The real impact of mental health care cuts
In July this year my husband took his own life, after a long and courageous battle against the low self-esteem he had had from childhood, heightened by his family’s homophobia. This was later compounded by the incessant demands to tighten the exam factory mode of production in school -where he was an ‘outstanding’ teacher.
He came out as a socialist in his teens when living in one of the few highly prosperous areas of northern England during the Thatcher years. More recently we had both become re-energised by the Corbyn project after years of disillusionment with the party’s support for the neo-liberal project.
However, on a personal level, the widespread harm resulting from the triumph of the few over the many did not really come home until we sought help from the NHS with increasing anxiety and stress-related illness. Following my husband’s serious attempt to take his own life, we went to our GP this February. With sincere regret and embarrassment, he told us he could only offer referral to a long, long waiting list for an initial assessment that did not guarantee treatment.
Fortunately, we had the means to employ a private therapist, not an option for many. However, as this private treatment was removed from the GP and NHS, my husband was able to hide some of his issues and behaviours because his care was not co-ordinated. The privatisation of NHS mental health care mitigates against patient-centred approaches, as private clinicians have no responsibility to keep the GP or NHS advised. My husband took his life one sunny afternoon in July. His secular funeral/celebration of his life was attended by over 160 people from home and abroad and his coffin was carried by his former pupils.
Sadly the failings of the NHS mental health service do not end with his suicide. For me, his wider family and friends, the glaring deficiencies of the service had just started. My GP was most prompt in prescribing sleeping pills, so I was able to get some sleep as we got through the initial stage of inquest investigations, notifications, funeral arrangements, etc. However, when I was referred to the NHS for access to bereavement services, the failing of the system became painful. A maximum six week waiting time for an initial risk assessment overran to seven weeks, when a call centre-based risk assessment was arranged, with no face-to-face assessment on offer. During the subsequent formal complaints procedure I’m pursuing, a response by a senior NHS official on this point was, “if we offered face-to-face assessment, everyone would want one.”
Part of the preparation for this phone call was being asked to complete a standard questionnaire. As the date of receiving the telephone call drew closer, I grew anxious, aware that I would be expected to share deeply disturbing and raw emotions about the suicide of my wonderful and remarkable husband. Given that I had already been coping with his earlier very serious suicide attempt, I was still in deep shock.
I left consideration of the questionnaire until the morning of the call: who willingly seeks to rehearse profoundly distressing emotions? As I progressed through the questions posed, I became increasingly agitated and stopped to walk about to prevent myself from crying, which is itself often physically painful and distressing, convulsing my whole body.
When the telephone call came, I was both apprehensive and all too aware of my poor emotional state fuelled by the standardised questionnaire that I’d just completed. The person at the other end was most polite and at first replies went fine, but after the first page, my earlier distress returned, still at an early stage in the conversation.
When answers to the question relating to suicide were requested, I was hit by the crass insensitivity of such standardised questions - and as my mind flashed to the circumstances of my husband’s suicide, I began to lose concentration. I was asked if there was any history of suicide in our family - yet my husband’s attempted and then actual suicide was the very reason I had been referred to NHS Manchester mental health services in the first place! I don’t remember much after that, only uncontrollable and painful crying, while a disembodied voice was saying “You’re doing really well” - a patently absurd attempt at reassurance.
It took me about an hour to compose myself and for the first time that night the sleeping pills did not work. Leaving a referred patient in such an unstable state, by virtue of the call centre system of assessment, clearly violates the clinician’s Hippocratic commitment to “do no harm”.
A couple of weeks later, I received a letter informing me that my file had been closed, together with a telephone number of local voluntary services to pursue should I wish.
What is most worrying is that bereavement by suicide is considered a most serious mental health issue that significantly increases the potential for those grieving to harm themselves, including suicide. If such serious and common health risks are treated with such neglect, what hope is there for non-suicide rated illness?
Over 20 weeks after first being referred to NHS mental health services for bereavement by suicide treatment I am still awaiting that support. My husband and I had been together for 21 years.