I’ve been back in secondary care mental health services as a patient for almost 18 months and I’ve been reminded just how grim and dehumanising they are. There is a distinct lack of hope. Not once has any clinician I have engaged with encouraged me to believe that I might regain good mental health and reclaim a life that is worth living. The psychiatrists have been the worst and have made me feel reduced to a suite of diagnoses and cluster of symptomatology rather than witnessing me as a whole person with substantial life experience and colour who has found themself in another episode of very poor mental health. In most respects, they’ve indicated that my identity as a middle-aged queer cisgendered person is irrelevant, despite and especially when I’ve tried to explain the extent of my trauma: the impact of growing up in poverty in a crumbling Northern city in the ‘80s, feeling minimised and othered for being a queer kid with a striking intelligence.
I accessed secondary care for the first time at 19, and it terrified me. The psychiatrist I saw reminded me of a stern schoolteacher – it was made clear that I had ‘failed’ by becoming unwell, and I was then discharged after being prescribed a very damaging medication to which I had become addicted. I volunteered to return to services at 26 after developing severe complications with withdrawal from psychiatric medication. Not realising how the system worked at that time, I then saw a series of impersonal, inappropriate and ineffective psychiatrists who did nothing but seek to crush my spirit and sense of self, and impose an ‘illness identity’ onto me at a time of youthful optimism. I remember being told I was ‘doomed’ when I asked about prognosis. Moreover, not one of them offered any expertise about what successful deprescribing might look like, resulting in several very risky and disastrous attempts to withdraw from drugs that were destroying my libido and sexual function in my twenties (a side effect which most psychiatrists did not deem to be ‘important’). After seven years of listening to their rubbish and becoming more reduced as a person, I discharged myself with the words of my outgoing psychiatrist ringing in my ears: ‘You’ll be back’. Sadly, despite great consternation and out of respect for my GP who didn’t know how to proceed, I decided to return some 13 years later after I had gone into crisis at the age of 46.
I’m still there now, 18 months on, and, oh my goodness, it feels just as bleak as it ever did, if not worse. Everything about secondary care seems so lacking in optimism or encouragement. Apart from the tokenistic and bland ‘recovery college’ where patients are supposed to magically master their mental distress through a short course on positive thinking or a pathetic ‘life journey’ storytelling course, there appears to be no real ambition for people accessing mental health services to have any sense of rich and meaningful lives. It feels so incredibly damning.
Everything I’ve experienced during this third period of accessing secondary care again has felt soul-destroying, right down to the miserable buildings where services are delivered which have either been ‘tarted up’ to make them seem more inviting or rebuilt to be ‘recovery-focused’ despite the ongoing rancid culture, which no lick of paint or glazed courtyard could ever eradicate. Reception and administrative staff seem irritated by and afraid of patients, often addressing them like annoying children and speaking in infantilising and condescending voices. Therapists and clinical psychologists seem lacklustre and formulaic, feeling wedded to contrived formulations based on esoteric ideologies and theory, some of which are very offensive. They pretend they don’t know anything about the medical model which just seems incredible given the environment they work in. Nursing staff seem robotic, often resort to platitudes and cliches about how to live a good life, based on zero understanding of an individual’s unique world view, values or aspirations. And psychiatrists come across as disinterested, with tunnel vision about medication and diagnosis only – sitting at the top of the tower, wilfully oblivious to all other areas of secondary care or wider expertise in tertiary services. If the true essence of the ‘bio-psycho-social’ approach were in place, mental health services might manifest some credible intention to help people manage mental and emotional distress, making a genuine commitment to protecting their quality of life.
I’m genuinely at a loss as to what benefit secondary care offers a person experiencing problems with their mind. Sure, they can offer ‘treatments’ and ‘containment’ when required. But apart from meagre attempts at symptom management and harm reduction, where is the real commitment to helping people find peace of mind and fulfilling lives? I find it so massively dispiriting that secondary care fails to offer any real hope of a way through difficulty, towards a life that is worthwhile. Instead, it ties itself to risk management and avoidance of potential litigations stemming from their own negligence. The humanity has gone. I am not confident it can ever return, or as I reflect on it further, if it was ever there in the first place. Our mental health services have got to do better than this and wake up to the fact that they’re in the business of people’s lives and not empty, commodifying, process-driven clinical ‘outputs’ only. When a commitment to hope within services is non-existent, those of us who are struggling with our minds can feel like our lives are meaningless, leading to genuine despair. Giving feedback to services seems to generate defensiveness, or worse still, insincere gestures of ‘co-production’ which ultimately tick a box or at best, consult on the naming of new wards or the colours of paint schemes.
I refuse to let secondary care rob me of hope. My life is too important to be restricted to a place of hopelessness and six monthly medication reviews with a resident doctor who furiously flicks through a copy of the British National Formulary, completely out of their depth. I matter.
About the author
The author is a middle-aged queer person who works as a therapist. In their private and professional lives, they witness how damaging mental health services can be for the people they are meant to support, care for and help.