started, that helps will be likely to continue unless there is an issue with it.

Any changes to it usually needs to come from the prescriber, and its a bit of half job if someone starts medication privately then expects all the monitoring etc to come from the nhs as it then becomes your gp (or doctors) responsibility to manage a medication they might be experienced in or choose.

For example in the case above if the ecg changed, or she was experiencing side effects then the gp is likely to discontinue it rather than trying an alternative or changing the dose. If the private person prescribed x dose of y then thats only what they will give. Adhd meds is probably a good example of this as its something lots of other doctors wouldnt feel comfortable in managing. If it was a med by the community mental health team then we would be asked to do all the changes, and even if the person is now closed, the gp can contact us for prescribing advice but often private prescribers dont offer support after that initial recommendation.

The treatment might also be seen as not appropriate thus unable to continue. Examples ive seen of this are where the medication is used "off license" (eg for a diagnosis that it isnt licenced for) or at an unusual dose (over the usual limit) which is common but when a new dr takes over then this because his responsibility so may decline to take on the recommendation.
This might also include if the burden of follow up is too heavy. For example there are certain meds that can only be monitored by the community mental health team, so gp couldnt continue. Others need intensive physical obs which might not be possible for gp to provide

Private psychiatrist might also recommend things that the nhs doesnt offer. They can have unrealistic ideas of what support other services can offer, prescribe a series of treatments then expect the nhs to fill that gap. So they might say you need a support worker when you dont meet the criteria for an nhs support worker. In my area we dont offer dbt therapy, we dont have dbt therapists as we offer another nice accredited therapy. We get lots of patients who are recommended dbt privately and have an expectation that the nhs must then be providing this.

OP I agree completely. Mental Health in this country needs more qualified people, more money and a complete overhaul. Waiting lists are out of control in my area. When I worked in a mental health outpatients clinic, waiting lists had to be frozen due to a complete staffing crisis.

I have also mentioned several times under various accounts in here over the years that ED services are inaccessible to most of those who need it and advice can be patronising and over simplified. I talk about my own first hand experience of using services only to be told in no uncertain terms that 'fat people don't have EDs', or that services should only be for the underweight, or that I am oppressing anorexics by discussing the narrow focus of services on helping those with low BMI instead of high. Open discussion about it seems to be too emotive for most and doesn't get any sensible results, I've often wondered if that's why things never change. I can imagine the daily mail headlines, politicians probably would be opening a can of worms if they suggested investing in helping 'lazy fat people who should just get off the sofa and exercise'. So some things will never improve because of the social taboos around discussing them and nobody in Westminster wants to be that guy. Very frustrating.

The truth is if mental health services were better then less people would need to be referred on to the more specialist ED and addiction type services as in an ideal world we would be preventing these problems before people became unwell.