Mental health service closures

Whilst working within mental health and mental capacity law, I’ve found that there are many situations which really strike me personally. In particular, I have developed an interest in wrongdoings within mental health services, because I can see the situation from the perspective of the outpatient service user, having been involved with services since 2012.

Access to services is a huge issue at the moment. I was rather lucky in that I was able to gain access to services quite quickly through IAPT, though, once my course of CBT had ended, I was basically left in the dark.

I read something on twitter the other day from a service user, stating that he’d missed an appointment because the letter from the hospital had taken so long to arrive. I mean, in 2016, how is that still happening? It may seem like a small thing to some, most likely to the hospital, but these appointments, in times of both crisis and calm, provide routine and stability for service users.  When I was making regular trips to appointments with mental health services, it gave me a sense of comfort just to know that I was doing something. Had I missed an appointment because of the appointment letter being sent by carrier pigeon, particularly with my anxiety when it was at its worst, that would have been one of the worst things that could happen; from the outside looking in, it seems that mental health services can’t empathise with this or many others’ experiences.

Access to inpatient services is where this real division of interest is shown. We’re all aware of the distinct lack of beds within mental health units, which are needed by those who are usually in crisis and cannot be treated effectively in the community. Yet despite this known issue, more and more mental health units and hospitals are closing every year.

According to The Kings Fund, ‘Mental health under pressure’ (November 2015) 40% of mental health trusts experienced a reduction in income in 2013/14 and 2014/15. The analysis by The Kings Fund confirms what many of us interested in this area already know – there are more and more people being detained under the Mental Health Act (a 9.8% increase in 2014/15 compared to the previous year); a lot of these actually receive poor care, particularly when in crisis (only 14% of patients say that they received appropriate care in a crisis); the number of beds is decreasing, meaning that services cannot meet the demand; and, despite this, mental health units continue to be closed down. So, what is the outcome from that? People are either left without the help that they need, or are detained in a hospital somewhere far from home, far from normality, and far from comfort. According to a Freedom of Information request by the Community Care and BBC News, 4,447 patients were sent out of area by 37 NHS mental health providers in 2014/15. 88% of the 4,447 were sent out of area due to beds being full.

I have been looking in to closures of mental health units and, even if you just give it a quick google, you can see the scale of the problem. By way of example, in October 2015 Bootham Park Hospital, York’s only public adult mental health hospital, was closed following a report by the CQC, with 5 days’ notice being given. How many people did this affect? 30 inpatients and 400 outpatients. When something like this happens, particularly with such short notice, it must be like being abducted, and ripped away from everything you knew. In February 2016, Outpatient services resumed, after a huge amount of local pressure. However, for those patients in crisis, requiring inpatient care, they, and their families, are expected to travel 50 miles.

50 miles isn’t the worst it could be. There are instances of people being placed 300 miles from home. But, when these patients are very unwell, to be placed in hospital in a completely new area, in my opinion, surely can’t help them in the short term. Whilst detained under the Mental Health Act, a patient can be granted section 17 leave from their Responsible Clinician. I can’t imagine how difficult it must be to enjoy leave in an area you have never been before. Leave is a way of readying patients for discharge, but, certainly for those with anxiety, going out in the community in an unknown area would be incredibly daunting, and could even be a bit of a step-back. It’s hard to see how having leave in a town 100, 200, 300 miles from home is going to prepare you for living in your community.

Another example of mental health unit closures, resulting in patients having to travel, and one that is actually happening right now, is The Welland Centre, in Market Harborough. I came across this closure in an article a couple of weeks ago – The Welland Centre, which provides adult community health services, hosts clinics for up to 450 patients. That’s 80 patients each week and approximately 4000 appointments each year, and patients will be expected to travel elsewhere to access the help that they need.

One patient of the service has developed a petition to save the service – https://petition.parliament.uk/petitions/131744 – which currently has 764 signatures, one of those, of course, being my own. Should the Welland Centre close, patients would be expected to travel for one hour and a quarter to reach the service. For those who do not drive, like myself, this is two bus journeys. When I was having regular appointments with mental health services at Warwick Uni, I had to travel by bus from where I lived in Leamington Spa onto campus. Sometimes, when I was feeling particularly low, I simply couldn’t do it. I had so much anxiety around the University campus, the bus, the students, that I physically couldn’t get on the bus to get to the appointment sometimes. I probably never would have attended any appointments if I had to take two buses.

Now, putting my legal hat on, one big issue for me in situations involving closures of services, is that patients, families, and those who simply have an interest, do not know that the law can assist. When people are informed that their service, usually a service they have used for many years, is closing, they can feel alone. People generally don’t know (and, to be honest, why would they) that there are possible ways to legally challenge the decision to close the service – to go back to Bootham Park hospital in York (https://www.theguardian.com/society/2016/mar/14/the-nhs-mental-health-hospital-closed-with-just-five-days-warning), lawyers are representing the families of some former patients of the hospital and are seeking a judicial review of the “forced closure” of the service.

Judicial review is where a case is taken to the High Court, and it is argued that a decision of a public body is unlawful. This could be that the body has acted beyond its powers, or has not taken something into account etc. Obviously, there is no guarantee that any challenge would be successful, but I think that it is vital that there is something that can be done legally, at least to try to stop any decision to close a service.

That is why I really enjoy working within this area of law. Despite all of the issues with mental health services, and despite the general thought that lawyers are cold and can’t help real people, I like to think that in this area we actually could make a difference and, if a difference can’t be made, it is always nice to say we tried.

 

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Mental Health and Exercise

Whichever mental health charity or self-help website you visit, there is always a common factor – exercise is good for your mental health. Ever since I was diagnosed with generalised anxiety and panic disorders in 2012, I have been scouring the internet looking for ways to not only understand mental health, but to aid my medication through natural remedies.

Unfortunately, exercise has never been a strong point of mine. I really, really am not a fan. So, even though I was seeing constant advice on the benefits of exercise in mental health, I didn’t bother. Surely exercise couldn’t help THAT much. I think my downfall here was that I saw the word ‘exercise’ and immediately presumed that that referred to a 10 mile run, which I am most definitely not capable of. I did find that a short walk to the shops helped to clear my mind and, when my anxiety was at its worst, going for a ten minute walk at a certain time each day gave me structure and was a little bit of an escape route from the stress of the future.

It has only now dawned on me that these small ten minute walks count just as much as a 10 mile run – exercise is great for mental health, but that doesn’t mean that you need to push yourself to become a bodybuilder. Whatever you feel capable of, perhaps like me it is only a ten minute walk, it really can help.

I read an article today entitled ‘Going on nature walks is good for mental health’. Coincidentally, I have just returned from a lovely long weekend away with my incredible partner. We went to the Lake District and some of the scenery was simply breath-taking, really putting all of life’s worries and anxieties into perspective.

lakes

The article focused on a study which has found that taking a walk in a natural environment can bring about positive changes in the brain and may help fight depression. Previous studies had already found a link between walking in a natural environment and an improved mood and decrease in anxiety.

It seems that I had been doing the whole ‘exercise’ thing right this whole time, I just didn’t know it. So, if like me you do not plan to become an Olympic athlete any time soon, take a 10 minute walk. And, if you decide to walk for longer, then all the better. Sometimes we just need to get away from the hustle and bustle of life, a nature walk can do you the world of good and really does take very little effort. My advice would be to set a time slot, one that you do not deviate from, in which you can go for a walk – whether to the shops, to a beauty spot or just to the park – and make this time slot ‘your time’.

Because my anxiety and panic disorders truly came to fruition during University, I had very little structure at that time. Exams were over, there were no lectures to go to and I really was left to my own devices. That is dangerous, because if you have nothing (or think you have nothing) to get out of bed for, then that’s where you’ll stay. During cognitive behavioural therapy, my therapist stressed the importance of structure and suggested that I have a set routine each day. This way, it would make me less panicked about the unknown, as I had a plan of what I was going to do each day and when I was going to do it – my therapist liked the idea of having meals at certain times of the day, waking up and going to sleep at the same time each day. That was difficult to do at University and I didn’t really listen to my therapist as much as I should have, thinking that going to sleep at 10pm one night and 3am the next surely couldn’t impact upon my mental health. Now that I have entered the big bad world of employment, there is a natural structure to my day – I have to get up at the same time each day, I take my lunch at the same time each day and I get home from work at the same time each day. So I have naturally created a routine for myself and it really helps a lot!

I certainly believe that structure is important when living with mental health problems. At the time of my diagnosis, I simply did not have the willpower or the energy to create a routine for myself. I have found that I have gradually slipped into a routine and that it has been the best thing possible for my mental health. Exercise can easily be factored into this routine and that can be as little or as much exercise as works for you.

Personally, I find walking to be very calming and, if the study that I have read today is correct, I had better find some more beautiful places to walk – I’m not going to complain about that!

Me, myself and Anxiety

“The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts)”               Scott Stossell, ‘My Age of Anxiety’

The major problem when it comes to Mental Health issues is not the person, not the illness, but the fact that such issues are surrounded by a cloud of silence and stigma.

Mixed anxiety and depression is the most common mental health disorder in Britain, with 9.7% of the population experiencing it.

During my second year of University, the pressure of exams was looming and I found myself in a place I had never previously been – one filled with anxiety, feelings of failure and a constant fear that I would never be good enough to embark upon the career that I had worked so hard for.

At the time that my journey with anxiety began, I was putting in 14 hour stints at the library – that seemed like normality for the majority of students at my University. I thought that I was fine, I had always prided myself on my emotional strength. That was, until it came to the date of my Contract Law exam and I had a panic attack in the library whilst I was attempting to read through my revision notes. It had taken me around two hours to read one page and it was clear that something was wrong. I didn’t want to have a panic attack, but I couldn’t stop it and, honestly, I had no idea what was going on. I didn’t know what a panic attack was, but I was left shaking and crying uncontrollably on the quiet floor of the library, 2 hours before what was, in my mind, the most important exam of my life. Of course, it wasn’t- that was the anxiety talking.

I had been revising for around two months – I should have been ready for exams. I was ready, but my brain would not let me pass this wall of panic in front of me.

Funnily enough, I actually had no idea that there was a problem with my mental health until the day that I had that first panic attack. Following that, things started to click in to place and I realised that, for the two months prior to that panic attack, revision had taken over my life and I was rarely eating and barely sleeping. My room was a mess (which was very unlike me) and, in all honesty, I was too.

I sought help from my GP, and utilised the help of IAPT. I was given medication to help to control my anxiety (Citalopram worked really well for me and I, thankfully, haven’t had to chop and change pills to find what suits me). I attended Cognitive Behavioural Therapy which taught me to change the way that I thought. Apparently, doing this means that I am in a minority – a YouGov survey of 2300 adults in Britain carried out for Mental Health Awareness Week 2014 found that one fifth of people who have experienced anxiety do nothing to cope with it. Indeed, fewer than one in ten people have sought help from their GP to deal with anxiety.

At first, admitting that I had a problem made me feel that I was weak. Once I had come to terms with my anxiety disorder and felt that I could tell those closest to me about it, I found that most people’s instant reaction would be to ask ‘Well, what are you anxious about?’ There was absolutely no malicious intent behind that question, it was just a question that simply could not be answered. As Critchley (2009) has stated, “If fear is fearful of something particular and determinate, then anxiety is anxious about nothing in particular and is indeterminate”. It can be difficult to come to terms with the fact that you have anxiety whilst at the same time having absolutely no idea why.

Now that my anxiety disorder is behind me and I have learnt to cope with any feelings of anxiety that I may experience, I feel slightly angry when I look back at that time of my life – that I didn’t know that I had a problem until it was too late. If only more people spoke out about mental health issues, and the help available were promoted further, people may not have to wait for their mental health issues to manifest themselves externally before they are able to receive help.

People simply do not talk enough about mental health issues and, even whilst writing this, I feel a sense of worry that people may look down upon me because of my experience with anxiety. That is wrong.

In the UK, one in four people will experience some kind of mental health illness in the course of a year. That’s a lot of people, and it’s likely that the majority of those people are too frightened to speak about their experiences, for fear of discrimination and being ridiculed.

We need to raise awareness of mental health issues and let people know that it is ok to speak out about their experiences. Speaking of your experiences with a mental health issue, whilst a bit daunting at first, is actually incredibly refreshing and, you never know, you could be the difference between someone suffering in silence or attending their GP and getting the help that they need.

During Cognitive Behavioural Therapy, I learnt more about what a panic attack was, and what the early signs of an attack were for me personally. Some techniques which helped me included focusing on something other than the attack. It used to be that I would be so worried and anxious that I would have a panic attack that I brought one on myself. My therapist told me to focus on colours, perhaps the colours of different leaves on a tree. I personally preferred to rub tea tree oil or some other scent on my wrists and simply focus on smelling that. It sounds so simple but it really did work.

Another simple thing that can make a huge difference is to talk about any issues you may be having with those around you. I was able to talk to my friends and my partner who were incredibly helpful and, as some of my friends also had mental health issues of their own, I was able to use some of their advice (the smelling scent distraction actually came from my best friend whose mum is an aromatherapist).

I also really like ‘The Quiet Place’ at http://thequietplaceproject.com/thequietplace which had the effect of basically bringing me back to normality. For me, my anxiety was mainly linked to exam stress and the general hardship of life. The Quiet Place is great as it allowed me to take a step back and really put my fears into perspective, the majority of which were totally irrational.

Mental Health is no longer something that should only be spoken about behind closed doors and I hope that we, as a society, are now moving in the right direction towards a better understanding of mental health issues and a more accepting approach towards those who suffer. In talking about mental health issues, we raise awareness and it is that awareness of such issues that will help those suffering to get the help that they need.

I have struggled with anxiety and have overcome it, hopefully by speaking out we can help others to do the same.