What makes more sense? Prevention or cure?
When it comes to secondary mental health services neither seem to apply. They much prefer to wait until you deteriorate into crisis, and then use a sticking plaster to cover a gaping wound. Or so it seems here in the north of England.
I met a friend for coffee yesterday. When I say friend, she’s actually someone I met at the bus stop a few months ago. We mentalists seem able to recognise a kindred spirit and know who it’s safe to talk to. Or perhaps we just talk to anyone lol. Anyway, K and I soon moved past the occasional hello and finally got round to meeting up for a chat over a cheap cuppa. It had to be cheap because K is surviving on basic benefits and couldn’t even afford the bus back home. No one appears to have advised her how to claim more money and she’s not the type to ask herself, being ashamed of claiming at all.
K has spent the last couple of years recovering from a particularly nasty cancer, which has left her with a host of gynaecological problems, in addition to a worsening of her long term battle with depression. Her partner of ten years is an alcoholic depressive, recently diagnosed as suffering from psychosis. They live together in a small housing association flat, quite far out of the city, in an area which has little more to offer than a small newsagents and a fish and chip shop. K is more of a full time carer than a girlfriend. They haven’t slept together in years. Her partner frequently comes off his medication and drinks to escape the voices in his head. K desperately wants to improve her life. She volunteers several times per week in a local charity shop and has admitted that it provides an escape from her homelife, which is becoming unbearable. She has wanted to leave her partner for some time now, but has nowhere to go, and would be perceived as having made herself intentionally homeless by the authorities, if she should move out.
K feels unsafe at home and has had to up her medication to treat her worsening mood. Her partner has only recently been allocated help from the crisis team, and only because he took an overdose. He refused to go to hospital and they can’t see past his alcoholism, saying that he can’t be helped until he stops drinking. He won’t stop because that is his life now. He never leaves the flat and suffers from paranoia. K knows the paranoia began long before the drinking, but can’t get the crisis team to take this on board. They will discharge him shortly and the only help then will come from a gp, who he won’t visit because he won’t leave the house. K has no idea what is happening because confidentiality rules prevent the crisis team from discussing her partners case with her.
K has recently started an affair with another volunteer from the charity shop. He’s considerably younger than her and has learning difficulties. I tentatively suggested that she has swapped one dependant for another, and she agrees, but explained that she just needed to do something that would make her feel alive for once. As far as she is concerned, her relationship is over and the new affair is just a bit of fun, but she had tears in her eyes as she spoke to me. Indeed, during our time together yesterday, K came across as a woman on the edge, desperate for comfort and full of guilt for not being able to cope. She admitted to having frequent thoughts of suicide, due to the knowledge that she is completely stuck in her present situation. It’s hard to take responsibility for your life and move on, when you only have a couple of pounds to your name and no family support.
So, on to mental health services. K sees the same consultant as me. It appears that we also share the same personality disorder label. K has repeatedly tried to get help from a social worker or community mental health nurse. As with me, the answer has always been a resounding no. K feels very angry that her attempts to help herself are simply used against her as proof that she doesn’t need any help. She is utterly exhausted and close to breakdown, but knows that when she comes out the other end, nothing will have changed. All she wants right now is a break from being her partners carer. Just a few days to get her head together. The affair is her first, and not at all her usual behaviour. She has reached the stage where it makes sense to her to take an overdose now. Not to die, but to get some time on the ward away from real life. In reality it is her partner who needs to be in hospital, but he knows enough about how it works to be able to escape a section. So what else can she do?
The reason I wrote about K today is that there are so many other K’s living in this country. Not quite ill enough to be allocated a keyworker or cpn, but too ill to manage their own lives. Let down by the NHS because it is so underfunded and understaffed that it can only help the worst cases. In a few months K will probably fall into that category. At least then she will receive help. But the road back to health will be so much longer than it needed to be. It’s a shame.