Mental health cruelty is not a historical issue

Over the past week or so, there’s been an impassioned Twitter discussion where mental health patients have shared their experiences of judgemental, disrespectful and downright cruel treatment from health professionals, specifically in the context of self-harm.

It was triggered by a series of tweets from the Government’s advisor on suicide prevention, who posited the opinion that this sort of treatment is ‘unusual’ nowadays.

Twice in last week I’ve been told of cruel comments by health staff to people who had self-harmed. I really believe this is unusual now but it shows there is something deep-rooted that we have to eradicate.

— louis appleby (@ProfLAppleby) November 24, 2019

Instantly, a huge number of people replied giving recent examples – some truly shocking – of how they’ve been subjected to borderline inhumane treatment at the hands of HCPs, particularly in A&E.

Still, though, the prof defended his position, implying that these scenarios were ‘common a few years ago.’

So, to be clear, I am wondering how widespread this is now, after anti-stigma campaigns & NHS guidance. We all know it was common a few years ago but that’s not my point. https://t.co/d2TpUt7bst

— louis appleby (@ProfLAppleby) November 24, 2019

 

I’m one of the many, many people who can testify that prejudicial and downright cruel responses to HCPs towards those of us who have self-harmed or are suicidal are still hugely prevalent – and causing untold damage to patients who have hit crisis point.

Here are just a few examples.

In Minor Injuries, being treated for self-harm, the nurse said to me, ‘I’ve never known anyone do this and still be in a relationship. You’re lucky your husband hasn’t left you.’

On a medical ward after a suicide attempt, and with new self-harm injuries visible, an HCA told me, ‘You look like you’ve been attacked by a cat.’

On the same medical ward, being treated for an overdose, I was too distressed and nauseated to eat. The nurse in charge said, ‘If you don’t eat something, we’ll put a tube down your nose.’

Related to this, on a psych ward and unable to eat (my appetite disappears when I’m severely depressed: not an uncommon symptom), an HCA came into my room and said, ‘Oh, we’re on hunger strike now, are we?’

Also on the psych ward, I was found cutting in my room. The nurse sighed and called for colleagues, saying in a world-weary tone, ‘She’s self-harming.’ She then ordered, ‘Give me that [blade]’ and told me to clean myself up with a wet wipe, even though the cuts were deep and needed medical treatment. Not once did she or any of the other staff show any concern for my mental state, or even ask why I’d felt the need to hurt myself.

In a busy A&E, while being put on a drip to counteract the effects of a large overdose, I asked whether it was possible to stay on the trolley rather than moving back to the seating area where I’d been sitting, despite being violently sick. The response? ‘Not a chance.’

I know the department was full of other people in need of beds, and in the end, I did get to stay on the trolley, but I was made to feel utterly worthless, and as if I was being punished.

Other forms of cruelty are implicit rather than overt, but still harmful.

I’ve had cuts that needed stitching hastily and dismissively repaired with steri-strips, which were inadequate and have left me with severe scarring.

I’ve had stitches without sufficient pain relief.

I’ve had a massive panic attack in A&E awaiting a mental health bed; my husband summoned a nurse to tell her I wasn’t well, and she pretty much shrugged and walked off.

I’ve been told, in a specialist psychiatric hospital, that no one would remove stitches for me, and I would have to get my husband to take me to Minor Injuries (I ended up taking them out myself).

I’ve passed out, mid-panic attack, at the feet of a mental health nurse, been asked, ‘What are you doing?’ and told to, ‘Get up.’

I could go on. And on and on. And others on Twitter can list just as many examples of casual cruelty – many of them far worse than I’ve ever encountered.

Of course, not every HCP is so judgemental or unkind. I’ll never forget the kindness of a young A&E doctor, who simply laid his hand on my back while I was wracked with vomiting. Or the A&E nurse who held my hand and said, ‘I’ve been where you are. You’ll get through it.’ Or the same nurse who, while making the mandatory call to social services (it’s an automatic referral in this area if you have kids and present at A&E with self-harm injuries or having attempted suicide), told them, ‘She’s a lovely lady. I have no concerns.’ Or the lovely doctor who let me suck on gas and air while he was doing my stitches.

Such small gestures, but such kindness.

These kindnesses will stay with me forever, but so will the harsh words, the dismissive treatment, the way I’ve been made to feel like a time-waster, an attention-seeker, a drain on services.

There’s a term for the damage that this compassionless, mean-spirited treatment can cause: iatrogenic harm. It refers to physical or mental harm caused by the process of treatment, including the actions of HCPs. And if you take a look at Twitter, you’ll see hundreds of people who’ve been mentally scarred in this way.

How I wish that Prof Appleby was right in saying that such cruelty is a thing of the past, or at least vanishingly rare.

But what I wish most is for HCPs to show a little humanity to those of us who are at the lowest possible ebb, and who have reached out a desperate hand for help.

I wish they’d remember why they went into medicine, before they became hardened to their patients’ suffering.

I wish they’d realise that NOT ONE of us would have chosen this life for ourselves.

And I wish they’d realise how much their words and actions hurt.

What can be done about it? I don’t know. If we report such cruelty, it’s our word against theirs, and because we’re written off as mental, crazy, hysterical – and often labelled with BPD – our word counts for nothing.

Something has to be done, though, Prof Appleby.

Because the scars are deep. They’re real. They can cause untold psychological damage, and even be fatal.

And they could all be avoided with a simple drop of human kindness.

 

Where should the money go?

It’s no secret that mental health services are seriously limited by their budgets. Just ask any of us who have waited months for counselling, needed a psych bed when none were available, or been discharged from a service long before we were ready – or even safe.

But there’s another issue when it comes to mental health budgets, and that is, where should the money be spent?

At the moment, a lot of funding is channelled into the IAPT scheme. That’s Improving Access to Psychological Therapies, or, as it’s known in some areas, the Wellbeing team/service.

IAPT allows people with mild to moderate mental health conditions like anxiety and depression to access psychological therapies more easily. In many areas, this means they can self-refer. Currently, a million people every year are helped by IAPT.

This is all well and good. No one would argue that people with mild to moderate mental illness should be able to access support. After all, early intervention could prevent people’s mental health deteriorating, as well as potentially saving millions of sick days every year (kerr-ching!).

But what about the rest of us? Those of us who have more serious and enduring mental illnesses, like severe recurring depression, bipolar and schizophrenia?

This is where resources are seriously lacking – and it’s dangerous.

Throughout my ‘journey’ with mental health services, I’ve been at the mercy of an underfunded NHS.

I’ve been sent home from hospital after attempting suicide with no ongoing support – on more than one occasion.

I’ve had to wait days on one-to-one observation in a general hospital because no psych beds were available.

I’ve been discharged from a mental health hospital despite pleading to be allowed to stay because I felt so unsafe, and told that I had to ‘take responsibility’ for my actions.

I’ve had countless crisis team late arrivals and no-shows, not to mention being discharged from the team after a meeting during which I was explicitly clear that I was going to end my life, including how and when – and yes, I did follow through with my plans.

I’ve had lost count of how many different psychiatrists I’ve been under in the space of six years or so, presumably because the NHS can’t hang onto its doctors, increasing caseloads and petty bureaucracy to the point that they simply can’t cope.

Most recently – just a couple of weeks ago – I had my care coordinator taken from me, even though I was in hospital as recently as June.

I’m far from alone. Spend five minutes on Twitter and you’ll find countless people who’ve been through similar experiences, or worse. And when you have a mental health condition, being treated like this can leave you traumatised and exacerbate your illness.

I’ve no problem with IAPT in principle, but I do have a problem with diverting so many resources into the scheme that people with severe mental illness (SMI) can’t get the help they need because the money isn’t there to finance it.

It’s a bit like treating a patient with a headache at the expense of one who has a brain tumour.

I understand why money is being sunk into IAPT. The NHS is under pressure to produce tangible results where people are ‘cured’ quickly and easily and discharged from services.

That’s far more achievable if they prioritise people with mild to moderate mental health conditions. Many of them can be effectively treated with a handful of CBT sessions and perhaps a short course of antidepressants, and be safely discharged.

This is no less than they deserve – but it also allows the NHS to ‘prove’ its successes. Patient treated? Yep. Patient recovered? Yep. Patient discharged? Yep. There’s demonstrable evidence that the initiative is working; the CCG managers get a big pat on the back and the CQC is happy.

(I’ll gloss over the fact that despite the relative success of IAPT, the most recent review shows that 41% of practitioners have been pressurised into manipulating data, for example by coaching patients to give the ‘right’ answers, and discharging people who are showing positive results early, to avoid having to report a subsequent bad recovery score).

Those of us with SMI, however, don’t reflect well in performance data and league tables. We’re harder to treat, and it’s usually a longer, slower process with a lot of trial and error. Our conditions may be lifelong. We have relapses of varying frequency and severity. We need more complex care, such as inpatient treatment, crisis team support and care coordinators. We can’t be ‘cured’ by a short course of therapy or frontline meds.

In the eyes of the NHS and the powers that control its budgets (I’m looking at you, Boris), we’re a money sink compared to those who can be successfully treated by a short-term intervention, so it’s no surprise that the resources are channelled into services that appear to have greater success rates.

In no way am I suggesting that people with less severe mental health conditions don’t deserve help. They absolutely do, and it’s right that they have access to that as swiftly and easily as possible.

But where does that leave us, the long-term, more complex ‘service users,’ who often find ourselves seriously unwell and unable to get appropriate help because there’s not enough money to pay for psych beds, crisis team intervention, and consistent, high quality care from secondary and tertiary services?

I can tell you where: at risk.

Back to blog?

It’s been a REALLY long time since I last blogged.

Why?

There are several reasons, really. For a good 12 months or so, I was writing on mental health for Metro, which satisfied the writing bug. It was a nice combination of productive and cathartic, despite being appallingly paid, and led to other media work: BBC News, BBC Breakfast and various radio programmes.

Bizarrely, despite being naturally introverted, and the intensely personal nature of what I was talking about (self-harm and suicide), I discovered I loved doing TV. It gave me a confidence I didn’t know I had, and a real buzz. I was damn proud of myself, to be honest.

Over the past year, however, the Metro work has dried up, with no explanation, no answer to emails. Perhaps mental health isn’t getting them an audience any more, but I’ve been ghosted, to use a very millennial term. And with it, my mental health advocacy has withered and died. I miss it.

My blog inactivity is also partly explained by the fact that I’ve spent much of the past two years very, very unwell. More of that to come over the following days, if the blog bug bites again, but I’ve had long periods of being too poorly to even think of writing.

And then there have been periods where things have been, well, normal. And in these times I don’t feel the same urge to write as I do when things are somewhere between low and crisis point.

So, all in all, my poor blog has been neglected.

Now, though, I find I want to write, and with no paid journalistic outlet for my (literally) mad ramblings, I think it’s time to breathe new life into this blog.

In the past two years, I’ve been through so much under mental health services, and there’s stuff I need to say. There are experiences that I need to document, to share, maybe even to bring to a wider audience. I’m still shell-shocked by some of the things that have happened, and I want to get it out there.

When I was last blogging, I was doing so privately. This followed some pretty awful experiences where my suicidal behaviour was reported to both my husband and services; the fallout was spectacular and after that, I locked down my privacy settings.

But now I’ve decided to press the ‘public’ button again. Now I’m not in a crisis situation, I don’t need to worry about what’ll happen if I blog about my experiences in the pit. I’m not ashamed of what I’ve been through, and if people want to trawl back through my old posts, that’s fine with me – maybe it’ll give them a clearer insight into the hell that is severe recurrent depression.

Maybe I’ll find my writing mojo and start to unpick some of the crap that I’ve been through since I last blogged. Maybe I’ll find that actually, I don’t want or need to write about it after all.

But this post is a start. Let’s see where it goes.