Opinion: Where do we now stand regarding mental health provision in the NHS?

nhs sign lrgMany people are clearly still very angry at, what they perceive to be, Liberal Democrats waving through Conservative plans to fragment and privatise the NHS – despite it not being in the Coalition Agreement – and believe that, within that, mental health treatment in the NHS will inevitably suffer.

I do not think that anybody who reads these pages will believe that the party can regain every vote which we have lost because of the NHS Bill.

I can only speak from personal experience and for me there have been two clear problems during my own course of treatment for anxiety and depression which I think need to be addressed urgently.

When I first went to my GP in July I immediately got the impression that he was doing things ‘by the book’ and did not have a real interest in listening to what my problems were or how best to help me. A friend of mine has told me that he has known people who have gone to the doctors suffering from anxiety and depression who feel that they have had anti-depressants ‘thrown at them’ – without a willingness to discuss a more detailed course of treatment. I am not for a moment saying that all doctors are like this, but this has been my personal experience and it is why I have decided to switch to a different GP.

The second problem has been the amount of time which it took between being referred to a Cognitive Behavioural Therapy course and actually starting on the course. For me, four months was too long to be struggling on my own and it was only the help of friends and colleagues which made this bearable. I am fully aware that for people who are more ill than I am and who do not have access to any support, such a period of time would prove to be far too long.

I hope that these are two problems regarding provision of mental health care in the NHS which will be improved by giving mental health parity of esteem with physical health in the NHS mandate.

The treatment which I have received has so far been incredibly helpful – providing lots of helpful tasks and activities which can help deal with mental illness – and all of my friends have been incredibly supportive and have offered to help in any way they can (especially one who spent the first six months of 2012 in a coma, attached to a life support machine!).

I truly believe that such support and understanding is a direct result of the growing understanding regarding mental health and the effects it can have on people from all walks of life. I hope that putting mental health on the same level as physical health within the NHS mandate will continue to improve the access people have to mental health treatments in the future.

* Tim Purkiss is a party member from Somerset and blogs at Nation Discussion

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4 Comments

  • David Rogers 9th Jan '13 - 1:15pm

    The second part of this is excellent in my view, with proper recognition being given to Liberal Democrat Minister Norman Lamb’s insistence that mental health should have parity of esteem with physical health in the Mandate. Indeed, the very fact that the Mandate exists is a positive aspect of the Health and Social Care Act 2012 (NB it has not been a Bill for over nine months now!).
    But the first paragraph starts with Guardianesque comments, without evidence and not based on fact. The article then conflates the writer’s personal experience with supposed effects of the Act. The reality is that these are yet to be seen, as the vast majority of the Act’s changes have not yet come into play – but will do in three months time. So anything that happened in July 2012 to date has been a consequence of existing systems and culture in the NHS, and is nothing to do with the new Act.

  • John Broggio 10th Jan '13 - 12:25am

    With respect David, the PCTs were already being wound up at that stage and strict freezes on those under their auspices (i.e. GPs). And you accuse the OP of not speaking from reality…

  • Richard Dean 10th Jan '13 - 2:38am

    This is a really interesting article which raises several issues. Everyone surely recognizes that mental health has to be addressed, but no-one really seems to be asking the awkward questions – like where are the limits?

    One is – what is mental health? Most people experience anxiety and depression sometimes – what is the difference between that normal experience and an experience that is considered to be a mental health issue? Is there a boundary, or is mental health a bottomless pit? How much should society be expected to pay? Should treatment be limited to the aim of helping a patient self-solve the problems?

    Another is – should we be assessing the whole situation? If a person is anxious without foundation, aren’t they likely to be anxious about their treatment too? Is criticism of the doctor really just an expression of the patient’s excessive anxiety and depression, rather than a balanced assessment of how the doctor responded? Doctors aren’t gods, they try a simple remedy first – like a pill – and then try something else if it doesn’t work. Can the patient assess a doctor if the patient’s world-view is the problem? How can accountability work in mental health?

    If mental ill-health is about the way we think, or the way we discipline ourselves in response to our perceptions of the world, then is it fair to expect a general practitioner to do more than simply pass the patient to a specialist? Helping someone re-assess the world can easily look like “brain-washing”. If mental ill-health is about the way we feel, can we expect a general practitioner to get personally involved? A lonely person can become depressed, but can we expect a GP to fill the loneliness gap? Isn’t the solution in this case more to do with social activity?

    I look at industrial/consumer society and I think it’s a machine for depressing people. Every day I wonder at how people seem to survive even so. I’m so glad that I couldn’t fit in, didn’t get any “treatment” for this mental health issue, and had to find another way. Depression for me is a way back to sanity. Should we be treating people like I was? And how can we tell who is who or what? :-)

  • John Broggio 11th Jan '13 - 9:43am

    Richard – so much to think about!
    “This is a really interesting article which raises several issues. Everyone surely recognizes that mental health has to be addressed, but no-one really seems to be asking the awkward questions – like where are the limits?” I’d suggest the limits be determined by qualified, competent physicians – just like in other branches of medicine.

    “One is – what is mental health? Most people experience anxiety and depression sometimes – what is the difference between that normal experience and an experience that is considered to be a mental health issue? Is there a boundary, or is mental health a bottomless pit? How much should society be expected to pay? Should treatment be limited to the aim of helping a patient self-solve the problems?” Trickier this one. I disagree that most people experience anxiety (as a medical condition as opposed to being anxious fora small period of time about a limited number of things) and depression (a protracted and outwardly symptom-free episode of melancholia ); most (55%) do not but its close (http://www.sane.org/information/factsheets-podcasts/204-facts-and-figures). If you a treating clinician thinks you have a mental health condition, that should be the *only* criteria for deciding whether treatment is needed and payment made available to support it. Those of working age who are not treated will inevitably have lengthy periods of time away from work (a huge cost but not “visible” to the state directly) as well as the drains made on their families.

    “Can the patient assess a doctor if the patient’s world-view is the problem? How can accountability work in mental health?” To the first, yes – CBT etc is designed to change exactly that but many (like myself) need(ed) to be stable enough in the first place to benefit from CBT. Not sure what your second question really means.

    “If mental ill-health is about the way we think, or the way we discipline ourselves in response to our perceptions of the world, then is it fair to expect a general practitioner to do more than simply pass the patient to a specialist?” There is a huge spectrum of mental health, some of which a GP can treat successfully, others where I’d imagine its utterly impossible. Just like physical health which ranges from warts to tumours – we readily expect GPs to defer to experts in complex cases there, I fail to see why we wouldn’t in mental health as well.

    “Helping someone re-assess the world can easily look like “brain-washing”. If mental ill-health is about the way we feel, can we expect a general practitioner to get personally involved? A lonely person can become depressed, but can we expect a GP to fill the loneliness gap? Isn’t the solution in this case more to do with social activity?” People think “wrongly” (or, perhaps more accurately, they take on too much responsibility for the actions & feelings of others); changing that is not brainwashing. As for GPs – I hope they never get personally involved in any case (physical or mental), I hope they get professionally involved (ie recognise their limitations and get appropriate expert help as & when needed). GPs as far as I am aware never seek to address any loneliness “gaps” but they will suggest ways of increasing socialisation if they feel that would be beneficial to their patient.

    “I look at industrial/consumer society and I think it’s a machine for depressing people.” Not quite – only those not in the 1%. “Every day I wonder at how people seem to survive even so.” Most people don’t (want to) know the reality of the situation that is facing them or are not as greedy as most capitalists would wish!

    “I’m so glad that I couldn’t fit in, didn’t get any “treatment” for this mental health issue, and had to find another way.” I’m both saddened & heartened to read this. “Depression for me is a way back to sanity. Should we be treating people like I was?” No. Not because you did anything “wrong” but it is lethal to extrapolate from one person to others especially as depression is only one class of mental health problems (a bit like saying my broken arm healed fine, so leave those with cataracts alone & they’ll be fine too). “And how can we tell who is who or what?” The person who can eventually answer that for every person in mental health will be extremely rich…

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