Personal reflections on mental health services

Hannah Eastcott and Keith Coupland share their personal experiences of mental health services: Hannah as a service user and Keith as an ex-service user, ex-mental health professional, and now peer supporter. We hear their thoughts on what works and what could be better about mental health provision in the UK.

Hannah

I’ve had mental health problems since I was 11, and I’m now 24. So I’ve been involved with mental health services for a large part of my life. My diagnosis is borderline personality disorder and post traumatic stress disorder. I was in hospital for two years, and have been in various treatment centres and rehabs, but my mental health has improved quite dramatically over the last year since I’ve been living in supported accommodation on a farm.

My experience of services has really varied. I was in Manchester for a couple of years and the services there were quite far behind the services I receive now. Waiting lists were a lot longer and there was more stigma.

I’ve had a lot of stigma from staff in A&E about my self harm, and from the crisis team that assessed me before I left hospital. It was a combination of things. The way they spoke and the assumptions they made about me, rather than actually trying to get to know me.

Talking therapies have really helped me to stay well. I have a psychotherapist and that service has been fantastic. There’s a really long waiting list though. I was waiting for a few years and was only offered it once I got out of hospital.

I still use the skills I learnt at Recovery College on a daily basis. Learning from other people with mental health problems makes a massive difference. There’s a level of understanding and respect that you can’t have if you haven’t been through something similar yourself. And it’s given me a real sense of hope, seeing that other people have struggled too, but have managed to recover.

It’s the emotional problems that affect you on a day to day basis and prevent you from being able to function. When professionals are able to communicate on that emotional level you feel you’re being understood and are much more likely to respond to the service.

If I could change one thing about how the system works it would be to improve crisis support. If you say you’re suicidal they won’t actually do much. If you’ve taken an overdose and you’re in hospital then they’ll get involved. There needs to be more input before the crisis actually happens.

Saying you have mental health issues certainly changes people’s view of you. They become much more cautious and don’t know what to say. A lot of people seem to link mental health with violence, or think of the way asylums are depicted in films. We just need more awareness. No big deal, just more realistic portrayals in the media.

Keith

I’d had problems with anxiety and depression since I was 18 and later in life was also treated for schizophrenia-like psychosis. For a number of years I was off work and would just hide in my bed and not do anything, hearing voices a lot.

I had risen to the top of my clinical field as a consultant nurse in mental health. I retired early because of my illness, but I came back into services as an expert by experience and also as a peer facilitator and lecturer.

Treating my symptoms with high levels of medication made it impossible for me to work (as did the psychosis itself). It helped that my case manager was an occupational health consultant rather than a psychiatrist. That was brilliant because she didn’t centre on my illness but on my whole life and my ability to work. She also found me effective psychological therapy that turned my life around.

There’s still a massive expertise gap in the mental health profession. A lot of people talk about shared decision making in mental health, but don’t really allow it to happen, particularly in regard to medication. It’s difficult, especially if someone’s been sectioned. Shared decision making is a good idea though, if properly implemented.

It’s a balancing act really. You want your doctor to show they have a higher degree of expertise on your condition than you do. But you want them to respect that you have a higher degree of experience of your own condition than they have. It’s about bringing both to the table.

Time limited treatment doesn’t work with all mental health issues. We mustn’t keep admitting people and then discharging them. We do want to bring mental health services up to the level of physical health services but we can’t treat them exactly the same way. The focus needs to be on the consistency of the healing relationship as well as the treatment of ‘symptoms’.

There’s been a huge de-emphasis on things like day centres and supported work. But removing those support networks has actually increased loneliness which in itself leads to physical and mental illness.

Myself and another service user help run a recovery college. We are role models for the recovery approach. We can relate our practical experiences, rather than it all being theoretical. The students can see that we are on the recovery journey with them. It has validity by experience.