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??

Yes and then the patient will be blamed if it doesn't work or they even become worse.

Sorry you are struggling so much right now OP. I hope things get better soon.

i guess the issue with this analogy is that there are only a certain number of ways to heal a fracture. Plaster cast, surgery, boot etc and the patientihht have set instructions to aid that recovery. MH is 100x more complex because recovery involves patient involvement, it requires engagement in a massive way. People scoff when their doctor suggests exercise, ‘well that’s not going to help’. No not on its own, it’s supposed to be part of a joined up approach to promote increased MH wellbeing. Some people don’t want tablets, some think CBT is a waste of time. The ways of helping people are hugely varied, the causes of MH can be associated to issues outside of healthcares remit, so how can we realistically improve MH if the source is say social circumstance. We have more and more people coming forward with MH issues and the healthcare system can’t cope. Sadly there is no quick fix.

I'm so sorry that you're suffering OP. It must be really hard and desperate at times. Well done for deleting social media, I agree it's not helpful in the slightest. Its only use is to make money (not for your bank account!)

I agree @BaklavaRocks though, the current comparison to physical health problems is not helpful. Both in terms of what the finite NHS resources can cater for and also what people can expect in terms of how to treat MH issues.

If you have a broken leg, it's because the bone is broken. Prescribe a cast/surgery to fix the bone and hey presto! Good as new.

If you are depressed.....well..
It's not as simple simple as prescribe six sessions of CBT and hey presto! All fixed!!

Therein lies the problem and why, even with all the money in the world, the NHS will never be able to solve for MH problems.

CoffeeCantata

I completely agree with your posts. Completely.

I was first diagnosed with MH issues at 17. I've had hypnotherapy, seen numerous counsellors, a psychologist, psychotherapist, briefly had DBT etc.

I was diagnosed with GAD and depression when younger, nowadays through my own reading, self reflection and understanding, it looks more likely that its cPTSD through childhood and adolescent abuse trauma.

I've gained some strategies that get me through daily life but I'm not 'well'. I'm better than I have been in the past right now but it fluctuates. Sometimes, I'm worse.

Sometimes, I feel I can't get out of bed, sometimes I feel I can't leave the house and sometimes I cocoon myself away for months and have very little contact with anyone outside work. I often feel despair, suicidal, have a desire to implode my life, and escape it all.

But I don't have the 'luxury' of being overwhelmed and ducking out of life.

I have a full time demanding career (that I struggle with and feel the fear from every day as much as I also love it). I have a relationship that I'm running into the ground because I can't cope with it.

And every day, I just put those blinkers on, put one foot in front of the other and get on with it.

I have no family support. I don't have contact with the parent who abused me, and the other is dead. Both were only children. I'm early 50s. So there are no aunts, uncles, cousins, grandparents. I have one sibling who is also affected by the same trauma and our relationship is difficult as a result. I don't have any friends because I find it difficult to maintain and sustain friendships as a result of my MH.

I also have two adult children and have spent my.life focused on making sure the cycle of abuse was broken. I've protected them from my MH as much as I've been able to.

I was a single parent. I had to work and I had to provide for them. I had to make sure that they were protected as much as possible. And I have.

And i will be perfectly honest that things have been better in the last 10 years since I realised that there wasn't really a lot that the NHS could do in real terms because of the reasons *CoffeeCantata and others have given. *

There really is an extent to which you have to take responsibility for making positive changes. They're not a cure but they do help.

Removing people from your life who make it work, getting outside into the fresh air, exercise, eating well, drinking water. All the 'soft touch' approaches that are recommended do help. They're not a cure but they mainly give you a sense of agency in your own life. But, as others have said, so many people reject them.

Some people's.MH will be so severe that this makes no difference. It only makes some difference to mine. It's certainly not a cure.

I think there is very little understanding of what people.can actually do to help themselves. Because most people can even if it only helps a little.

Actually I think the analogy with physical health is valid - there are many, many physical health problems that are hard to treat. To take the broken bone analogy - many are minor fractures and heal well, some fractures don't and cause permanent disability. Hip fractures have a high death rate. Most mental health symptoms are minor and either need no intervention or GP care. Some people will have lifelong symptoms but live an independent life, others have severe and enduring illnesses such as schizophrenia- with a variable level of treatment response. It's important to be realistic- no one can cure eczema or psoriasis, and some people will have very severe problems, but most have minor symptoms that respond to treatment. Mental health is underfunded but the level of expectation has gone up hugely and it's just not realistic.

I was sectioned with psychosis and the crisis team were ok. But after that the care was appalling and I went private where I got diagnosed with bipolar and treated. It's joke. I have serious mental health problems and can't get the help on the nhs!!

Whilst I agree with many of the points raised here (eg the medicalisation of distress, the modern habit of pathologising normal emotions etc) there is an awful lot of survivor bias here too.

There are people out there who are resilient, take responsibility, 'put in the work' at whatever unsatisfactory treatment they are given, if any, and don't make it, or are so marginalised in society that they can't come on mumsnet and tell their story about how they forced themselves to get on with it.

There are people who can't have children ' to break the cycle of abuse' because the abuse they suffered was so severe they can't tolerate touch however much they might crave it. Or maintain work or any relationships as their mind simply cant make emotional connections or are completely shut down.

And yes, I'm sure then will come the 'oh, but I don't mean those people'. But all we can do is speak from our own experience. If something worked for you that's great. But there is a long history of psychiatric/mental health treatments blaming the patient when it doesn't work.

And no, often they don't work (I actually think such treatment is pretty much as scientific as banging on a tv to get the picture back).
But I am concerned about the increasing tendency to talk in absolutist terms (not jist on this issue but everywhere). This goes just as much for those who declare every feeling of nervousness as 'anxiety' as those who go 'people need to take responsibility/build resiliance/I/my daughter/my next door neighbour managed to put one foot in front of the other and this is just what people need to do'.

Everyone is different. Which of course makes prescribing the right course of treatment for each individual impossible.

The sad truth is, sometimes there isn't an answer. Which, in a roundabout way, has been the consensus of this thread.

But I think what might help those for whom nothing has 'worked' regardless of engagement/non-engagement/perceived resilience/taking/not-taking of responsibility would be an understanding that your experience is not necessarily their experience and that most people are doing the best with what they were given in life.

That’s you. Other people have multiple conditions, experiences and different brains. Not everybody can just get on with it.

What would excellent mental health care look like, what is the point a Dr says you're cured, is there a cure?
You break your leg, cast or operation, you might walk again but be left with residual issues, but in effect you're walking so you're cured
Cancer - operation, chemo - the cancer may be gone, but you're left with multiple issues following chemo or radiotherapy, but you're classed as cured as cancer free

So on that basis, maybe there is no long term cure? Maybe you just have to learn to live with and manage your symptoms like people do with a physical illness

@Treeper22
Whilst I agree with many of the points raised here (eg the medicalisation of distress, the modern habit of pathologising normal emotions etc) there is an awful lot of survivor bias here too.

There are people out there who are resilient, take responsibility, 'put in the work' at whatever unsatisfactory treatment they are given, if any, and don't make it, or are so marginalised in society that they can't come on mumsnet and tell their story about how they forced themselves to get on with it.

Couldn't agree more.

I also think that the short term "reprogramming thoughts" type treatments - CBT et al. - are actually better suited to the type of people who don't reflect on things themselves, haven't much reevaluated their lives or tried to change things. Those who have done all they can, thought things through, often realised themselves that their issues come from trauma (especially childhood) are rejected from services as they don't fit the 6 sessions of CBT model, but other, more exploratory therapies are not available. Nor are crisis services.

On the one hand the attitude of medicalising distress is immensely frustrating. On the other hand, I can't think of an example from real life of anyone suffering and having that attitude. They all have an idea of where their problems come from, often desperately want to work through stuff in therapy, try to look after themselves in other ways, don't expect a quick fix or a pill. It's actually those around them, if anyone, who medicalises things and wants them to pop off to the doctor and "get well soon".

On that note I will add - it seems to me that society in general is more psychologically informed than mental health services! I would hope things are changing, but 20 years ago when I sought help as a young person, they were appalling. I had thought things through, had made efforts to improve my life (following up on things I enjoyed, trying to build a life, sensible with money, looking after my physical health food and exercise wise), and was able to give a history of the development of my issues with reference to key events. Any therapist worth their salt would have had loads of threads to start pulling at and help me work through stuff. But no one seemed to care about that. They evaded offering therapy at all. They basically didn't do anything, just sort of had me on the books and treated me in a punishing, disapproving manner for presenting in crisis due to ongoing lack of any support or hope. (I'll leave it there. I could write a book...) Now we have widespread availability of CBT but little else for those who need to dig deeper.

Mental health services actually made me much worse. They didn't even speak to me like a human worthy of respect, let alone speaking kindly as I was feeling awful. One issue I think may be quite widespread is that repeatedly presenting in crisis for them to do fuck all (I also was trying to get help going to GP etc when NOT in crisis) was actually traumatising in itself. To be terrified and in huge emotional pain, reach out but receive no support, the horror of it replays itself every time (not to mention being locked in police cells and so on as "a place of safety"). The nightmares I had about mental health services were the ones that plagued me for the longest...

Realising that psychiatry had become my abuser was the first step (of a very long road) in actually starting to heal. Unfortunately, people are very keen to insist on "seeking help", and the last thing you need when horribly low/having suicidal thoughts is to have to deal with 8hrs in A&E waiting to see the crisis team, who check you have their number then bugger off. It's very rare to have people around who can understand someone is in pain/deeply sad, but trying to survive, and just... being with them. Having the small smiles when the big ones won't come. Just quietly being there and sharing. This is what turned out to be the most healing thing for me.

Poor mental health is not curable, we have to learn to manage it by researching as much as possible ourselves and look for ways to make it more bearable. Some of the posters on here are spot on with their responses . Any suggestions of what may help anyone ?

You have said your the person you know didn't get the therapy they needed... and that is different to my point, which was some people get the therapy but just don't engage... and they then complain that it does not work.
It is like having physio, and not doing the exercises at home, and then blaming the NHS for being shit.

Plus - the NHS isn't equipped to deal with "SLS" - shit life syndrome.

The appalling treatment of poor MH, sadly, comes down to money:
a) it is medicalised beyond necessity because the big Pharmaceutical companies fund the diagnostic tools we use. Poor attachment has a lot to answer for, but that won’t make a lot of money.
b) EAPs are making a fortune by opening up call centres sold as ‘counselling’ funded by your employer. In reality they are anything but! ‘Counsellors’ are given strict instructions to type notes as you talk and stay within a very narrow solution focussed modality’. With 2 minutes between calls and calls which a randomly monitored your ‘counsellor’ is unlikely to have the capacity for the emotional containment they would normally offer.
c) educational providers and training centres are churning out unsafe practitioners to get bums on seats and tick their own boxes. A tiny proportion of the people who trained alongside me did the personal development and self reflection required. It is frightening to think how many people qualify each year by essentially buying a degree (or foundation qual).
d) societally we expect healthcare to be free but will pay a fortune for entertainment, technology, hair and beauty etc. our MH is probably one of the most important things we could invest in. It has the potential to improve our wellbeing, relationships and ability to engage meaningfully with employment.

The combination of the above make it daunting and frustrating for anyone with MH difficulties to find, trust and access helpful support.

How do you know she didn’t have anxiety? How do you know the others who claimed to have anxiety weren’t diagnosed with it?

I’m not saying you haven’t met some chancers but being so dismissive doesn’t help anyone. I did have anxiety. I was diagnosed. I hated everything about it and it took me a long time to get better because I took the approach that I should be able to just get over it. I couldn’t and I made everything a million times worse.

If someone claims to have anxiety and shows minimal outward signs of it then they might just be doing a good job managing it.

It’s not fair that others are expected to pick up the slack for those with mental illness. I was a bad employee and probably hated by a lot of my coworkers but I was always trying. The fact is that at my worst I had trouble sitting at my desk because every sense was overloaded and I had to constantly fight the urge to run away. I tried getting in early and was told off (there was an unwritten rule that though early to early was promoted it shouldn’t actually be done). I tried working from home sometimes and was told off (another unwritten rule). I tried working in meeting rooms and was told off (though I was always available by phone or messenger I needed to be seen at my desk).

I finally got signed off and spent half the time panicking about it and the other half sleeping. When I came back the attitude was that I’d been signed off so I was fixed now and it was time to work 150% to make up for being signed off…

but maybe keeping positive during hard times is teaching resilience and enabling people to find a way to avoid their issues escalating?

Most people aren’t getting the therapy they need. When young people rated as red on transition or who have tried to take their life repeatedly aren’t getting the therapy they need it is clear the majority aren’t.

It absolutely isn’t the case that the high numbers of struggling young people is down to high numbers not bothering or engaging with treatment. They are struggling because they weren’t given adequate treatment in the beginning, are kept from highly qualified staff and conditions have been left to get a whole lot worse.

Waiting lists are horrendous. In the vast majority of cases adequate MH support and treatment just isn’t there. That is the problem so let’s not gaslight the many many people caught up in this.🤔

That is impossible for many people with complex conditions and diagnoses and frankly shows a huge amount of ignorance. When you are struggling with self harm, suicidal idealisation and have other conditions to manage on top researching your way out of it just isn’t possible. Some of the ignorance on here is truly astonishing.

This.

BUT, I fear this is just a far too logical approach I would be sceptical that it would actually happen. Shame though it just makes so much sense, It's probably quite complex to implement in reality, another reason why it could be put on the too hard pile by the powers that be.

@CoffeeCantata makes very good points.

You see on MN people pathologizing normal emotions; shyness becomes social anxiety, feeling low becomes clinical depression, being nervous become anxiety.

People are still going on about the effects of lockdown on their child's MH. Desperate to outsource parenting teens to CAMHS or the school.

Anti-depressants and counselling seen as a panacea when they are anything but.

So those who genuinely need help can't get it because no healthcare system can cope with the demands of a nation obsessed with Mental Health.

I'm not sure if you know of the Out of the FOG site, there is also one called Out off the Storm about c-ptsd you might find helpful. Kind thoughts

https://outofthefog.website

https://www.outofthestorm.website

I don't think the main problem is the NHS not having a clue (although the chaos you describe - referral systems failing; dropping off a list etc - does sound awful and very much like a system issue. I'm sorry that you've missed out on help you could have had).

I think the main problem is that no one has a clue.

Despite loads of research and funding, we simply don't have very effective mental health treatments. Various drugs help people with specific presentations - I used to be very sceptical about mental health medication but seeing how it has transformed things for, as an example, some people with acute psychosis, has taught me not to dismiss them. However, no drug works for everyone with xyz condition, and of course they come with side effects that some people are understandably not prepared to tolerate.

Then we have therapy. Being a bit of an insider on this one (both as a former patient and as a working therapist now), I think therapy can be great if the problem someone is going to therapy with is very specific. I have seen people make incredible recoveries from certain types of social anxiety or panic disorder, for instance. But most people's problems are complex, and even a huge amount of therapy with the most competent and compassionate therapists in the world (not claiming that status for myself!) would not necessarily enable people to overcome their problems. Some people feel sustained or nurtured by therapy but because it's a limited and expensive resource, the NHS is always trying to limit how much each person can get - life-long therapy will never be prescribed.

So we are looking at a terrible debilitating set of problems that have no known cure... and given that the development of mental health problems is so complex - that they are caused and sustained by varied mixtures of possible genetic aspects, traumatic experiences, attachment and personality styles, social issues, poverty or status pressures, habits of thinking etc etc - well it's not exactly surprising that there is no simple way out.

Some people do recover fully; for others recovery means living the best life they can with problems that won't go away.

It's so hard and I don't see what anyone can really do about it. I'm a huge pessimist, I know... What I see in my team is people desperate for mental health support which they hope will be wholistic and long-term, coming into a system where the whole rationale is to discharge people as soon as possible and to accuse them of not taking responsibility if they don't 'engage' with the interventions offered to them. I hate the ethos of managers etc but I do sympathise with one aspect of their position: they point out that there is no evidence that supporting most people long-term / offering them loads of appointments and different therapies etc will actually 'work' in terms of helping those people actually recover!

I think what my whole rant really boils down to is that these aren't medical problems in the same mould as other types of medical problems - cancer; a broken ankle - but they are being treated as though they're comparable. A 'something is broken so let's fix it' approach rarely works with mental health except with small number of very specific things.

(And yes I realise that recovery from physical health problems has social and psychological aspects too, and that physical health is also very complex at times, and that people can be let down when struggling with those sorts of things too!) It's almost like we aren't robots that can just be reprogrammed and 'fixed'! (revelation!!!)

I also wonder if the level of intensity of our lives pushes some of us over the edge. Work, Internet, plastics bright lights, no sleep, ultra processed food lacking nutrients and with plastic in, cars, pollution, consumer culture.

A pre industrial revolution kid working in the fields might be bored, tired, cold, uneducated, clouted by their dad, and suffering a load of physical pain like a dodgily healed broken arm, badly fitting shoes or toothache. So their life was hard and they were not happy. But some elements of life were likely to improve mental health like going to sleep when it gets dark, waking with the dawn, getting outside. So anxiety would be situational as it is for people now, but about more "real" things like pain and having no food.

We have loads of things that are supposed to make us happy but actually overstimulate us ridiculously.

But what do you want? Did you have a clear goal for your appointment? Because of you wanted to fix the symptoms, the only option was medication or a waiting list for therapy. It's not exclusive to the NHS, the same "fixes" are available in the private sector.
If you had some recovery goals, that's a different conversation and there is some scope for rehabilitation which won't remove your symptoms but can improve your quality of life. But that needs an active input from you at all stages of the process including goal setting and agenda-setting for your appointment.
As another poster mentioned above, the majority of recovery goals we come across are "I want to be normal" or "I want to be happy". These are not actionable goals and there is nothing the service can do to "make you" happy or normal. But we can often work with you on taking your kids to the park or returning to exercise or vocational rehabilitation...