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Catch 22

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A catch22 is a paradoxical situation from which an individual cannot escape because of contradictory rules. The term was coined by Joseph Heller, who used it in his 1961 novel Catch22.

The news that George Cloony is currently remaking Catch 22 into a TV series is exciting for me, not least because I am very partial to the silver fox but also because book was one of my favourites as a teenager. The frustration of people being stuck in a situation not because of outside forces but because of rules that just don’t make sense.

Recently it has occurred to me that being someone with a mental health problem is just like being in a Catch 22 situation. I have bipolar disorder and tend to become unwell around once a year, such is the nature of the illness. For the rest of the time I can generally live a fairly stable life, albeit with a few ups and downs. But illness for me can be catastrophic. When I experience hypomania it can feel wonderful for a while but soon comes the crippling anxiety and then the huge plummet in mood where I have to press the pause button on my life until I feel well again.  

Unlike a lot of physical illnesses mental health conditions are often treated with minimal expert intervention. If it is a severe and enduring condition then you may be diagnosed and prescribed medication by a psychiatrist but then you can go for years without seeing a doctor. That is until you hit a crisis point.

Unfortunately, there are few options when you are having a crisis. In my work as a script advisor for a mental health charity, writers tend to always go down the route of someone being hospitalised voluntarily or under section when they are unwell. In fact, the number of hospital beds for people with acute mental health conditions, has fallen by almost 30% since 2009. People are becoming much more open and aware about mental health and it is firmly on the political agenda but these facts speak for themselves. You may be aware of your mental health condition but you may not be able to get help for it.  

So, in a crisis you are advised to phone the Samaritans. This is a service I have used many times and they are fantastic. But they are a listening service. They are unable to advise on what to do. In extreme cases you are encouraged to take yourself to A&E. We all know how stretched the NHS is and busy emergency departments are not the best place for people in a mental health crisis. Again, I have done this on a few occasions in a bid to keep myself safe. What this generally means is hours of waiting in a busy ward to be seen by a psych liaison (if you are lucky) and sent home with a sleeping pill.

If you have attended A&E in an emergency you will hopefully be referred to community healthcare where you may be visited at home for a few days by a team of doctors, social workers and nurses. Again, I have had this treatment a few times and it has varied in usefulness. I have also been told that I should consider myself lucky to have my life, asked what I have to feel depressed about and also told I should pray. Not useful advice when your confidence is at an all-time low and you are already feeling guilty about ‘using resources’.

But then when the crisis is over often so is the care and this is the real issue. Unless you are actually at the point of planning to kill yourself there is often no help available. This doesn’t mean you have had a few suicidal thoughts, you have to confess to being in the middle of a suicide attempt. When people’s lives come crashing down in a mental health crisis, they need help. Urgently. According to Mind Only 14 per cent of people in crisis got all the help and support they needed.

I didn’t realise that at one stage I was one of the lucky ones. Until last year I was under the care of a local bipolar clinic which meant I did have access to appointments every few months. But such is the nature of my illness, I was well, I was well for a few months and so I was discharged from the service. Although I was told at the time that if I ever needed to see a doctor I could just ring them which I did in the middle of my most recent depressive episode. However I was told I would need a new referral from my GP. This was made, and I received a triage phone call a couple of weeks later. I was asked the usual questions.

‘Have you had thoughts of killing yourself in the last week?’

‘Do you have thoughts about harming anyone else?’

‘Have you experienced any psychosis or paranoia?’

Of course, at this stage the answer to all these questions was no, a couple of weeks had gone by, I had increased my medication, I was no longer feeling suicidal. The conclusion was that I was no longer in crisis and so I wouldn’t be able to see a doctor.

Then came the pleading. I still was very unwell, I wanted to change my medication, I didn’t want to reach meltdown again, could I please see a doctor. The answer was still no. I went back to my lovely GP asking for a change in medication but they insisted it would have to be prescribed by a specialist. Too unwell to be seen by my GP but not ill enough to get a psychiatrist appointment.

Over the next few weeks I didn’t get any better and went back to ask to be referred again, mentioning the fact I had been having thoughts of suicide. This seemed to do the trick and I was rewarded with a psychiatrist appointment. The only issue being it was in four months time.

Fast forward to the golden ticket (the appointment)  when I finally got to see a doctor. I still wasn’t well but had returned to work and tried to pick up my life again. I got my ten minutes with him while he asked me all the usual questions (see above) and I spoke to him about my desire to change my medication. I had done my research and had a pretty good idea of what might work for me as what I was taking was clearly no longer doing the trick and has the side effect of not being able to function in the mornings due to heavy sedation.

The conclusion? He could see no need for any change in my treatment and referred me back to the bipolar clinic, an appointment was made for November, seven months after my first referral.

The doctor also wrote a report for my GP that I got through the post this week. It was interesting reading but the bits that leaped out at me were:

She presented as a well-kempt and appropriately dressed young lady She made good eye contact and good rapport was established. Objectively she appeared a bit anxious with a reactive affect.

What this means is that I just did not appear sick enough. Had I have attended in my pyjamas or fancy dress would this have meant I would get help?

He concluded of course that I was not actively suicidal. This for me is like a doctor telling someone that they have heart disease but that they cannot get any treatment until they have a heart attack.

We often hear of cases where people have gone on to take their own lives after begging for help. One of these cases that touched me personally was the death of journalist Sally Brampton. I had worked with her professionally and was in awe of how open she was about her depression. When she died I was tasked with making a short film in tribute. People often romanticise suicide and this was the case here. Everyone from fashion designers to former colleagues talked gently of how it was almost inevitable and the idea she had simply walked peacefully into the sea was bandied about. Then the inquest came that found she had been desperate for help. She had been in crisis and was failed by the mental health services. All of which points to the fact that she really didn’t want to die and was screaming out for someone to stop her. I read a quote the other day that said that people don’t generally want to die by suicide they just want the pain to stop.

The recent ONS figures that showed a drop in suicide is fantastic news but it should not make us complacent. Suicide is a preventable death and the only figure we should ever celebrate is when there are no deaths by suicide in this country. According to Mind:

We know that a significant proportion of people who take their own lives have asked for support for their mental health within the last 12 months. Nobody in touch with mental health services should reach the point of suicide. 

I met with a friend recently who has cancer for the second time but is also understandably incredibly depressed. Her cancer is being treated but her mental health? She gets the occasional phone call from a doctor. I was talking her through options when she is feeling suicidal but she told me she already had the Samaritans practically on speed dial. The only advise I could offer her was to sign up to Elefriends which is an supportive online community where people can get support any time of day or night. But note this is peer to peer support not medical help. I also told her about the brilliant Maytree crisis centre where people can self refer to and stay for a few days if they are feeling suicidal. It seems ridiculous that this crisis home run voluntarily and probably not able to keep up with demand is one of the only options I could offer her. Her cancer may be treated but it is her mental health that is the real threat to her life.

I am lucky I am no longer in a situation where life is so bleak for me, I am well and I finally got my change of medication but had to go to a private doctor to get this. I do also know that I will end up there again, such is the nature of my illness. It just seems so short sighted to me that instead of regular support and crisis prevention the only time you can ever get help is in an emergency and that often this help is not fit for purpose. We all know that prevention is better than cure and I am so pleased that so much effort is now going into young people’s mental health with everyone realising the importance of early intervention. But  even with a real focus on young people a CQC report earlier this year still found that Some children and young people struggling with their mental health have been told by GPs to “pretend things are worse than they are” to increase their chances of receiving treatment. For those of us stuck in this Catch 22 situation where we have an enduring mental health condition but are just not sick enough to get any help or support things really need to change.

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