To say that the healthcare system hasn't a clue when it comes to mental health??

[Danghormones]

I've struggled with mental health my whole life. I've been told an annoying number of times by people 'you've your life so together'. For context, I am fortunate to have an excellent career and I'm married to a wonderful man and have a beautiful baby. Nothing exceptional or out of the ordinary but I'm young in my profession to have got to the level I'm at so from a general point of view, it looks like I've my shit together.

Underneath I feel like I am ready to explode at any second

About 5 years ago my mental health was at its worst and I can honestly say the NHS were no help whatsoever. I actually dropped off their list for therapy and they rang to apologise....7 months later. I was in hospital for mental health reasons and the follow up was absolutely abysmal. I have paid for private therapy 4 times because of this.

Most recently I was referred to a psychiatrist (finally!!) querying BPD and even at that they told me to go look at a course that's in my area. I rang straight away to enquire about it...they said they don't know when or where it's running but it'll be the new year anyway. My psychiatrist also after looking at my notes asked was I referred to the post natal mental health team after I told my health visitor that my mental health wasn't good. I wasn't; I didn't even know it was a thing! She was apologetic and said i'd been let down by the system....what's new I thought??

I have private health insurance and even trying to get an appointment with them was a 4 month waiting list. It mightn't sound like a lot but when you're in crisis mode, 4 minutes is a long time never mind 4 months.

Just so frustrated that I feel like there's so much encouragement to speak up and get help etc and when you do...well you just feel like what is the actual point??

I think a good way of looking at the less acute and extreme MH issues would be to think of it in a 'what do you want to achieve from the treatment' way. So - it might be, "I want to feel confident enough to go out, get on a bus, do my shopping'. Or 'I want to be able to get a reasonable night's sleep', or "I want to be able to work in an office and not be terrified of how I'm going to get out of the building in a hurry' (all situations friends or relations have been in).

It might be possible to address these issues successfully - I don't know. But what MH services (or any services!) cannot do is to help with the expectation 'I want to be happy'. Many people both now and in the past were not 'happy' (what does is even mean?) and it's not a useful target. This comes back to the major problem with all this - the very open-ended nature of MH issues, where they are seen as a problem to be 'solved' to everyone's satisfaction. From what I've seen, that hardly ever happens and if we expect that outcome, nothing will ever 'work'.

My daughter, for eg, had a really great career in London in a difficult-to-get-into field, but she couldn't continue due to anxiety about travel, the tube, cities in general. She was diagnosed with ASD and is also bi-polar. She now works in a pub and lives with family in the countryside and says she is really happy (and seems happy). She was mainly put on a course of CBT which seems to have benefited her, but she also takes medication. We are aware that, while life is good for her at the moment, she is always going to be fragile and that brings its concerns for the future. But frankly, what else could have been done?

The NHS is a disgrace in general but mental health is especially bad.

The women (some kind of “clinician” so not a doctor) I saw asked me nothing just offered anti depressants. I had to inform her I had been on them for 20 year at that point.

She kept saying “but what do you want ? This is the NHS” without even the decency to be embarrassed at not having anything at all that could be helpful except a waiting list.

Don’t even offer a follow up appointment or suggest what to do if I got worse.

Beyond useless.

Mental illness covers far more depression and anxiety
Severe and enduring mental illness,s such as Bipolar ,schizophrenia ,schizo affective disorders ect are still very taboo and nobody takes about them

I am speaking from the perspective of someone who has worked in MH for over 20 years. I also have a sibling with severe and enduring schizophrenia so I'm not immune to the impact of MH on families.

The reality is that the current MH offer DOES NOT work for many. There are of course people who have been helped and supported by the NHS and feel their support has been life changing. But the truth is, many many people do not have that experience. The MH system at present is simply not working for many many people and needs a huge over-haul. We just do not have enough money, staff or resources to give everybody the long term therapies and/or MDT support that would make a fundamental difference to their lives.

We need to start again and some of that overhaul of the MH system may need to begin with education in school from primary age as pp said, as well as a big change in the medicalisation of MH.

I began experiencing mental health challenges around the age of 12, and I can relate to how you’re feeling now. At that time, there was much less awareness about mental health, and it was heavily stigmatised—something you couldn’t openly talk about. It wasn’t until my late 20s that I started taking medication, which helped significantly, but I still felt broken inside.

Over the years, I’ve spent much time analysing myself and trying to understand who I am and why I feel this way. For me, it’s been a combination of factors: genetics, a family history of mental health issues (my mother), and the impact this had on me as a child. My personality also played a role—I’m highly sensitive, struggled with low self-esteem, and lacked confidence, among other things.

Now, in my 50s, I’m in a much better place, but it has taken a lot of hard work and self-discovery. I’ve learned to identify my triggers and develop healthier coping mechanisms. I’ve also made significant adjustments in my life, such as reducing my work hours, stepping away from social media, and cutting out toxic relationships. I’ve lowered my expectations, stopped comparing myself to others, and worked on liking myself for who I am. Despite my flaws, I’ve come to recognise and appreciate my many good qualities.

You're not wrong. I've seen people who have nearly died from throwing themselves from height during acute psychois, being turned away from the hospital with a crisis line number scrawled on a tissue. As soon as their physical injuries have healed enough they just say 'bye'.
I personally have been turned away by three different MH services. The only thing left is to try through Mind. But I'm scared of being sectioned again so don't trust speaking to anyone. They can section for anorexia as the treatment is forcing you to eat. But most other MH treatment seems like guess work. There's no funding for it either, even though it's growing as a national problem.

There's no accountability. The staff I've had contact with have been appalling - rude, disrespectful, uncaring, complete disregard for following processes etc & there's no way of speaking out about it.

There's a case going on at the moment where a ward manager & chief executive are being prosecuted for corporate manslaughter. This is the first time individuals have been held to account for Mental health failings. I hope it will set a precedent & force these services into tackling widespread failings, neglect & abuse.

Mental health care is really not like the rest of the NHS. It is more like the prison service.

Unfortunately most people with severe mental illness will only receive compassion & fair treatment when they come into contact with police eg in a s136 or welfare concern. At least the actions of police are scrutinized.

I would urge anyone interested to read 'out of her mind' by professor Linda Gask published recently as its a brutal honest look at women's mental health care in the NHS.

I think they probably don’t - but then neither do patients.

Most of my patients think ‘a wee bitty sad today’ is depression and needs ‘therapy’

They have no idea about the severe and enduring mental health conditons people and the battle to ensure the limited resources go to those in most need, not those shouting loudest!

I do think this important to address because I do think there’s a lot less resilience today in general and I’ve seen that particularly in my job. However that said, there’s also the complex danger of over generalising actual mental health conditions.

I remember over covid a video was going around from a local sports club where people said how they kept their mental health in tact and someone said ‘I make my bed everyday’ and as well meaning as the video was I remembering saying ffs if your mental health issues can be solved by making your bed I think you’re ok….so I do understand this viewpoint entirely. It’s the same thing I said earlier; one tight chest in the winter doesn’t make you an asthmatic. One bad day or week etc doesn’t mean you have a mental health condition. If anything it’s ruining it for those of us who actually do have severe MH conditions and trivialising it and feeding that ‘get on with it’ attitude.

Don't be so dismissive. Small routine acts such as changing the bed or walking to buy the newspaper daily can actually be very helpful to people with severe mental health conditions like bipolar and schizophrenia.

I agree with this.

My sibling's MH (Schizophrenia) is so bad he lies on bed all day everyday in the dark (not because he's lazy but because it's the only.plave the voices don't find him). It would be incredibly difficult for him to change his bedding. Going for a walk would make a bug difference to him, and does help his mood a little if he's able, but he is too scared of the voices which bombard him when he leaves not just his home, but his bedroom, so he is often unable to.do this.

What do you think would make small positive difference to your MH OP? What do you think you need in order to recover? and why?

Absolutely awful but I can't say I'm surprised sadly
I worked in the same trust where the Edenfield centre ( which is a medium secure facility for patients with severe mental illness and are being treated there rather than prison ( usually) waa exposed on Panorama ,a couple of years ago ,the behaviour of some of the staff was appalling.

I have friends with MH issues, they've said the biggest help for them has been consistency.

Short term therapy doesn't help. They get to know the person then they're gone.

The ones who're managing the best have had the same physcatrist for years, or the same MH Nurse for years. Seeing that person consistently, a person who knows them and their situation so they don't have to keep explaining. People who don't come in and change their medication on a whim or who are happy to contact the people treating their other conditions so they have a consistent approach and so everything works together. Has been the biggest help.

NHS needs to focus on consistency and helping those people. There will always be people who claim MH issues and want to see those people to, but if the overall mh of the community/country improves then surely it's worth it?

These people didn’t have serious mh conditions. It was a local sports club. Im in a low swing at the minute and my bed being made is the least of my concerns

edited to say: apologies I didn’t mean to be dismissive at all and I know these small things can be massive for people with serious MH problems but this was a sports club and I knew most of the people in it and it was more about keeping positive over Covid kind of thing

I have been receiving mental health treatment through the NHS since 2005. I. My experience the specialist services are very helpful. I have had great experience with the 16-19 services when I was a teen, the early intervention team I was with for 3 years when I was first diagnosed with bipolar, the perinatal team after having my daughter and the infant parenting service for bonding therapy. In between times I have been under cmht and they have broadly been hopeless aside from a bit of medication monitoring.

I agree with this. I have been sectioned with psychosis before (suspected schizophrenia as onset at 27). The nhs threw the kitchen sink at me for which I am forever grateful; section, psychiatrists, psychologists, CBT, medication, and preemptive care and monitoring during high risk subsequent periods - pregnancy and post partum with the perinatal MH teams.

And whilst NHS got me through the crisis period and stabilised me enough to be able to be able to think straight enough to begin working on myself; it was the work I did afterwards that has meant I am stable, medication free and back to my normal self. Relapse free 7 years on now.

That’s pretty much unheard of for 27yos with severe FEP. I am an anomaly. And I’m incredibly proud of how I have managed to rebuild my life. And I’m not minimising their input. The NHS provided scaffolding in a way to prop me up. Without that I wouldn’t have been able to have that chance. But afterthat it was 100% me and my thoughts, actions and circumstances that mean I am where I am today.

And about making the bed. It’s not about making the bed. It’s about making a choice, taking control, taking personal responsibility, a sense of achievement; however small it first is.

OP. You know you best. You know what it's like to live in your head.

What sort of mental health treatment do you think would be helpful?

What would your goals be?

What have you tried? Properly, genuinely, tried? Engaged with for months, putting into practice what you've been taught, including at the end of the sessions?

The NHS obviously isn't set up to offer open ended long term 'venting' type therapy, where you go each week and talk about how you feel for a bit of relief. It offers short term intervention, based on evidence-based treatment protocols, backed up by research. It is in line with NICE guidance, because it'd be unethical to offer treatment that doesn't have some evidence behind it that it's effective. However, it isn't effective for everyone. No one treatment is. Physical or mental.

A previous poster hit the nail on the head around why comparing mental and physical health issues isn't always helpful. The whole 'if you had a broken leg you'd see a doctor! If you have mental health problems see a therapist! It's no different!'

But it is different. Typically with a physical health issue you take the medicine or do the exercises or have the surgery as advised, and it will probably get better for most people. But mental health treatment requires a lot of effort and engagement from clients. No therapist is magical enough that they can simply heal people by being in the same room, when those people have usually had many years of repeating the same patterns, avoidance, withdrawing, or engaging in unhelpful behaviours. There's a reason when you start CBT that the therapist says 'this is not a talking therapy, it's a doing therapy, and if you don't 'do' the treatment, it won't help'. This goes for many mental health treatments. Because there's nothing magical anyone can say to make your mind work better.

It would be a good start to think about what you want, what you believe will help, instead of just generic 'mental health treatment'.

The higher tier treatments( not crappy CBT lead by somebody poorly qualified ) lead by high qualified staff and medications have been life changing
Exactly what I said. Psychiatry is mainly pharmaceutically led. You need a specialist to understand the specificity of each medication and the effects these come from. One person will improve massively on one drug whilst another will have horrific side effects, including suicidal tendencies.

The point is that if medication can't sort out the mental issues, there are not many interventions a psychiatrist can suggest. It then comes down to therapy. Therapy comes in different ways, but they all have one thing in common, they only work if the patient is fully engaged and accepting that they are the driver of the changes. They WILL have to push their comfort zones and face their boundaries and that is the very tough part and the ones that many patients sadly fail at. It's so hard to recover, and takes a long time, but is also so rewarding because it makes us so much stronger, understanding and resilient.

Most mentally unwell people want to get better but need good quality therapy done by well qualified professionals. It’s far easier to do the work when this is provided.

You are right.
I have known many people who had MH treatment via the NHS.... and complained bitterly that it was "shit", "didn't help" etc. Yet would admit the worksheets and homework they had from therapy sessions were dumped at the door when they got home and never looked at.
MH therapy is like physio for the brain. You have to do the exercises and homework, otherwise you are going to be stuck.

I think this conversation would go better if we could stop chucking "psychiatric illness" and "mental health problems" into the same box.

Some people need psychotropic drugs.
Other people probably can think themselves out of things to an extent (better lifestyle habits, societal stuff, CBT).

If the OP has BPD, then "mental health" is not really the right label to apply here. BPD is a psychiatric illness.

yes I agree with this 100%.

Sorry that was supposed to be @GreenTeaLikesMe

Where is the evidence for this?

My ND dc had several debilitating NHS diagnosed conditions and didn’t get the therapy she was supposed to get. After being given a support worker that thought gardening and cbt exercises would solve everything to hold her and didn’t even scratch the surface it took a PALS complaint to get the therapy she should have had. Therapist then kept cancelling and she had half the sessions she should have had. Surprise surprise she’s still struggling with said conditions so back we go to do battle again.

I would like to point at that many ND young people are more likely to have MH conditions and end up needlessly on medication which STOMP is there to give protection from. Access to decent quality therapy done by properly qualified staff is crucial in this and it’s very difficult to access.

Young people are woefully let down by CAMHs and conditions get worse. They are then pretty much forgotten and left to scrabble around for themselves under adult services with transition and the 18-25 provision being particularly bad. It all backs up and treatable conditions become harder to treat.

That is not the fault of patients.