I Ain’t Happy with the NHS…Again

This uncertainty with C is doing my head in. I spent this afternoon looking online and through Yellow Pages for private clinical psychologists in my area and found the sum total of two such half-decent practitioners, one of whom I’ve already seen (!). I then tried to work out if I could even afford weekly private therapy whilst unemployed – it can be done, in the most literal of senses, but it’ll take about half my monthly earnings to finance it.

Maybe I am overreacting and maybe C has no intention of ending this herapy in January, unless there is some miracle (and if there is some miracle then it is obviously fine to finish in January – but of course there will not be). But the mixed messages from him are sublimely frustrating – “don’t worry, we will never just suddenly end things” and “we will get there” versus “you know this is a finite process on the NHS,” yadda yadda yadda.

Partly the annoyance is with him and partly it is with this stupid bloody system. Sometimes I think we’d be better off with private healthcare after all.

On the one hand, C is the person that makes the immediate decisions on how long he sees his clients (as far as I can tell, anyway), so he could just say to me, “let’s keep on meeting for the next six months,” or whatever. He refuses to lay down any long term plans, ostensibly as he feels it is important to work to short-term-ish goals. I disagree, but at least he has a rationale, and in any event I am no psychologist. However, if therapy is coming to an end in about five weeks then what is the rationale for that when I am clearly still a nutjob?

On the other hand, C is constrained by all the financial bullshit of the NHS, not to mention the ludicrousness of the service’s inherent bureaucracy. No doubt he has targets and timeframes, must palm off the stupid mental within a few months cos the trust can’t (won’t) pay for the stupid mental any further than that and if he hasn’t cured the stupid mental in that time then he is an evident failure, don’t you know. Targets, man, targets!

The problem with this is that it will end up costing the health service much more in the long-run, and perhaps in more ways than one.

Let me break it down.

  1. I am 26. I have been utilising mental health services on the NHS since I was 13. Had I seen a proper therapist for a proper length of time then, how much money could they potentially have saved themselves? Instead, as this post attests, six different public sector salaries were funded, some of the resources of which were devoted to me. Epic fail. (Of course my own money was spent on three other therapists because of the NHS inadequacies. Epic fail again). The point is, one way or another, I will end up back at the GP’s or psychiatrist’s office begging for help yet again, and we’ll be back to square one. Why not just agree a sensible timeframe with someone I know and trust – and clear things up to whatever extent that is achievable – now?!
  2. I am so mentally and – yes – emotionally fragile as things stand that if therapy ends in the near future I am convinced I will end up in the bin. One hour of C’s time per week versus 24 hour care by several RMNs, psychiatrists and auxiliaries. Which one sounds cheaper to you?
  3. A third possibility, and this may be seen as a threat which it is not intended to be, is that I finally can’t cope and do myself in. When my mother and A instigate litigation against the NHS, as they inevitably would were this possibility realised, even if the NHS won hands down, they would be forking out a fortune to fund their fuckhead solicitors. I used to work for litigation solicitors specialising in the public sector. I know what they charge; even for minor cases that are easily contested and won, it is a bloody fortune. That’s not even including barristers’ fees if it came to court, or out-of-court settlements.

Other points to consider are the following:

  1. Dr C is constantly reminding me that psychotherapy is the “mainstay” of my treatment (rather than medicine), yet it seems to be her intention to see me long-term, albeit hopefully only for monitoring purposes once a suitable cocktail of drugs is found. How can therapy be the mainstay of my treatment if I am only seeing her, who only deals with the medicinal and organic sides of things?
  2. I know I’ve ranted about this before, but it so utterly and completely fills me with disgust and contempt that I have worked in both full- and part-time capacities since I was 14, and given 11% of my salary to the health service since I was 16. I had two major breakdowns, including this one, during that time – but it still amounts to, I think, eight years of work. When you think about it, is it really that different from US health insurance? Maybe the percentage figure is lower, but then my employers had to pay a percentage of my salary for my insurance also. So why would I get medium- long-term therapy in America, but I can’t here?
  3. I am familiar with people in other NHS trusts that have been guaranteed therapy of at least a year and a half on the health service. Now, one person I can think of has a lot more issues than I do, and so that’s fair enough – however, that individual is one of five people I can think of off the top of my head. I would hasten an educated guess that I have much more psychological baggage than each of those other four, but if not, certainly two or three of them anyway. Why, then, is it OK to fuck me about? (Incidentally, I noticed none of them had any trouble seeing psychiatrists either, so maybe my trust is just shit. Now it sounds like I’m playing a teenage game of “but they’re allowed it, so why am I not” – but I hope I’m not. I’m just genuinely mystified as to why my case is different).
  4. As stated yesterday, I have been mental for many years. I received my first diagnosis (clinical depression) 13 years ago or so, but as I have discussed here at other junctures, I was mental well before that. Normal children don’t try to amputate their limbs. Normal children don’t hallucinate. Normal children aren’t obsessively paranoid. Normal children don’t deliberately coop themselves up in the house, listen to Bach, read Grey’s Anatomy and seek out the company of the elderly for intellectual discourse. They go outside and play with their friends. So when I said ’13 years’ yesterday, I probably really meant 23, to be honest. Point being, how can two decades of madness be alleviated in less than a year? It’s fucking preposterous.
  5. If I had a physical ailment, the NHS would treat me until it was cured, or, were it chronic, then indefinitely. I am not asking for indefinite treatment for my psychological difficulties, make no mistake. But the striking inequalities between the health service for physical health and the health service for mental health disgust me.

In any case, I cannot see why C has to keep reminding me that the psychotherapeutic process is finite. Of course it is fucking finite, I am not stupid – and I certainly don’t want to be in need of it indefinitely as I want to be able to manage my conditions by myself. However, for the NHS’ sake as well as my own, surely that finity (if that’s a word) ought to be directly correlated with the progress of the patient? Surely it is the height of irresponsibility to discharge someone that is clearly still fucked up and only going to, at best, waste more resources?

Fuck it all to hell. I feel like emigrating.


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12 Responses to “I Ain’t Happy with the NHS…Again”

  1. A very well-argued and rational approach. If you can, bring these points to C’s attention. They are difficult to refute.

  2. I agree with A. I think you do need to discuss this with C which I know is really difficult. But if you don’t tell him what you’re thinkng and feeling he won’t know.

    He should know that fear of abandonment is part of BPD so hopefully he should be sensible about it.

    I have to admit I feel guilty about the fact I’m finally in a position with decent psychological help but I’m sorry you’re not.

    Hugs xxx

    • Please don’t feel guilty – I am so sorry I made you feel that way, it was never my intention. As you probably realise, you are the person I feel is most deserving of their services; you have been through so much and really, really deserve the help you’re receiving from the NHS. Please don’t feel guilty, I’m sorry.

      As for C, well – as you know, we had a really horrid session yesterday in which I brought some of this up. I will write about it in the next few days.

      Hugs honey x

  3. Your analysis of the NHS approach to mental health is quite correct. It is massively over-funded and there is corresponding massive waste on failed diagnosis and failed treatment.

    The real problem with C is not that the treatment is finite, but that the treatment has almost no chance of leading to your recovery, no matter how long it might continue.

    If you do want to consider private treatment, a clinical psychologist is very unlikely to be a good choice. The CBT Register is a better place to start. I can sometimes find other practitioners whose details are not visible in the public database — e-mail me if you would like me to look.

    • Thanks for the link and indeed for your kind offer to check other therapists; I may well take you up on that. The only thing I’d say is that, having been through CBT and found it distinctly unhelpful (sorry), I’m concerned about that being the only type of therapy these people practice. The website of one of the local therapists on the CBT Register did say he conducts schema therapy, though, in which I’d be more interested (although, as I understand it, it’s basically an advanced version of CBT ((please correct me if this is incorrect)), I have read that it’s much more effective for BPD than traditional CBT and even DBT ((which I also found unhelpful as many posts here colourfully attest))).

      I’d also had Gestalt Therapy recommended to me, but find that partsof it are slightly iffy.

      I’d be interested in your thoughts on appropriate types of therapy if you have a moment? Thanks as ever for commenting and again for your kind offer 🙂

  4. As far as the US private health care system, it has its own inherent bigotry where mental cases are concerned. In my coverage for instance, because I choose single coverage with no dependents, I pay out no fee and my employer picks up the whole tab. The downside is that I have to meet my deductable of $1200 before my benefits kicks in AND you have to pick up a provider who is in their network. I am (or was) completely healthy outside of my mental status as I never sought medical treatment for anything until this last go-around when I was committed, so I had to pay out of my pocket that $1200 fee before my medical coverage kicked in. And for normal medical cases the coverage is 90% with me picking up the remaining 10%.

    However their coverage for mental care reduces to 50% coverage, leaving me to pick up the remaining 50%. To add insult to injury, the psychiatrist I have been seeing, while within the insurance’s network with previous employers, he is all of a sudden not in my network with my current employer, so I have to pay 100% out of my pocket (the hospital in which I was involuntary committed was in their network, thankfully). Here is another kicker. I am only allowed 30 days/year of inpatient hospitalisation and limited to 50 individual therapy sessions/year. Thankfully, my individual therapist is in their network, but I still have to pay 50% (originally I thought it would be 90% when I saw her the first time—the office made a mistake when I checked out after that first session). Given that, I will only see her once a week; I should be covered for the year (50 out of 52 weeks).

    The sad state of affairs is the stigma that our private health care system places on mental health. While every other medical problem is covered at 90% once a deductable is met (which varies from plan to plan), all mental cases are only covered at 50%. That’s tantamount to saying that mental health diseases aren’t worth paying for at the same level as other health care crises.

    • Eek. That does sound pretty bad, actually, and quite often when I am ranting about the NHS I remain cognisant of the fact that in so many ways I ought to be(and am) grateful for it. I just sometimes wonder to what extent is committed to real care, real solutions, as opposed to bureaucracy and targets. I mean, to be fair, I know its frontline workers are normally so – but they are bound by a sometimes daft system.

      What you describe, especially the inequality between psychiatry and physical medicine, sounds very similar to private insurance here too. A few weeks ago when I was seriously considering admitting myself, knowing that the NHS putting people in the bin if it can help it, I looked at private insurance with a view to going to a private hospital. It would not be possible, sadly, because of the ridiculous stigma these assholes are also attaching to mental illness.

      If you weren’t mental before you tried to use the mental health system, you certainly would be after 😦

  5. Although I’d too inebriated to read your 5000 essay in total, I’d agree with you on a hunch. The services in OZ ain’t much better.

  6. Hi, I totally hear what you are saying. I am having major problems with the NHS too. I suffer from Dissociative Identity Disorder and PTSD and the NHS doctors are trying to convince me that I don’t need any therapy at all. When I dared to question them they went quite berserk.

  7. Hi there again,
    Like I said in my post yesterday, I’m having horrendous problems with the NHS. I’ve found a private therapist whose rates are reasonable and more importantly she is experienced and excellent. I am SICK of the NHS and their bullshit. My entire experience of them has been traumatizing in and of itself. I find them patronizing, negative and judgemental and instead of helping me they’ve gone out of their way to make me feel like a freak and a loser for having issues in the first place. In fact I feel they treat me more like a criminal than a survivor of childhood rape. For me, no more NHS. It was just a big fat waste of time.

    • Hi Pumpkin

      I’m absolutely disgusted that the NHS is refusing to treat DID. You’re the second person I know of that they’ve done this to (Wounded Genius, who comments here sometimes, is the other). What gives? How can they not see that it’s a serious condition caused by horrible treatment as a child? It’s despicable that they’re demeaning you and the severity of your illness like this.

      I’m really glad that you’ve got a good therapist privately, but it’s so sad and infuriating that you’ve had to go down that route.

      I look forward to reading your blog and hope to see you again here 🙂

      To both you and Di – I’ll email the password to the latest post.

      Take care

      SI x

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