It was late at night when Eleanor*, a 20-year old university student arrived at the A&E department of Charing Cross Hospital, with suicidal feelings and auditory hallucinations.
After calling 111 and being asked to come to the closest hospital, Eleanor and her flatmate, who had been instructed by the 111 call handler not to let Eleanor out of her sight, arrived at the hospital for a visit that would last approximately four hours and not yield any results.
Eleanor, who has been dealing with mental health issues for more than ten years and is diagnosed with major clinical depression, generalised anxiety disorder and obsessive-compulsive disorder, stoically describes how everything spiralled out of control when she was faced with an anxiety-induced dissociative episode that night.
“I went to the A&E because a series of new symptoms that I had been feeling for quite a while got a lot worse in this particular day. For a few months I had been dealing with auditory hallucinations, which were mainly the sound of birds, and people talking to me, which as you can imagine are quite scary things to happen to you,” Eleanor recounts.
“I had also been feeling what I now know is called dissociation. I felt like I wasn’t in my body or like everything was a dream, that things weren’t real, people weren’t real. Then that sort of progressed into me getting really paranoid, and having these really nagging and strange beliefs and thoughts in my brain that made me very anxious.
“I was feeling really bad. I was having suicidal thoughts. I looked at myself in the mirror and didn’t recognise my face, couldn’t feel pain, couldn’t feel the water on my skin. It just got to a point where I was so confused and so distressed, that I called 111 and was told to go to the A&E,” Eleanor continues.
“I felt so desperate and helpless. I thought that not even in the worse state I had ever been I would get help.”
For four hours, Eleanor was assessed by four different people. No one could reach a consensus. The team solely included mental health nurses, and she was never seen by a psychiatrist.
Following the common procedure of mental health assessments, she stayed in a private room with her flatmate and waited for a verdict from the psychiatric nursing team until she was sent back home, without any further guidance — just a GP referral. Although, initially, she was told she would have to be kept on hold for a significant period.
This incident wasn’t the first time Eleanor had tried to seek help, which left her feeling quite distrustful of the prospect of receiving further assistance from the NHS Mental Health Services.“I felt so desperate and helpless. I thought that not even in the worse state I had ever been I would get help. I remember describing quite vividly the thoughts I was having and the things I was going to do to myself. They [the psychiatric nursing team] even wrote it down in the letter that they sent to my GP, but that still wasn’t enough for them to get me any help,” she says.
“An A&E wouldn’t even have one psychiatrist there if anyone with psychiatric complaints came in asking for help. I just don’t understand how one can go from ‘yes, we’re going to hospitalise you’ to, ‘no we’re sending you home with hallucinations and suicidal thoughts’ and just let you be,” Eleanor tells us.
According to the Adult Psychiatric Morbidity Survey, one-in-six people suffer from a mental health problem in the UK.
However, despite recent advances in the public perception of mental illness, there is still a great stigma attached to being mentally ill, often preventing people from seeking the help they require. When these individuals finally decide to pursue help, they are often confronted with situations similar to Eleanor’s, enormous waiting lists and a significant shortage of mental health professionals.
The same survey also states that the proportion of people with mental health disorders seeking treatment in the UK has increased. In 2014, more than one person in three (39.4%), was receiving help.
A survey conducted by the Royal College of Pstchiatrists on the experience of 500 diagnosed mental health patients “found that some had waited up to 13 years to get the treatment they needed.”
Thomas* is a Mental Health Peer Trainer for the NHS. A peer trainer is usually someone who deals and has experience of living with a mental health problem, and who has utilised available recovery tools to manage these issues better.
Peer Trainers aim to provide guidance and support to those who might be dealing with similar problems, helping them seek the help they require while also providing guidance to staff in regards to dealing with mentally-ill patients.
Thomas started dealing with mental health issues in his teens, and the road to recovery wasn’t smooth. Becoming a peer-trainer was a ‘no-brainer’ — he wanted to provide people with what had lacked in his journey: “I first started to have mental health problems in my teens so for me I absolutely got into the field to try and better the system,” he says.
“I find it absolutely fascinating that even the future king cannot get celebrities to endorse his mental health charity. It just shows you how strong the stigma still is.”
For him, there is a huge split between staff and patients, which hasn’t been dealt with in the best way. This ends up hindering treatment and delaying the recovery of patients.
“There is such a divide between staff and people who use services. There is this toxic ‘them and us’ culture. As a peer I am someone who is trying to break down those barriers; I am a staff member who also has a mental health diagnosis,” he says.
“This is important for two reasons: firstly it gives the staff a sense of hope that people DO recover and get better and can be functioning members of society, but it also proves to people who use services that staff are there to listen and support,” Thomas tells us.
Regardless of the apparent segregation between those who suffer from mental health issues and those who treat them, when speaking to patients and NHS mental health professionals, certain points are invariably brought up by both parties – the underfunding of mental health services and the shortage of mental health specialised staff in various parts of the country.
In 2012, the government legislated to initiate a ‘parity of esteem’ between mental and physical health in its Health and Social Care Act. This would signify equal opportunities for access and treatment and the improvement and funding of services. At the time, the government committed to achieving the milestone by 2020. However, the milestone is yet to be reached.
A report on the practical effects of the parity of esteem legislation produced by The King’s Fund shows that, although 84% of mental health trusts did receive an increase in funding from 2012 to 2017, acute and specialist hospitals have been given more funding in a shorter period of time with an increase of 16.8%. By contrast, mental health services only received an increase of 5.6%.
Furthermore, these problems have been escalated by a shortage of staff. As reported by The Guardian, figures from the Department of Health and Social Care, show that “more than 2,000 mental health staff a month are leaving their posts in the NHS in England.”
It is not difficult to test these figures empirically. More than 1,000 vacancies show up when conducting basic research online for NHS jobs with keywords: ‘mental health practitioner’ and ‘mental health nurse’.Anna Conway Morris is a child and adolescent psychiatrist consulting in the NHS. Her practice has felt in the first instance the consequences of this shortage.
For her, the vast number of vacant mental health posts across the country is inextricably linked with the social stigma attached to being mentally ill. A prejudice that is still ever-present in society and might even affect medical professionals who tend not to choose the mental health career path, due to fear of being judged.
“Doctors choose not to specialise in psychiatry, and I think part of it is because of the stigma associated with psychiatry,” she tells us. “Even within the medical profession people think that somehow psychiatry, psychiatrists and mental health aren’t a good thing or will somehow be associated with themselves.”
“They also think they will, in some way, be tainted by that [mental health stigma]. That feeling is still very strong, and I often see it in medical students: they do come to my psychiatry clinic, but many are reluctant to say they’re interested in psychiatry because they worry that people will judge them,” says Morris.
Heads Together, the mental health initiative created by the Duke and Duchess of Cambridge (Prince William and Kate Middleton) and Prince Harry, strives to fight the prejudice attached to being mentally ill. Both William and Harry have been rather open and vocal about their own personal struggles with mental health and have engaged in several mental-health related actions, in order to raise awareness of the subject.
However, that hasn’t always been an easy task. In January 2019, Prince William mentioned in a press conference at Davos World Economic Forum how difficult it had been to receive celebrity endorsement for his initiative – he revealed that “a lot of stars” had been approached over the course of three years, but none had wanted to have their name attached to the cause.
“I find it absolutely fascinating that even the future king cannot get celebrities to endorse his mental health charity. It just shows you how strong the stigma still is,” says Anna Conway Morris.
“You can’t tell a depressed person, an anxious person, etc. ‘Oh, just be happy, just be calm’ — that’s never going to happen.”
There is consistent use of the word ‘stigma’ around mental health discourse. It alludes to an ingrained mindset that equals being mentally-ill with shame and humiliation. During our research, Artefact found out that most live in fear of being told that what they are feeling isn’t ‘real’ or that they should be ‘ashamed’ of their suffering.
Barbara*, 22, a university student, has been dealing with mental health issues since she was 12 years-old. Prior to her twenties, she suffered from depression, anxiety and self-harm tendencies.
In 2016, Barbara developed bulimia, which prompted her to seek specialised help. Two years later, in 2018, she finally received it. The waiting time led her to seek help from the private sector, however, Barbara was unable to afford it being a university student, and dependent on her parents.
She then went back to the care of her GP, being referred to them by the private health clinic that had given her an initial consultation.
“I felt like my GP was extremely, extremely ignorant to eating disorders and the help I needed when I first went to her. When I initially told her I was bulimic, she literally told me to ‘try and stop’ and suggested I ‘tell my mom’. I also initially asked my GP for blood tests, as bulimia is very damaging. I had to push for them, as she ‘didn’t see the point’.”
“It was humiliating and frustrating,” says Barbara. “My advice for those going through the NHS for help is to self-advocate. You cannot expect your GP to understand mental health so you need to be blunt and tell them what help you need whether that’s a referral or medication,” she concludes.
Morris believes that although waiting times can indeed be exasperating for patients, the root of the issue lies on the general advice that is initially given by GPs. Especially when younger patients are not used to going to the doctor.
“I think sometimes rather, the problem is not much a ‘my complaints are getting ignored’. Many GP’s now have much better mental health training than they used to have, but of course, the first port of call for any mental health problems, or any health problem in the UK, is still the GP,” Morris explains.
“I think what GPs often do is give some quite general information to start with or maybe say to someone ‘why don’t you try this’, ‘maybe modify your lifestyle’, ‘try to get more sleep and come back if it doesn’t get better’.”“I don’t think that’s an unreasonable approach but I think that for some young people who are not used to being unwell and are going to the doctor, that can feel like ‘Oh, nobody is doing anything’, but sometimes these things do work,” Morris commented. “I agree, there are long waiting lists for accessing mental health services but I think some of it is also due to the kind of intervention that is used for mental health initially which that can often seem like quite general advice that is given,” she says.
The conversation around mental health is complex. Those affected express their need to be treated like any other patient and, similarly, practitioners do what they can with the limited amount of funding they are given which is still not enough to meet the increasing amount of people seeking help through the NHS. There is a need to understand that mental illnesses are just ‘illnesses’, after all, and so deserve the same amount of attention and care that a physical injury would.
“I would like to get treated as any other patient, we are treated as if our illnesses are not as valid as physical illnesses and as if our complaints are not as valid as complaints about other things. For me, it’s terrifying the fact that health professionals have this mentality of ‘Oh well you can just will yourself to be better’ when that’s not true,” says Eleanor.
“You don’t tell someone with a broken leg to just ‘unbreak it’, you don’t tell someone with asthma to ‘just breathe’, you don’t tell someone with diabetes to ‘just produce more insulin’ — that’s absolutely impossible. So you can’t tell a depressed person, an anxious person, etc. ‘Oh, just be happy, just be calm’, that’s never going to happen. There needs to be a bigger sensibility about what they [health professionals] should do in these situations,” Eleanor states.
In October 2018, Philip Hammond (UK’s Chancellor of the Exchequer) announced that the NHS Mental Health Services would receive a £2 billion per year boost as part of the government’s budget. This increase in funding should provide better mental health support in every main A&E department. Hopefully, a step in the right direction of a portion of the NHS that for long has been neglected.For those going through mental hardships, Morris advises not to surrender and look for alternative options, if help isn’t given right away:
“The main thing is not to give up and to use the services that are available there’s a lot of charities that work in the area of mental health and it’s really useful to do research online and see what is available locally. There is a lot of support available locally to people, and people are often not aware of it,” she concludes.
Eleanor has now been referred and assessed for a third party mental health service, however, she hasn’t heard back from them or been informed if she has been placed on a waiting list.
In regards to her complaint, a spokesperson for Imperial College Healthcare NHS Trust, said:
“We have a psychiatric liaison team which is available in our emergency department at Charing Cross Hospital 24 hours-a-day. When a patient is referred to them, the team, which comprises mental health nurses and psychiatric consultants, undertake an assessment and devise a bespoke care plan.
“No changes are planned for mental health services provided in the emergency department though we continue to work in partnership with our mental health provider, West London NHS Trust, to continuously look at how we can improve our care.
“We take any concerns raised by patients very seriously and would advise any patient who is not happy with their care to speak to our patient advice and liaison service in the first instance.”
Mental health is a real problem that an ever increasing number of people in the UK are faced with, it is important that the National Health Service is prepared to meet their needs, both in practical and moral terms. It is also important to be aware of one’s needs and not be afraid to fight and speak up for them.
* Names have been changed at the request of the contributor.
If you or anyone you know is struggling with mental health issues or suicidal thoughts, please contact/refer to one of these resources: Mind UK and Samaritans at 116 123 and The Listening Place at 020 3906 7676.
If you feel in immediate danger, please contact 111/999 or go to your local A&E department.