Recently I have been wondering about the unintended consequences of this bastion of the nation's welfare state. I love watching '24 hours in A&E' and more recently, 'Ambulance'. Focusing on the most acute needs and how the public services and people who make up the NHS meet humanity at its often lowest and most vulnerable point of need. At its best these television programmes show the dedication and endless compassion and professionalism of our doctors, nurses, porters, paramedics. Bizarrely, you may think, I find both of these programmes uplifting.
From time to time, though there is the exposure of an element of disdain from some of those phoning for emergency help. 'Where is the (expletive) ambulance? I've fallen over...', 'are you breathing?'....'*@!&ing get me some help....', 'Are there any injuries, are you bleeding, are you in a vulnerable position, are you or anyone with you at immediate risk of serious injury or death?', 'No, but you have to sort me out...' and so the demands go on, with long suffering Control Centre staff dealing with the abuse whilst watching the lights flash as serious emergencies build up, requiring response. Perhaps, this demonstrates the truth that familiarity - and availability breed contempt?
Before I was finally diagnosed and was able to access some very good Mental Health Services, locally - flawed and imperfect, but to me an absolute lifesaver! - I remember being contacted via the magic of t'interweb by a former student from my days teaching A Level English. She had qualified as a Neuro Scientist and had secured a post doing research at Harvard. Our email exchanges were enjoyable discussions of my fresh understanding of my own condition and some really interesting research she was involved in to do with brain structures, the limbic system and the impact on mental illness. However, naturally the discussion also included our experiences of accessing health in the USA and UK respectively.
I had received a number of different referrals, starting with my GP who had worked with me to explore beyond an acceptance my 'over-emotional' responses as anxiety and depression, the treatment for which seemed to only offer temporary relief from the patterns identified in my medical history. I was referred to specialist practitioners and consultants until we arrived at a diagnosis which led to a treatment pathway. Most of all, even though it was a label, what it gave to me was a way to understand the pervasive symptoms which had plagued me all my life.
The waiting times in 2011 had not suffered much from cuts in services so waiting times for appointments varied from two weeks to nearly a year. Despite having to wait at different stages, at no time following diagnosis was I left 'adrift', I maintained weekly appointments with my CPN and monthly appointments with my GP until the treatment I was offered had a place for me. Following five years of consistently good care, (there was the odd disappointment along the way), I was discharged with the skills I needed to manage my condition. Thankfully at no point was I forced to weigh up treatment options based on what was left in my bank account (very little as it happens).
My former student, though, shared with me that although she had very good medical insurance provided by her employer, was facing a $50,000 bill following hospitalisation after she had been involved in a serious car accident which led to her being in hospital for four weeks. The bill was for the portion of treatment not covered by her insurance.
So yay for the NHS. However, I have observed in myself along the way some attitudes which could loosely be described as 'learned helplessness' - simply because if I have any little concern about my health all I have to do is book an appointment online or by phone (forget the waiting time) for free to get it checked out. This is where our expectations and the realities of the limits of any therapy (physical or mental health related) clash. Because of the ease with which we can ask for help, I think we can sometimes confuse this with the abilities of any intervention to undo the ravages of time and/or trauma whether physical, emotional or mental. With this mind set I begin my journey towards therapy with an assumption that the professional in front of me is embued with some magical 'fairy' dust called 'The NHS Magic Dust' which they can sprinkle on my area of need and immediately bring about healing.
An unintended consequence of the availability of free healthcare is that when I am prescribed a therapy or medical intervention which requires
The first thing that made me pause for thought following my diagnosis and referral to DBT (Dialectical Behaviour Therapy) was the initial meeting with my therapist when she made clear to me that she could not stop my distress, nor could she remove the emotional pain I was experiencing. However, what I was offered was hope that TOGETHER we could work to develop skills and practises which would eventually help me to manage my condition.
I recognise why A&E staff groan when presented with someone in emotional or mental distress. If I turn up with an obvious physical wound, you can offer me support and even the means to lessen or remove the pain I am feeling.
I wonder if another unintended consequence of the NHS is in regard to our Mental Health more than our physical health. I have blamed the failings of the NHS for not providing a personally tailored solution to the complex emotional and mental challenges caused by a combination of my biology and my experiences of life. Looking at it in black and white prompts me to ask myself: 'who told you, you were the centre of the universe and the focus of all public health efforts?' It also begs the question - without referring to that other Dr - who could possibly undo my brain structures and the impact of my limbic system, or the impact of my life experiences on both of those? Certainly no earthly physician - as far as I know. Yes antibiotics have managed to help us eradicate the threat of bacterial infections. However, I am often reminded of how simple those 'germs' are as organisms compared to human beings. More than any other aspect of our health, our mental and emotional health requires that we are fully engaged and involved in both understanding and managing the struggles that we face.
A Sea-Change in attitude is emerging - a recognition that medicalising and medicating mental health is not effective as an approach, in isolation. As a complex being, I probably am likely to respond better to interventions which see me as an integrated and whole human being, rather than focusing on my challenges in isolation. 'I am not my diagnosis' resounds.
I hope that as we move forward we do so as patients and professionals joining forces to find the best outcomes for each person in need. After all, the NHS cannot possibly be present for the 95% of my life which is where I am fighting the majority of my battles against ill health. If I can do all I can to help myself as much as I can, then maybe I can leave the NHS and its precious resources for when I really need it and therefore release more resources for those who are in urgent need right now.
