Artwork by Nick Scott
This article originally appeared on VICE UK.
It was Kerry's "worst breakdown." She was 27 years old and convinced she had to set herself on fire to save the world. Now she was wrestling with the lid of a petrol can.
Kerry knew she was really ill. She'd had schizoaffective disorder since she was 19. She could spot the warning signs. She'd already tried, and failed, to get help from her doctor and other services. Eventually, feeling unable to stay safe, she went to the A&E (a British term for "emergency room") in the middle of the night and pleaded to be admitted. She was told that a bed couldn't be found and sent home with the promise that a mental health team would visit in the morning.
"I was lucky. I couldn't get the lid off the petrol can. It was stuck shut. So that's kind of why I'm still here. Three days later I was sectioned [British slang for 'committed to a mental ward']. The whole thing really damaged my trust in services. I kept asking for help but no one was really doing anything."
Now 31, Kerry has seen the best and worst of NHS mental health care. The frustration of being dumped on long waiting lists. The anger at being shunted "like pass the parcel" between services. The trauma of being stuck in a police cell while mentally ill—"one of the worst experiences of my life." But the support she received from a specialist psychosis team transformed her life. She just wishes it hadn't taken seven years to get it.
"That team pretty much turned my life around from not really functioning at all, to me doing a master's degree and then getting a job and getting engaged," she says. "They were absolutely brilliant. But before I got to see them, I'd found it really, really difficult to access services."
Mental health conditions are common. Around one in four Britons (23 percent) has a mental health issue each year, according to the last official survey. That figure includes a range of conditions, from the 15 percent of people with depression or anxiety to the 0.4 percent with psychosis disorders like schizophrenia.
But experiences like Kerry's aren't unusual. Good care is out there, but it is too rare and takes too long to find.
Barely a week goes by without a crisis in mental health services hitting the headlines. A national bed shortage means people in crisis are being shunted all over the country for hospital care. Kids are waiting more than two years for treatment and being admitted to adult psychiatric wards. Worst of all, in the 21st century we still see thousands of mentally unwell adults and hundreds of children put in police cells because NHS services can't or won't take them.
Why is this happening? Partly, it's because our mental health system is being forced to do more with less.
Demand is rising. Doctors prescribed an average of more than 1 million antidepressants per week in 2013, double the number prescribed a decade earlier. There were 1.75 million adults getting help for severe mental illness in 2013–14, up 10 percent from the previous year. People were detained under the Mental Health Act more than 53,000 times in 2013–14—the highest recorded level, and 30 percent more often than ten years ago. And the number of children admitted to hospital for self-harm is at a five-year high.
These growing numbers may partly reflect improving public attitudes to mental health. The fear of seeking help is being broken down, partly due to the national Time to Change anti-stigma campaign launched in 2009. And awareness among medics is improving, too. As one doctor said to me, "Why are we seeing more mental health cases? Partly, because we're better at looking for them."
And yet the growing demand for mental health care also reflects the stress on our society. Austerity has hit hard. A study published in the British Journal of Psychiatry last year found that suicides in Europe had been declining until 2007. But in 2009, the year after the economic crash, there was a 6.5 percent increase—a level sustained until 2011. And in a survey of mental health social workers published last year, three quarters of respondents said benefit cuts were the greatest challenge facing their clients.
Daisy Bogg, a mental health social worker, tells me deep cuts to housing, social care, and welfare have increased the stress on people at a time when they're vulnerable. And the "strivers versus skivers" rhetoric trotted out by politicians doesn't help.
A 2012 study concluded that mental illness accounted for 23 percent of the NHS's disease burden but got 13 percent of the cash
"We're very punitive. That's fed by sound bites about 'hard-working people' and all of that. It's not the only factor, but it feeds the general idea of social unacceptability," says Bogg. "Because actually we all just want to belong somewhere. You can cope with a lot of things if you have something to anchor you. But if everything's falling apart, then what have you got left?"
Mental health services don't get their fair share of NHS funding. A 2012 London School of Economics study concluded that mental illness accounted for 23 percent of the NHS's disease burden but got 13 percent of the cash.
Pinning down whether that funding picture is improving or not is trickier, as the coalition government scrapped the only national survey of mental health services. But an investigation I carried out found funding for NHS mental health trusts—the organizations providing most mental health hospital and specialist care—dropped 8 percent over the coalition's reign. A second set of figures showed that spending on children's mental health dropped 6 percent between 2010 and 2013.
The funding shortage impacts care at all levels of the system. I recently sought help for depression. Mine's pretty low-level. My doctpr prescribed me antidepressants. He also recommended I joined the queue for talking therapies, and I was told I'd face a six-month wait. I fared better than some. A survey of 2,000 talking-therapies patients published last year found that one in ten had waited more than a year to get help. One in six attempted to take their own life while waiting. My doctor also referred me to a dermatologist for a minor skin condition. That took two weeks.
If you have long-term or more severe mental health needs you'll probably be put in touch with specialist from mental health services. These vary depending on your needs but include psychosis teams like the one Kerry eventually got help from and community mental health teams, where social workers or nurses will give you ongoing support and monitor your condition. The problem is these services have seen funding flatline over the past five years, while referrals are up about 20 percent. The result is staff hold more cases. People are seen less. Waiting lists increase. And people fall through gaps in the system—deemed too unwell for talking therapy, not ill enough for specialist services.
But it's in crisis care that the pressure is really showing. People going through their own personal hell and in need of emergency support are routinely being let down. People phoning crisis helplines are struggling to get through to understaffed teams. Beds are scarce. More than 2,000 mental health beds have been lost while the number needing them has increased as the health and social care support to keep us well and out of hospital has been stripped back. A Royal College of Psychiatrists survey of more than 500 doctors found more than a quarter (28 percent) had sent a "critically unwell" patient home because they couldn't get a bed. If beds can be foundthey are often hundreds of miles from patients' homes. Worse still, at least seven suicides have been linked to problems involving access to beds.
The problems are similar in children's services. Nikki Mattocks was 14 when she started to hear voices. She began to self-harm and made several suicide attempts. She sought help through her school, doctor, and A&E but found herself turned away time and again.
"It was horrible because it takes a lot of courage to say, 'I need help,'" says Nikki. "I was told I wasn't severe enough even when I was self-harming or just told waiting lists were long. It's ridiculous because if you had a broken arm you wouldn't be expected to wait a few months and see if you're alright by then." Nikki has just turned 18.
A Royal College of Psychiatrists survey of more than 500 doctors found that 28 percent had sent a "critically unwell" patient home because they couldn't get a bed.
She received help after six months. But she eventually needed several hospital admissions. There was a young person's unit five minutes from Nikki's house, but it was always full. So Nikki ended up in hospitals up to 30 miles away. It made it difficult for friends and family to visit.
"When you're ill you need people that you know and love around you to remind you of why you want to get better. When you're sent away you can't really have that," she says.
But have services ever been up to scratch or are problems just receiving more attention now?
I asked Bogg, who has been a social worker in mental health services for more than 20 years, how the current state of services ranks. "Services haven't always been great but it has got tighter and tighter in terms of what we can offer," she says. "The chance to build up relationships has pretty much gone. Have I known it to be under as much pressure as it is now? No. We see services cut, beds cut, staff cut... everything."
Ask people working in or using services why our services have been allowed to be cut back and they tell you that mental health has long been treated as a second-class part of the NHS.
For Sir Simon Wessely, chair of the Royal College of Psychiatrists, the inequality rears its head in different ways. General hospitals are full of flowers, but mental health wards are often bare. Some medics still treat psychiatry as a lesser branch of medicine and some mental disorders are dismissed as "not real illnesses." The same bias means mental health services are low down the pecking order when local NHS commissioners carve up their slice of the £97 billion ($145.8 billion) NHS budget.
"Clinical commissioning groups have been told to do more on mental health but the standard response is, 'Once we've handled the important issues—A&E, cancer, maternity services—then we'll get to mental health.' That's not parity," says Wessely.
The flip side is that those in power are showing a greater interest in mental health than ever before. More people with experience of services are also speaking up to raise awareness of mental health generally and the need for drastic improvements in care.
Paul Farmer, chief executive of the charity Mind, points to some key moments. Three years ago MPs spoke openly about their own mental health problems. A social-media-led campaign forced Tesco and Asda to withdraw "mental patient" costumes. The last year has seen more high-profile media exposure of problems in the system. And now, says Farmer, people are increasingly demanding improvements to services too.
"That's one of the reasons the public is paying more attention and why politicians are paying more attention," he says. "People are much more confident at saying it just isn't acceptable for us to have a mental health system that really isn't fit for the twenty-first century."
Farmer is leading an NHS task force charged with improving the system. It's the latest effort to close the gap between mental and physical healthcare. In 2012 the coalition enshrined in law a pledge that the NHS would value mental and physical health equally. That commitment was a landmark moment but true equality is a long way off.
"Clinical commissioning groups have been told to do more on mental health but the standard response is, 'Once we've handled the important issues—A&E, cancer, maternity services—then we'll get to mental health.' That's not parity." —Sir Simon Wessely, chair of the Royal College of Psychiatrists
There have been other steps forward. The coalition also introduced the first ever mental health waiting time targets. By this time next year more than half of people experiencing psychosis should get care within two weeks. At least 75 percent of people seeking talking therapies should be treated within six weeks.
The government's final budget committed to spending £1.25 billion ($1.9 billion) extra on children's mental health services over the next five years.Proposals have also been floated to ban the use of police cells for mentally unwell teenagers. And mental health seems, for the first time, to be an election issue rather than simply buried in manifesto small print.
Ask Kerry and Nikki what the next government should do and both say help needs to be available for people much earlier. Nikki also wants to see mental health lessons taught in schools. Farmer, Wessely, and Bogg all say securing more funding to stop the rot and help services deliver better, earlier support has to be an immediate priority. "A bit of reality" on the damage being wrought by cuts to welfare and social services, which look set to get worse, is well overdue, says Bogg.
Will politicians listen? Who knows. But, as Wessely points out, in the past year Nick Clegg has dedicated several speeches to mental health. Ed Miliband became the first party leader, and Jeremy Hunt the first health secretary, to visit the Royal College of Psychiatrists. David Cameron has championed research into dementia. And NHS England's five-year blueprint for the health service features mental health prominently.
"All of that is symbolic, but it means something. We'd like to see it translated into a real increase in resources for services but it's a start," Wessely says. "In an era when it's easy to be cynical about politicians, let's be clear that the change in the importance given to mental health has been tangible."
And you can see it, too. Mental health gets a total of 44 mentions in the three main parties' election manifestos, compared to seven in 2010. It's on the front page of the Lib Dem manifesto, with plenty more inside (33 mentions specifically), including a promise of £500 million ($759 million) a year in extra mental health funding. Labour say they'll increase the proportion of mental health cash that goes to children's services and introduce a new right to access to talking therapies. Meanwhile, the Tories promise better mental health support for pregnant women and people who are out of work.
But with most polls forecasting a hung parliament there's no guarantee these promises will survive coalition talks—remember the Lib Dem promise to scrap tuition fees back in 2010? And with all of the parties looking to reduce public spending it also looks like the cuts to welfare and social care that can contribute to mental ill health are set to continue to some extent.
Ultimately for those depending on services, the policies and rhetoric need to be backed up—not just with funding but also by those in government taking responsibility for the state of the NHS mental health system that they oversee.
"At the moment we just keep hearing, 'It's not down to us, it's down to decisions made by NHS commissioners and different groups'," says Kerry. "You can say all the wonderful things you like about mental health but if the money's not there, too much of it is just gimmickry."