Mental health: a conversation about services

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Recently, I sat down with a good friend of mine to talk about mental health. Our conversation ranged from the NHS and private healthcare to ways in which education can be improved and society can better help those who suffer. I’ve wanted to have this conversation for a long time, but more so after recently writing a commentary of CQC’s report on the state of mental health services as of 2017. It’s all well and good reading a report, but I wanted to see if it reflected the opinions of people who have experienced these services first-hand. Obviously, one person cannot be used as a general commentary on the whole of healthcare in Britain, but it was interesting to find similarities in what Eloise had to say and the assessment two years ago.

Eloise’s experiences of mental health services started when she was around 13, after she described herself feeling depressed and suicidal. She and her mother went to her GPs asking for help, however described the atmosphere as that of ‘little concern.’ The overall message of that meeting was, as Eloise described it, ‘you’ll be fine, it’s just hormones, come back if you still feel like this.’ So, after that disappointing first meeting Eloise did go back a few months later, at which point she was referred to Off The Record, a ‘mental health social movement by and for young people aged 11-25 living in Bristol and South Gloucestershire.’ However, this referral was just that: she had to do all the organisation, including putting herself on the waiting list. At this point, Eloise was now experiencing bulimia, making herself sick ‘two or three times a day.’ Now on the waiting list, she was to wait eight months before hearing anything from OTR, and, despite going back to her GP during this period, was given no further help other than that referral. After 8-months, she received her first contact from OTR, but it was a further four months until she was given the course of therapy she needed. Following a year of waiting and referrals, Eloise was finally given six weeks of CBT- cognitive behavioural therapy. Whether or not CBT would work for Eloise or not remains a mystery, as once the six weeks was over, she was told that it would be another year until anything else could be done.

After deciding that she could not wait another year for possibly six more weeks of treatment, Eloise tried to apply for CAMHS, the NHS run specialist unit for young people’s mental health. However, her appeal was rejected, despite having bulimia, depression, heightening anxiety and was now self-medicating with recreational drugs. Her family then made the move to go private, and despite her negative experiences with her GP, OTR and CAMHS, she was very positive about that time, ‘I really liked her [the therapist], she helped a lot. It was more open than CBT which I preferred. But it was really expensive.’ Because of this expense, once Eloise started to feel better about herself, she stopped the private treatment. The following year, she sat her GCSE’s to great success and had a ‘far better time’ than in year 10. However, when summer came around, periods of depression and self-medication started to reoccur. She applied to CAMHS once again and was successful this time, however, it was another year until she was taken off the waiting list and given an appointment, which brings her story to September 2019.

To an outsider, Eloise’s experience with mental health services appears frustrating, however for someone who has felt what it’s like, it infuriating. This issue of long wait times that arose for Eloise was also something that was highlighted in CQC’s report of the whole country, so seeing it in this instance didn’t surprise me. However, what did was the fact that throughout both of these year-long waiting lists neither OTR nor CAMHS got in touch with Eloise or her family to check up on her, despite being a clear risk to herself (bulimia, anxiety and depression as well as self-medication through drugs). This wait without someone checking in makes young people feel isolated from those who are meant to help them, so by the time a first meeting occurs, expectations are already lowered.

Now that I’ve outlined Eloise’s story and the way in which she came about mental health services, I asked her about those experiences, mainly focusing on her current support network, CAMHS. The more we discussed, I found mixed feelings. Eloise’s current quality of care, while in meetings, is good, and she does say that they help her. However, as previously mentioned, waiting times drastically affect people’s mindsets when it comes to treatment, not aided by her first meeting with the new team. After waiting for over a year for this treatment, the first time she met anyone from CAMHS was taken up by discussing what she was going to do after them, before discussing any issues. CAMHS only treats young people, so once they exceed the age of 18, they find somewhere new. I asked Eloise how this appeared; reassuring that they were thinking about her future and the care she would receive after they were unable to treat her, or dismissive, in the sense that after waiting so long for this they were only concerned about getting rid of her. Unfortunately, she said it was the latter. Furthermore, I hastily stress that while Eloise is satisfied with the care she receives in those meetings, outside of them is a very different story.

This leads on to the consistency of meetings that CAMHS offers, which drastically varies. In the summer before her final year of school, Eloise was seeing CAMHS practically every other day. However, once school started this instantly changed to once a fortnight; this surprised me, and I even asked her to clarify whether it really was that sudden. A sudden decrease in the consistency of meetings can greatly affect someone’s recovery, so in my opinion, there should have at least been a transition period instead of this dramatic change, especially given that Eloise was starting another year at school after a long rest over the summer. However, the worst was yet to come. Eloise currently has not seen CAMHS in almost 2 months because of cancellations on their behalf- she has never once cancelled a meeting because ‘I know that they’re so difficult to get.’ These cancellations mostly occur on the same day as her appointments, giving almost no warning, ‘it’s always been on the same day, I’ve never had it a few days in advance.’

CAMHS have always stressed how important the role of family is in recovery, and because of this parents are often very involved in meetings. Eloise’s mum sits in with her during meetings, a choice made by her, and is apparently very satisfied with the care that she receives throughout. However, this satisfaction is mixed with two sources of disappointment: firstly, the long wait time that Eloise experienced. Seeing their child suffering is excruciating for any parent, particularly for those actively trying to get help to no avail. Secondly, the long string of cancelled appointments are enough to make anyone lose faith in a system, creating a rather turbulent mix of satisfaction and frustration on the part of Eloise’s mum.

As previously emphasised, Eloise is very happy with the meetings themselves: there is never an allotted time, they can last from 20 minutes if that’s all that is needed or in excess of 2 hours in rare instances. The clear positive is that time is clearly available for as much as people need, but one thing Eloise did say was that sometimes they can be too long, especially sessions that last up to and in some cases exceeding two hours. The overarching experience with staff was also positive, Eloise described the staff she’d encountered as ‘80% caring, with very few exceptions,’ and she said that there was never an encounter that she deemed unprofessional.

Despite at the start of this article stating that one case cannot be compared to the immense number studied by CQC, I can’t help but draw parallels from what Eloise said about her experiences and what they found. The overarching quality of care is good, the staff themselves are good, but the wait time is too long which isolates both patients and parents alike.