Thursday, 24 March 2011

Treatment in the UK

Following on from my last blog I thought it was time I wrote a little bit about what is available in the UK in the 21st century by way of treatment for the mentally ill. The majority of people will come under the care of Community Mental Health Teams (CMHTs). This can be a simple matter of visiting your GP and them prescribing medication or referring you to counselling. For slightly more serious cases you may need to see a psychiatrist who will prescribe the next level or drugs or refer you for other therapies and/or specialist counselling. You might be allocated a Community Psychiatric Nurse (CPN) to help monitor and support you in taking medication and associated services. You might also be allocated a Social Worker to help with the day to day business of things like shopping, finances, housing etc. (the practicalities of living in Britain today).

It is important to note that all the above are done with your own consent. If you are ill and only need this level of support you are not forced to take any treatment at all, although a lot is done to try to persuade you to agree to it for your own safety and well-being.

The only exception to this is when people become so ill that they merit being sectioned to stay in a hospital (or committed as it's known in other countries). I personally loathe the term committed as it has connotations of someone being guilty of a crime, which when you are ill is hardly fair. A thought occurred to me about forced or imposed care e.g. forced injections or medication. This only happens when the sufferer is so ill that the medical professionals consider them to be in danger to themselves. Is it any different then to a person arriving at an Accident and Emergency department after a car crash? Medical teams then don't stop treatment, refuse a blood infusion, pain relief, an operation or decide not to restart your heart in such circumstances. It is given that they will do all they can to keep you alive without your consent. So it is when people are sectioned.

That said, I know from my own experiences of being section back in 1998 that once in hospital consent is still sought first. It was pointed out to me that if I refused medication the medical team could force it on me but they left me time to come round to the idea of accepting that medication. How long they would have waited for me to agree I don't frankly know. It was a bit of a fait accompli but I'm glad that they gave me that time nonetheless. I did need the medication then and still need milder medication to this day because unfortunately my brain doesn't tick quite right without them. It is no different to me to a diabetic needing to take insulin to correct a lack of a chemical that nature/genetics has inadvertently missed giving them.

The interesting thing about that is that it is widely considered that you are ill if you take medication on a regular basis even though the drug you are taking maybe a corrective one for a deficiency your body has e.g. thyroxine (which I also have to take). The truth is you can be well with the medication and are likely to be ill without it, just as a diabetic would be. It's another example of how public and indeed medical perception needs to change to become in line with what is actually happening.

A word about thyroids.... Very approximately until about 30 years ago, under and over active thyroids cause people no end of trouble with their moods and behaviour. Sadly there are still some GPs who are unaware that the corrective measure of thyroxine can totally cure this as too many people that get diagnosed with depression when in fact it is a thyroid gland malfunction that it actually the root of the problem. So if you experience lows, make sure you get your thyroid function checked out first and the solution is incredible simple.

The book listing the number of conditions (DSM-IV - Diagnostical and Statistical Manual of Mental Disorders - 4th Edition) is about an inch thick. The list of medication is just as long. This is good news for sufferers as it means there are a myriad of options to try. It means that it is now largely recognised that everyone is different and that their metabolisms will respond to different things. Gone are the days of every sufferer being subjected to the same brutal and drastic measures of the 1950s (lobotomies, Electric Shock Treatment or insulin shock treatments). Gone too are the days of 30 years ago whereby merely suppressing symptoms and not addressing the root cause for the malady was common practice. For example GPs will not (or should not) prescribe Valium for more than three days at a time as it is now recognized that it can become addictive. Tranquilizers, like all other forms of medication for the mentally ill (e.g. antidepressants and mood stabilizers) come in a variety of forms so that the sufferer only has to find the one that works for them.

Other Treatments
Top of the list is the myriad of forms of counselling e.g. Gestalt, Cognitive Behavioural Therapy (CBT) Cognitive Analytical Therapy, to name but three. Again the idea is to marry the treatment with the individual sufferer and not to go the route of one form of treatment cures all.

Additional to these are Art, Drama and Sport therapies which can help build confidence, self worth and self-esteem. They have also proved effective in helping people to reintegrate and socialize with mainstream society. Cooking, Gardening and social clubs and activities such as day trips are useful in this way too along with courses to help build up skills for work such as wood and metal work, computer and photography classes.

The main supplier of all these services tends to be the National Health Service here in the UK, but not for all services. You'd be extremely lucky if you were able to access Art, Drama and Sports therapies outside of hospital so these are more commonly offered by mental health charities such as MIND as activities rather than as therapies.

All these elements are essential to cover the 25% of the population who become ill under the extremely varied conditions under the mental illness banner. There is just one problem. Demand exceeds supply and funding is woefully behind where it should be given just how many people are effected and become ill. This is not only true of the NHS and it's services but also true of all the mental health charities, social services, research and associated services.

The brain is the most complex organ in the body without a doubt. So far it is thought we only understand a tenth of how it functions. Aside from automatically controlling other organs it defines who we are. It seems therefore bizarre to me that it continues to be such a low priority when it comes to finding cures and treatments when it hits a problem, for as I've already pointed out in previous postings - no one is immune from that no matter how much they may wish to kid themselves otherwise.

When we look back now over the history of Mental Health Care we can clearly see it has come a long way in the last century. I am hopeful it will continue to make great strides in the future and indeed within my own lifetime, but it does require more dialogue with sufferers and more funding to develop and refine treatments further. I like to think the most brutal and barbaric treatments are firmly a thing of the past and would like to thank all those responsible and participating in reshaping treatments so that they are indeed more humane than of yore. There have been decades dedicated work from thousands of people to get us this far. For me the biggest challenge, and the one that's gumming up further development is to eradicate the stigma. If we can ditch that one, change people's mindsets on what can be done then perhaps all else will fall into place.

PS: I'm off for a meds change myself now, so may not be blogging quite so often. This was never intended to be a site whereby I shared my experience of being ill. It has always been my intent to to write about the issues that prevent recovery and more to the point what works for me. The reason I'm going for more help is not because I have gone back to merely surviving life - I'm still very much living it - but because recent pressures have put me at risk of becoming ill again. My moods have been darker recently and that's a trigger for me to take action. Therefore I am taking the precaution and preventative measure of getting the help I know I need early on to avoid a prolonged or intense episode emerging. That is what the ideal for long term sufferers means... we learn to manage our own health so that we stay well.

Remember, none of us are ever obliged to share anything of ourselves with anyone and I am no exception. I'll be back with whatever hints and tips I come across once I have got myself back as myself. I have spent too much time being well to ever want to risk being ill again. Or to put it another way... I need a bit of 'me' time to recover from recent events.

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