Let me start with a disclaimer. This article was tough to write and is not easy to read so I’ve mismatched it with a very happy picture of myself not looking back in anger at all my experiences of the mental health system in Ireland and in London.
So… the green waiting room: sounds like the title of a Sherlock Holmes mystery, right?Although my journey through the mental health medical system has at times felt like I am stuck in the plot of a novel, the green waiting room in question refers to the ‘soothing’ colour that psychiatric units like to paint their waiting rooms. I have found myself in many of these waiting rooms over the years and somehow the green has never quite been soothing enough.
I wish I could say this is the only problem with our mental health services. I have experienced the system both in Ireland (where it’s overseen by the HSE) and here in England (where services are run by the NHS). There are clearly some differences but they both operate a similar model, in which your first point of contact with the system is usually your GP, who will then refer you to services available in your area. In times of distress (more of which later, you’ll be glad to know!), I have once or twice ended up in the A&E department of my local hospital who have then referred me on to mental health units, but generally the route into local services will start with your doctor. (Of course this relates to support provided free as part of a national health system; private clinics can have different arrangements.)
I feel very thankful to be able to say that I haven’t needed any contact with mental health services for over two years now; my primary care all comes from my amazing GP. Emma is the name of this wonderful woman. She is based in Cork and I go home every six weeks or so to check in with her. I could write a whole book about how supportive and wonderful Emma has been; suffice to say I am very lucky to have her and I am very grateful for her support. You may be thinking that it’s a bit weird that I live in London and my GP is in Ireland. It is indeed strange, but through trial and error I have found that this system works for me. I am registered with my local NHS doctor and I go there for most medical issues that crop up, but for issues with my head I go to Emma.
I have found the NHS to be incredible at treating issues of physical health. For example, I burnt myself quite badly a few years ago by accidentally spilling boiling hot tea all over my lap. The care I received from the NHS was exemplary. Unfortunately, that contrasts starkly with my experience of mental health support here, which has been mostly terrible. GPs seem to have their hands tied by the system, and they simply don’t have the time that is needed to deal with issues. Appointments are strictly for ten minutes maximum, and this is (unsurprisingly) not long enough to open up to a GP you don’t know if you are feeling distressed.
The pressure that this system puts on GPs can lead to some becoming quite brusque and losing their bedside manner. To illustrate this, let me tell you about the ‘Smarties’ incident. This happened not long after I moved to London, about five years ago. I had registered with the nearest surgery to the flat I shared with my then-partner. I ran out of my medication whilst having a very low patch and was so anxious that I couldn’t physically leave the flat to get to the doctor. Josh (being the lovely man he is) rang the doctor to try to get my prescription. The GP’s response to him (and I quote verbatim) was: ‘If Sinéad wants the smarties, she has to come and get them herself’. Yes, this really happened. This is just one very extreme example of my experience in trying to access primary care services for mental health in this country.
So what happens after you get referred on to mental health services? At my very sickest back in Ireland, when I was suicidal and self-harming almost everyday, I ended up in hospital a few times. This happened in the following way. My GP, who I saw regularly, realised I needed more urgent care than she could give and on several occasions referred me to the nearest mental health service. Being an acute case, this basically consisted of writing me a letter and sending me into the hospital. There I would wait in the aforementioned green waiting room (I say room; more of a small airless cubicle) in the psychiatric unit of the hospital, to be seen by the doctor on call. The doctor spoke to me, assessed my state of mind, and either admitted me to the unit if they had a bed, or (if the unit was full) sent me home on a high dose of some sort of medication. I would then be seen by a psychiatrist (or one of his team) a few days later in an out-patient clinic.
My experiences of needing acute care were so distressing that I am unsure of how to start unpicking them. Firstly, let me say again that doctors working in acute services, like GPs, are for the most part dedicated and fantastic, but they are crippled by a lack of funding. There is a huge problem in Ireland and Britain in getting the right services to the right people. Basically, the option to assess a patient and then match them to the service that they need is not available. The patient has to take whatever is available in their area at any given time, and this is determined by funding and sometimes by sheer luck. The patient’s needs are not the determining factor in what care they receive and I feel they really should be.
Patients may also have to travel hundreds of miles in order to access mental health services. And when they get there, they may be cared for in psychiatric units that cover all illnesses, even if this proves to be highly unsuitable. In my case, I was a young girl in my early twenties who had been raped and was in severe distress. I was treated in a unit with alcoholics, drug addicts and people suffering from schizophrenia. Clearly all of us had an equal right to be there, but my main memory of my time in hospital was being too scared to sleep at night, hearing patients screaming and shouting at the poor over-worked nurses. I think any therapeutic benefits of being in hospital for me were lost in the sheer terror of such an environment.
Of course, these are just of my personal experiences of mental health services and the problems as I see them. Clearly both the HSE and the NHS are facing serious challenges when it comes to mental health. Both systems are trying to move away from a hospital model towards providing care for patients in the community and in patients’ homes. The NHS is heavily pushing a strategy called Improved Access to Psychological Therapies, and tries to get patients into this programme within six weeks of referral. These are all improvements, but we need to keep talking about mental health and pushing it onto the public agenda. If we make enough noise, those in power will have to sit up and take notice of what we are saying.
To finish up, my thoughts are still about waiting rooms. My clearest and most distressing memories of that time in my life are all about that waiting room. Sitting in a tiny cubicle of a psychiatric unit waiting to be assessed by a doctor was so distressing. Tiny changes to these waiting rooms could make the experience a little bit easier for patients. For what it’s worth, I think it would help for patients and ex-patients to be included in hospital task forces, so that they could highlight the small things that would make a big difference. Surely those who need the services should be consulted about them? The future of mental health policy is so important for all of us as a society. To improve our systems we need to start at the ground level and include patients’ opinions as much as possible. This is the way forward: the way to get the right services to the right people.