Our Healthcare System Isn’t Equipped To Deal With The Mental Health Crisis
Looking back, thinking of the 120 tablets I’d just been given by the doctor, it was no wonder I attempted to overdose after a particularly bad time with my mental health.
The only question the doctor asked before giving me the antidepressants was if I was going to overdose, to which I answered no. The doctor then handed me – someone who’d suffered with mental health problems since they were 17 years old – the means with which to do myself serious harm.
The big question is, how and why was it that easy to be given so many tablets?
A few months prior to the incident, I had just moved to a new city, which meant registering for a new doctor’s surgery. For the first time in my experience of having a repeat prescription, this practice didn’t do repeats for antidepressants, meaning I had to make an appointment each month to get them.
Anyone who’s been ill and needed to see a doctor knows what a ball-ache it is to try and get an appointment, so the idea of trying to do that on a monthly basis just caused further stress and anxiety for me.
With this policy in mind, and with such a sensitive issue, you’d hope to be able to see the same doctor with each visit. However, this was never the case and I’d see a different doctor each time. This made it impossible to build any rapport with anyone, therefore I felt I wasn’t really able to properly open up and address the underlying causes of my poor mental health, reverting to medication each time instead.
Eventually, I was able to get three months of tablets at once, meaning I didn’t have to stress about making an appointment all the time. However, it was then I started receiving around 120 pills in one go. After halfheartedly being asked if I was going to overdose, I was given the large amount of tablets without any further questions asked and, arguably, without any more shits given.
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A few weeks later, I went through that particular rough patch and attempted an overdose with the tablets I was given. Fortunately, after a brief trip to A&E and a blood test, my attempt hadn’t done too much damage. When taking the tablets, one thought that crossed my mind was the GP who gave them to me.
Part of me felt like it was a bit of a ‘fuck you’ to the doctor who didn’t give me the time of day, in the hope they wouldn’t make the same mistake again if they got wind of what I had done. The rest of my thoughts were obviously not particularly rational – I often define depressive episodes as feeling drunk and out of control, then the next day hindsight kicks in the same way a hangover would.
According to the NHS, prescriptions of antidepressants have almost doubled in a decade: in 2008, 36 million were prescribed, while in 2018 there were 71 million. To me, this shows how the medical sector doesn’t have the time necessary to invest in their mentally ill patients, instead sending them on their way with pills because it is both more time and cost effective.
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Last year the British Medical Association (BMA) revealed that thousands of patients are waiting more than six months for access to psychological ‘talking therapies’, like cognitive behavioural therapy (CBT) for example, to help them cope with negative thoughts and feelings.
While I managed to come out the other side of my ‘rough patch’ and recognise the causes behind it, others aren’t always as lucky, and I can’t help but feel being passed around from doctor to doctor – though they may have been doing the best they could – exacerbated the problem, and allows those with mental health issues to feel as if they’re falling through the cracks in the system.
Catherine, from Leeds, talked about her experiences, telling UNILAD:
When I was in a mental health crisis for several months I had a GP who would just give me medication each week, and I had no support beyond this. When I asked each week how I was going to get through each week, my question was never really answered.
I see the same GP now which helps me because we get on really well. I’ve built up trust with him and my notes are so long if anyone else saw me they wouldn’t have time to read them and understand my situation the same.
Nikki, from Croydon, had a similar experience, telling us:
I’ve had extensive experience of trying to get help from my GP for my mental health, some good and some bad. For example, I’ve had times when I’ve been in crisis and a GP has seen me whilst on their break when I just turned up, they fought for me to see a specialist and I ended up getting the support I needed (I was sectioned).
However, the last time I saw the GP for a review, they just wrote in the notes that I was OK without even asking me then rushed me out the door.
Both Nikki and Catherine said they feel those with mental health issues need more support – whether that be between appointments, or being allocated longer slots with the GP so they don’t feel rushed. They both now see the same respective GP at every appointment, and feel this has massively helped their state of mental health.
Patients aren’t the only ones aware of the lack of time doctors have with them.
Charlotte Armitage, a psychologist, told UNILAD:
Doctors do not have a good enough understanding of mental health and with only a ten minute appointment, where they tend to be rushed and overworked, they aren’t able to sit and really think through the issues that a patient is presenting with. Furthermore, patients with mental health problems may be challenging and highly emotional, they also may not be, but doctors are not trained to deal with or understand this behaviour.
The problem is that, even when it is identified that a patient needs further intervention, the waiting lists are long. Therefore the doctor ends up potentially being the ‘holding’ person for the patient until they get access to the most appropriate service.
Agreeing with this point is Dr Samar Mahmood, a GP, who feels colleagues do need longer with many patients, including those with mental health issues.
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GPs don’t have enough time to give to patients generally – 10 minutes to listen/talk to, diagnose and treat a patient is nothing. Unfortunately, due to short supply of doctors and high demand for appointments, 10 minutes has become the standard best balance between meeting appointment demands and dedicating enough time per consultation. Research shows that 16 minutes is the ideal duration though.
When it comes to mental health, however, longer is needed – especially for a patient presenting with their symptoms for the first time (follow-up appointments of course can be conducted a bit quicker).
Ideally, mental health patients should be given longer slots to ensure a more satisfying conversation for patient and doctor, and if mental health problems weren’t common then most GP practices would try and accommodate this every time.
However, given that mental illness has become very common, to offer every patient with a mental health issue a longer slot would impact the number of appointments available to others and would ultimately mean that many patients with other ailments don’t get seen at all.
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As well as concerns over lengths of appointment, Dr Mahmood agreed with the idea mental health patients in particular should see the same doctor each time, but that unfortunately doesn’t always happen.
It certainly would help if patients were seeing the same doctor each time. We call this ‘continuity of care’; it makes it easier for patient and GP when this does happen, and helps to build up the doctor-patient rapport, which is invaluable in mental health conditions.
When possible, surgeries do try and offer this. However, for many reasons, it does not always happen and this again ultimately boils down to clinicians being in short supply.
Until the current NHS staffing crisis resolves or at least improves considerably (which I predict could take several years at best), GPs are firefighting within a health system in crisis, and patients (particularly those with mental illness) are not getting ‘ideal’ care.
It all appears to be a vicious cycle: doctors don’t have time to talk to their patients in depth, so refer them for things such as CBT, which have an incredibly long waiting list. However, most people who have gone to their GP for mental health purposes are needing help there and then, therefore the best short-term solution a doctor can find is to prescribe medication, eventually leaving those suffering to feel forgotten about, as a prescription is rarely the long-term fix.
The problem is by no means an individual GP’s fault – unless, in my one experience, they give halfhearted time and attention to a patient.
And of course, it’s impossible to pinpoint the particular causes – from falling numbers of GPs, or a lack of mental health professionals readily available, and the rise in the number of patients suffering from poor mental health, to simply a GP’s schedule not falling in line with a patient’s – with the recent rise of mental health issues, it’s arguable the medical sector has been slow to react. Again, this is not the GP’s fault, but, it seems, more a systemic issue within the medical sector.
The UK is undergoing an unprecedented mental health care crisis, and it seems to only be getting worse. However, a few small measures taken – such as seeing the same GP at each appointment and making it easier to book those appointments – would go a long way to help those suffering with poor mental health.
If you’re experiencing distressing thoughts and feelings, the Campaign Against Living Miserably (CALM) is there to support you. They’re open from 5pm–midnight, 365 days a year. Their national number is 0800 58 58 58, and they also have a webchat service if you’re not comfortable talking on the phone.
If you’ve also been affected by any of these issues, and want to speak to someone in confidence, please don’t suffer alone. Call Samaritans for free on their anonymous 24-hour phone line on 116 123