So if you or a love one were mentally ill, what would you do?
Coming into the mental health system is scary. I think most of us have an image in our head that involves straight jackets, liquid cosh (Massive dose of fast acting sedatives administered to knock people out in crisis who are dangerous) and padded cells; the thought of being incarcerated against our will with the entire world misunderstanding us and that we'll never be free again. In rare circumstances this does happen, and if you read the history of the treatment of the mentally ill it does make for frightening reading. I still find it amazing that "hysterical" women in Victorian England were treated with orgasm machines as it was felt sexual frustration made them neurotic. Couple that with the odd demon possession case, witchcraft accusations and experiments with hallucinogenics we're all set for joyous sanity!
Moving on. In my life time "Care in the community" has come into being, which involves trying as much as possible to deal with people's care outside of a hospital setting. The dawning realisation that sufferers need the comforts and safety of their home, to have as much normality as possible and a sense of control of their treatment is paramount. There will always be a need for a secure environment for those persons who are too ill to be safe to themselves of others and that is appropriate. I lived really near to Broadmoor when I was a kid, and the 10am siren used to scare the living daylights out of us every Monday morning. We'd wait in terror for the second siren to go off which confirmed it was the regular test and not an escapee. The imagination can run totally wild if left unchecked! And for me when I was diagnosed, I already understood the distinctions and nuances of mental illnesses, treatment interventions and levels of care required. I've worked with severely mentally ill people before I had my diagnosis so in some ways, I feel very lucky that I had that insight. If you are coming into it totally fresh, the whole thing is baffling. It's also terrifying. Go to Mind.org.uk for LOADS of really good info.
Being mentally ill is hard work. Couple that with the modern choice based empowerment regime regarding treatment, it can be a recipe for disaster. It's like asking someone with a compound leg fracture if they a) Recognise they have a broken leg, b) Would they like it treated? c) Would you like to treat it yourself as I cannot force you to have it treated by me unless you are putting yourself or someone else at huge risk of harm? d) If you do want to walk around with your bone hanging out that's fine, I cannot do much about that as although you seem really unwell, you appear to still have some capacity to make choices, therefore, I cannot intervene, e) If it get to the point of gangrene and you might die and become delirious and detached from reality, we'll have a very lengthy discussion about you and possibly put you in hospital against your will for 2 days 100 miles from your house and decided whether or not to do something! Obviously this is a worse case scenario example, but this stuff can happen.
It's funny. If someone has diabetes, and you tell them a daily injection regime will save their life, they'll do it without thinking. It appears clear as Chrystal that they have a life threatening condition. With Bi-polar, also recognised as a life threatening condition, mention medication and all hell breaks loose. "I don't want to take a pill every day and be chained to pharmaceuticals for the rest of my life." "I can get well on my own", "I'm not really that ill or unmanageable", "I won't kill myself. "
There were 6,708 suicides
in the UK and ROI in 2013. That is 18 people a day for a year. It's also getting worse. (http://www.samaritans.org/sites/default/files/kcfinder/branches/branch-96/files/Suicide_statistics_report_2015.pdf)
The stigma attached to mental ill health is staggering and it cripples a sufferers willingness to accept their condition and get help. Society lacks compassion and understanding, therefore treats sufferers with fear and discrimination. Services are underfunded, understaffed and continuously overlooked by other agendas, that in my humble opinion, are less important. Quite frankly it's a big mess. My own local CQC report on our mental health provision makes pretty grim reading.
So when they told me I would need to be in secondary care mental health services for a few years my heart more than sank. In my 8 years so far, I have seen at least 5 different psychiatrists in the community, waited 18 months for a course in CBT and a further 18 months to see a CPN for couples support in dealing with living with my condition. I have been turned down for psychotherapy as my condition is too unstable and even if I did get put forward for it, the wait is 2 years. I'm too ill for normal counselling (Talking therapy) but also, as I function quite well I am not entitled to a CPN to see me regularly to make sure I'm OK. I see my psychiatrist once every 4-6 months, and when I go to book myself in after my appointment, they look in the calendar and say, "Sorry the clinic is full on that day, can we contact you by post when an appointment becomes free?"
I live in a first world country with a free health system. I live with an enlightened generation of people as far as mental health understanding goes. There is provision of care available for people like me, but it is so far from perfect it's scary. I am blessed in that I have insight, I can read and have access to a computer, I have a loving family and support network around me. I am also able to thrash out what I think works for me and what doesn't. I know for a fact that 25 years ago when I first became ill, undiagnosed and nutty as a fruit cake I was in real trouble. I was "Hidden homeless", unsupported and self medicating with drugs and alcohol. I was surrounded with fear and violence, was misunderstood and very afraid. I was totally isolated and had no idea what to do. I tried to take my life twice, and the second time was very nearly successful. I still vividly remember seeing my divorced and estranged parents standing at the end of my bed on the hospital ward looking helpless and afraid. I don't think any of us quite knew what was going on or what to do.
It took a little while, but I realised on some deep level that noone was actually going to help me, and that I had to drag my own sorry arse out of the mire an into the world of the well. I'm one of the lucky ones. Think about those 6,708 people that weren't as lucky. Think about their families and children then next time you look away from at that odd bloke or dishevelled , sad looking women, or moan that someone threw themselves under the tube. None of us are exempt from a mind bending, weird out episode. It doesn't take much I promise you. And if they do try and get help, what awaits them is complex and challenging and can be a massive disappointment.
So if it was you or your loved one, what would you do? How might it be?