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The NHS Can't Afford to Help Mentally Ill People Unless They're Desperate

Which means more people are becoming desperate in the first place.

by Hannah Ewens
17 September 2014, 11:15am

Collage by Marta Parszeniew

Yesterday, mental health charity MIND released some stats that made for pretty depressing reading. In Britain, four in ten people who have tried to access therapy in the last two years have waited more than three months to be assessed after being referred by their GP. One in ten people wait over a year. Having to wait can have grim consequences. While waiting for treatment, four in ten people harm themselves and one in six attempt suicide.

Rob Richman took an overdose in March. He's 39 and has struggled with anorexia and depression for the majority of his adult life. He got treated quickly when he took the pills, and was put on a ventilator, but he says emergencies like that are the only times he gets the help he needs. "If I get help it's when I've taken overdoses or done things to myself," he told me. "That's when help has - in inverted commas - been there for me. It's not there beforehand when I've needed the support." If people who are suffering from mild to moderate mental health problems get treated, it can stop their condition becoming worse. But the NHS is increasingly unable to help anybody other than the most desperate cases - and that is causing the number of those cases to increase.

An investigation by Health Service Journal recently found that mental health services are "close to collapse" after two years of budget cuts. Freedom of information requests and analysis of workforce data revealed that the NHS's 57 mental health trusts had lost 2.3 per cent of their funding, equivalent to £253 million. The result is fewer doctors and nurses, and an epidemic of moderately unwell people whose conditions deteriorate as they are left to suffer.

Rob

"With my experience of depression, your life has to be in immediate danger," said Rob. "You're in 'the community' until such a time as you do something harmful to yourself or they think you're about to." It's something that Rob has noticed becoming more of an issue over the past few years and he's not alone. GPs, mental health boards, charities and sufferers are now acutely aware of this.

A student at Goldsmiths, University of London, who suffers from cyclical depression and identity crisis, told me that he spent months trying to get diagnosed on a seemingly endless waiting lists for Improving Access to Psychological Therapies treatment (IAPT is the NHS programme to get mental health patients better treatment). He didn't want to be named, but he said, "In my personal experience, it was the waiting that nearly pushed me over the edge."

Harley Hodgson-Tuck, a 23-year-old bartender was diagnosed with PTSD after seeing his friend commit suicide. He went through a personal hell while waiting to be seen. "I was having nightmares for a month after it happened and crying almost every other day. It was a traumatic experience and I wish someone had been there quicker than they were."

It hasn't always been this way. Mental health workers recognise both the disappearance of services for the mild-moderate cohort and the extension of the waiting list. Dr Ali Rofique, GP in Tower Hamlets, said, "If you look back two years, patients were assessed quite quickly and would have a treatment plan in place within a couple of weeks." The new MIND stats also show that over the last 12 months, more than half (57 per cent) of therapists are worried that their patients are putting up with increased waiting times and two thirds (62 per cent) report shorter courses of treatment. The level of care has become very crappy, very quickly.

Worryingly, GPs are having to look for different ways to get people seen to that they might not have opted for in an ideal situation. Dr Elliott Singer, London wide LMCs (Local Medical Committees) medical director and a GP principal in Chingford, East London, said in a recent survey of 500 GPs for Pulse, the GPs magazine, that he refers patients to A&E for assessment and that his local NHS Trust is discharging patients without enough community support in place. "It is a very high-risk strategy the Trust is adopting", he said. "My concern is it's a waiting game until a tragedy happens, if patients are not being monitored properly."

A lot of the time, GPs are having opt for medication, doping people up on pills because there are no resources for therapy. One question in Pulse's survey was "How often are you forced to prescribe because the local IAPT service is not able to help a patient?" To this, 84 percent answered positively with 11 percent "all the time", 39 percent "often" and 34 percent "sometimes". Dr Louise Irvine, Lewisham GP and chair of the Save Lewisham Hospital campaign agreed, saying, "The longer you have to wait for counselling or therapy or CBT [Cognitive Behavioural Therapy], the more pressure you're under to prescribe, in order to be doing something."

Harley had medication for PTSD while on his waiting list. "It helped initially in that it was mind-numbing," he said. "It numbed my thought processes but only to supress the feelings of anxiety and depression but it'd come back to me and I'd take another pill. It's second rate - it doesn't really work."

Sadly, the disappearance of services is hitting children the hardest, at least in some areas. Dr Irvine explained that in Lewisham, cuts have meant that "there's no treatment at all for children with mild to moderate mental health issues." She told me that if you refer a child with mild to moderate mental health issues in Lewisham, you'll just get a standard letter back from the Child and Adolescent Mental Health Service giving you a list of organisations and charities and other groups, suggesting you refer your children there. Basically, you're fobbed off.

As is often the way, by trying to be cheap, the government is going to end up spending more money in the long run. Half of adult mental illness starts before the age of 15 and 75 percent by the age of 18, so not treating it early will just make things worse in the future. "Looking after children with mild problems can mean that you intervene early and stop things getting worse," said Dr Irvine. "But in Lewisham, for example, there's just no money for that."

Many people suffering are left with only one realistic option: to go private.

Rob is currently having private treatment for his long running eating disorder because as he is within a mild-moderate bracket that wouldn't be covered by NHS. He said, "If I was referred to the eating disorder unit, they wouldn't have anything to do with me. Eating disorders on the NHS are literally done by BMI. If you're anything but dangerously low, that's it." He's terrified his insurance won't cover him soon as his illness is chronic.

The MIND figures show that one in four people seeking treatment for mental health are going private, compared to one in ten last year. The influx of patients is being felt by the private health sector too. The United Kingdom Council for Psychotherapy and British Psychoanalytic Council surveyed 600 private therapists, 89 per cent of whom say clients have come to them because the NHS could not give them the help they need.

That's fine for those who can afford it. But for many people it's not an option. "In Lewisham we don't have that many patients that can see a private therapist, said Dr Irvine. "If people could do it, they would do it." Statistically, poorer people are more likely to suffer from mental health issues in the first place, so they're doubly screwed.

Mental health has always been underfunded. But it hasn't always been this bad. Nick Clegg is saying that he's going to prioritise mental health service, pledging that Lib Dems would spend £50million on research by 2020. But he's saying this at a time when his government is allowing mental health services to crumble, leaving those with moderate mental health problems to deteriorate, driving more people to the private sector and forcing doctors to medicate their patients rather than send them to a therapist.

@hannahrosewens / @MartaParszeniew

More articles about mental health problems:

Perfectionism is a Mental Illness and It's Ruining My Life

Why Are There So Many Mentally Ill Drug Addicts in Cornwall?

Stop Pussyfooting Around My OCD