Over the past week or so, I have seen a few worrying examples online of people asking for help for their mental health and having some really difficult and invalidating experiences. And whilst psychologists do not take a hippocratic oath, I felt that I couldn’t sit back and say nothing, in case I could share something that might possibly help someone.
My current job involves helping people to find the right mental health support for them as well as training and providing consultation to other non-mental health professionals (e.g. GPs, social workers, housing officers) about how best to support and work with their own clients. After fifteen years NHS service, working with many clients with a vast range of mental health difficulties in the community as well as in-patient hospitals and prison, I feel I have a good understanding of the help available.
Many of the stories I have read online have reflected what can only be described as poor practice and a clear lack of compassion and understanding. However I do want to just take this opportunity to say that GPs have an extremely challenging role; many have limited specific training in mental health, despite so many people presenting to them with these difficulties, and mental health services are often over-subscribed with long waiting lists. This can result in them feeling unsupported and overwhelmed and very unsure as to where to refer their patients. And although this can never excuse bad practice, I always try and hold this in mind. So many people present to them with mental health difficulties, and with nowhere to refer these people, it can become a very difficult situation for everyone.
However, here are some of my thoughts from my own personal and professional experience, and whilst this is in no way an exhaustive list, I hope that this is helpful to someone who might find themselves struggling to know where to go or how to ask….
Making sense of what the problem is
Sometimes you may be clear in your mind what it is that you are struggling with (e.g. anxiety) and what you want help with (e.g. being able to manage / reduce panic attacks), but sometimes it can all feel pretty overwhelming and confusing. It is the job of the healthcare professional you see to try and help make sense of it, but in order to get you to the right place, it can be really helpful if you can identify a few things:
- What is it that is troubling you? What emotions (or lack of), physical responses or thoughts have been causing you distress? What impact is it having on your behaviour (e.g. are you doing less / more of something that you used to? Are you engaging in a new behaviour to cope, for example avoiding certain situations or drinking alcohol?)
- How long has it been going on for?
- Was there anything in particular that triggered it?
- What have you tried before to help (if anything)?
- What impact is it having on your daily life?
Whereas I would always say to avoid Dr Google like the plague, sometimes you might have an idea of what is going on and want to find out a bit for yourself. In this instance, I would always say to look at information about key symptoms using reliable online resources such as:
- NHS Choices
- Time to change:
Likewise, it might be helpful to take a few moments to think about what you think you need and what you want. Then, if you are offered something you don’t want (e.g. therapy), or not offered something you do, then you can be prepared to present your reasons as to why.
Knowing where to go to ask for help and some tips on how to ask
Your first port of call should almost always be your GP as they are the gateway to most mental health services (but I will discuss other options below). Sometimes it is a good idea to ask if your practice has a GP with a specific interest in mental health; these GPs tend to have a closer link with local mental health services and have had some more specialist training.
I know it sounds simple, but it is always worth going armed with a list of questions and the difficulties you have experienced. Having it written down can help you to get your key points across in what can be a highly emotive situation.
However, if you feel as though you cannot speak about your difficulties by yourself, take someone with you. This could be a family member, a friend or an independent advocate. You can find out more information about advocacy here:
Understanding your options
There are guidelines for evidence based treatments for physical and mental health difficulties that should be followed by the National Institute for Health and Care Excellence (NICE). These can be found online here:
These guidelines discuss mediation and therapy options and are based on highly robust research.
I won’t talk in detail about this because I am not a medical doctor. However, what I would say from my experience of working with clients who have taken medication is the following:
- There are many different options available, so please do not be disheartened if one does not work
- Ask about side effects, dosage, coming off them in the future so that you feel fully informed in the decision you are making
- Read the leaflets and information that the doctor gives you
- Don’t suffer in silence if you are having side effects or you feel that the medication isn’t working – go back and discuss making some changes
- As with all medication, they all work differently for different people – just because it didn’t work for your friend, doesn’t mean it won’t for you
- They can take time to work, so don’t give up too soon
- You don’t have to take them forever if you don’t want to – there will always be options
- Always talk to your GP before coming off any medication so that you can do this safely and with ease
- Medication alongside therapy is often better than medication alone
Not all therapies and therapists are the same; different mental health difficulties require different approaches and you should try and access something that has the correct evidence base for the problem you are experiencing. The GP and NHS mental health service will be able to help you with this.
Most people will start with being offered support via their local Increasing Access to Psychological Therapies (IAPT) Team. These teams of psychologists and other therapists provide psychological therapy for mild to moderate mental health difficulties, including anxiety and depression. Many of these services have their own websites where you can refer yourself. The best way to find this is to google ‘IAPT [your local borough]’ and these websites tend to have excellent resources on them too. They will often undertake an initial consultation over the phone and may offer you:
- Guided self help
- Brief psychological therapy (mainly, but not exclusively, Cognitive Behavioural Therapy; CBT)
- Group therapy
- Signposting to other relevant support services if they are not the right place for you
However, it may be that your difficulties are more severe or require a specialist service, and these teams are commonly referred to as ‘secondary care services’ (which essentially means that they work with clients with more complex or longstanding needs). These services may include:
- Perinatal mental health
- Eating Disorders
- Personality Disorders
You will always need to be referred to one of these teams by your GP or another mental health professional that you are seeing.
What to do if you are dissatisfied with the outcome
There may be many reasons as to why you might be dissatisfied with the outcome of asking for help:
The person I saw was dismissive / rude / unprofessional
- You have every right to request to see a different healthcare professional to try and access the support you need
- You can discuss the behaviour of this professional with your local Patient Advice and Liaison Service(PALS) and raise a complaint
- You can also ask the reception staff / practice manager about their complaints procedure as all practices should have one
I wasn’t offered what I wanted
This can be very difficult, particularly when you have worked hard to build the courage to ask for help. Again, there may be so many potential reasons for this, including:
- The person you saw thought that you weren’t ready for a certain intervention.For example:
- If you have recently suffered a trauma or bereavement, there can sometimes be benefit in ‘watchful waiting’, since it is expected that you may feel distressed after such a traumatic event. However, do query this and ask more questions if you disagree
- You have only recently finished therapy. There often needs to be a break between trying different therapies to give you time to integrate the skills and knowledge you have gained
- There may be other needs that must be met first – for example, ensuring that all of your basic needs are met including safety, housing, finances, physical health etc. These may be causing (or at least perpetuating) your mental health difficulties and until they are met, therapy might not be effective
- The service that you hoped to be referred to has admission criteria that doesn’t quite fit your need. In this instance, I would hope that you would always be offered an alternative. Again, always ask about alternatives
- You were offered a group therapy rather than 1:1. This may be due to service demand and trying to meet the needs of the many, many people who need help. Whilst it is not ideal, mental health services are struggling to meet demand, and group therapies are an excellent way to help lots of people quickly. Sometimes groups are an initial treatment that can then be followed up with 1:1 therapy. But for what it is worth, groups can be an excellent resource and I wouldn’t rule it out immediately. I can understand how scary they seem and how vulnerable and exposed you may feel attending the first session, but it is important to remember:
- Everyone there is in a similar boat
- Often these groups are skills and information based – so you aren’t expected to bare all and tell everyone why you are there and what your difficulties are
- You can often learn just a much (if not more) from other people in the groups as you can from the facilitators
And remember, you have every right to go back and ask again and to query why you weren’t offered something that you wanted.
I was offered something that I didn’t want
- You have every right to request an alternative. However, it is always worth exploring what it is that concerns you about what is offered. Sometimes, with time, research and discussion, you may find that this is worth a go. The key is to take your time and to ask, ask, ask.
I have tried [medication / therapy] before and it didn’t help
It can be very disheartening when this happens and I have seen many, many people in this situation. It is really important to remember that:
- Not all therapies or therapists are the same and each of them can offer different benefits at different times
- Sometimes it isn’t the right time for therapy and you may find that revisiting it again may actually have a very different outcome
- There are many different medications for common mental health difficulties, so it is worth exploring all of these options
Considering all the options
Sadly, the NHS isn’t always able to meet everyone’s needs or preferences. Mental health services are chronically underfunded despite the overwhelming demand. There are however some other options that you might want to consider:
Therapy and other support through charities and voluntary organisations
There are actually a lot of charities and voluntary organisations out there supporting people in a huge variety of ways: specific mental health charities, those aimed at children and families, women specific charities, ones for veterans, bereavement services – the list is endless. Your local IAPT service should normally have a list and be able to signpost you or you could do a quick google search.
This is often not an option to people because of the cost, which can be very expensive. If you have private healthcare, maybe through work, then therapy can be funded through this.
If the cost of long term therapy is too much, it might be worth (if possible) considering paying for an initial assessment session to think about what your difficulties are and if the therapist can make any recommendations for things for you to try / resources to tap into / books to read. Although this may not feel ideal, it could be enough to make things more manageable until another option is available.
Occupational Health / Employee Assistance Schemes
Some workplaces have specific occupational health services where you can access therapy and other forms of support for free. This is particularly important to tap into if your difficulties are making it hard for you to attend / return to work.
Some common misconceptions / unhelpful intrusive thoughts that you might want to challenge
“No one will be able to help me”
I have seen so many people who believe that there is no hope and that they are beyond help, but there is always something that can be different. And sometimes the smallest changes can make the biggest difference.
“My problems aren’t that severe; there are so many people more worthy of help than me”
There will always be someone in life worse off than you, but that does not make your problems any less worthy of support. Youareworthy and deserving.
“I am a failure for not being able to fix this myself”
We are not made to do this alone. Even healthcare professionals, who know all the skills, cannot be expected to help themselves.
“Nothing has helped before, so what is the point in trying again?”
It is understandable if you feel disheartened, hopeless even, when you have tried something and it hasn’t helped. Before writing it off, it is worth making a list of all the ways in which previous support wasn’t helpful to try and prevent them reoccurring. When starting therapy with someone who has had therapy before, I find it incredibly helpful to talk through these things and see what can be different. Therapy is at its most effective when both parties are open to feedback and trying something new.
If you ever feel as though you are unable to keep yourself safe, you should immediately go to your local A&E department. They will have links with their own psychiatric liaison team who will be able to assess you and your needs. This won’t always mean being sent to hospital, as most mental health trusts have something called Crisis or Home Treatment Teams, who can look after you by visiting you regularly in your own home and being on call 24 hours a day