Rachel Kelly
Writer, Mental Health Campaigner, Public Speaker

Ineffective treatment can be worse than none

I’m de­lighted to share this ar­ticle writt­en by Julia Cresswell.

Julia is now lar­ge­ly re­tired, but spent her work­ing life splitt­ing her time bet­ween writ­ing books, main­ly re­fer­ence books or books about the his­to­ry of En­glish, work­ing on big pro­jects as a lexicog­raph­er and teach­ing at Uni­vers­ity level. For the last twen­ty years this has had to be fit­ted round being a carer, in­itial­ly for a parent with de­men­tia; lat­ter­ly of a son with severe de­press­ion and an­xiety dis­ord­ers. Julia could not have done this with­out the help of her won­der­ful­ly sup­por­tive and patient hus­band Philip.

I read a local paper and a nation­al one week­days, so usual­ly give myself a rest on Sun­days. Howev­er, the other Sun­day my hus­band had a cold, so I thought he might like some dis­trac­tion, and I bought a copy of the Ob­serv­er. There I found a full-page ar­ticle by Rac­hel Kelly head­lined ‘Talk­ing about ment­al il­l­ness helps – but we need money more than words’. No one caught up in the nightmare of try­ing to get qual­ity care from ment­al health ser­vices could dis­ag­ree. But what rea­l­ly caught my at­ten­tion was re­fer­ence to Pro­fes­sor Sir Simon Wes­se­ly, Pre­sident of the Royal Col­lege of Psyc­hiatr­ists warn­ing that a lack of special­ists means ment­al health patients are not being treated by peo­ple trained to deal with their con­di­tion.

This has cer­tain­ly been our ex­peri­ence. Our local Ment­al Health Trust has no one with a special­ist know­ledge of treat­ing Ob­ses­sive Com­pul­sive Dis­ord­er (OCD), a con­di­tion that makes our son’s life a tor­ment. Nor, so far as I can tell, do any of the neighbour­ing ser­vices, de­spite NICE guidelines say­ing that every trust should have one. All that is avail­able loc­al­ly is group Cog­nitive Be­haviour Therapy (CBT) clas­ses, only suit­able for those in the early stages of the il­l­ness. These are a re­cent in­troduc­tion and would not take on a case like my son. The nearest place for ad­vanced treat­ment is 2 hours’ drive away. I did man­age to bully the local trust into re­ferr­ing him there, in it­self some­th­ing of a mirac­le. Treat­ment would have had to be re­siden­ti­al and as the unit is un­staf­fed out­side work­ing hours they can­not take peo­ple con­sidered a dang­er to them­selves. As suicid­al thoughts are one of my son’s com­puls­ions that put us back to square one.

It is not that he has not had treat­ment from the local trust, off and on, over many years. It is that he has not had pro­per­ly qualified treat­ment. The peo­ple de­al­ing with him have done their best, and it is not their fault that their train­ing has not equip­ped them. It is al­ways worth trans­lat­ing ex­peri­ences in the ment­al health field into equivalents for phys­ical health. Com­pare: ‘You need brain sur­ge­ry, but I’m af­raid we don’t have a neurosur­geon on our books, so we’re going to put you in the hands of a rea­l­ly good gener­al sur­geon who is bril­liant with gall bladd­ers.’ An­oth­er pro­blem is that any im­prove­ment, howev­er tem­pora­ry, can be treated as job done – like tell­ing an ac­cident vic­tim that the hos­pit­al has set some of the brok­en bones, but that they are being sent home to deal with the rest them­selves.

The net re­sult of this lack of special­ist care is re­peated failure. OCD is an an­xiety dis­ord­er, so suf­fer­ers tend to have a poor self-image and low self-esteem. For us, the net re­sult has been a har­den­ing of his con­vic­tion that it is all his fault and that there is no cure for him with a steady in­crease in his pro­blems. And this br­ings us back to the Ob­serv­er head­line about lack of money. Charit­ies such as Re­think and Mind are bril­liant at runn­ing events for Car­ers, and I re­memb­er one speak­er talk­ing about how dif­ficult it was to fill train­ing spaces for psyc­hiat­ry. More glamor­ous dis­cip­lines could pick and choose the best; they took what they could get. Th­ings may have im­proved now there is so much more pub­lic­ity for ment­al health, but who is going to choose to be a special­ist in a field where hours are long and de­mand­ing, tight re­sour­ces gett­ing ever rarer while de­mand in­creases, and you are con­stant­ly hav­ing to tell peo­ple the help they need is many months away (my son’s man­tra: ‘If they are going to make me wait six months for treat­ment then I want the treat­ment I’ll need then, not what I need now’), or simp­ly not avail­able at all?

For more in­for­ma­tion about guest blogg­er Julia Cresswell visit www.juliac­resswell.in­fo