‘My View on the Mental Health System’ – Invisible Illnesses and Waiting for Crisis

Lost in the Echo
Lost In the Echo by Anna Vanes (c)

Those suffering seriously with illness but able to, apparently, from the outside, function relatively well, may need a health crisis before they find their care needs being met. The assumption for such individuals (often internalised by the person themselves) can be that as long as they are able to perform the basic tasks in their daily lives, they do not need or deserve resources or attention.

Delaying or denying treatment to such individuals until a breakdown or peak of crisis can mean greater personal harm for the individual and more costly and extensive treatment needed for the individual. From all perspectives, a more attentive and early intervention approach is sorely needed from the healthcare system.

Individuals must, in the absence of a well-funded and effective healthcare system, be advocates for themselves. This means, overcoming internalised stigma of seeking help and overcoming barriers to access placed in their way, whether from commitments such as employment or by resource-starved healthcare systems. For individuals experiencing social anxiety or depression symptoms, this need to be assertive and an effective communicator can be an unassailable barrier to receiving necessary attention and care.

“i end up feeling guilty for needing that appointment,” a blogger writing about their mental health journey shares. “i am always aware at how stretched the GPs are and dont want to feel that i am wasting their time.”

Work and other commitments can make attending an appointment difficult. As a fast food worker explained, she is given her shift times from week to week, meaning that it is “almost impossible” to schedule a doctor appointment in advance.

In the UK’s NHS, patients are typically entitled to 10 minutes to see their doctor and with internalised self-doubt and busy waiting rooms, patients may feel pressurised to accept less than this. For individuals with mental health issues, such as anxiety, communicating with a doctor effectively under this pressure can be difficult. This is exacerbated in cases of multi-morbidity, where multiple illnesses are present and interact, making understanding, diagnosing and treating more complex.

GPs (General Practitioners) in the UK report being overwhelmed by patients to the extent of their judgment being affected by fatigue and irritability. One in 10 reported seeing some 60 patients in one day, double what they consider to be safe. Medics surveyed were working an average 11-hour day, including three hours of administration. One Hertfordshire GP said: “There is a point where I feel cognitively drained; after about 20 patients, there is not an iota of empathy left.”

Social anxiety disorder is typically treated on the NHS with Cognitive Behavioural Therapy (CBT). Having completed a self-report questionnaire on anxiety and depression, an individual who passes a certain threshold is referred to therapy. As the mental health journey blogger writes: “you are restricted to how many appointments you are allowed to have and the waiting list is huge. For some people Therapy needs to be longer term, but that isn’t always available to the people who APPEAR to be functioning well. Going private is so expensive and out of my price range, so it isn’t really an option for me.”

Increasingly, mental health sufferers in UK who have not reached peak crisis point, must turn to private treatment whether in the form of counselling or therapy.  The cost of private treatment and the challenge of identifying suitable and legitimate treatments from the vast array available can be barriers. Without intervention or treatment, individuals may struggle with their illness medically untreated, doing long-term and, potentially severe harm to themselves – until a crisis or breakdown makes them visible to the healthcare system and to themselves.

Image designed by Anna Vanes.

To read the full blog-post ‘My View on the Mental Health System‘ written by a blogger recording their mental health journey, click below:

Reblogged: This Is Me

Little Sketch by Anna Vanes

The importance of early psychological disorder diagnosis is extremely evident in Tamra’s beautifully written blog-post, This is Me, – which must be read in its entirety – in which she provides a lucid biographical outline of her journey from childhood with anxiety and type 1 diabetes to middle-age and living mostly house-bound, suffering a variety of serious health problems.

Tamra’s case, albeit anecdotal, of multi-morbidity, long undiagnosed, suggests that early psycho-therapeutic attention is vital, especially, in such cases of concurrent conditions. Her type 1 diabetes diagnosis helped to obstruct her family’s attention to her psychological difficulties and also became another to ‘reason’ to hate herself for ‘inadequacy’ or ‘inferiority’ and engage in a lifelong pattern of self-harm and, later, self-medication. From this, as Tamra outlines, her health deteriorates, step-by-step, exacerbated by moments of misfortune.

“I come from a family thick with type 1 diabetics. There are six of us that I know of, my father, an aunt, one of my brothers, two cousins, and myself. Type 1 diabetes does have a hereditary link, but not always, and it is extremely rare for it to be so prominent in one family as it is in mine. I was diagnosed at age eight. I felt frightened, I knew what this disease is, I knew how dangerous it is, I knew I would forever have to take shots, prick my fingers, eat carefully, and would probably lose a leg, go blind, and die young. It was the mid 1980’s and these were the possibilities at that time.”

At the age of eleven, she lost her father, as a result of a stroke caused by complications from his type 1 diabetes. Tamra’s rage and self-harm only increased, as she paid little or no regard to her body and condition, “always running sky high blood sugars.”

She began to skip classes and then whole school days as she developed agoraphobia symptoms alongside her social anxiety. Her problems went unrecognised, even by herself. Though she graduated, she went on to suffer similarly in college and in the workplace: “I went through part time minimum wage jobs like a person with a cold goes through tissue. As soon as the anxiety of responsibility mixed with the anxiety of social environments and the outside world got too much, I would up and quit, take some time to recoup and then find a new job.”

Marriage and friends would bring new stresses and risk, alongside benefits. In her 30’s she describes using social drinking and smoking to suppress her pain and fear. A series of serious health crises followed. She underwent triple-bypass heart surgery necessitated by damage caused by her poorly managed diabetic condition and exacerbated by consumption of alcohol and her smoking. She then had multiple eye surgeries and would go on to suffer from hypothyroidism.

At this belated stage, however, her social anxiety and agoraphobia were diagnosed and she started medication and therapy. However, the impact of hypothyroidism and accompanying problems with obesity interrupted her treatments, as did a bereavement and serious accident.

Currently, she describes herself as being mostly house-bound, suffering insomnia and hypersomnia as well as some dysfunction with conscious awareness: “My dreams are so vivid (nothing new there, they always have been) I sometimes think they are real, and my reality feels like a dream. I also have trouble with my memory sometimes.”

It is notable that Tamra describes her brother’s childhood response to her father’s death as to become “militaristic” about taking care of his blood sugar levels – the opposite of her heightened reckless and, even, self-harming response. One can speculate whether the diagnosis of social anxiety and agoraphobia, as a child – even if subsequent treatment had zero effect on symptoms – would have reduced negative judgement of her by others and by herself,  by explaining her behaviours and difference, and, whether the pattern of self-harming could have been diverted.

Image by Anna Vanes

To read Tamra’s full blog-post at her site, tamrakgarcia.wordpress.com, click below.