Saturday, 10 October 2015

20 Things I've Learnt about mental health in 20 months of working for an NHS mental health trust

1. Mental health is misrepresented to make it more palatable. Anxiety & depression are often the only mental health problems discussed and are often reduced to "being a big worried" and "feeling a bit sad". These conditions are presented in such a manner that makes them easier to accept. This is damaging to people with these conditions and those with other conditions that aren't mentioned.

2. NHS services categories are often damaging. The NHS uses the following categories to provide services
- Adult Services
-Child & Adolescent Services
-Forensic Services
-Learning Disability Services
-Older Adult Services
-Substance Misuse Services
-Eating Disorder Services
 So essentially if you are a fifteen year old person with an eating disorder and a learning disability your treatment is decided by a clinician deciding which service you will use. It may be that you're stuck in the learning disability service, the only young person there, or that you enter treatment for your eating disorder only to find barrier to your treatment due to your learning disability.

3.  Anti-medication rhetoric is empty rhetoric. "People with mental health problems need support not meds". This is far from true and often contributes to the erasure of huge groups of people. Having been on psychiatric medication for my own anxiety & depression (whilst having a supportive partner and friends around me) I know for a fact that medication allowed me to live my life. In fact some people's medication alleviates symptoms like psychosis & delusions of grandeur that no amount of chatting about with friends would stop.

4. There is no shame in seeking treatment. Just like there is no glory in recovering from a broken leg without the appropriate treatment of a cast, there is no glory in "getting through" mental illness without treatment and treatment includes medication. If medical professionals, family or friends try to pressure you out of using medications with the shame argument they are using social biases towards non-disability to do this. You should consult (further) medical professionals who don't use this kind of argument for less biased advice.

5. Treatments aren't usually to cure. For most of us, the treatments we receive via the NHS or other avenues are mostly to help us exist with our condition rather than to "cure" us.

6. Treatments include (I've put some loose examples after each.)
 -Self help (practising breathing exercises for anxiety)
-Hospitalisation (being put under a Section to prevent suicide or harm)
-Peer Support (an assigned Peer Support worker assisting with everyday tasks such as filling in forms)
-Neurosurgery (surgery used to treat conditions not aided by other treatments, very uncommon)
-Social Care (a social worker to help someone leave an unsuitable housing situation that is causing stress)
-Medication (someone with bipolar disorder using the mood stabilising drug lithium)
-Psychotherapy (a child attending play therapy or a person with OCD being referred to Cognitive Behavioural Therapy)

7.  Since 2010 many local authorities have been forced to cut their social work budget increasing strain on NHS services (especially in dementia care, where people who were functioning in the community find their condition deteriorates due to reduction or removal of social care and support for their carer's or family).

8. Forensic mental health services should be more funded & prisons should be abolished. Forensic mental health services are those that cater to inmates of prisons. With statistics showing that 9/10 people in prison have mental health problems, it's clear that prisons aren't a suitable treatment to social 'ills' or to mental health problems. Now if 9/10 of those inmates would be better placed in a a mental health setting the population of prisons would essentially render them useless.

9. The reported statistic that  1 in 4 people experience mental health problems is actually much higher. ('Obviously!' I hear you groan).

10. Mental health services are a gendered experience. 'women more likely to receive treatment than men' & 'men three times more likely to commit suicide than women'  (no evidence about non-binary gendered people or even current statistics on transgender people's experiences in contrast to cisgender experiences)

11. Mental health services are incredibly institutionally racist. Black, Asian & Minority Ethnic people are 'less likely to report their mental health problems' & they are 'more likely to be turned away from services'. (

12. NHS Staffs' mental health is impacted negatively by cuts. Now this is not absolute evidence, but as the person who coordinates the staff mediation service for a mental health trust that had £8 million cut from its budget, I noticed that after the announcement my case loads had basically tripled in comparison to my pre cut caseloads. Which means that for some reason (fear for their jobs, stress, etc) staff began arguing more.

13. You can see if NHS staff would recommend the mental health trust they work for (a very telling indicator) by looking at staff surverys.

14. The majority of violent crimes are committed by people who don't have mental health problems. (So you can stop using the word psychopath or schizo to describe behaviour of violent people, now, thanks.)

15. Everyone has the legal right to NHS mental health care in an accessible language. This means whether you communicate in English, Urdu, British Sign Language or German, you are entitled to have letters, instructions, questions and results communicated to you in an accessible language. This is the same for all public sector organisations and is often a contentious issue for right wing pressure groups in the U.K.

16. Addiction services should be preventative services. Often in the U.K addictions are presented as something that puts a blame or burden of "cure" at the hands of the individual addict. The media (press & social media) tells us that addicts are weak and criminal. This is wrong. Addiction is a mental health problem that can be helped with mental health treatments such as therapy and medications. But importantly addiction is best treated by reform of drug laws, fully funded & appreciated social work & education. When I was 17 I found myself needing to enter treatment for addiction. I received help from addaction that I believe saved my life. When addiction is seen as the fault of individuals and not a societal problem addiction services are more likely to be cut which is dangerous.

17. Your employer has a legal obligation to make reasonable adjustments for you mental health condition. (e.g. Allowing a person with PTSD to work in a quieter office)

18. Specific diagnosis's aren't always useful. Although often a necessary key to open doors to treatment, for many, the broad, changing and varied mental health symptoms they experience aren't always usefully diagnosed. Having a term to apply to something say 'anxiety' may mean medical staff don't always know to factor in symptoms outside of anxiety.

19. Even the government acknowledges that mental health problems can be disabilities.

20. Given that mental health and physical health are for most an intertwined state- our healthcare system should be able to treat both. It is exhausting, expensive & frustrating to have to traipse around to seven different medical appointments a month at different hospitals, in different towns and be treated as person who is purely defined by their need for psychotherapy one day  and a person who is defined by their need for physiotherapy the next. Many mental health services are working on making physical health more of a priority and I for one have my fingers crossed this works and is reciprocated by other health services.

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