Cost and sustainability

rant1

A blackboard with “rant of the day” printed at the top and the letters NHS with pound signs drawn in white chalk

I had a list of things I wanted to blog about so instead I’m going to write about something completely different which came up few days ago.

I’ve been trying to get more into doing work outside of Mind which uses my lived experience of having mental health problems, last week I attended a workshop on Outcomes Based Commissioning (OBC). I’ve learnt that mental health meetings and groups loves acronyms, an alphabet soup of conditions, job roles, legislation and projects.

I’d like to tell you more about exactly what that is but honestly I’m not entirely sure myself. I can tell you that 8 organisations some statutory such as the NHS and some charity such as Mind and Spear are working together to change the delivery of mental health services in Richmond and somewhere in all this they’re looking for contribution and input from service users, carers and people with lived experience of mental distress.

One of aims from the mental health service is to ensure sustainability and deliver cost effective treatment, I have a couple of issues with this. 1) you cannot guarantee sustainability, you can do your best the make services sustainable but don’t make false promises especially to vulnerable people, 2) cost, now unless you’ve been living under a rock you’ll know that the NHS is chronically underfunded and overstretched; mental health has always been refereed to as the Cinderella service and when the going gets tough the tough gets cutting and mental health is often one of the first areas to feel these cuts.

So what’s the problem with pointing this out or looking to save money? well mental health already comes with a nice big serving of guilt for many people, guilt for putting pressure on loved ones, guilt for not working, guilt for being unreliable and it’s hard not to feel the need to justify the cost of treatment as I wrote in my last post I’ve been told by Drs in a&e to consider how long it took to treat me compared to the time it took me to cut myself, I’ve been questioned on why I called an ambulance despite feeling faint from blood loss. I didn’t choose to have mental health problems, my actions may be my choice but having these issues is something beyond my control partly due to my upbringing and home environment growing up.

Having the cost of treatment pointed out or hearing the providers talk about services being cost effective makes people feel guilty for something they can’t help and even puts people off seeking treatment whether that’s for self harm (I know people who will suture or glue themselves) or more long term treatment like psychotherapy or counselling.

The financial situation with the health service is complex but nobody should be made to feel guilty for needing healthcare or social care or feel they don’t deserve the help they need.

Advertisements

Dear Dr (a message to Healthcare professionals treating self harmers in hospital)

I’m a regular in my local, that probably doesn’t sound unusual or uncommon except I don’t mean my local pub I mean my local a&e department. Like around 1 in 4 people in the U.K. I have mental health problems and often require medical attention for self harm, I decided to write a post about my experiences in a&e as an open letter to medical professionals.

A collage picture of a wolf howling with song lyrics “Lately it’s hard to let you know that I’ll never learn” above and below

Dear Dr or health care professional

The NHS is underfunded and over stretched, you work long hours in a challenging conditions often with little thanks or support; it’s impossible to be oblivious to the current state of our health care system. When you’re juggling patients and trying to be in 3 places at once it’s not hard to understand why you might not want to spend an hour or more treating someone for self inflicted injuries especially when you’re coming to the end of a long shift; however you chose a career helping people and taking care of their medical needs and I am a person in need of medical attention.

If you’ve never experienced a mental health problem or felt a need to harm yourself then I don’t expect you to understand how I feel or why I do what I do but the way I got my injuries doesn’t change the way they should be treated. I’ve been treated in ways I can’t imagine people who are there after an accident would be. 
I’ve had wounds washed out in a sink in front of all the other cubicles and taken from one part of the department to another with nothing covering my arm while people stare at me often horrified, on one occasion my arm was covered so it wouldn’t scare the children in the paediatric a&e. 

I’ve been stapled with no local anaesthetic and told it’s fine because it doesn’t hurt (it does), I know this is in partly due to guidelines but I’ve also had malicious treatment where one Dr repeatedly pulled the Staples out and re did them all the while telling me if I didn’t stop I’d lose my arm while I sat in bed crying. I’ve had Drs tell me to think about how long it took them to treat me compared to the time it took me to hurt myself and when I’ve felt faint from blood loss and said I need to sit down told I can wait a couple of minutes. 

In my a&e notes it says most of the time that I’m not distressed or that I was making eye contact; apparently that means I’m fine. My mental state is frequently being judged as fine because I’m not shouting or being abusive or absconding however on times when I have been visibly upset I’m ignored.

I know accident and emergency staff are there to treat my physical injuries and leave the psychological side of things to the psych liaison but please remember that attached to the arm you’re treating is a person, I know my cuts can be deep and you may need another opinion but I’m not an exhibition for everyone to come and have a good look and discuss the damaged I’ve done, I see the signs that talk about dignity privacy and respect yet that doesn’t seem to apply if you’re a mental health patient; a little discretion wouldn’t hurt.

This isn’t intended as a criticism of the NHS I know I’d be dead without it but I didn’t choose to be this way, it’s something I’ve not been able to break away from despite treatment and no amount of snapping elastic bands of holding ice cubes has ever replaced it as a coping mechanism.

Self Harm coming up for air

A picture of my legs in the air, both are bandaged


This Post is likely to be triggering please read with caution.
I was running a youth wellbeing session last week, it was a drop in so a much more scaled back and basic session than I’d usually do. We had a small power point which contained an animation about depression by Time to Change. The video shows an illustrated woman swimming in a blackness that surrounds her, trying to come up for air and not knowing which direction to go in, that’s how I feel about self harm.
It’s a complex issue like many mental health problems or behaviours that come from them; I only know one person other than people online who actively self harms who I think understands the way I feel and who I can relate to. To me it’s not necessarily something that always has a precise trigger there isn’t always something that’s happened to cause it, there can be a million reasons or none sometimes I just need to cut.

I think I related to the video because my feeling can be suffocating and when I cut it’s like coming up for air or letting out a breath I didn’t know I was holding as if my whole body breaths a sigh of relief and I feel calm and still. Unfortunately it rarely lasts long and it always builds up again it’s a cycle I’ve not managed to break, the build up will come again and there is a limit to how much I can distract myself or keep busy it often feels like I’m just delaying the inevitable.

When you don’t like or value yourself it’s hard to find a reason not to give in to something that has made you feel better so many times despite it being damaging and harmful. The experiences in a&e are often not positive with many Drs short on  time and energy angry at treating someone that has inflicted an injury upon themselves, treatment is often less than ideal with the quickest and easiest option taken, it can be painful, distressing and even humiliating I’ve been treated in ways that I find hard to believe I’d be treated if it were an accident.

The question of whether self harm counts as an addiction or not is often debated in the mental health community but whether it is or not I believe it has a strong hold over me one that holding ice cubes, snapping elastic bands or talking about has never quite been enough for me to come up for air and stop drowning.

Time to Talk Day 2017

ttd2

It’s time to talk it’s time to change. Today is Time to Talk Day an annual mental health awareness day as part of the Time to Change campaign encouraging people to have conversations about mental health. Talking about my mental health isn’t exactly something I really need encouraging to do, most of the work I do with Richmond Borough Mind involves using my lived experience whether it’s running peer support groups for adults, youth wellbeing sessions for young people or co-delivering mental health awareness training I’ve spent the past four years talking about myself.

Today I’m writing about something more personal and less general than my overall mental health, I’ve written about my diagnosis of Borderline Personality Disorder and one of the most difficult parts of having BPD is forming healthy relationships. Without going into the details of how and why this is such a problem early childhood experiences are usually one of the causes of BPD and shape future attachments and how we view people. Some people have described BPD as the emotional equivalent of having third degree burns, for people who know me well and know how cynical I am it’ll be no surprise to know that I hate that comparison it is true though that intense emotions and mood swings are certainly an issue and when it comes to relationships and attachment this can be a factor in the way someone with BPD views others.

For me that attachment is often transferred onto people who can’t be what I want or people I can’t have the type of relationship I want with. I guess I almost have a type and it’s always the same kind of people I get attached to, it’s something I find hard to admit to that I find embarrassing to talk about but this is Time to Talk Day so I’m going to talk about it. Inevitably people leave, they move on, find new jobs or retire it happens when the people you get attached to are mental health professionals or employers, people with their own lives and careers. That doesn’t stop it hurting, loss and endings are something I struggle a lot with. There are three people who have been there over the past few years the last five years in particular, two of them were my care coordinators/ individual therapists one left a couple of years ago and one retired in September.

The third is an employer who leaves in two weeks but she’s not just my manager she’s seen me from almost the day I started at Mind as a service user who barely spoke to anyone (oh how times change), when I started my training as a peer volunteer to now harassing anyone that will listen to let me have a few minutes to speak at events, she’s not only been a good project manager but supportive when I’ve been struggling or in crisis; on several occasions she’s stayed past her working hours to talk to me when I’ve felt unsafe of wanting to self harm. I’ve cried a few times and no doubt will a few more, it’s painful as endings often are especially when combined with mental health problems but the biggest thing I gained from 2 years of intensive treatment for BPD was being able to talk more about how I feel and today feels like a very fitting time to open up about something difficult and hopefully in time feel less shame around my feelings.

Service user involvement and mental health awareness (RB Mind AGM 2016)

agm16

A picture of me wearing a sparkly maroon jumper and gold star necklace with a floral lanyard around my neck, I am holding a piece of paper and talking into a microphone.

I’ve been volunteering with Richmond Borough Mind for just over four years, this was a speech I gave at the 2016 Annual general meeting (AGM).

One of the things that appealed to me when deciding to become a volunteer with RB Mind was being able to use my lived experience to benefit myself and others and the importance Mind place on the voice of service users. I’d been a group member in the Peer Network for a while but had never considered or planned to get involved in mental health in any capacity other than being a service user or patient, before joining Mind I’d never seen any benefit to having a mental health problem after all my experience had just brought me trauma, disappointment and more prescriptions for psychiatric medication than I can count.

Over the past four years I’ve progressed as a volunteer across different projects and areas of the charity and have used my lived experience as a Peer Volunteer, Youth Wellbeing trainer and by becoming more active with service user involvement being able to speak on behalf of people with mental health problems in Richmond. I’ve been a part of the local crisis concordat group for a year now looking at the way crisis services are delivered and how they can be improved I’ve also attended the changing minds festival at the Southbank centre, been part or research into unmet needs in the borough and sat on a panel talking about mental health and art at the Music and art for Mind fund-raiser.

Service user involvement is often under-represented and many people don’t realise that their views and opinions are not just important but needed and aren’t aware that these opportunities to talk about their lives exist. People with experience of mental health problems and those who have used services whether NHS, charity or support groups are known as experts by experience for good reason because no one knows us or our needs better than we do something which goes for everyone not just people with a mental health problem or a certain diagnosis.

Another project I’ve been working with is the mental health awareness workshops with the volunteer coordinator, this is a training programme offered to organisations wishing to boost levels of mental health awareness in their workplace. So far I’ve told my personal story to two groups of people with English as an additional language many of whom also struggle with their own mental health difficulties and were able to discuss this after I talked about my problems.

I was recently described as “very articulate” and told I could “probably talk my way out of any situation” aside from possibly being the best description of me ever it’s what motivates me to continue to do the things I do. In January I’ll be co-delivering part of the mental health awareness training and talking about myths and misconceptions surrounding mental health and I plan to use my skills to raise awareness and do what I can to improve and influence mental health services not just for my benefit but for the benefit of all the people who aren’t able to be as involved as I am. On the days where my mental health is getting me down or I feel angry and frustrated because of my issues I try to think of all the things I’ve done over the past few years the experiences I’ve had and people I’ve met none of which would have happened if I didn’t have a mental health problem.

World mental health day (a backdated plea for acceptance)

A pink square image with the words I have borderline personality disorder #endthestigma #1in5 #youarenotalone written in bold white letters

People say attitudes to mental health are changing and to an extent I’d agree however there are still many aspects of mental health and types of mental illness that are still not socially accepted and are heavily stigmatised. Mental health problems are rarely glamorous or exciting many are still associated with fear and misunderstanding. 

Personality disorders were said to no longer be a diagnosis of exclusion in 2003 yet are still highly stigmatised in the health service and rarely mentioned outside of the mental health environment unless being referred to a patient at broadmoor. I have borderline personality disorder it’s not glamorous, it’s spending hours in a&e hoping you’ll be treated by someone understanding who won’t get angry because it’s self inflicted and only two weeks since the last time, it’s medication and years of trying different kinds or combinations and weighing up the benefits with the risks, it’s talking about the same things in therapy so often you think either yours or the therapists head will explode, it’s questioning everything and feeling out of place even in the mental health community, it’s being afraid to be open and make posts like this because of the lack of understanding and misconceptions. 

So for world mental health day I’d like a great acknowledgement and understanding of the wide and varied world of mental health.

Better late than never (an introduction i suppose)

anime-me

A Japanese style drawing of a young woman’s head and shoulders with blue and pink hair and a piercing below her bottom lip

 

Because I was late even for my own birth I’m starting a blog several years too late. I’m Georgie (or Georgiesaurus in some parts of the internet), i’m chronically mental with the double luck of having both mental health problems and physical disabilities, I’ve been volunteering for a mental health charity for 4 years and have been involved in service user representation.

Too much waffle for twitter and too old for tumblr yet that millennial need to post my entire existence on the internet (having people to read it is more a bonus than necessity) a blog seemed like a good place to digitally dump the contents of my brain.

Aside from being chronically boring I have a slight obsession with a certain cosmetics company known for their bath bombs and the grumpiest DR around House MD, I live in South West London and spend too much time watching YouTube.