Treatment in the UK

Following on from my last blog I thought it was time I wrote a little bit about what is available in the UK in the 21st century by way of treatment for the mentally ill. The majority of people will come under the care of Community Mental Health Teams (CMHTs). This can be a simple matter of visiting your GP and them prescribing medication or referring you to counselling. For slightly more serious cases you may need to see a psychiatrist who will prescribe the next level or drugs or refer you for other therapies and/or specialist counselling. You might be allocated a Community Psychiatric Nurse (CPN) to help monitor and support you in taking medication and associated services. You might also be allocated a Social Worker to help with the day to day business of things like shopping, finances, housing etc. (the practicalities of living in Britain today).

It is important to note that all the above are done with your own consent. If you are ill and only need this level of support you are not forced to take any treatment at all, although a lot is done to try to persuade you to agree to it for your own safety and well-being.

The only exception to this is when people become so ill that they merit being sectioned to stay in a hospital (or committed as it's known in other countries). I personally loathe the term committed as it has connotations of someone being guilty of a crime, which when you are ill is hardly fair. A thought occurred to me about forced or imposed care e.g. forced injections or medication. This only happens when the sufferer is so ill that the medical professionals consider them to be in danger to themselves. Is it any different then to a person arriving at an Accident and Emergency department after a car crash? Medical teams then don't stop treatment, refuse a blood infusion, pain relief, an operation or decide not to restart your heart in such circumstances. It is given that they will do all they can to keep you alive without your consent. So it is when people are sectioned.

That said, I know from my own experiences of being section back in 1998 that once in hospital consent is still sought first. It was pointed out to me that if I refused medication the medical team could force it on me but they left me time to come round to the idea of accepting that medication. How long they would have waited for me to agree I don't frankly know. It was a bit of a fait accompli but I'm glad that they gave me that time nonetheless. I did need the medication then and still need milder medication to this day because unfortunately my brain doesn't tick quite right without them. It is no different to me to a diabetic needing to take insulin to correct a lack of a chemical that nature/genetics has inadvertently missed giving them.

The interesting thing about that is that it is widely considered that you are ill if you take medication on a regular basis even though the drug you are taking maybe a corrective one for a deficiency your body has e.g. thyroxine (which I also have to take). The truth is you can be well with the medication and are likely to be ill without it, just as a diabetic would be. It's another example of how public and indeed medical perception needs to change to become in line with what is actually happening.

A word about thyroids.... Very approximately until about 30 years ago, under and over active thyroids cause people no end of trouble with their moods and behaviour. Sadly there are still some GPs who are unaware that the corrective measure of thyroxine can totally cure this as too many people that get diagnosed with depression when in fact it is a thyroid gland malfunction that it actually the root of the problem. So if you experience lows, make sure you get your thyroid function checked out first and the solution is incredible simple.

Medication
The book listing the number of conditions (DSM-IV - Diagnostical and Statistical Manual of Mental Disorders - 4th Edition) is about an inch thick. The list of medication is just as long. This is good news for sufferers as it means there are a myriad of options to try. It means that it is now largely recognised that everyone is different and that their metabolisms will respond to different things. Gone are the days of every sufferer being subjected to the same brutal and drastic measures of the 1950s (lobotomies, Electric Shock Treatment or insulin shock treatments). Gone too are the days of 30 years ago whereby merely suppressing symptoms and not addressing the root cause for the malady was common practice. For example GPs will not (or should not) prescribe Valium for more than three days at a time as it is now recognized that it can become addictive. Tranquilizers, like all other forms of medication for the mentally ill (e.g. antidepressants and mood stabilizers) come in a variety of forms so that the sufferer only has to find the one that works for them.

Other Treatments
Top of the list is the myriad of forms of counselling e.g. Gestalt, Cognitive Behavioural Therapy (CBT) Cognitive Analytical Therapy, to name but three. Again the idea is to marry the treatment with the individual sufferer and not to go the route of one form of treatment cures all.

Additional to these are Art, Drama and Sport therapies which can help build confidence, self worth and self-esteem. They have also proved effective in helping people to reintegrate and socialize with mainstream society. Cooking, Gardening and social clubs and activities such as day trips are useful in this way too along with courses to help build up skills for work such as wood and metal work, computer and photography classes.

The main supplier of all these services tends to be the National Health Service here in the UK, but not for all services. You'd be extremely lucky if you were able to access Art, Drama and Sports therapies outside of hospital so these are more commonly offered by mental health charities such as MIND as activities rather than as therapies.

All these elements are essential to cover the 25% of the population who become ill under the extremely varied conditions under the mental illness banner. There is just one problem. Demand exceeds supply and funding is woefully behind where it should be given just how many people are effected and become ill. This is not only true of the NHS and it's services but also true of all the mental health charities, social services, research and associated services.

The brain is the most complex organ in the body without a doubt. So far it is thought we only understand a tenth of how it functions. Aside from automatically controlling other organs it defines who we are. It seems therefore bizarre to me that it continues to be such a low priority when it comes to finding cures and treatments when it hits a problem, for as I've already pointed out in previous postings - no one is immune from that no matter how much they may wish to kid themselves otherwise.

When we look back now over the history of Mental Health Care we can clearly see it has come a long way in the last century. I am hopeful it will continue to make great strides in the future and indeed within my own lifetime, but it does require more dialogue with sufferers and more funding to develop and refine treatments further. I like to think the most brutal and barbaric treatments are firmly a thing of the past and would like to thank all those responsible and participating in reshaping treatments so that they are indeed more humane than of yore. There have been decades dedicated work from thousands of people to get us this far. For me the biggest challenge, and the one that's gumming up further development is to eradicate the stigma. If we can ditch that one, change people's mindsets on what can be done then perhaps all else will fall into place.

PS: I'm off for a meds change myself now, so may not be blogging quite so often. This was never intended to be a site whereby I shared my experience of being ill. It has always been my intent to to write about the issues that prevent recovery and more to the point what works for me. The reason I'm going for more help is not because I have gone back to merely surviving life - I'm still very much living it - but because recent pressures have put me at risk of becoming ill again. My moods have been darker recently and that's a trigger for me to take action. Therefore I am taking the precaution and preventative measure of getting the help I know I need early on to avoid a prolonged or intense episode emerging. That is what the ideal for long term sufferers means... we learn to manage our own health so that we stay well.

Remember, none of us are ever obliged to share anything of ourselves with anyone and I am no exception. I'll be back with whatever hints and tips I come across once I have got myself back as myself. I have spent too much time being well to ever want to risk being ill again. Or to put it another way... I need a bit of 'me' time to recover from recent events.

Understanding terms

One of the most alarming things I've heard in my journey through the Mental Health Care system is that it is both 'normal' and 'healthy' not to want to associate with people with mental health problems. Certainly I can quite see how it can seem odd for people to choose to mix with the ill of any description, but such comments do not help overcome the stigma of those of us who are or have been mentally ill.

I found this question posted on Stephen Fry's site: 'Would you employ someone with a mental illness?' Here's another "Would you knowingly choose to marry a person with a mental illness?

Before I give my own answers I'll explain why I think such questions ought to be asked.

They both challenge the person to think of what the term 'mental illness' actually means. Most people will immediately think of dramatic and severe symptoms when asked to define mental illness. 'Behaving oddly' isn't usually sufficient to encapsulate what people's thoughts and feelings are over what such a term means to them.

This 'public' perception of severe cases is common because of sheer ignorance and has been largely promoted by the media albeit unintentionally. On the news we don't hear of success stories of sufferers who, despite their illness, reach heights of astonishing achievements; there isn't a equivalent of the Para Olympics for the mentally ill. What we hear of are the murders.

FACT: Only 3% of all murders in the UK are committed by the mentally ill. That leaves 97% of murders being committed by the 'sane'.

There's an obvious argument here to define all criminals as insane or mentally unwell, after all the one thing they all have in common is that they have been guilty of 'anti-social behaviour' of some kind. I'm personally against such a move as that would only serve to further increase the prejudice against the vast majority of the mentally ill who are more likely to be victims of crime than perpetrators. It strikes me right away though that terminology and classification needs revision.

The Arts too have played their part to unwittingly add to the prejudice and fear of the uneducated. Ironic as the intent has generally been to highlight the plight of the mentally ill and educate people. As I mentioned in a previous posting, until the film 'A Beautiful Mind' came out there was no true life story of a person living day to day with an illness, learning to manage their condition and being a success that I'm aware of. However, it's only one film and it isn't up to date with regard to treatments that are available in the here and now in the 21st century and the enormous strides mental health care has made.

How many films about mental illness show patients receiving ECT (Electro Convulsive Therapy), lobotomies or insulin injections can you name? Yet all these treatments have been on the decrease since the 1950s. In this country you'd have to beg for a lobotomy and even then you're unlikely to get one. ECT is done with the consent of the patient more often than not and I've not personally heard of anyone other than a diabetic receiving insulin injections. Yet it remains embedded in the public psyche that such treatments are still standard practice and commonplace.

It's also in their perception that success for the mentally ill is something that only artistic people ever achieve and that they can never be well or even manage their condition. I've even heard one person comment that only the deeply disturbed can produce great literature, art, sculpture and music. Films and documentaries about artists such as Vincent Van Gogh or Tchaikovsky demonstrate extreme states and neither have a happy ending for the individual.  I'm frankly not surprised that people throughout the ages have turned to art in order to express themselves in such an unforgiving and judgemental world when it some to mental illness.

Mostly the majority of people who suffer from a mental illness do so once and get better. The majority of sufferers display none of the obvious symptoms that most people associate with madness and out of those who do suffer from those conditions the majority can and do learn to manage and control them themselves with mental health care. Finally, and I'm not sorry to disappoint the sensationalists, the majority of treatments available and most commonly used do not involve those already mentioned and it is standard practice in this country these days to agree a course of treatment with the patient whenever and wherever possible.

I wish people would, of their own volition cease to be ignorant and get informed; ceased to assume and just asked.

I promised my answers and here they are. I would (and have) employed people who have been mentally ill based on their ability to do the job required. I also had to refuse work to someone who was mentally ill because they were too ill and they needed to regain control of their illness. I did however leave the door open for them to return at a later date.

With regard to marrying someone who is mentally ill, I initially found the question harder to answer because I found I didn't want to be a full-time carer. I didn't want a repeat of living with someone as severely ill as my mother was. My perception was based on that but also coloured by the broader mindset that I have grown up  with - that of prejudice against and fear of madness. However, I then realized that by feeling that I then had no right to expect anyone to take me on board to marry me as I too have been mentally ill. 'But I'm not that difficult to get on with' I thought, 'I'm at less risk when I have someone to share my life with.' Yet I knew too that many people would find my lows a burden.

My answer is, if they are right for you and you are right for them then marry because (as I keep saying) the illness is not the person.

A Final Question
Is it abnormal and unhealthy to want to associate with someone who has some other form or illness or impediment? What if they are paraplegic, blind, deaf, have a stomach ulcer, cancer, a heart condition or simply have the flu? If the answer is 'no' it's not abnormal or unhealthy in these scenarios to mix with the ill then surely it is high time it isn't when it comes to mental illness. 

Suppositious Fears

Aside from depression, high up in the ratings of forms of mental illness are anxiety, stress and phobias. I'm not sure if they can be separated from depression or vice versa (will leave you to ponder that one). At the root of all of these is fear.

In order to become fearful we imagine and are not dealing in facts. "Really, but what about when you've been through a traumatic event?" I've heard some say. Even when fear is based on a horrendous past experience it is our imagination that is carrying that memory forward into the here and now. Fears are more commonly be based on the unknown though..

Recently I've been experiencing ups and downs due to just such fears. I'm thinking of moving house to another part of the country. To me it makes sense as a means of establishing a lifestyle I've always dreamed of and this might be my only chance of making it happen, but then the demon fears started. What if there are no jobs there? What if the people are horrible? What if it doesn't have the outlets I enjoy doing. A location in the countryside may be great, but if it doesn't come with other things is it worth it? What if I find I get stuck in limbo between moving out of my current home and not able to move into a new one?

Added to which there are fears about a family member who has been extremely ill. Fears of plummeting into a recurring depression at the thought of losing another family member along with fears for them.

In both cases I need to deal in facts, not assumptions. One of the thoughts I have about moving is that it could allow me to become a carer for any family member if they become terminally ill, but before I can leap ahead with that one I need facts about their illness and not least to know if they would want me to be their carer. It's an anxious time but there is no point crossing bridges before we come to them, because by worrying and making assumptions we often find we put ourselves through hell for no reason. I certainly have as close friends and family will testify.

This applies to all our worries and fears. We are all prone to worrying; it seems to be part and parcel of being human. We can find ourselves worrying about our job security, or finding a job or the stress of an increased workload when others have been made redundant and their work has to be taken on by those who remain. We could be worrying about our personal relationships, what others think about us, how we come across or how others that we care for are behaving.

There is nothing wrong in asking and by doing so we get a better idea of where we stand and consequently become better equipped to plan ahead based on what we know rather than what we are guessing at.

I've never been one to fear going out, but I've met many who have been; sometimes due to fear of others and sometimes due to fear of what might happen. To understand fear, we have to acknowledge when it is out of proportion and gone way beyond 'normal limits' of just understandable and natural anxiety. It would be less 'normal' not to be anxious when confronted with major life changing events or decisions regardless of whether they are self inflicted or not.

The first step toward confronting fear is to acknowledge that it is there. Listing facts and compiling evidence to counter that fear will start to make in roads, but I acknowledge it can be a long hard battle to get things back in proportion and is especially difficult if there is a traumatic event associated with that fear. As with all forms of mental illness we have to want to overcome the illness above all else. We have to try to visualize a day and a life without these impediments that can so cruelly hold us back.

Not only do I advocate not crossing bridges before I come to them, but I also recommend seeing things in terms of a journey divided up into manageable stages. For example I have now resolved that if the results state that we have another terminal illness in my family then and only then will I start to think about 'how long' and 'what can be done' to minimize suffering while increasing quality of life for as long as possible according to that person's wishes.

The prospect of death does highlight the need in all of us capitalize on what is good and precious to us in the here and now and for the future. How sad it is that we waste so much of our lives in worrying about what might never happen. For me that has become a major key to combating fear for by focusing on what is still good, pleasurable and possible I regain hope and that fear diminishes to a more manageable size. That, if you like, no matter what, I can still enjoy the sunshine of a spring day and flowers coming into bloom.

I consider myself lucky to have learnt that and blessed that I am determined and tenacious enough not to let fears become barriers to all I want to achieve for long. My dearest hope is that others become as determined in fighting their demons too.