Mental Health Still Matters

Four years ago today I posted what has become – by a distance – my most ‘liked’ post ever, as you can see from the ‘top ten’ in the right hand column. It clearly struck a chord with many. I reblogged it a year later and in the run up to World Mental Health Day (aka WMHD, on 10 October) I thought I’d revisit it. I’ll share the original post unedited, and then return for an updated commentary. This is the original:

MENTAL HEALTH MATTERS

At the risk of repeating myself, I started this blog to share my experience of depression in the hope that it would help others. I worked for more than 20 years in the NHS for a large mental health Trust and although I haven’t blogged much about it recently mental health is still a subject about which I care deeply. Last week there was a story in The Times which alarmed me about the way mental health is supported, and which I felt I had to share. This post is about the situation in England but I suspect that the issues are common to many other countries around the world.

A little bit of background: when the Tory-led coalition government came to power in 2010 they embarked on a major restructuring of the NHS. There had been no mention of this in their manifesto, but that’s another story. One of the key changes was the creation of Clinical Commissioning Groups (CCGs) which were intended to put the power in commissioning health services into the hands of health practitioners (largely, General Practitioners, i.e. GPs) as this would, in theory, mean that those who knew best would be commissioning the services needed by their local population. There is an ongoing debate about how effective this has been and a range of other issues too, but I’m not going there. What interests me at present is this:

Copyright Times Newspapers' Click to enlarge
Copyright Times Newspapers. Click to enlarge

Apart from the fact that they are going against Government policy and misusing their funding, I am horrified that so many CCGs fail to see the importance of providing good mental health services. These are supposed to be the experts, those who know best. It beggars belief that they can be so ignorant. The Times commented further on this in their editorial section:

Copyright Times Newspapers. Click to enlarge
Copyright Times Newspapers. Click to enlarge

I’m with them 100%. The figures speak volumes, both in terms of the abuse of power these CCGs are engaged in, and of the pressing need for more investment to be made in mental health services. I started working in mental health in 1993 and even then it was recognised by many to be a Cinderella service, pushed into a corner and under-supported. And children’s mental health services were seen as the poor relations within that! Finally, it seemed, we had a government that was doing more than say nice words about this, but they are being let down by the very people who they thought would be best qualified to enact their wishes.

There have been many studies which have shown how good mental health can be of benefit to physical health, and vice versa. One of the problems in these days of evidence-based treatment is in measuring the effectiveness of mental health care. With a physical illness it is relatively easy to assess, likewise with injuries, such as broken limbs: there is clearly visible evidence available in such cases. But this is not always true of mental illness. To use my own case as an example, the diagnosis I was given nearly five years ago was treated, I returned to work until I retired, and since then I have not felt any recurrence of the original symptoms. So, does that mean I am a successfully treated case? Probably, as I’m no longer costing my local CCG anything for treatment, but who is to say that I am ‘cured’ or whether that is even possible? And does that mean that my local CCG shouldn’t spend the money it has been given to treat people like me on people like me, that it can choose to use it for other treatments? I think not!

People with mental illnesses have for far too long been discriminated against and stigmatised. Whilst this may be recognised by some, far too little can be done, both in terms of treatment and education, as the funding just isn’t available to do all that is needed. I know that the NHS in general is underfunded and that CCGs are under severe pressure to balance their books, as are provider services, but to take money away from the most needy part of the service is totally unacceptable, particularly when that money is supposed to have been ring-fenced for those services. Are the CCGs deciding on their service commissioning on the basis of discrimination and stigmatisation? Who can say, but it could be argued that they are showing signs of doing this. If the supposed experts don’t take mental health seriously, what hope is there that the general population can come to recognise the need to do so?

(Footnote: I am having a week of mental health awareness posts. This is my second, after yesterday’s reblogging of It Asda Be from three years ago. More is to come.)

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And this is me again today. I’ve been thinking about what I’d be saying for this year’s WMHD post, as we are in such strange times and much of what has gone before has been overtaken by the pandemic. Somehow, given all of the pressures under which they have been working, it feels a little churlish to criticise the CCGs, but that doesn’t mean that I think they have improved their performance on mental health. It just doesn’t feel like the right time to have a go at them – but there will be a time for that, I’m sure!

This year’s WMHD theme is: Mental Health For All – Greater Investment, Greater Access. The focus of healthcare services is, naturally, on treating and controlling the coronavirus: however I am sure there will be a devastating long term effect on our mental health – both collectively and individually. It would be easy for the mental health aspects of the pandemic to be overlooked: given the situation here that I described in my post four years ago, I fear that they will be. Mental health does matter: good mental health, and services to support it, should be seen as equally important as physical health. In current circumstances, mental health may matter more than ever. I just hope that the ‘powers that be’ recognise this, and that they do something about it.

Taking Stock

I think that we should all take stock of our lives every once in a while. The last time I did that here was a year ago today: I posted Missing, Inaction, in which I reflected on the effects of an enforced 15 day absence from the internet, and how dependent we had all become on it. That was the main reason for what had been an 18 day gap between posts, but I also mentioned that I had been having a stressful time in my life, having had to move home – a natural hazard when you are a private renter and are at the mercy of the landlord’s wishes. Reading the post again I noticed I had said that I intended to write about the effects this had been having on my mental health but, in the usual fashion, best intentions went out of the window. Things began to settle down, I was getting used to my new home, and it didn’t feel right to be talking about my mental health when there were many people in far worse situations than mine, people who had real stories to tell. The anniversary of that post does, however, seem a good time to be ‘reviewing the situation,’ as Fagin put it.

Looking back to this time last year I now realise how much the whole episode had destabilised me. I didn’t notice at the time but there were impacts, in particular on my sleep patterns – which were shot to pieces. I’ve had sleep problems for years, and was tested (negatively, I’m happy to say) for sleep apnoea during my long spell off work in 2011-2 with depression. Retirement had helped enormously in stabilising that: no longer being required to get up and go to work meant that if I needed to sleep in I could, whatever day of the week it was. I occupied a lot of my time in the internet break by reading – 16 novels in 18 days – but even so, I found myself nodding off at odd times: I’ve never been one for afternoon siestas, but I had a few then. It didn’t register, but these were probably a sign that all wasn’t as it should be.

Over time, though, I began to settle into a new routine, and into a revised version of life. It’s funny how a move can change your outlook on life, and I don’t mean just the view from the window. But that wasn’t the only important factor for me: I had been able to get the medical treatment I needed for a long term condition, and the benefits of knowing that I was in good hands for that had a positive impact on my mental health.

I got to the end of 2019 thinking I’d done well: I was over the move, my health was improving, and I’d managed to get through some outrageous behaviour by my ex-landlord. 2020 was to be the year I really began ‘taking back control,’ to borrow a phrase, but then along came Covid-19 to show me that my use of those words was about as meaningless as they were in their more widely known context. My mobility is limited, so I don’t get out much anyway, but being told that I had to stay in and couldn’t see anyone – not even my daughters or granddaughter – wasn’t part of the plan. Much has been said and written about the impact of the pandemic on our lives, both in the obvious sense of our being required to stay at home whenever possible, with shops and public venues being closed, but also on the hidden factors, such as the effects on our mental health.

Using myself as a sample of one, I can see how my mental state has changed since lockdown began in March, and it hasn’t improved! I’m not saying that I have relapsed into depression – far from it, thankfully – but I can see that my outlook on life is different. I don’t have to go out much, but I know that at some point in the next few months I will need to go back to my doctor for the periodic testing that keeps me well, and I really will need a haircut! Normally, I’d think nothing of either of these but now, if I’m honest, both of these prospects scare me. Am I being stupid? I’d like to think not. Every day we hear new warnings of the potential for a second wave of the virus, and with the reopening of shops and public facilities there comes a relaxation in people’s minds of the need to be alert to the danger that may be lurking. I know I can do the right thing if I go out, but can I trust others to do the same?

I’m potentially vulnerable, and I don’t think I should have to take risks to go out and do simple things. That plays on my mind: I don’t want to become a hermit, but I can see how easy it would be. Looking at those words on screen they strike me as a little pathetic, but they are accurate. I think back to my dark days of 2011-2 and I know that is how I behaved then: I don’t want to go back there. This may all be in my head, but it’s hard to shift, and I doubt that I’m alone in feeling this way.

This time last year I was looking ahead to what I believed would be better times, now the outlook is very unclear to me. Anyone familiar with Maslow’s Hierarchy of Needs will know that the basic level is classed as Physiological needs, which include food, shelter, health, sleep and clothes. Here is the pyramid, in case you haven’t seen it:

Those Safety needs in the second level include factors like personal, emotional and financial security. Somehow, I think that many of us will be struggling with this tier of the pyramid at present, and for some time to come. That will impact on our move up the levels: relationships with those we love will be affected, and there will need to be a lot of rebuilding after enforced separations.

The future is uncertain for all of us. My outlook is very different from a year ago, and I’d imagine that everyone feels that too. I wonder where we’ll be a year from now? Maybe I’ll take stock again then – hopefully whatever passes for ‘normal’ will have returned, given time.

How do things look for you? How does that compare with a year ago? Are you having to readjust your hopes and plans? I expect we’ll all be doing a lot of that now and in the months to come. As I said at the outset, I believe that we should all occasionally take stock of our lives: I don’t think any of us has had to do so in circumstances like today’s.

Why Do You (Still) Pretend To Be Normal?

In these strange days of pandemic and lockdowns, many articles have been written about what life may be like when it is all over. Will we ever go back to being as we were, or will we have adapted into a ‘new normal?’ It was therefore a bit of a coincidence to see that I had posted this a year ago today, and I thought it worth sharing again for newer readers, or for those who might have enjoyed it so much the first time round and might be so bored in lockdown that they would welcome a chance to see it again.

As you will see, the main part of this is a reworked version of a post I originally wrote in 2013, but I haven’t really changed my view in the intervening seven years. Normal, for me, may still very well be different from what passes for normal for you or others: I’m pretty certain that Numpty Trumpty’s version of normality is miles away from mine, for example! Whatever (to get in a plug for my WOTY), it is a concept that I think we might all be revisiting in the months and years to come: “do you remember what life BC was like?” Let’s revisit this in a year’s time and see what we think then!

A couple of footnotes:
1. Mention is made in the previous posts of Men’s Health Week – it is coming around again, this year from 15-21 June.
2. BC, in case you needed reminding, stands for ‘Before Coronavirus.’

Take It Easy

A fellow blogger – Stevie Turner – published a post on Monday about the odd phrases that people have entered into search engines as a result of which they have landed on her blog. Her post is called ‘WordPress Search Terms,’ and can be found here – as with all her posts, I recommend it. I’ve often marvelled at some of the weird and wonderful things people search for. In my case, I once wrote a post for Think About Sex Day – yes, it really does exist – which gave me the opportunity to use the word ‘sex’ in the post’s tags, giving rise (or not, ahem) to countless disappointed people since then. I commented on Stevie’s post that my all time favourite was someone who had found my blog by asking ‘why do you pretend to be normal?’ I’ve always hoped that wasn’t aimed specifically at me, but…

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