When the NHS mental health service fails

I know that yesterday I promised a blog post on anxiety (which is still coming, I promise), however as I sit here at 1:30am on a Tuesday night/Wednesday morning in A&E with a long wait still ahead of me I feel that right now, the events leading up to tonight will be of much more benefit documented. Because tonight is a result of a failure, once again, of the local mental health service it is thus also the perfect example of why we need charitable mental health organisations such as that of Mind.

I was first referred to the secondary care mental health services in 2011 and have since been propelled from one “professional” to another. I use the word “professional” tentatively as I have been unfortunate enough to have received the short straw in the bundle of mental health workers on numerous occasions. Don’t get me wrong, I have also been fortuitous particularly whilst an inpatient, but regardless I believe that no individual should be faced with some of the awful excuses of mental health teams which I have over the past five years, with the majority of these based in Durham, my university city.

The first time I felt seriously discriminated against by trained, mental health professionals was in November last year when also in A&E, this time having attended only under the promise that I would be seen by the crisis team. As soon as I arrived, the triage nurse noted down exactly what I was wearing from head to toe just in case I ran, in which case the police would be contacted and I would be brought back to the hospital. Attending A&E voluntarily in fact did not feel voluntary at all. I felt suffocated. Treated as if I were a criminal who had just committed an abominable crime, I was placed in a small assessment room rather than the normal waiting area where I could be watched by numerous members of staff through a glass observation window and was given the instructions that I was not to leave this small, dingy room until I had been assessed. That’s right, I wasn’t even to pop to the toilet alone. This in itself is ridiculously inappropriate treatment towards somebody with any mental health condition, let alone somebody who has just disclosed a history of anxiety and panic disorder, partly triggered by claustrophobia.

Seven hours later, the crisis team arrived. According to the government’s website, the job of the mental health crisis team is to:

“provide support and short-term help until another team is available or the help is no longer needed”

but this was not the experience I received. Instead I was ridiculed and provoked into feeling significantly worse when sent home as to when I had arrived. Apparently, studying two psychology modules as part of my degree should mean that I would be capable of controlling my own mood without the use of medication. That’s right guys, it seems that a module on child development and a module on neuronatomy should leave students immune to mental illness. Spread the word(!!!!). The only thing I am grateful of that night is the fact that I was discharged after midnight, meaning that all shops were long closed and thus leaving me no means to buy a store of painkillers to abuse as it is no exaggeration when I say that I left A&E that night in emotional turmoil.

Nevertheless, I hoped that this ludicrous treatment would be a one off and that once settled within the community mental health service (CMHT) and seeing the same people on a regular basis, my treatment would improve. I regret to admit that all which followed was a series of disgraceful events.

Throughout second term, my mental health took a rapid decline. My snowballing impulsivity, rollercoaster emotions and worsening self injurious behaviours led to the decision by the CMHT that my referral for psychological therapy should be put on hold until my level of instability decreased which in itself I believe to be a bizarre conclusion considering the specific therapy for which I had been referred was in fact designed to increase stability. But of course, I had no say in the matter and I thus relied on medication to stabilise me in the meantime. Nevertheless, having started a new regime in late November my medication was long overdue a review by the prescribing psychiatrist but this appointment was never made and gradually, my relationship with my care coordinator, my main and only point of call within the CMHT, broke down. This begun with the introduction of a student nurse into my weekly appointments, with my care coordinator only asking for my permission for her presence whist the student nurse was already there – it doesn’t take a genius to figure out that any person crippled with debilitating anxiety is unlikely to request to a student’s face that they leave an environment whereby they are receiving necessary experience for their degree, so of course I smiled, nodded and pretended this was fine. Having voiced my concerns outside of appointments as to the impact this student nurse was having on my ability to communicate, my voice was ignored and the student nurse continued to show. Whilst any student nurse obviously has training to do, some remarks of which were made were far from tactful so as her presence increased, my honesty levels descended in fear of judgmental, tactless comments.

The biggest blow came following a particularly bad week (which will be explained in a further post) which involved multiple trips to railway station platforms (with no intentions of travelling) as only one example of exacerbating impulsivity and decreasing capacity to keep myself safe. Prior to my appointment, I had decided that I would finally open up to my care coordinator about my concerns regarding my rapid spiral of decline but low and behold, in walked the student nurse and as always, a barrier was instantly established. My anxiety seemed to have cut off any pathway somewhere in my brain which controls the transition of thoughts to speech and I shut down. I couldn’t get out a single word. Rather than having patience with me in order to break through my anxiety, the appointment was cut short after only ten minutes as I was told I was wasting both of our time and my care coordinator left. Cue feelings of shock, hostility and ultimately abandonment. The following week’s appointment had also been cancelled and I was told to make contact when I was “ready to communicate”.

As my care coordinator left, I panicked. Panicked because I’d wasted her time. Panicked because I had no further arranged appointments. But ultimately panicked because my mental health was rapidly deteriorating and I’d counted on that appointment for a plan to be composed in order for me to improve. I thus came to the conclusion that the best course of action was for me to construct an email apologising for having wasted her time and explaining exactly why I shut down in that appointment, as well as sharing how much I had began to terrify myself over the past week. I have always found it significantly easier to communicate using the written language than to do so verbally. But I never received a reply. Cue further anxiety and intensifying depression, but no support.

Within days, my anxiety had reached a point whereby I was incapable of leaving my university accommodation without numerous panic attacks and as you can probably imagine, this creates a major dilemma in terms of travelling to the local pharmacy to retrieve my weekly medication. I made my team aware of this in the hope that I would be supported in collecting them, but again, no response. Without psychotropic medication for the first time in five years, my mental health was only destined to crumble further and so it did. Eventually, I managed to retrieve my medication which had gradually built up to a solid supply meaning that a system which is designed to only provide me with seven days of medication at a time to avoid the case of overdose, had collapsed. Although contact with my care coordinator was rebooted thanks to the support of the welfare system within my university, neither the cracks in our relationship nor my health were repaired. I contacted my GP who wrote to the CMHT to request that I was seen by a psychiatrist promptly and that my medication was reviewed and increased, but this advice was unsurprisingly ignored and by the start of third term, I consequently overdosed on the stock of medication I had unintentionally built up.

You would perhaps think that following a serious suicide attempt, concerns would increase and one’s fragile state of mind would finally be taken seriously but this was not the case at all. Rather than restoring my faith in the mental health service, my care coordinator broke it further.

Following this life threatening overdose, my medication was understandably “postponed for two weeks whilst the excess was cleansed from my system, by which point it would be reviewed in an appointment with a psychiatrist”. Although anxious about the impact of another two weeks without medication, I was hopeful that a psychiatric review would mean that the best course of action could be taken. But two weeks became four and four became six and six became eight. Urges from myself, the GP, A&E, my care coordinator from home and the duty workers within her own team were all ignored and my mental health continued to decline. I decided to return to my GP for the last time and requested that they took full control of my medication. This request was denied following communication between my GP and my care coordinator, as my GP was informed of a complex case meeting planned for the following week. I had previously been aware of this upcoming meeting, but considering the fact that I was not allowed to attend combined with the current state of my relationship with my care coordinator, it was clear that this meeting was not a medication review and I was not hopeful of it’s outcome. My GP informed me that the two possible outcomes of this meeting were either that I would be discharged from secondary services and referred back to primary care as a result of “non-compliance”, or a plan for my care within the CMHT and the transition from Durham to home for the summer would be put in place. Either way, the GP was unable to take any action until any outcome was reached.

The wait was painstaking.

But once again, I was let down. The meeting was cancelled and I was only made aware of this as I just so happened to attend the GP for a completely unrelated issue on the morning of which it should have been held. I should not have heard of this news from the GP before I did from the mental health team. I was distraught and disappointed for an uncountable time.

Only a week before I was due to return home for six weeks, it was clear that no action was going to be taken in Durham, meaning that my treatment would be on hold and I would return to university in August to sit exams in an extremely vulnerable state of mind. I was petrified at the thought of failing my first year of my degree as a direct result of failings of the mental health system so requested that care would be handed back to my home CMHT and medication restarted whilst home so that I would have stabilised in time for my exams. Rather than supporting this course of action, my care coordinator told me she had instructed my home team to not treat me and most importantly, not prescribe me any medication on the back of a risk assessment conducted by herself, who I had not seen in a month and by a doctor I have never even met.

So here tonight, I sit in A&E awaiting stitches following a significant episode of self harm, as a result of the intense feelings of hopelessness and despair which are becoming increasingly present as the CMHT continue to disappoint.

Whilst I am a firm believer that nobody is to be blamed when it comes to mental health, I do also thoroughly believe that the deterioration of which I have experienced over the last eight months could have easily been prevented had I received structured support by those of whom are both trained and in fact paid to provide it. Instead of being shown the compassion and care I am entitled to as much as any other human being on this planet, I resolutely believe I received nothing but broken promises from those I should be able to trust most to support me in times of crisis and it is important that this is shared because unfortunately, I know that my own experience is not in isolation as I witness growing fury among fellow CMHT patients.

Any patient suffering with significant mental illness and therefore placed under the Care Programme Approach (CPA) will have a specific crisis plan in place in case of sudden decline. For me, the two steps on my care plan are to 1) contact my care coordinator or to 2) contact the crisis team. So what happens, when as it has done in the past eight months, this crisis plan becomes counterproductive because no response is received from your care coordinator and you are ridiculed by your local crisis team? Further deterioration is what happens, and potentially in many regrettable circumstances, suicide.

This should not be the case.

Whilst suddenly improving the current state of the NHS mental health service is an unrealistic task, raising money to instead help improve access to charitable services is less so. When the NHS fails, charitable support is the only other option. Presently, in Durham, a Mind branch of its own is non-existent so there are no Mind therapies to be offered when the NHS unfairly decides you are too “unstable” for therapy so the patient has no alternative and the helpline which can otherwise be used as a substitute to face-to-face support when the mental health team refuses to listen still requires funding to operate. But Durham is not an exception. Although a fantastic charity offering life saving support, Mind can only run from donations, so its impact is limited to where funding allows.

With increased financial support from all of you who read this post, even at £1 each, accessibility to Mind’s services can be expanded. Whether this money is used to keep the Mind InfoLine open or increase access to talking therapies, these are all options available to victims of mental illness when the NHS doesn’t fulfill its duty of care.

Every single person is worthy of love, support and ultimately treatment so please help me to ensure that this is something all can access by sponsoring my skydive for Mind today.

Thank you for reading x x x


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