Socking great trigger warning (suicidal thinking/mental health system rage): this post is not going to be a cheerful one. I will try to write more positively in the near future about ways of working around the giant flaws and funding gaps in the system to keep yourself safe (there are some, I promise), but first I think I need to be angry for a while about how absolutely we’ve been betrayed by this government. Remember this poster?
Everyone in the system knows the cuts to mental health services have happened, and that they’re getting worse, but exact figures and dates aren’t easy to come by, and their effects are much wider-reaching than tangible things like cuts to bed numbers: they permeate every layer of treatment through understaffing, undertraining of staff, and the general terrified atmosphere among patients afraid we’ll be discharged before we’re ready because of the increased pressure on services. None of these are clear-cut or quantifiable, but they all affect our recovery. For the sake of clarity, I’m going to focus on the multiple points during my treatment as an inpatient where underfunding clearly prolonged the length and severity of my crisis, and so turned out to be a false economy for the NHS and a right pain in the bum for me.
1) Short-term solutions
I was referred to a crisis house for the first time in early April. Crisis house stays are limited to two weeks, plus or minus a few days, a policy which is clearly driven by finance rather than patient need – some people’s crises may be dealt with within that time, but you can’t fit your illness to someone else’s timetable. I went home after two weeks and was admitted to hospital three days later. This is what happens if sticking-plaster, one-size-fits-all solutions take the place of treatment based on what people actually need, and it feels like someone holding a gun to your head and shouting, “Recover now! Recover now! What do you mean, I’m just making you more anxious? You’re obviously not trying.” It makes the road to recovery longer (therefore costlier) and more traumatic all round; every time you’re let down by an underfunded system it becomes that little bit harder to ask for help the next time you need it.
2) Cuts to community crisis services
Thanks to the cuts, the crisis teams in Camden and Islington only offer phone support at night, so unless you can time your suicidal crisis so that it falls neatly within office hours, you have a big problem. I find talking on the phone difficult at the best of times, and asking for help in a crisis almost impossible even in person, so you can imagine that phoning the crisis team to talk through suicidal or otherwise dangerous thoughts isn’t exactly easy. But for months people have been telling me to tell someone before I do anything dangerous, so on the night I went into hospital, I asked my mum to phone for me and tell them I didn’t feel like I could keep myself safe at home. When I couldn’t bring myself to talk to the worker on the phone, he said (after mum had told him she was putting him on loudspeaker so I could hear), “What do you want me to do? She won’t talk to me! If it’s really so bad she can’t wait till morning, go to A&E.” As though we’d have been phoning at all if it wasn’t so bad I couldn’t wait till morning.
A&E isn’t a particularly helpful backstop either. Yes, they have a mental health team there 24 hours, but before you get to see them you have to speak to the receptionist and the triage nurse and tell them who you are and why you’re there. I have times in crisis when I can barely speak to strangers at all, so how I’m expected to walk up to more than one person and calmly announce I’m suicidal is not all that clear to me.
These cuts are also particularly cruel as the loss of hospital beds is often dressed up as a switch to a different model of care focusing on treatment in the community rather than in hospital. Whether or not that’s a good thing is a whole different argument – but if you cut funding for community crisis services at the same time as inpatient beds, people’s lives are put in danger.
3) Lack of beds
The night I went into hospital, I was told by the psychiatric nurse who assessed me in A&E that there were no beds on psychiatric wards or in crisis houses anywhere in Camden or Islington. This meant we spent a long time going through unhelpful “solutions.” “What about if you went home and your family didn’t leave you alone/took away all your medication and everything sharp? Do you think you’d be ok until morning then?” Why would I have gone to A&E, which at the Royal Free is a grimy, noisy dungeon of a place, if I thought there was anything that could be done to keep me safe at home? How could I possibly be expected to be open with my family about the specifics of the thoughts in my head? When I’m in a crisis my intrusive thoughts are like a hydra: every time one way of hurting myself is made impossible, two more rush in to fill its place. Even now, more than a month later, I still haven’t been able to go into some of them with a psychologist I know and trust, so of course I couldn’t come out with all of them straight away to someone I’d just met who seemed to have no concept of how upset I was because I wasn’t screaming or shouting. All I could express was that I knew I wasn’t safe at home.
Eventually I managed to get the nurse to understand how bad things were. And then we waited – and waited – for a bed to be found. Unsurprisingly, I was getting pretty anxious, but the nurse my mum asked about medication refused to even speak to a doctor about it because I “wasn’t violent.” Next time maybe I’ll try punching people at random until they section me and stick a needle in my buttock. At 3am, we were told they’d found a bed in a private hospital in Roehampton. By the time transport arrived and we’d driven across London, it was nearly 5am. Horrible experiences like this one keep people sicker for longer.
On a 14-bed ward, I only spoke to 2 people who were private patients. Everyone else I met while I was in hospital were patients who couldn’t be found beds closer to home, and most of us were from Camden or Islington. I’m assuming the ratios were pretty similar on the male ward. This is disgusting given that the excuse given for cutting beds and closing 2 inpatient units in Camden and Islington back in 2011 was that beds were apparently being underused.
It also lengthened my overall stay in hospital; I waited days to be seen by the consultant and arrange a discharge plan in this hospital, and, hours after I had, was transferred to Highgate (with almost no warning, no information about what kind of ward I was being moved to, and late at night) and had to start all over again. It takes so much effort to get to know and trust staff, and to settle into a new and frankly terrifying environment, that every move somewhere unfamiliar sets you back a little further; and if there’d been a bed for me closer to home to start with, I would almost definitely have been discharged to a crisis house within a few days rather than a week.
So where does all this leave me, and my fellow patients? Mostly, it leaves us hanging off a cliff over a safety net with holes big enough to drop a truck through. That has consequences, which I’ll write about another day, when I feel strong enough. I survived this particular crisis because my family were around to get me to A&E, and to encourage me to keep trying to explain what was in my head. But lots of people with mental health problems live alone; what do you think happens to them in that kind of situation? It shouldn’t be our job as patients to work around the screw-ups in the system. We fight our own heads all day, and when we manage to ask for help, we shouldn’t have to fight for that too.