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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BBC Three Mental Health Season

I’ve been watching the BBC Three mental health season programmes with interest. I’ve actually been quite impressed – most of the programmes have been well rounded and informative, not the freak shows I feared they would be. And although I count myself a bit of an expert (in the layperson sense of the word), I found myself learning quite a bit.

My only frustration with the series is just how ‘young person’ focused it is. Every programme I’ve watched – and I’ve seen most of them I think – has concentrated on mental health issues in teenagers or people in their early twenties. “Don’t Call Me Crazy” looked at life in an adolescent psychiatric unit, and “Failed By The NHS” followed the stories of young adults crossing over from child and adolescent services to adult services. “Extreme OCD Camp” should have been called “Extremely Young OCD Camp”, and even the programme that seemed to promise a look at the long term, chronic nature of some mental illnesses – the programme about Frank Bruno’s battle with bipolar – was really about his daughter.

I not saying that there was anything intrinsically wrong with all the information in the programmes. The information was accurate and well delivered, and will, I think, have opened people’s eyes to the severity of the issue. Whilst following the Twitter feed #extremeocdcamp, a number of people had the reaction ‘I never knew it could be so bad, so controlling, so debilitating – how on earth do people cope?’ There has definitely been some awareness raising.

My concern is that these programmes are encouraging the idea that mental health issues are somehow teenaged by definition, and that they are something you grow out of. It’s great to raise awareness of these conditions, but not once has it been suggested that most of these conditions are chronic, and rarely disappear just through ageing into a new decade.

In some ways, “Failed By The NHS” has been the most painful of all these programmes to watch. A group of young people not long out of school or college feel they have been failed by the NHS – either by GPs, or by A&E, or by CAMHS (child and adolescent mental health services). But nothing was said about the general mental health services. As someone who does to some extent feel let down by the NHS, I wonder how long it will be before boring old chronically unwell adults are given some sort of platform to vent their frustrations.

A risk of sounding soap-boxy and woe-is-me, let me use my own experiences as an example. At 19 I went into a psychiatric unit feeling suicidal. I was in a room with three other women, one of whom had night terrors, because there wasn’t money to staff the single rooms further down the corridor. I was put on medications without knowing what they were for, and offered no therapy of any kind. I stayed there for as little time as possible and lied to get out because it was more unbearable being in hospital than being in the world. The hospital was in Durham, where I was at university, and when I was discharged I decided to go back to my parents house in London. It was seven months before I was seen by a psychiatrist as an outpatient, and a further eight before I had any therapy. I was never, in any of that time, offered a social worker, CPN, or counselling. As a young person, I was seriously failed by the NHS, at a time when I didn’t have the confidence, energy, or presence of mind to stand up for myself and fight my corner.

But fast forward a few years to the present. Following the depressive episode I had after MicroBob’s birth, I had so much difficulty persuading anyone that I wasn’t being treated correctly that I paid to see a private consultant who was a specialist in Bipolar Disorder. He offered me a two hour assessment, involving questionnaires, blood tests and interviews, by the end of which the diagnosis was watertight. Since taking the report to my NHS consultant, he and I have been ploughing through a massive medications change to swap my high dose antidepressants for a preventative mood stabiliser. I see Dr K every four weeks, which doesn’t feel like enough, but can’t be increased without a huge reduction in his patient load. When I saw him a couple of weeks ago, he informed me that he would be on holiday all of August, so I wouldn’t be able to see anyone until September. And his closing advice was to ‘only phone the crisis team in a REAL emergency’ because, since no-one is covering his absence, they would be the ones picking up the slack, and would therefore be inundated. I could broach the subject with a CPN, but as I am not suicidal or psychotic, I don’t qualify for one. I would consider talking to my psychologist about it, but nine months after my referral I still haven’t seen anyone. It’s probably worth saying that Dr K completely agrees with the other doctor’s diagnosis – he just didn’t have the time needed to make it himself.

Both in a broad way 13 years ago, and in a more specific way these last few weeks, I feel let down by the NHS. Normally I’m the one fighting their corner – I have seen how fast doctors can run in an emergency, and know that most doctors are working huge numbers of hours to get everyone cared for. I had excellent medical care when I had severe pre-eclampsia and had to have an emergency caesarean followed by ICU for me and my baby, and when I seriously broke my arm four years ago, I was treated as quickly as possible and operated on within a day. When I was in too much pain I was given morphine, because my opinion was respected with regards to how much pain was too much.

So why are my physical health and mental health experiences so different? Why is it that my broken arm is treated swiftly and with dignity, whereas my broken brain is ignored for as long as possible? I would honestly like to know. I would like to understand how the NHS can defend the care that mentally ill people get (or don’t get), and how they can justify the decisions to put so little of their budget into mental health care. One in four people in the UK will experience a diagnosable mental health problem in any given year (stats here). That’s 25% of us. That’s huge. So why does so little of the government money pot for health go into making our brains better?

Answers on a postcard please…

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