Thursday, April 9, 2015

Alone on an island

A few months ago I saw this story, which mentions that Cardiff and Vale University Health Board (i.e., the NHS trust to which I belong) is currently being investigated because of its piss-poor mental health services, and it awakened in me a feeling of familiarity and exasperation.

I can personally attest to the woeful inadequacy of the NHS in this respect, having sought help several times over the past few years and having always been left with a feeling that I am being ignored or seen as a burden.

Most recently, that was last month. After waiting four weeks for an appointment, I went to see my local GP on 16 March. Jenn came with me because I had told her how ineffective the NHS is at dealing with mental health and she hoped that two people asking for help might have greater effect. It didn't. The doctor offhandedly suggested my standards are too high –– I'm expecting too much out of life. Those weren't his exact words, admittedly, but that's more or less what I heard.

Beyond that, I was told there wasn't much that could be done for me apart from putting my name on a waiting list.

"Yeah, I've been on that waiting list before," I said. "It'll be 6 to 8 months before I get to see anyone, and then it will only be for five sessions. After which, I will not be allowed to request more counselling for at least 6 more months."

"The waiting list is shorter than it used to be," my doctor said.

"How long?"

"Shorter than it used to be."

The other stuff remains as true as it has always been. You get five sessions with a counsellor, each lasting just 50 minutes. It is barely enough time to properly introduce yourself let alone begin to identify and/or address any real issues.

At the end of those five sessions, those 250 minutes, those four hours and a bit (for fuck's sake, Gone With the Wind is 221 minutes long –– watch it with adverts and you will have invested more time in Scarlett O'Hara than the NHS is willing to invest in me), at the end of that they usually give you a pamphlet.

A pamphlet.

Good grief, man, I've told you that I've been struggling off and on for more than two decades; do you really think that can be remedied with a pamphlet? Do you think that no one before has ever thought to hand me a fucking pamphlet?

You know who does a better job than the NHS? The Mormons. Their answer –– pray –– is oversimplified, but at least they will listen and take you seriously. And they've got pamphlets.

I'm not even kidding: I have often thought about just calling up my local Church of Jesus Christ of Latter-day Saints ward and asking they send some missionaries round to try (again) to convert me. Just for the sake of having someone to talk to.

They'll send a nice, clean-cut kid from Montana and a big dude from Tuvalu who will give me a free book and all the pamphlets I could want and who will listen to me babble for as long as I please even though they don't really understand my point, and then the dude from Tuvalu will put his hand on my shoulder and say: "Brother, I just want us to pray on this."

None of it will actually help, but it will feel a lot more helpful than the great big pile of nothing-poop you get otherwise. Because let's think about it, y'all: one of the most common aspects of depression is what? A feeling of being sickly alone, of being irrelevant, of being unwanted, of being ignored. 

What, then, is the worst way to address that feeling? To make a person wait a month to have a 5-minute conversation with an overworked GP, then dismiss him or her with the fallow promise of being placed on a waiting list that is months or years long.

"Don't call us; we'll call you. Try not to fling yourself off the M48 bridge in the meantime because fishing your body out of the Severn is a waste of resources for our already cash-strapped councils."

And that's an aspect of the process that isn't mentioned in the BBC story. You have to plead to be put on these waiting lists. The implicit message you will get from many GPs is that you should really just suck it up and join a flower arranging course or some such thing because these mental health resources cost a lot of money. They are for people who are really hurting, and the fact that you've managed to comb your hair and show up for your appointment on time is evidence that things aren't that bad for you. That incessant pain you feel is made up. You're being overly dramatic. Why don't you just choose to be happy?

And I only just realised this today: in all those short counselling sessions I've had, the counsellors have said things like, "I don't really think it's right to use labels," and avoided using terms like "depression" or "bi-polar disorder." It only just occurs to me this is not because they were being progressive in their therapy but because to use those words comes close to diagnosis, which might make me eligible for actual psychiatric care. And that's money they sure as hell don't want to spend. The BBC story I linked to above says the current waiting list for psychotherapy in Wales is 2 years. TWO FUCKING YEARS. That's 730 days of desperately fighting the urge to cause yourself harm; 17,520 hours of hell.

Ever seen one of those films where a character steps off a bus in the dusty middle of nowhere? The camera shows her suitcase (it's usually a "her" and she's usually wearing cowboy boots) being set down in the dirt, then you see the bus pull away –– you hear its whine of acceleration –– then there is silence. You see the character standing there, alone on the outskirts of the middle of nowhere, with a look on her face that says: "Uhm, OK. Dang. What do I do now?"

That's what it feels like after you've been handed a pamphlet and sent on your (not-so) merry way. Even in Britain, where the buildings crowd you, where the cars never stop, where people literally bump into you on the crumbling sidewalks, where you are always –– always –– within view of some security camera, the world seems suddenly desolate. You feel alone. You've got your pamphlet and not a lot else. And you think: "Alright, well that didn't go as I'd hoped. I don't feel any better at all. If anything, I feel a little worse."

If it happens to be sunny on this particular day you might be able to work up a bit of good ol' fashioned self-delusion and think: "Right. Fine. Looks like I'm going to have to Bear Grylls my way out of this and fix things myself."

But you can't. And deep down inside, you know you can't. Because depression makes you stupid. It staggers your memory (especially short-term memory) and robs your ability to think around corners. It feels as if your cerebrospinal fluid has leaked out and been replaced with Mrs. Butterworth's.

If you're lucky, have an incredibly supportive wife and are blessed with the quirk of being easily addicted to ideas (Welsh, Strictly Come Dancing, motorcycles, etc.) rather than chemical substances, you may be able to muddle through. You'll come up with a new This Fixes Everything scheme every fortnight or so then forget about it just as quickly. You'll have some good days, have some bad days, have some terrible days, and eventually find yourself back to the point of feeling desperate and no longer in control of what goes on in your head, nor what it makes you do.

And each time you come back to that point, a single truth will grow ever larger and undeniable: no one fucking cares.

In 2013 in the UK, 1,713 people were killed in road accidents. In that same year, some 6,233 suicides were recorded. They've got safety cameras anywhere you look in this country, and traffic laws up the wazoo. But if you're struggling with the simple act of finding the will to get out of bed in the morning all they've got for you is a pamphlet.

You're alone on this island, son.

2 comments:

Unknown said...

Hi Chris--
I am sorry to learn that you've been struggling with your mental health and the NHS. I have recently been enjoying the archives on your motorcycle site, and I can see that you are a very talented writer who has dared to do difficult things. I envy the life you have built for yourself.

But I know that pointing to the obvious is not going to help much. Depression is not a mood, it is a disease and it is trying to kill you. Attempting to argue with your depression is like trying to reason with a tumor. (But if any tumors out there would like to receive a pamphlet, drop me a line.) I hope that if you need help, you can get it.

That said, the situation you describe is criminal. The UK has also dared to do difficult things in building a single-payer health system, something we in the USA are not even allowed to contemplate. Now the NHS is being starved and dismantled by a generation of politicians who stoke resentment of the poor and immigrants in order to undermine the power of a self-governing people.

Debbie said...

Totally agree with you Chris. I had one session with a counsellor and she was dreadful. She was so judgemental and my GP had had other terrible complaints about her and asked me to make an official complaint. Which I did. I was offered another counsellor but I had been totally put off. It is so hard to find the best support and I agree with the previous comment that the NHS is being forced into decline by politicians. I have 2 friends that have to also deal with severe depression, one is Bi Polar. I will ask if there is any support that they know of that may be of help to you. The one lives in Penarth. Keep strong xxx