Living in the UK, we benefit from the increased awareness of mental illness. This has allowed certain practices, such as engaging in therapy, taking psychoactive drugs and spending time off work or school due to poor mental health, to become more normalised.
You probably already know that if you experience a mental health problem, you can book an appointment with your GP who can help you; or if necessary, refer you to a specialist. But did you know that the type of treatment you receive depends on where you live, your skin colour, its cost, time and even your attitude?
I spoke to four young people who sought NHS mental health treatment to understand how accessible it really is.
*(Names have been changed to provide anonymity.)
Medicating Mental Illness
In 2014, one in six adults in England met the criteria for a common mental disorder, whereas only one in eight currently receive treatment for it. The most common treatment is, you guessed it, psychiatric medication — yet whether drugs should be categorized as ‘treatment’ is debatable. Mind Cymru assert that antidepressants aren’t a long-term solution. For someone like ‘Chad’, medication has only exacerbated the struggle: ‘I get nightmares and olanzapine makes me really drowsy, which makes it hard for me to be on it because I’d sleep for 16 hours a day and miss my lectures and seminars at uni’, he admits.
Treatments that tackle underlying causes and consequently have high success rates, such as therapies, are tougher to access. The pandemic has seen an increase of antidepressant prescriptions alongside a decrease in therapy. Private therapy is expensive, confirms ‘Joyce’: ‘For my disorder, it’s like £80 pounds [a session] plus’.
Unfortunately, mental illness is twice as frequent among the poor as among the rich, thereby ruling out the privilege of private therapy for many. For therapy on the NHS, it’s waiting lists that are the problem: ‘I’m currently seeking NHS treatment’, explains Joyce, ‘and I’ve been on the waiting list for over a year’. Chad benefits from receiving NHS therapy but notes that: ‘In the four years I’ve been here, she’s the first therapist I’ve been offered’. ‘Susan’ raises another problematic issue with NHS therapy — qualifying for it: ‘I was finally referred to an actual psychiatrist’, she recalls, ‘and it felt like such a victory. But when I requested psychotherapy, I was basically told that I might not be able to handle it because I have a history of drug abuse’. I was shocked to learn that professionals were denying treatment that people felt would best meet their needs. However, Susan was offered an alternative, which was also offered to ‘Jade’ — ‘group sessions; which were just not okay. It was more targeted towards stress, rather than an actual mental health problem’. Chad, likewise, is dissatisfied with his psychiatrist: ‘In Singapore, I met my psychiatrist really frequently, maybe like every other week, so coming here it was really strange how you’d only meet them every few months and when you do, it’s purely about medication … They didn’t seem to understand that mental health is a lot more than just taking a pill’.
Should the NHS Modernise?
The NHS are seemingly aware of barriers to non-pharmacological treatments. They introduced the Adult Improving Access to Psychological Therapies programme in 2008 and boast that it has been accessed by over 1 million people in the past year for anxiety and depression. Quick, easy and efficient access to IAPT is an undeniable triumph, but it still excludes some vulnerable individuals. Joyce has borderline personality disorder and has repeatedly been told by NHS professionals that her problems are too ‘advanced’ for treatment. She says: ‘I feel like a lot of the time things like depression and anxiety are taken seriously, they’re treated … I think there needs to be more funding for disorders that aren’t as pretty’.
IAPT also offers a limited range of therapies (cough, CBT, a.k.a Congnitive Behavioural Therapy). Jade, who suffers from anxiety and depression, recalls her experience with CBT: ‘It wasn’t very helpful … I feel like CBT just dismisses all your problems. It creates the idea that your problems are all in your head, like the way you think about things is wrong and you need to change it; whereas, actually, a lot of the thoughts you have are absolutely valid’. Susan also had a negative experience with CBT: ‘It was completely the wrong approach for me’, she argues. ‘I tried talking to my therapist about my abusive childhood, and she just kept dismissing all of my problems and saying things like, “everybody has that sometimes” — and that’s clearly not the case because I was with Social Services’. Research from 2015 revealed that CBT’s effectiveness appears to be decreasing with time. So, should the NHS consider modernising its options?
Recurring Themes
There is a reoccurring theme among my interviewees of their problems being dismissed by the very people who are supposed to help them. Joyce went to A&E when she was suicidal and recalls that: ‘I waited around six hours to see a mental health professional’, she begins. This reflects findings that only 33 per cent of people in crisis are assessed by the NHS within four hours, as recommended by NICE. ‘I had chipped black nail varnish on, and she was like, you do your nails, which means you have pride in your appearance, which means you can’t be that suicidal. Based on that alone, she judged me as being mentally healthy and discharged me’. Susan also ended up in A&E after a suicide attempt: ‘At the time I wasn’t talking to my mum, so when she was called to A&E I didn’t want to see her. A nurse exclaimed, “you need your mum in your life! That’s why you tried to kill yourself!” She had good intentions, but I think it was extremely unprofessional’.
Mental health problems account for 23 per cent of the burden of the disease in the UK, but spending for it consumes only 11 per cent of the NHS’ budget. This is probably why only 46 per cent of trainee GPs undertook a training placement in a mental health setting. Likewise, 82 per cent of practice nurses felt ill-equipped to deal with aspects of mental health for which they’re responsible. Since 90 per cent of people receive mental healthcare exclusively in primary care settings, they are mostly dealt with by general nurses, like in A&E. When asking a nurse about the mental health training she received, she informed me that they just did mental health first aid. This is a course covering psychosis, anxiety, eating disorders, CBT, depression, stigma, discrimination, action plans, suicide and non-judgement. Regardless, she described the course as ‘not 100 per cent’ useful. Moreover, 42 per cent of practice nurses receive no mental health training at all, and only 29 per cent of people in crisis report feeling that they have been treated respectfully by all staff.
When it comes to treating people from ethnic minorities, additional barriers arise. The Mental Health Foundation lists some of these as language barriers, financial barriers, not feeling understood and white professionals failing to understand their experiences of racism and discrimination. ‘Do you know how many times I’ve been in a ward, screaming out for help, and they’re like, “you need to calm down” — because I’m a little white woman?’ says Joyce; adding: ‘If I was a black man, I could be sedated, arrested, even thrown in jail. I have black friends who’ve been treated like monsters when they’ve needed help by white doctors who perceive them as threats’.
Conversely, Chad, who is of Ghanaian descent, has experienced positive discrimination: ‘My care coordinator is from my country, so she’s very understanding of African family dynamics, which has been very helpful’.
If my white interviewees have felt unheard, misunderstood and abandoned by healthcare professionals, imagine someone of colour, already historically disadvantaged by the wider social system, trying to explain their mental health problems to a white GP who is not so sympathetic or knowledgeable of other cultures.
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