Pink & Blue Mummyland

Pink and blue parenting through pink and blue moods….

Healthcare

So, I saw my doctor this morning, who has added in more medication to help with the depression and anxiety I’m experiencing. I knew I was feeling bad, but I have a tendency to play down my symptoms, feeling like I should stay strong and stoic and somehow manage my moods by willpower alone. Fortunately my doctor is ace, and knows me well enough to see how unwell I am just now.

Doctors are so important in the management of bipolar. The more I read and follow people with bipolar, the more I realise just how different medical care can be with regards to where you live. I’ve been asked by some of my American friends and followers how healthcare works in the UK, as it seems so different to the States. So here’s a short explanation of how services in the UK work, and some of my opinions – other Brits please feel free to comment and put me right on any mistakes.

We are fortunate enough here to have the National Health Service. The NHS was formed in the nineteen fifties, and means that all medical care is free at the point of use. You don’t have to pay to see a doctor or any other medical professional at an appointment – we all pay taxes dependent on how much money we earn, which pays for everybody to have the same access to healthcare. There are some people who complain that if they don’t use the NHS they shouldn’t have to pay for it (there are options for private health insurance for those who can afford it, where you can see a doctor much more quickly and for much longer appointments), but for the most part the system works, and it’s a relief to know that in an emergency there is everything one could need without anxiety over the bills it will incur.

Whatever treatment you seek, you will start with a GP – a general practitioner – who works in a local surgery. They will see you for short (normally ten minute) appointments, during which they will decide if and how to medicate a problem, and whether to refer to an expert consultant – for example, an oncologist, gynaecologist, or, in my case, psychiatrist. The specialist will then treat you until you are well enough to be referred back to the much more regularly accessible (and much cheaper) GP. I am now under the care of my wonderful GP, who is able to alter my meds if needed, refer me back to the psychiatrist if she thinks it’s necessary, and books me double appointments without me even asking.

If your GP refers you to a consultant (specialist), all you have to do is wait for the appointment time to come in the post. The main problem at this point is the wait, which in mental health is often due to the shortfall of psychiatrists (or the shortfall of money to pay more of them). When in crisis last year, just post hypomania and in a horrifically mixed state, I had to wait six weeks to see a consultant psychiatrist – and that was on the fast track. When I finally saw him, he referred me to a clinical psychologist, which turned out to be a nine month wait (although he did continue to see me every other month while I was waiting). All this meant that my non-specialist GP was the one responsible for the management of what can be a very complicated condition to treat. (I should also mention at this point that when I use the term specialist, I don’t mean a bipolar specialist – general psychiatrists cover all mental health problems).

The downside of having a nationally funded health system is that there is often a lot less money than would be ideal for the healthcare of everyone who uses the NHS – much of this caused by the economic crisis that has forced austerity measures. Every department is being forced to find ways to cut back, and none more than the mental health system. As I write, 23% of the NHS workload falls under the umbrella of mental health, and yet in some areas less than 7% of the health budget is allocated. It is also worth noting that for ‘physical’ illness there are imposed waiting time limits; in mental health there are no limits, so a patient can wait months just to see a consultant psychiatrist, and then again for any referrals they might need.

One of the major problems I see with the NHS is that, because of the budget cuts, it is forced to be short sighted, and mental health is the area where this is most apparent. There is no extra money to fund preventative or early intervention because all the money has to be spent on crisis care. But, as us service users know, having the opportunity for early intervention care or support can prevent a huge amount of later crisis.

In an ideal world (or, at least, the way I see it) there would be a period of extra investment in mental health services, so that people can get support before reaching crisis point, but the patients already in crisis can also get the best possible care. Early intervention can often (although not always) lead to crisis being averted, and is much, much cheaper than inpatient care – as well as being much more bearable for sufferers and their families.

In some ways this seems to paint a somewhat drear picture, where people are left on their own to suffer because the system can’t handle its workload, and where there is always the risk of patients falling through the gaps with devastating consequences. But I want to state it now that the NHS is awesome. For all it’s faults (and believe me, people complain about it all the time) the knowledge that I could be homeless with no money but still get medical care is an amazing comfort. From what I gather, nowhere else in the world boasts a system completely free at point of delivery.

The NHS is a huge blessing, and for all the ways I would change it, I wouldn’t give it up for a private system for anything. But I’m aware that everyone feels differently about it, so I’m opening up the floor for discussion. Please do comment – especially if you are from elsewhere in the world and have a completely different system. It would be good to know what you think.

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