What thing would help people's mental health

[PassingStranger]

Just wondered, when people say, they didn't get the help they need, or needed for their mental health.
What does this actually mean?

Does it mean, there's a lack of affordable professional help available.
People have to wait too long for help, there's no help???
I'm interested in this, what would help people?
What missing?
What do people need.
I've heard the expression didn't get the help they needed, so what is that?

Absolutely spot on. 👏👏
I could have written your post.

👏👏 Well said. To be seen by a 'mental health professional' who seemed like they even vaguely had a clue, I had to go private! Up to that point, everyone I encountered was beyond useless.

The PP said they have compassion fatigue. A sure sign to get a new job. Not fair on their service users otherwise.

My "help" made me so much worse.

I've been struggling with anxiety. Spoke to my GP, was referred for CBT over the phone. Sessions were short and rushed, and I said a few times it really wasn't helping me but was told I needed to complete all sessions.

Not only didn't it help, I'm now having panic attacks and struggling to leave my house.

Yep, CBT is the catch all solution to MH issues nowadays. It is not suitable for everyone, but it makes the NHS look good... like they are doing something.

If someone has a lump in their breast, they get it looked at, and have a biopsy etc. If a breast lump was treated like MH issues, you would be told you might have a scan/biopsy, but you need to try and massage it away first... but you wont be told told how to do that for months.

Sorry you have been let down. Th say the squeakiest wheel gets the oil. Sometimes it is a case of pushing more and advocating for yourself. Really hard when you feel like no one really cares though.

Please get the Dare response book from Amazon. They have a free app as well.

it’s a type of exposure therapy and it changed my life. It’s not about making the anxiety and panic go away, but it’s about learning not to be afraid of it anymore, which in turn makes it less intense and less frequent.

It seems as though the consensus is that what people feel would be helpful is 1:1 long term individualised therapy with a skilled practitioner for as many sessions as required. I don’t necessarily disagree but I think it should be self evident why this is not offered on the NHS: it would be completely totally and utterly unaffordable to offer such expensive therapy to all who would benefit. That’s why CBT and DBT are largely what the NHS offers because they are manualised and less based on therapist skill levels and time limited so that demand can be managed. The waiting lists for everyone to have the kind of therapy that people would like would be indefinite. Before IAPT services were invented this was the case waiting lists were just in the realms of fantasy. So it’s not CBT or long term psychodynamic therapy that’s the realistic choice it’s CBT or no therapy at all.

@ninjahamster It’s similar with my Dad. He had a happy, stable upbringing but has had lifelong mental health issues. He’s constantly asked about his childhood as well!

Personally, as a non-health professional, I think it must be innate with him, it’s part of who he is.

I often think that I wish I could rid the world of abusers and that would revolutionise mental health and do me out of a job. I wish I had a magic wand or maybe more of a magic sword to do away with all the neglectful abusive parents and partners. I don’t have one of those obviously but investment in early years, parenting support and a change in society’s attitudes so that abusive men are not tolerated. Those might be achievable and then we would not need such expensive therapy.

@QuestionableMouse I’d go back to your GP to discuss medication- or switch to a different one if you’re already taking one.

I’d got to the panic attacks stage when I finally went to the doctor and asked for help. I also had CBT but tbh, the medication is what really helped me. You won’t necessarily need a high dose, I started on 20mg and reduced to 10 after a few months. It just stops the crippling anxiety and I feel like myself, instead of a nervous wreck. Good luck. 💐

Medication plus CBT is the evidence based treatment for anxiety disorders though. It really is. Often there is a ‘stepped care therapy’ approach where you will not get to the next rung up the ladder with the more experienced therapist unless you complete the first course which is why you were encouraged to continue. (once again it’s a resource issue where not everyone can have the most experienced practitioner as they only have so many slots) Plus it is often a bit worse before it is better when you are trying to expose yourself to something feared. Please don’t give up.

I agree, even if things were arranged people dont feel like going out and meeting people.

A huge part of the issue is what we are referring to as ‘mental health’ There is such a broad spectrum of issues that come under this umbrella that people expect help from MH services for that it’s hard to see how it could ever be all things to all people.

For severe psychotic illness medication will be required, for anxiety disorders actually CBT is good, for trauma based problems not so much. Why isn’t psychotherapy offered to inpatients? well that’s because it would not be much use to people with acute mania and psychosis who are most of the people being admitted these days and length of stay is such that you’d be discharged before you could complete any course of therapy. 1:1 psychotherapy is not a suitable treatment for the setting or the client group of inpatient services hence it is largely not offered in that setting. It would be a waste of scarce psychology resources that would be better used for the CMHT post discharge.

People are angry that autism and ADHD are poorly served by MH services but that’s because neurodivergence isn’t really a mental illness as such and it’s quite odd that psychiatrists have wound up being responsible for these services (like dementia why is that under psychiatry when it should be neurology?) I’m not saying more awareness wouldn’t be good but if you wonder why we aren’t good at it well many of us were never trained in this area. Recognition of ADHD in adults is a relatively new phenomenon and was not on the curriculum at all when I trained so yes I admit I suck at it. I could retrain (beyond obviously the basic mandatory training) but I already have more than enough to do with all the other conditions I was trained for and am good at treating so I tend to just be honest with people and tell them that it’s not my speciality area.

I wonder if people would be less disappointed if we stopped talking broadly about ‘mental health issue’ and admitted that generic NHS inpatient and CMHT services are really mostly for severe psychotic mental illness and we developed different services that were more psychotherapy based for trauma based presentations probably run by psychologists and not psychiatrists and therefore with less focus on making diagnoses and more on formulation. There are some fledgling efforts towards this type of service in my area but woefully under resourced and therefore overrun with long waits.

You raise some really good points. I have been in hospital, and like a PP said on here, it was basically a holding pen. No therapy. But you are right. Once you get admitted, no one knows how long you can be there, so they can not realistically offer you any sort of therapy that will be long enough to matter. We did daily mindfulness when I was in hospital.
I did have DBT when I was inpatient, but I was already on the program and it just so happened that it was running on the same site as the inpatient ward, so I was still able to go.

This is the inherent problem with mental rather than physical health though. We literally don’t have any handy scans or blood tests or biopsies that can give an accurate pathology level diagnosis like you can with breast cancer or an infection or a broken bone so it is really not so simple to be definitive about what is the correct treatment when getting the diagnosis correct is not straightforward. Your analogy doesn’t hold up for that reason. If we actually knew in the same way what would definitely work then it would be easier to have a route to provide it.

For some conditions like schizophrenia diagnostic criteria are well established and probably valid, there’s an evidence base and treatment guidelines can be reliably applied

For some other things I think we ought to admit that our attempts at diagnosis have less validity. Psychologists keep trying to explain to me how EUPD and cPTSD are different but I can’t see it myself. They look like facets of the same problem (early life relational trauma) to me and I am afraid social class might have more to do with which one you get allocated than any inherent different pathology. When I see people diagnosed with a laundry list of stuff like OCD, depression, anxiety, gender dysphoria an eating disorder and a PD they are usually neurodivergent and/ or traumatised and people are just trying to stick labels on the many manifestations of their distress. Often these labels are used to justify quite harmful treatments like off label antipsychotics. In situations like that there is no clear evidence base and no consensus on what treatments would actually be helpful so it’s no wonder that treatment is unsatisfactory as these problems don’t fit a medical model.

just to say @ThePure - thanks for all your contributions to this thread, very helpful perspectives

Lack of counselling on NHS - it's a very long wait and then you get six sessions. Long enough to remove the sticking plaster but not enough time to deal with what's underneath. So you're left exposed and vulnerable.
Not all GPs are good at understanding depression. Lots of work to be done there. (One told me to shut my eyes and think of a happy place when I get low. Easy peasy.)
We say we've removed taboos around mental health but we really haven't. Many people either don't understand or are too scared/embarrassed to talk about depression so people suffer in silence.
Support is often required in the form of practical help early on. Helping people get access to steady employment, decent housing, the right medical care, three meals a day - these are all basic needs that can drive people into mental health struggles if not met. The UK is increasingly a country of extremes when it comes to housing, jobs and wealth and I think that's a huge factor in our mental health.

These ideas are just for starters, sadly.

A full diagnostic, therapeutic assessment of a person with MH issues to establish if it could actually be Autism, ADHD or a personality disorder. Then the person receives the correct treatment and begins to understand their condition and learns how to manage and accept it.
I'm convinced that had I received a dianosis that I was neurodiverse, I would not have had the severe bouts of depression and anxiety that I've had. For me emotions are complex and a lot of human behaviour, wants and needs are strange and so I never felt 'right' as a teenager, adult, mum and I felt that I never properly fit in, I was acting a role and feeling lost.

All services are so disjointed, unless you fight and push relentlessly, you don't get properly diagnosed or access to suitable support, and let's face it if you have MH issues you often just cannot do that.

When you're in crisis you have to wait and wait for support. By the time it comes, you are no longer in crisis.
If you have anxiety you aren't prioritised.
If you're a middle aged, middle class female you won't be taken seriously anyway.
If you're agoraphobic you're invisible.

In a lot of cases, it’s that the physical health issue didn’t get suitable attention and remediation and rehabilitation.

Which then starts a downward spiral.

Tend to agree, at first somethings are very scary and make you panic
Over time it can be less so.

The biggest factor in mental health decline is technology. The biggest ‘help’ would be to ban smart phones. But clearly that isn’t realistic.

So many people are addicted and they aren’t able/willing to accept that tech is the problem. Social media, doom scrolling, media, dopamine hits from smart phones, anxiety, inability to form real life friendships. It’s terrifying.

6-8 free sessions is usually insufficient to get to deeper rooted issues and waiting lists are long.

People are waiting months and sometimes over a year to access NHS provided mental health support but can't afford to pay privately.

People also need to be in a safe place in order to mentally heal or safely address trauma, however its getting harder to flee domestic abuse, people are financially under more pressure than before which means it's harder to leave unsafe relationships or family dynamics, it's harder to access housing so harder to move away if you need to. Etc etc more community based provision is closing its doors due to lack of funding which is exacerbating the pressure on statutory services. So it's harder to access addiction/ gambling support etc.

There's also issues with systems being too rigid eg. If you want to access rehab where I am you need to be clean for 12 weeks prior by yourself in the community. This won't work for many people. Or vulnerable people being closed because they've missed 3 appointments in a row with mental health services when actually they really needed help to attend and have issues with capacity to attend independently.

I've also seen really awful responses from GPs when taking clients to appointments to try and access help for their mental health which is a massive barrier considering your gp is the gateway to most support services.

Also recognition that many social services/community providers are under so much pressure they're close to burn out or have functioning burnout which impacts their ability to safeguard effectively.

Lack of support available in some schools for vulnerable children again due to pressures on teaching staff, so issues like bullying/ mental health/ domestic abuse/ eating disorders etc are not being effectively dealt with - particularly if the pupil is still achieving academically. I work with so many pupils who have just been put on reduced timetables when alternative support to help them sustain school have been offered but not accepted by the schools.

It all combines to make a melting pot that creates a downwards spiral of pressure on services creating pressure on society creating pressure on services etc.

To throw a spanner, but this is like asking what would help people's physical health.

A multitude of conditions. No single answer.

Yes, I do disagree.

Like I said, CBT is good for some people, not all.

It is more difficult to measure the helpfulness of psychotherapy, that doesn't mean that it is useless. Again, it doesn't help everyone. There is no one approach that helps everyone.