So here’s the thing, over the last few weeks I’ve noticed that there have been numerous bits and pieces in both local and national media relating to mental health, mental health services and service users. Many of these posts have appeared to be very negative with quite a few relating to “crises” in many different NHS trusts; a lack of money, lack of provision and what appears to be a chronic lack of accessible services throughout the UK.

All of the articles I’ve seen seem to be following the same narrative which always seems to lead back to budgets, funding and a general lack of investment and while I absolutely agree that this is a huge part of the current struggle faced by service providers I’m not convinced that a lot of the problem doesn’t lie with us as a society.

Let me explain.

As most of you know I’ve been in and around mental health services for most of my life, both personally and latterly in a professional capacity. I’ve had (and continue to have) my own personal struggles with my mental wellbeing and have been lucky enough to be able to access services as and when I’ve needed to.

Now, over the years I can’t honestly say that every professional I’ve seen has been helpful and not every service I’ve accessed has met my needs but neither can I honestly say I’ve always taken the advice I’ve been given, used every strategy I’ve been given nor have I taken the best care of my own self whenever I’ve felt myself begin to dip. What I can honestly say is that had I not accessed some of the services as and when I had I absolutely would not be here today.

As I’m sure you can all understand there have been times throughout my late childhood and adulthood when this thing, this darkness became so bloody all-encompassing that all I wanted was for it to just….go, to end. If that meant I had to end with it then so be it.

Now, let me just clarify here, never have I ever actively wanted to end my life.

Never.

Sometimes though, the need to break out of the blackness became more pressing an issue than keeping myself safe and that in itself has led me into some pretty prickly situations, recklessness really. At those times the thoughts I would have wouldn’t be of finding an “out”, more to see how far I could push because let’s be honest the worst thing that could ever happen to me had already happened, what the hell could possibly top it?

So I would push.

Behaving recklessly, drinking too much, “partying” too hard, living carelessly. It all culminated in a bit of a breakdown driving home one night and I half-purposely took a roundabout too fast in my Mini, clipped a kerb and barrel-rolled the car several times.

I was bloody lucky that I literally walked away unscathed but I knew immediately that if I didn’t get proper help then the next time I wouldn’t be so fortunate. Cue psychology, psychotherapy and the beginning of a LONG road I’m still navigating.

(It took a few years to knock the toxic lifestyle on the head but as usual…..I digress).

What I didn’t do though was label myself, advertise the fact I was literally mentally imploding. Probably because in those days there was still a huge stigma attached to mental health and I had absolutely no wish to be seen as a nutter, as unstable or as weak. Nowadays things are a bit different and that’s where I think we’re beginning to slip up.

In all the years I’ve worked in mental health I’ve been lucky enough to work in numerous different services, from general adult mental health units to specialised services like Child and Adolescent services and latterly mental health rehabilitation.

During this time I’ve had the utter privilege to help others when they have been at their lowest ebb, to hold hope for someone when hope is all that they have left. It is without question one of the most beautiful experiences being afforded a role in someone else’s recovery, to walk with someone as they go from the depths of despair and hopelessness in an alien environment and go back home to their own life, their family, job, back to their own idea of mental wellness.

With the exception of the odd client most of the people I have worked with had one singular fact in common: an unwavering wish to get well, get home and get their life back on track again. No one wanted to be ill, to be in a mental health hospital and very few people saw being an in-patient as nothing more than a means to an end, certainly not something to be lauded.

As my career has progressed I have begun to realise that alongside the de-stigmatisation of mental health, for some there seems  to be a shift in how they identify their own mental health, a  personalisation of it if you will.

Now before I go any further, before I ruffle a few feathers (which no doubt I will), please understand that this is merely my own opinion. I’m not for a single second suggesting that I am absolutely right nor would I infer that anyone else is wrong, this is just how I see things.

What I have noticed is whenever I would work with people going through a mental health struggle they would usually refer to whatever illness or disorder was triggering their episode as something separate from their identity, for example “I have depression/anxiety/OCD etc etc etc” or  “I suffer from depression…etc…etc…etc”. For a large number of people that I come into contact with recently (not everyone by a loooong shot I MUST add), that seems to have changed even if just the language that people seem to be using and often the narrative now is  “I’m OCD”  or often “my anxiety, my depression” and for some it is a major part of how they self-identify, almost like a badge of honour.

Oooh, controversial.

When I was a bit younger I struggled to express my sexuality because I had a tough time quantifying it. Society wasn’t as accepting as it is nowadays but I guess to a degree neither was I. Its only really recently (as in the last 10 years or so) that I have been completely able to make peace with many different parts of myself including my sexuality but I still don’t necessarily see it as a main part of my make-up.

Sure, it’s a big part of me but it’s not the most interesting part of me. Kinda like my past, it’s stamped through me and always will be but it doesn’t define me. And that is where I begin to challenge the current trend towards mental health acceptance.

For a distinct group of people I’ve worked with it is how they define themselves. It is the most prominent facet of their identity. Believe it or not there are clandestine games played between some social groups where points are scored dependant on what level of service a person can access, for example (and don’t quote my scorecard): 5 points for a GP appointment, 10 points for an out of hours appointment, 15 points for a Community Nurse appointment etc etc until the ultimate goal of in-patient admission is achieved.

Whatever happened to Mousetrap???

Seriously though, over the last few years working within the services there has been a huge change in how assessments and admissions have been manipulated by a select group of service users to get themselves admitted to hospital.

Once admitted it’s often really difficult to get those select service users discharged home because for some folk the uncomfortable truth is that being in hospital often proves to be a more appealing option than being at home and having to deal with the normal stressors of everyday life.

Now let me just say I’m not suggesting that this is a conscious decision for everyone and anyone, far from it. Some souls really cannot cope with the pressures and general responsibilities of everyday life due to illness, disorders or diminished resilience. There are however a small number of people who validate themselves by their own perceived level of unwellness, excuse their poor choices and crappy behaviours with the banner of mental health (kinda like the recent fuore around Roxanne Pallett) and as harsh as this will sound, will often orchestrate an in-patient admission and once admitted can be nigh on impossible to discharge.

I’m sure you guys can imagine how this would impact on the services we do have: beds are taken when they shouldn’t be, people that could really use the beds can’t get admitted and vulnerable people are left struggling at home without supports that they desperately need. The flip side of that being a frustrated group of staff not being able to work with the people they really should be working with because Bob, who doesn’t need the bed is in one and effectively refusing to leave, threatening suicide, self harm, overdoses, the whole nine yards and well aware that no one would dare take that risk and force a discharge. He gets discharged against his will and his family direct their ire at the service. He doesn’t get discharged and someone in the community harms themselves and their family direct their frustrations at the service.

Catch 22.

So what do we do? Well I’m buggered if I know. All I know is that just now as an “insider” it feels like a no-win situation, your very much damned if you do and your damned if you don’t. I’m not in any way shape or form trying to exonerate our mental health services from any shortcomings, far from it. Our services are in crisis and do need improving. 

All I’m trying to suggest is that sometimes things are not as clear cut as they seem. budgets will always play a part; how the services are managed will always play a part but so does how the services are used and, I’m sorry to say, often abused.

Like any public service there does seem to be a small nucleus of people who use and abuse it for their own gain, for their own means and that will have an impact on how each service is delivered and until that small group can be managed properly there’s always going to be an issue.

Does that sound harsh? Probably.

Judgemental?

Call me Judy.