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.

Mh services in the NHS have been chronicly underfunded for years unfortunately the current situation is just compounding an already awful situation.
I've had very poor service - was assessed for emdr in Feb 2019 had an appointment in December thought I'd be starting treatment no they reassessed to see if I was still needing treatment. They said yes I did put me on a new waiting list and told it would be January 2021 before I got treatment - I'm assuming covid will have delayed this even more. Had no contact since January bar a generic letter saying if I no longer need it please cancel.
And don't even get me started on cahms. The staff I have met are brilliant but the system is broken as is physical care for none covid reasons.

To be fair @furrypesto a lot of physical health conditions do require patients to take reponsibility for their own health. Even serious health issues like heart attacks, after the initial acute health issue, most of health care is done by the patient at home

The problem with mental health is its so widespread, so underfunded and requires longterm help. Often people who arent in a suitable state to help themselves, and sometimes help isnt that easy or simple to give. It cant be medicated against (not truelly anyway) and it cant be operated on. The NHS doesnt have the capacity to provide mental health services at the rate they are needed. Mental health professionals have massive case loads and are often people who have suffered mental health problems themselves, and arent immune to stress and further mental health issues or ill health

It does seem obvious to me that number of therapy sessions offered does need to be capped when the waiting times to start therapy are as high as two years. We offer up to around 30 sessions but as I said the wait is now over two years to start. If we offer more sessions, the wait will be even longer.
The only way around this is to increase capacity e.g. employ more therapists.

We have around 80 on our waiting list for therapy (last time I checked). Just a handful of therapists.

YANBU that the MH in the NHS clearly needs improvement. But YABU to cancel therapy because of a few skipped weeks during a global pandemic. It’s not realistic to expect MH sessions to continue weekly when so much resources need to be directed towards Covid wards and testing.

@Dancethen oh I do agree. But I suppose what I am saying is that if someone who has suffered a stroke can no longer do certain acts of self care then they wouldn't be blamed for that and told to 'take responsibility'. They can't magic away their limited capabilities.

I also agree that it is a highly complex area which involves so many factors (sociological, economic, familial) that means there is no simple answer. Although I do believe if we could eradicate childhood adversity and abuse then the rates of serious mental health conditions would be reduced.

I think also what happens (I know a lot of therapists!) is the really empathetic caring ones burn out because they feel helpless in the face of the crap provision and often leave the NHS which sadly leaves the ones with less empathy.

I have had some shocking experiences and sadly it was not due to 'bad luck' it has been something that seems systematic. I also believe, like a lot of profession as well as attracting people that genuinely want to help it attracts those who enjoy the power. And of course there is no way to complain because a psychiatrist has the power to discredit you like no other clinician. For that reason I would strongly advise all meetings be recorded. I have seen in court documents clinicians openly lie.

And, as you say many clinicians have suffered from their own traumas and mental health problems (which is why psychotherapy and psychoanalysis - whatever you think of those! - require the therapist to work through as much as possible their own issues).

Sorry, that should have read @DanceThen

Like so much of the NHS it varies wildly from area to area. I'm lucky in that my wait for "talking therapies" was only 3 months, which is nothing compared to the 2 years some here have had to wait. (It felt like forever at the time). However, we only get 6 sessions, although my therapist is asking her manager if I can have more as she can see the improvements. It took 4 of my 6 sessions to trust my therapist enough to start opening up and we still have so much uncovered ground.

My friend otoh, who lives in another county, went to A&E after attempting suicide. She's a single parent with a high needs child. She was 'patched up' and sent home. No follow up. Nothing. Not even a ss referral. :(

I used to be a mental health support worker so have been on 'the other side' as it were. I've seen (and been) the staff who are run ragged trying to help everyone when we don't have the time, staff or funding to give them what they need. That was in a private setting, and as I understand it its even worse in the NHS.

I've spent the last 16 years trying and failing to get adequate or frequent help from them, it is ridiculous compared to physical medical help.

a lot of physical health conditions do require patients to take reponsibility for their own health. Even serious health issues like heart attacks, after the initial acute health issue, most of health care is done by the patient at home

I agree. I worked in cardiac rehab for a while (group education sessions for people recovering from heart attacks) they were expected to attend all sessions, track their exercise, monitor their heart rate before/after exercise and stick to a healthy eating programme. Most had individualised diet and exercise plans and medication regimes they were expected to follow at home.

Same with surgery; even after a hip or knee replacement the patient is expected to mobilise as soon as they can, engage with physiotherapy and practice exercises at home, take the meds prescribed and attend all follow up appointments. Often people wait years on the NHS for elective surgery, even when they can hardly walk or function.

It’s the same with MH in a way; patients are expected to attend appointments, comply with medication and therapy, attend group support sessions if recommended. I understand it can be hard to attend an appointment when anxious/depressed but it can also be hard for patients with physical illnesses/injuries to attend. Once you get a DNA on your file a few times HCPs often stop offering appointments/support.

OP I can understand your frustration but I think cancelling your psychotherapy sessions may be detrimental to your recovery. Lots of people are desperate for psychotherapy on the NHS and cancelling is likely to lead to even less help from services as they’ll assume you don’t want to engage.

People with psychosis, bipolar, psychotic depression or those who have frequent inpatient admissions can often be forced to accept help (eg if they lack capacity or are on a CTO) but other conditions the patient is expected to take some responsibility. You could contact PALS to complain or request a different therapist but it could be a long wait!

But I suppose what I am saying is that if someone who has suffered a stroke can no longer do certain acts of self care then they wouldn't be blamed for that and told to 'take responsibility'. They can't magic away their limited capabilities

They won’t be blamed but they will be expected to work with therapists to regain some (or all) of their lost capabilities. On an acute stroke ward most self care tasks will be done for them, but once they move to a stroke rehab ward the nurses, physios, SALT and OTs focus on helping them regain as much independence as possible, from re-building muscle strength to re-learning tasks like brushing their teeth, washing themselves, eating, talking, walking etc.

Then once discharged they’re expected to keep practicing the exercises and self care tasks, usually with the support of a community team. It’s about enabling people and helping them towards independence/semi independence, so the patient does have responsibilities too.

I totally appreciate what everyone has said, especially the point made about MH help often being long term and not having a ‘start’ and ‘end’ point so therefore being unsustainable.

I don’t think that is relevant to my situation though. I have never had MH issues before. This isn’t a long standing problem and it began for a very specific reason (pregnancy illness) I genuinely feel that with a consistent course of treatment over a relatively short period of time I could have been cured by now but that has never happened.

I’ve been passed from person to person, left for weeks without appointments and generally messed around since the start of the year.

It’s like going into A&E with a broken leg, only to be told it’ll be a week until they can X-ray you because the radiologist is on a training course, then another few weeks till they can put you in a cast... because annual leave, then when you finally drag your gangrenous, deformed leg back in to get the cast on they’re like ‘wait just remind me what happened to you again and why we are putting this cast on so we can assess whether a cast is the right course of treatment’.

Absolute piss take really

I think a major part of the problem is that mental health issues are at epidemic levels now. We're all encouraged to accept this as normal because of constant coverage on TV and in the press over the last ten or so years. Yes, it's great that we're all talking about it but NHS services haven't kept up with demand.

@RattleOfBars has summed it up perfectly. A major part of therapy/rehab is giving patients the knowledge and tools but the bulk of the work needs to be done by them. In my previous therapy team, we often discharged patients who wouldn't engage despite lots of encouragement from the team. The thinking behind this was that we were under tremendous pressure. There were also lots of other people who needed our help and were prepared to make the effort.

Lots of people complain about the NHS but the reality from being on the other side is that we encounter an awful lot of time wasters. We would routinely have appointments cancelled on the day because patients thought a hair appointment or cup of tea with Mavis was more important than a therapy session.

My experience was very positive. At the beginning of the first lockdown this April I received a text from my GP suggesting if I self refer to my local nhs mental health team if I felt like I needed extra support during the uncertain times. I haven't been to my gp in over 10 years so it was totally unsolicited. My anxiety was at its highest at this point so I guess I was just lucky that this was offered to me at the right time. I completed an online form and got a call back within a few days. I've completed a full course of stage 3 CBT with 6 sessions via video calls. The administration was a bit shaky with missing emails and I had to chase for reading materials that was promised to be sent to me but I had fantastic support from my therapist and I working on the anxiety. I just wish everyone else could receive the same level of service that I did.

"Piss take" implies that the service is deliberately thwarting your treatment. As has been stated, annual leave has to be taken and mandatory training has to be attended. Sounds like you've been unlucky with timing. The real issues are waiting times and length of therapy, both of which are capacity issues caused by inadequate number of therapists vs number of patients needing therapy. Demand for therapy through the NHS is sky high.

It’s like going into A&E with a broken leg, only to be told it’ll be a week until they can X-ray you because the radiologist is on a training course, then another few weeks till they can put you in a cast... because annual leave, then when you finally drag your gangrenous, deformed leg back in to get the cast on they’re like ‘wait just remind me what happened to you again and why we are putting this cast on so we can assess whether a cast is the right course of treatment’

I see where you’re coming from OP, but we’re in a pandemic and every dept has a triage system as there just aren’t enough staff to tend to everyone immediately.

If a patient came to A&E with a serious life threatening leg fracture (eg fractured femur/open fracture/compartment syndrome) they’d be taken straight to surgery. Then on discharge they’d be be expected to work with physios and attend follow up clinics.
If the fracture was minor (hairline, simple break etc) they may be taken to Minors and have it strapped up or put in a cast or brace then sent home and re-assessed at a later date.

With MH it’s not as simple as an X-Ray to diagnose the severity of the condition. MH staff are trained to spot signs of psychosis, mania, severe depression, delusions, suicidal intent. These patients are usually admitted and have intensive treatment as inpatients.

Patients with milder depression/anxiety often get stuck on waiting lists (or assigned a therapist if lucky). I’m sorry yours went on annual leave and training when you needed her. Ideally some other support would have been offered, but resources are scarce just now.

I think NHS staff are doing their best, but we’re human too.

I'm still waiting for peri natal mental health team to contact me after I had dd. She's 19 months so pre pandemic and now can't be seen by them because dd over a year old and need to go on the other list.

They did offer to speed things up and I could be seen in 3 months if I wanted to pay. I unfortunately wasn't in a position to pay for treatment at the time.

I'm doing ok now.

dooratheexplorer many thanks for what you do. I’m one of the sort of success stories. My treatment is ongoing for life and there is always a risk. Having been around MH services for six years of which two I spent in a three day a week group session in a tier 3 service I have met a lot of shall I say characters. These were people at the extreme end of illness, a few of them were actually dangerous. I know most people with MH issues are not but some of these were. Seen non coperation and manipulation that is at a shocking level. Some of the patients found it funny. We were forbidden contact outside of the service but some defined that. The stories that were shared in those therapy sessions were so terrible. What happened to all of us sounds like stuff out of horror films, many just would never share as worried they would not be believed and also that they would scare or distress others. I have heard about stuff that is from the depths of human depravity.

You may not want to share the exact nature of your illness op but the MH boards used to be useful on MN. I was on them a few years ago and there was a daily check in thread. The only advice I can give is do not drink alcohol at all it’s positively dangerous when mentally unwell, if you get very anxious try and move around a lot and burn off excess adrenaline. I will still run on the spot and do star jumps in the middle of the night if needed. Be totally honest with any MH professional however bizarre or awful your thoughts are they are not shocked by anything. Good luck.

Our mental health support system is a joke. It has failed so many people I know, not due to lack of empathy or even poor quality of staff, but due to gross under funding on behalf of Government or even NHS management.

My latest therapist however, was rude, told me I was too unwell for her to help (which fair enough, might be the case, but chose your bloody words better) and changed our appointment slot to a time I couldn't attend, refused to change it back and then reported me to my GP for not attending.

I subsequently complained to the service and have had her replaced with someone much better.

I find online forums have an awesome support network. I know of a few good ones if anybody would like me to share them.