To say NHS MH help is a joke?

[Pumpertrumper]

I sought MH help during my pregnancy. I was passed around a lot, did multiple ‘assessments’ having the same conversation over and over.

I was then assigned a psychiatrist (hurrah) but the apts were inconsistent. She agreed I needed weekly sessions but was frequently on holiday, dealing with personal issues or in training. I was going 2-3 weeks at a time with nothing! Then lockdown hit.

I struggled having given birth and gone into lockdown. I really needed consistency but my psychologist was even flakier than before despite WFH. So I got exasperated and told her exactly how I felt. She was apologetic and agreed it was not helping or supporting me, if anything it was making me worse. So she suggested I move to CBT.

I agreed. It took a couple of months for CBT to start but the first few weeks went well. I felt there was some improvement BUT after week 3 the therapist announced she had substantial annual leave/training coming up so I would have to miss those sessions. So far I’ve missed 3 sessions and will miss another 2 over coming weeks. It’s so counter productive. Makes the whole thing disjointed and spend half the session recapping where we left off!

Yes everyone deserves annual leave and needs training but surely missing 5 sessions of a 12 session course is ridiculous. Surely this is a job in which you know consistency is important.

A friend of mine recently had private CBT and not a single session was ever missed or cancelled.

I’ve now decided I’m just going to cancel the CBT and give up.

I wouldn't say it's a joke but that's only because the dire situation it leaves everyone in isn't funny.
There are some very talented MH professionals out there who can't do their best work because of budgets and resources

I have no faith in the nhs mental health team.

My sibling attempted suicide, was in ICU for 4 weeks, moved to a normal ward for a week and spoke to a psychiatrist twice and was singed off! How is that even possible when 4 weeks beforehand they had thrown themselves off a bridge? How can this happen?

I work for the NHS. Mental health provision is under funded, however, talking to colleagues it would appear that we have the best public offering in the world.

Things have been incredibly tough with Covid and it sounds like that has impacted on you.

If you want consistent weekly sessions then unfortunately you are going to have to pay for it. Expecting that from the NHS is quite a big ask I'm afraid.

@dooratheexplorer

You realise that’s saying that only the wealthy deserve to be mentally well? Right?

I mean I probably could afford private CBT although after paying significant taxes for years and taking very little from the system I don’t see why I should.

But what if I couldn’t? What happens to those who can’t afford to pay for private care?

• it would be a stretch for us, we couldn’t afford it easily.

As someone who works in NHS mental health, all I can I do is agree. And say that it’s incredibly frustrating form my side. We have fuck all resources and a massive number of patients who need help. It feels impossible, hence your experiences. It’s incredibly demoralising.

I thought it was interesting that I was told that I must prioritise the weekly phone call from the therapist and commit to all the sessions, but part way through, the therapist went on holiday and so three weeks were missed.

It was disjointed and, as you say, time was spent recapping previous sessions. I don’t know what the answer is. Perhaps we’ll just have to accept that we pay for everything that isn’t an emergency. Except many things become emergencies.

[quote Pumpertrumper]@dooratheexplorer

You realise that’s saying that only the wealthy deserve to be mentally well? Right?

I mean I probably could afford private CBT although after paying significant taxes for years and taking very little from the system I don’t see why I should.

But what if I couldn’t? What happens to those who can’t afford to pay for private care?[/quote]
I’m not sure it is, tbh.

I think the problem is that curing many MH problems isn’t realistic. It’s about management. Ongoing management of that nature is too costly. Unfortunately there’s a lot of snake oil in MH services.

No, that's not what I'm saying.

I'm saying that the resources just aren't there and a shed load of people need help. The NHS simply cannot cope with demand. It's not a bottomless pit.

If you have a broken leg, it is visible and treatment has a start point and end point. Mental health just isn't that simple. I work in a therapy team which include psychologists and a lot of our clients have life changing injuries which severely affect their mental health. Most of them are helped by very simple practical strategies; routine, having some sort of purpose however simple, volunteering and/or work, building a support network, eating properly, exercise, spending time in nature, meditation, mindfulness, etc. Despite that, there are some people we cannot help because they are not prepared to put the work in. I have a relative who has suffered with her mental health all her life. The biggest part of her problem is that she expects someone else to fix her with absolutely no input herself. I've given up on her now.

If the NHS cannot support you then you need to find an alternative in the form of a charity or private therapist.

If people want a better funded NHS then they need to stop voting Tory.

I have had mixed experience of mental health services both for myself and for family.

Help for my OH's anxiety was patchy and frankly useless. But when he was in a nursing home and suffering from paranoia, the CPN and the consultant were absolutely brilliant.

Help from CAMHS was so slow for my niece and for my GS; for one the services were brilliant once they had got to the top of the list; and for the other were absolutely hopeless, and also after a long long wait.

Most of my help has come from GP - and that has been good. I did have some CBT, but found the person I saw detached and disinterested.

MH problems tend to recur and this is one of the reasons that the underfunded service gets overwhelmed. Watching programmes like Ambulance shows us that the number of people with mental health problems out on the streets and trying to survive is very common. And prisons are full of people with MH problems. All this only goes to show that our MH services are totally down the pan. How to change that I wonder? I have no idea.

I agree about management of MH I am a sufferer of periods of extreme MH issues. I have had amazing support. I have been offered ongoing management and they have said I will have help for life. I think the behaviours of myself and the other people on the course that I met are why this was offered. Being a danger to yourself is almost irrelevant as awful as that sounds when it comes to access.

@dooratheexplorer

I work for the NHS. Mental health provision is under funded, however, talking to colleagues it would appear that we have the best public offering in the world.

Things have been incredibly tough with Covid and it sounds like that has impacted on you.

If you want consistent weekly sessions then unfortunately you are going to have to pay for it. Expecting that from the NHS is quite a big ask I'm afraid.

My local mh team earlier this year informed me I should be over my mental health issues and PTSD by now, considering they've refused me help consistently since I was 18, and I dont have the means to afford it privately, I fail to see how I'm supposed to be over it.

They even refused to help me when I attempted suicide twice.

Best public offering my arse.

If you want consistent weekly sessions then unfortunately you are going to have to pay for it. Expecting that from the NHS is quite a big ask I'm afraid.

It damn well shouldn't be considered a big ask - it is basic.

Repeated assessments, playing pass the parcel with people, being inconsistent, etc etc cause harm.

Avoidable, foreseeable iatrogenic harm is not acceptable and any HCP defending it needs to take a look at their ethics.

I’m sorry you had a bad experience. NHS mental health services are VERY underfunded. There just aren’t enough resources to go around.

I agree your therapist was unprofessional missing planned appointments. But she may not have been ‘flakey’ just overwhelmed with a caseload of other patients. Sometimes patients go over time or admit they’ve just taken an overdose or have a suicide plan so she might have had to take action immediately (calling police and ambulance, trying to secure an inpatient bed, keeping person on the line until help arrived).

Or she may have had issues of her own especially WFH (kids around etc). Being a therapist is emotionally very draining so she could have been unwell or stressed herself.

There’s a misconception amongst many MH staff that perinatal MH team stay involved so yes unfortunately people get bounced between services.

Is going private an option? Many registered psychologists and therapists offer reduced rates if a client can’t afford them.

Also have you told your midwife how you feel since having the baby? She might be able to speed up a referral, mums of new babies are usually prioritised in MH services.

Sertraline is commonly prescribed alongside therapy for ante-post natal depression and anxiety, have they offered you this?

YANBU . I had a phone assessment last week, told I’m severely ill with anxiety - ie I spend 95% of my day panicking, trembling and scared to do even simple stuff like get up to pee - then told I could be waiting up to two years for help .

Meantime GP said I can have as much Valium, beta blockers and sleeping pills as I like .

I’m a student - I can’t afford private either .

The funniest part is my problem is PTSD .

Which the NHS have admitted they caused .

Now that they’ve admitted it, they still won’t help me .

I agree, I have been suffering with severe OCD for the last 10 nearly 11 years and I've only just started getting treatment for it after years of asking for help.

My sibling attempted suicide, was in ICU for 4 weeks, moved to a normal ward for a week and spoke to a psychiatrist twice and was singed off! How is that even possible when 4 weeks beforehand they had thrown themselves off a bridge? How can this happen?

Sorry this happened to your sibling. How are they now?

5 weeks in hospital is quite a long time, and due to the reason for admission she would have been reviewed by the MH team as soon as she left ICU. Her risks would have been analysed regularly.

2 ward rounds in one week with a psychiatrist is the norm, sometimes patients only get 1. But as an inpatient she would have been regularly monitored by MH nurses, HCAs, OTs, junior doctors etc who all communicate with each other. Her mood and behaviour would have been closely monitored. If they felt she was still at risk they wouldn’t have discharged her, believe me no doctor wants to attend coroner’s court or have a patient bounce back in.

Was she given community support on discharge?

A long time ago I worked on orthopaedics with a patient who’d jumped from a motorway bridge (onto grass so staff felt it was more a cry for help than a suicide attempt). She had several fractures and surgeries. During the time she was on our trauma ward the MH team visited her weekly, also asked us for feedback on her mood, behaviour etc. After about 6 weeks on the trauma ward she was discharged home, as she said she regretted what she’d done and it had been an impulsive response to a stressful event not planned. So she didn’t go to a MH unit as the MDT and family felt she’d recover faster at home. She did have community MH input after discharge though.

Inpatient MH units are usually swamped, patients often have to go to another county to get a bed.

NHS MH services are extremely poorly funded, and there are enormous staff shortages.

@RattleOfBars I’m actually not sure how he is now, he has isolated himself and been moved to a homeless unit away from where we all live, contact is sporadic. I’ve been had to take a step back as he was making me ill with stress and anxiety.
As far as I’m aware he was placed under the community team straight after for a few weeks but that was about it. Not sure if that was his doing or theirs, he’s a very difficult character.

It's high time that MH services were wrestled away from the NHS. The medical model of mental illness is hugely flawed anyway and the flaky inconsistent way that services are delivered is massively harmful. GPs are, for the most part, totally unequipped to deal with the MH epidemic that we're facing; all they can do is refer onwards to services that are often piss poor with huge waiting lists. They also often have some fucking bizarre ideas about the SSRIs that they push, including the old 1980s myth that you can stop taking them overnight with no ill effect.

Psychiatry is, at best, concerned with symptom masking and is often little more than quackery. The most potent tools in their "toolkit", the drugs that they push, have a range of horrendous side effects that can lead to a range of physical co- morbidities. That's why people with severe and enduring mental health conditions tend to live twenty years less than everyone else; their medication can cause them to become overweight and sedentary. On top of that, the drugs really aren't all that effective anyway which is one reason why a lot of people in the MH system are heavy smokers and misuse alcohol. Needless to say, this is rarely discussed with the patient.

Needless to say, NHS systems and admin cause huge problems for patients. Appointments are made but not communicated to the patient, leading to discharge because of DNA. Referrals take months to even leave the office. Discharge paperwork goes astray leading to serious breaches in confidentiality. If some of these clowns worked for a medium sized paper merchant they'd be out on their arse after a month.

I don't deny that there are dedicated people doing their best in a branch of the NHS that has never been well funded but please let's stop pretending the NHS is actually a good thing. Its a bloated and rather sinister plutocracy that nobody dare reform because of the horde of pan banging zombies who would crucify anyone who tried. Perhaps if we stopped paying £3 billion a year for the sort of final salary pension scheme that went out of fashion years ago for everyone else we could all have better services? Maybe we could do away with all the bullshit infrastructure like CCGs (as though GPs are the best people to commission secondary and tertiary services lol), CSUs (papering over the inadequacies of the above), clinical Alliances (why?!) and all the other quangos like NHS Property etc? No room for efficiency savings there then.

@dooratheexplorer

No, that's not what I'm saying.

I'm saying that the resources just aren't there and a shed load of people need help. The NHS simply cannot cope with demand. It's not a bottomless pit.

If you have a broken leg, it is visible and treatment has a start point and end point. Mental health just isn't that simple. I work in a therapy team which include psychologists and a lot of our clients have life changing injuries which severely affect their mental health. Most of them are helped by very simple practical strategies; routine, having some sort of purpose however simple, volunteering and/or work, building a support network, eating properly, exercise, spending time in nature, meditation, mindfulness, etc. Despite that, there are some people we cannot help because they are not prepared to put the work in. I have a relative who has suffered with her mental health all her life. The biggest part of her problem is that she expects someone else to fix her with absolutely no input herself. I've given up on her now.

If the NHS cannot support you then you need to find an alternative in the form of a charity or private therapist.

If people want a better funded NHS then they need to stop voting Tory.

What happens if you are too scared to do those things though? I have a constant nagging sense of impending doom, I don’t think I would be able to socialise just now . Can barely get dressed as when I do I think I’m going to collapse .

I’m so utterly desperate for some sort of relief, it’s absolutely awful . But it’s like every door you knock on they either need money or they can’t help . GP said she wasn’t interested - not her job to deal with mental health apparently, apart from giving tablets .

Psychiatry is, at best, concerned with symptom masking and is often little more than quackery. The most potent tools in their "toolkit", the drugs that they push, have a range of horrendous side effects that can lead to a range of physical co- morbidities

It’s not like this in all areas. Maybe in some.

IME psychiatry is based on medications AND therapy including psychotherapy and OT. Most inpatient units have activity workers who try to engage patients in therapeutic groups and activities.

Many psychiatrists prescribe minimal medication (anti histamines long ago replaced benzodiazepines for anxiety/agitation). Accuphase or rapid tranq is only used in situations where milder meds haven’t helped the patient, and only if the patient is a danger to themself or others.

Anti-psychotics are necessary if somebody is experiencing psychosis but doctors tend to start with the milder ones and work up, closely monitoring the patient for side effects and switching meds if necessary.

I'm not sure what else can be done. NHS clinicians have to take their annual leave and mandatory training courses have to be attended. Private therapists probably rarely take any leave and will attend far fewer training courses and will be able to organise these around their clinical work. You're comparing apples and oranges.

The waiting list for therapy in our service is over two years. It's a really sad state of affairs.