An Open Letter to the NHS, Signed, a Service User with Chronic Mental Illness

Source: Wikipedia

Service users with severe mental illness are rarely given the help they need,

By Anonymous

I have had some amazing therapists. Some are the reason why I am working towards a career in the field. Some unknowingly saved my life, and it’s impossible to express how thankful I am to them. But there are too many healthcare professionals who are ignorant and make damaging comments to the very people they are supposed to understand and help heal. I’ve come away from appointments thinking it’s a miracle I’m not in a worse place, because their words would surely have thrown me off the edge. Almost worse is the inaction of services. 

I am aware of the limitations placed on staff due to our severely underfunded NHS. However, this doesn’t change the reality of many people dealing with mental illness who have essentially been abandoned, many of whom have chronic and severe conditions. Though I’m conflicted about the term, for the purpose of brevity and familiarity I will hereafter refer to this group as people with SMI (serious mental illness). I find it questionable that those of us who fall into this bracket  — and therefore tend to be less able to work  — have greater difficulty getting treatment. This will be discussed in greater detail later on. 

All the hotlines and mental health awareness in the world cannot lead you to recover. I say this having been a helpline volunteer and a psychology student hoping to go into clinical practice, wellbeing allowing. These are incredibly valuable resources and helpful forms of support to a lot of people. But that is what they are: support. They are not a substitute for SMI treatment and it’s dangerous to pretend otherwise. Yet this is what many are forced to do. Sometimes it’s the case even when there technically is a community mental health team, because actual care is either unavailable or inaccessible. 

Maybe, like myself, you call to chase an appointment that should have happened months ago. Someone asks the routine questions that check you’re not about to end it all. Once they’re satisfied, you’re told to contact the crisis line or call duty if things get bad. You’re told things will be sorted out, but they never are. You give up.

Circling back to my earlier point about the discrepancies in the availability of treatment for people with different experiences of mental illness: services cater more towards individuals with less acute or disabling conditions. Those with SMI wait weeks, months and even years longer. It reminds me that I am a burden in a capitalist system where productivity and value are so easily conflated. After all, IAPT services (formally known as the Adult Improving Access to Psychological Therapies programme) were primarily rolled out to get people suffering from mental illness back into the workforce. 

According to the NHS, one of the IAPT initiative’s aims when founded in 2008 was to make therapy more available to people with mental health related absences from work. Its provisions, IAPT acknowledged, could also serve to prevent employees from taking leaves of absence due to symptoms of stress, anxiety and depression. Ajay Maisuria, Senior Employment Advisor at LTW Leicestershire County and Rutland, commented: “The principal aim of this integrated approach is to create a culture of prevention and early intervention to make sure people get timely access to health support and suitable employment support so they avoid long-term unemployment.”

In other words, mental health services are provided with the ultimate purpose of getting people back to work, rather than in accordance with the fundamental human right that is access to healthcare. In a document entitled Outcomes for mental health services: what really matters?, the King’s Fund — a Parliament-founded think tank  — states the following: “At the heart of this debate is the tension between the population health perspective and concern for the individual in health and care. Should we focus on […] the number of people in employment? Or should we focus on delivering responsive care that is tailored to individuals, attending to their personal needs and aspirations? Both are laudable objectives, and the simple answer is that we should try to do both, but they do not sit entirely comfortably together. Some service users and professionals clearly believe that the balance has shifted too far towards the pursuit of generalised outcomes for the population rather than attending to the individual. Any approach to outcomes that loses sight of the individual is surely part of the problem, rather than the solution, and unlikely to lead to humane or effective care.”

Part of me wonders whether the IAPT initiative’s attitude has filtered down to community mental health teams (CMHTs). Perhaps CMHTs lack a sense of urgency because service users with SMI are generally (though not always) less able to “contribute” to the workforce, at least not as much as those using IAPT services. If full-time work with minimal absences is the objective, how motivated would you be if it’s unlikely to be achieved in the short term? The sad irony is that we need treatment just as much as our counterparts — arguably more. We represent a smaller proportion of people with mental health difficulties. Theoretically, there should be shorter waiting times. Yet many people with SMI wait indefinitely.

I know there is a lot of nuance I’m missing here. For example, it’s probably more doable financially to employ recent graduates and train them than hire experienced or specialist mental healthcare professionals who are better suited to people with SMI. However, as someone living with a treatment refractory mental illness, this is what it feels like. It feels personal. It feels like even the people whose literal job it is to help me have given up. There’s also something to be said about the negative impact trying to access treatment has on mental health, even from a service that you are already under. But I think that would be a separate article.

So, where do we go from here? I honestly don’t know. Many of the changes that need to be made are directly related to the government underfunding mental health services. Fortunately, Rethink — a UK-wide mental health and money advice service  — are campaigning for amendments to the NHS Funding Bill with the aim of achieving ‘parity of esteem’ between physical and mental health funding. You can add your voice by emailing your MP and they make this process simple on the Get Involved section of their website. Another necessary step forward is to dismantle mental health stigma in therapists, psychologists, psychiatrists, GPs and other NHS staff who work with people who live with mental illness. Many charities offer awareness training which is delivered by people with lived experience of mental illness, and there is also a promising move towards involving people with lived experiences in recruitment and running services. It would be beneficial for this trend to grow.

I hope my messy rant-turned-article is a comfort to someone out there. You’re not alone in feeling alone. Some day, hopefully in the near future, services will change for the better. Please hold on. Look into advocacy services or complaints procedures if that feels right to you. Where possible, have someone get the ball rolling on your behalf if you’re too unwell. You are deserving of support. You are deserving of respect and understanding. We are. 

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