Losing It: Our NHS on Mental Health

We all have mental health. We don’t all have a mental illness. we have not all experienced a mental health crisis. Sometimes you hear people talking, especially online, about how they had a crisis and sometimes I wonder if the term “mental health crisis” has become somewhat watered down and overused, much like the term “trauma”. Many now refer to trauma for anything a bit significant and overwhelming. The problem with this is that the reality and severity of trauma and mental health crisis become diluted the more they are overused or, alternatively, used out of context. This is why, although difficult viewing, I was really relieved when I saw ‘Losing It: Our Mental Health Emergency” listed on 4OD.

The show follows patients through a mental health trust in Nottinghamshire and shines a light on the extremes, the harsh, petrifying and heartbreaking reality of a mental health crisis. In episode 1 we met Laura and Briena. Laura was experiencing her first-ever episode of mental ill-health and was detained on Section 2 for post-partum psychosis – her illness nearly cost the lives of her entire family. Laura was super compliant with treatment in order to get better, however, experienced variations in her mood and energy states, which highlighted the subtlety that psychosis can have: the conviction in delusional thoughts, the not wanting to rest and agitation, the deadish eyes in a family photo that in hindsight give Laura a glimpse into how unwell she was, “I don’t particularly like this one behind me because I think you can see in my eyes that I’m still ill”.

Once she is well, she reflects on the experience and she really hit home. Having come out of a crisis and hospital admission, “we will never be the same people as we were before that day because of what I tried to do but it doesn’t make me feel any better by crying over it…I still regret it and I still live with the guilt” Reflecting she recalls how the realisation of how unwell you’ve been once you’ve recovered from an episode can be harder than being ill, “it’s mad how when you’re ill you don’t realise how serious it is, and then when you come out of it, it hits you even harder …it’s crazy how much… its just kind of come back”.

We are also introduced to Briena, an 11-year-old with deeply disturbing suicidal and intrusive thoughts. She sometimes struggles to articulate herself and has panic attacks so severe she looks to be in real agony. It’s heartbreaking and painful to watch. You can’t even imagine how her parents feel watching their daughter in so much pain and being essentially helpless.

The world of mental health has changed dramatically in the last decade, heck it has changed beyond recognition and even in the last 5 years everything just keeps changing. This can make navigating the system and services out there difficult. It can be more difficult when more people ask for help, because all of our campaigning has worked in de-stigmatising mental illness and mental health difficulties. Unfortunately, the system isn’t prepared for this influx of pleas for help, and so it is, in the words of my social worker yesterday, “they’re changing the system to be more streamlined, so people come in and go out very quickly in order to deal with the influx of need”. I’m sceptical; this sounds like a false economy, where people go in to the system at crisis point and come out just as quickly without the longer term input and support that helps people to get and stay well, “gone are the days when we could support someone for years, we just can’t now. We’re really looking at months”

With this new system I haven’t had a care coordinator allocated to me and I’m one of 70 in my team to have a named professional. This is apparently the worst it has ever been. I have now been told that I won’t be allocated someone new and will instead be discharged because I haven’t had a crisis for a while and although I still need medication adjustments and tweaks about twice a year, I am quite frankly not a priority. I understand this, and in hindsight despite being petrified for the future, I am so grateful I got unwell before Tory policies came into effect because a lot of the treatment and support I’ve had, the very treatment and support that has helped me to get to this point of relative stability and resilience is no longer available. So even though we have reduced the stigma of being open about mental health, and in asking for help we still have a lot more work to do in order to make sure the help and support is available to people who need it.

This is no longer a battle. This is a war. People have lost their lives, and more people will – and that’s just not acceptable. No one should be left alone to end it because the support isn’t there. I think the place to make the biggest impact is perhaps to contribute towards the charity sector who are plugging a lot of gaps as best they can – and maybe people of power with a real ability to influence legislation and funding, or perhaps help set up practical services beyond signposting to the Samaritans or an online chat forum would be good. There’s a lot of talking and celebrity endorsement going on, but for the people on the ground without privilege, where are they going to turn when they can’t get the help they need from the NHS? For as well intentioned as it has been , we have perhaps missed the mark in the context of this political fuckery we are currently in.

Losing It is a great documentary opening the doors to providing a platform for people in crisis talk about what they’re going through, but without real action and funding, it seems you have to nearly die or kill someone to get help – and if you ask me, that’s just too risky a system. I don’t have the answers, I’m just a bit petrified for my own situation and for those who have it much worse than me any time from 2017 and into the foreseeable future. We’re talking, but the conversation is bleak.

What’s quetiapine gave me

Although scientists do not fully understand the ways in which quetiapine works, the trade off is that it is a very versatile drug; it can be used as an add-on treatment for treatment resistant depression, it can be used as an anti-psychotic for those experiencing psychosis such as hearing and seeing things that are not there, it can be used to treat and manage mania or hypomania alone, or with another medication. Ultimately it seems to have the ability to do a bit of everything in regards to managing the symptoms of severe mental illness. Quetiapine is an atypical antipsychotic that also has the properties to effective act as a mood stabiliser. The difference for all of these uses is the dosage, release profile and tolerability to the person taking the drug.

Even if you are convinced that a drug will work in treating mental health, it is not so much selecting the right drug that is the difficulty in prescribing. There is getting the correct dose, and taking those doses at the right times in the right format. Sometimes you need a couple of drugs, at just the right doses, in just the right formats, to be taken every day at just the right times. It is no wonder that finding the correct medication regime for severe mental illness is such a drag. This process can take numerous years, crises and adjustments, often alongside psychological and emotional intervention.

Quetiapine saved me and gave me so much. It saved me from additional lost years to being a non-functional person floating endlessly around Lewisham Shopping Centre. It has saved me from not being able to keep friendships because I am now more than a shell of myself overrun by mental illness. It has saved me from continuing the string of many suicide attempts and ever escalating self harm, all of which arose from an inability to cope with unmedicated bipolar disorder and borderline personality disorder all mashed together into an ugly chaos. It saved me from sleeping my life away because leaving my bed every day isn’t an act of mild torture. It saved me from wasting my working years not tapping into my talents. It saved me from a life void of purpose. It saved me from myself. It saved me from my illness. Yet it was the first drug I was prescribed in 2011 by adult mental health services.

What stopped me from reaping the benefits of the drug back then? I was not ready to accept the weight gain side effects, and learning to overcome this fear took years of hard work and treatment. The dose was not right. I was out of control and without the input of such extensive therapies targeting my behaviour, past traumas and screwed up way of interacting with the world that had developed from trying to raise myself in a chaotic home environment. Without these therapies, schema, DBT, and psychoanalytic therapy the medication would have never worked alone. I needed the input and nurturing obtained from my therapists, social workers and doctors.

All of it together has given me the ability to think. Without quetiapine, I am pretty useless at thinking clearly. I just cannot. With it I have the ability to be creative and coherent. Quetiapine gave me the opportunity to respond appropriately to emotional circumstances. It gave me the assurance and confidence in my own thoughts and feelings that I am not being mad or irrational. It has given me the confidence to socialises because I don’t feel or seem inherently mad. It has given me a drive to make something positive from these experiences. It has given me a sense of where I have come from and what I have gone through to get to where i am. It has given me gratitude, to the small moments in life, the scientists who made the drug and the wee animals who underwent horrible experiences and death so that I could have my life back. It has given me hope and stability.

Now when someone asks me how I have been, I can answer that I have been well and it’s much less likely to be a lie than ever before in my life. If I’m honest, sometimes things are so stable and well that I can start to feel an inane boredom creep in. It’s not the type that creeps in and I stare at walls because there is no joy to be hard from even my favourite activities. It is the kind of boredom that blesses those who are not living from crisis to crisis. It is the kind of boredom where I look at myself and think, “yeah, I’m ready to take on a little more, bring it on”. The kind of boredom that gets you out of the house in the morning to see the world and be busy. The kind of boredom that lights a little fire in your belly that could well be described as a lust for life. Now there’s something I haven’t felt for very long at a time for years and years. I may even start thinking about my next birthday celebrations because I am convinced I will be here, alive, and well. This is something that could not be said for a long time before. I feel privileged to be feeling bored with stability. What an absolute privilege it is to have a sense of normality.