The reality of mental health care

How would you react if someone you’d just met told you they thought about killing themselves every morning, noon and night? Would you stay and counsel? Would you falter, lose the words and leave? Maybe it’s happened to you. Maybe, more harrowingly, it’s happened to you with someone you know, someone you work with, someone you love. It happened to me this week, and I faltered.

On Monday, I volunteered at IRIE Mind, a mental health drop-in centre in Hackney working with up to 40 people daily, 365 days a year. Mental health problems don’t stop for the holidays, and you get the sense that any break from a routine which masquerades as normality for the vast majority of service users may be the tipping point into a darker, deeper and more debilitating shade of their illness. The truth is, up to 80% of those hanging out in the centre have a dual-diagnosis, meaning they are drug or alcohol dependent in addition to coping with a wide range of mental health problems, such as depression, anxiety and acute psychosis. Getting better, perversely, is low on the list of priorities for these service users; there is more concern about their next benefit payment, their next meal, their next cigarette, their next tablet. 
In 1999 the Labour Government set out a new, clear mental health agenda, with a National Service Framework establishing seven standards in care and treatment. Ten years later, the Framework came to an end and it’s clear that during that time mental health succeeded in becoming a priority issue for policy makers, health professionals, employers and campaigners. However, there is still so much work to do, particularly in creating equal access to mental health provision and increasing the availability of user-run services. 
The successor to the Framework is the Department of Health’s New Horizons programme, which will take us to 2020. However, with this week’s spending cuts review painting a stark picture of how we’ll endeavour to rebuild our economy, it’s clear that we need to focus on two things: acknowledging the impact the recession has had on the mental health of the UK, and how more job losses resulting from the spending cuts will exacerbate this; and prioritising spending within the NHS so that future cuts don’t adversely affect the capacity of mental health services to support people at a time of increasing demand.
It is a fact that one in four people in the UK will experience poor mental health during their lifetime, and good work has been done in recent years by a number of organisations highlighting the fact that mental health problems are indiscriminate; they unite class, race and age. That one in four might be you. Yet the reality remains that the process of dealing with the impact is potted with inequalities, presenting some eye-openers about the levels of therapeutic care based on who is prepared to speak up. 
I was struck by one significant thing whilst working at the centre; most of the men and women visiting had limited, if any, family and friends. Theirs are not the middle class, educated and Beaujolais-filled breakdowns, the kind you read about in the Observer and then soberly remind yourself to spend more time with your kids. No, theirs are the gritty ones, peppered with life-long psychosis, depression, addiction and abuse. Theirs are the kind which are manifest from poor education, broken homes and lower incomes, and where the chance of their being excluded from family life is high. If you are so broken that you can’t get out of bed, let alone pick up the phone and book an appointment, you need friends and family to do this for you. Help outside the system will, in turn, find help within the system – help which will be personal, relevant and speedy. New Horizons must strive to give everyone this service, regardless of their background, otherwise getting better will never be paramount. We cannot expect a day centre currently running on thrupence and a lollipop to fill that gap. 
As the statistics prove, my life contains loved ones who have suffered – who still suffer – from that most terrifying prospect; losing your mind. By the end of my volunteering I felt as lethargic and joyless as those I had shared the centre with, selfishly acknowledging that I would be able to leave and spend a sunny evening with friends, intellectualising the experience and coming to half-formed conclusions about the shoddy state of mental health care in the UK. I also selfishly acknowledged that should I ever experience mental health problems, I would have no need to go to a day centre and eat lunch with people whose problems would far outstrip my own. I would have friends and family to help me.
I am not armed with the skills to help the woman who told me of her suicidal tendencies, and I know that once we parted at the park she went home to an empty flat with no-one to call, hoarding her meds so she may, one day, take an overdose. A friendly chat at IRIE Mind might just be the start of her recovery process, but centres like this need the funds and the support to make sure that they become a recognised part of that approach, providing the holistic and therapeutic care so lacking in the current prescription-easy, cost-efficient system. Crucially, these centres play the part of the informal support network, with their managers becoming friendly faces prepared to listen, make a cup of tea and put in a call to the right people. 
We need this now, more than ever, as we steer the UK out of these dark days; as Alastair Campbell once aptly said, “It cannot be entirely a coincidence that the word depression has an economic as well as a health meaning.” True, and more poignantly it seems mental health, like so many other things, still comes down to who you know.

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