CW: NHS, poor health service, navigating a stressful health service, getting a mental illness diagnosis, mention of suicide.
Navigating bureaucratic systems, especially one such as the NHS, can be a headache. It’s an institution for the people, run by certain people. Now, anything I suggest in the following post is to be taken mildly tongue in cheek but has ultimately been derived from truth, experience and a multitude of perspectives as I collate conversations with other people and their journeys – as well as my own past and present experiences.
Getting a diagnosis or the help you need is not easy, there is no system for it and it does not work the same way as physical health problems. It just doesn’t. I’ve grown despondent over the years, given up and gone private. Malpractice and a systemic ignorance to avoid chipping away at the austerity ridden budget is what you’re going to face, but let’s give it a try.
- DO NOT trust your GP. Some people are fortunate enough to have a GP slightly in the know or up to date with certain elements of less life threatening mental illnesses – or general mental health – but always focus on the ‘general’ of GP, they have broad knowledge of many things, mental health is not one of them. DO NOT be afraid to say no to them offering SSRIs without going away and coming back, anti-depressants, given to the wrong person, can be fatal. Do your research on meds available from your GP and bear in mind they can’t prescribe mood stabilisers and are very stingy with stuff like Valium.
- If you’re not middle class, you need to learn to be. They know how to play the system and the system is classist. Now, imagine being working class and also being a POC on top of that; then think how that interplays and how that will affect your treatment. You have to navigate this system confidentially and treat the doctor as if they are working for you. So, that means scripting what you’re going to say, understanding the route in which they have to take you and how limited their power is.
- The referral. This is where you need to go, the GP will push CBT (cognitive behavioural therapy) on you – which can be very beneficial to the right person, or not – and unfortunately, when they do refer you to the mental health team in your borough they will not respond quickly. You will have to go back and ask them to prompt the team again and again. They will often also tell you to self-refer. Do it all. It’s tedious, soul destroying but you need to keep at it. Do the online referral, call them, go back to your GP and also fill in any paper forms.
- They are all about saving money. At every turn you will be pushed and coerced into taking group therapy, group CBT etc etc. If that isn’t for you, say no. They will probably make you refer again or there will be another waiting period but do it. Once you’ve turned down group once, they aren’t likely to offer it again.
- DRINK and DRUGS. The NHS mental health team works on a few different levels. If you have a mental illness and have heavily self-medicated, you need to be picky with your words. DO NOT mention you think you have drug and alcohol problems if you’re not prepared to go to AA or NA before getting NHS treatment. They do not consider it a mental health concern, but a disease and you’ll be rejected. So be vigilant. Now, I’m not suggesting you lie or keep it a secret, that’s detrimental in the long run, but you need to be aware that even during CBT they will say stuff like “if you come in hungover or coming down I will cancel your appointments”. They are very stern with this.
- You’re going to be asked about suicide a lot. You’re going to be asked if you’ve thought about it, planned it or attempted it. This can be tricky. Suicide, again, is on a different tier than general mental health or mental illness. If you are suicidal, you need to call 999 and go to the crisis team found in most A&Es. However, if you aren’t suicidal, never have been BUT have had really low thoughts, be careful with your words. Suicidal tendencies, or patterns of suicidal behaviours will alter how they deal with you. It can lead to you being pushed away and told to go to A&E or that their treatment isn’t appropriate for you right now as you need urgent care. Ironic, I know. So please, be careful.
- If you’re nosey like me or just cynical, you read everything a doctor writes and sneak a peek at all their notes on you from their computer. Psychotherapists and psychiatrists, during sessions and diagnosis, will comment on your appearance and demeanour. So, if you’re dressed scruffy or in comfy – but not fashionable – clothing they will say something like “low effort of appearance, showing signs of depressive behaviour”, for example. Likewise, if you look tired or have messy hair etc etc. Take this as you will, if you come in genuinely tired after having troubles sleeping or are depressed and are slurring your words or are feeling anxious, it will go down on your record and their interpretation of how you are in that given moment. Therefore, it goes with this line of thinking, if you go in looking like you’re ready for a job interview they might take you seriously or think nothing is wrong. Caution necessary. Note, also, they check how you sit, eye contact, your posture and general physical functionality too.
- Ultimately, you want therapy. Realistically, they want to give you meds. You could be someone that needs both, you might not like the idea of meds and without therapy they can be bothersome/harmful. The NHS will not give you therapy unless they see that you’ve put in the graft to earn it. They want to know you have genuine mental health concerns or a mental illness worthy of a year’s therapy. That means you need to slog your way through the 3 month waits, probably a misdiagnosis and multiple trips back and forth between GP and local MH teams. This is where fabrication comes into play. I would suggest lying about therapy, say you’ve paid privately it’s been wonderful but you just financially cannot continue and really need it. This can prompt them to take you more seriously and see you as a good candidate. REMEMBER, you and your private therapist – fictional or otherwise – have no legal or medical obligation to send notes, reports or contact between the NHS and themselves. So, if they ask, say no you’re not comfortable with that. You have no reason to give details of their practice, where they practice or what their name is. Just say you’d rather not, end of story.
- You can sometimes be “not ill enough” they might make you feel like what you’re experiencing isn’t so major and that you will not be given therapy due to being ‘high functioning’. I am high functioning, I can hold down a job, hobbies, complete a degree – they don’t class me as high threat. Who is high threat? Your unstable patients, your extreme personality disorders, bipolar I, schizophrenics and so forth. So, this is where you have to beef up your story. Make sure it’s got layers, mention the things you think aren’t worth mentioning and be sure in it. Your story of mental health or illness will be tested against the people they are told to give priority to in a system that allows those able to suffer in silence to do so, you have to push push push.
- Finally, if you have done the first 3 month wait and have your next appointment, you have to be wary of two things. A.) a quick diagnoses B.) being discharged rapidly. Firstly, I got diagnosed within an hour, stuck on meds and left out to dry, 2.5months of malpractice followed and I made a formal complaint. The formal complaint, I feel, prompted them discharging me early. They are known for doing that with ‘troublesome’ patients – i.e. those that demand actual care and accountability from their practitioners. If they say they are going to discharge you say no, say you aren’t ready and need more time. If they give you a heavy diagnoses within your first session say you’re not happy with it but you’d be happy to talk more in another session. This is where the middle-class thing comes in, they should be helping you into getting medical treatment – not making you walk the plank with tick tock the croc underfoot.
I won’t add an eleventh point due to liking round numbers, but if you’re pursuing a diagnosis really question why. If you want confirmation of what you’re going through, research and chat to people online whilst holding out for therapy – therapy can change your perspective and interaction with your mental health massively, and positively. Remember that getting a diagnosis can actually be detrimental. For example, as someone now diagnosed with bipolar affective disorder if I were to ever get a driving licence I’d have to renew it every year, opposed to every seven years for those without it. Same goes for certain personality disorders, they stick and are stigmatised. They shouldn’t be, but that’s the society we live in right now – your worth and ability is determined by how you are effective at functioning within capitalism and the 1%’s idea of normality. It could get in the way of a job in your future. Things to bear in mind. Sometimes just having someone to tell you what you’re experiencing and ‘here’s the help you’re going to get’ is enough, be mindful.
This was prompted by many conversations with people – far too many of them putting their health in the hands of GPs or accepting psychiatrists word as gospel. I was also prompted to think out my own tactics today as I had a psychiatrist appointment and I’ll be damned if after three years of NHS ping-pong – and £1500 of my own money on private therapy – that I’ll not be getting the service I deserve.
Persevere, hold tight and be as confident as humanly possibly in your own integrity. Write notes, keep a journal, go in with a fucking binder of your mental health. Do your research, understand the terminology and be ready to impress.
They do not give it up easy and it stinks. So, you have to not give up and keep going, if you can!
If you can’t do any of this then that’s absolutely fine. You can only get by with whatever you are capable of and that is perfectly fine. Don’t beat yourself up.
Try what you can, when you can.
Lots of kisses and many love.