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Absolutely mental

It was encouraging, the other day, to be shown a page in the Metro campaigning against mental health stigma. The admittedly fantastic mental health reforms that have occurred over the past few decades worry me, because there’s a danger that people now think the transition is complete. It is not. Mental health is still a taboo. It is still astonishingly underfunded. And those in need of help are now caught in a tricky, well-meaning middle-ground that aims to reduce stigma, but could actually be doing more harm than good for some people.

On the internet today, news broke of a man in Leeds who, after discussing his depression with his employer, was told that the company would have to let him go. The reason? That his difficulties would be likely to lead to prolonged poor performance at work.

Employers aren’t allowed to fire somebody because of illness. Of course they’re not. People get ill, it isn’t their fault, and they should never have their right to work taken away from them as a result. But the burden of proof does, to an extent, lie with the person who is unwell. Do you have a doctor’s diagnosis to prove it? No? Tough: you’re not ill, then.

This manifests in a variety of different ways. Some employers require you to present a doctor’s note if you wish to take more than a couple of days off sick. In the case of mental health difficulties, it can be a lot more damaging. These illnesses don’t go away on their own after a week or so. They require effective treatment, in the long term, and this is at odds with the plans of big business.

But if a doctor will vouch for you, diagnose you with something, present a document to prove that it is the case, then the law kicks in. You can’t have your contract terminated. Unscrupulous companies will of course try to find a way around this – they’ll suddenly decide that your performance has been shoddy in the past, despite having never raised the topic with you before, for example. But at least the system’s there to protect you. If you’re ill, and a professional agrees, the ball should be in your court.

The problem in these cases lies with the NHS’ well-meaning strategy that suggests mental health difficulties aren’t necessarily illnesses, they’re just emotions that people go through from time to time, and the right balance of lifestyle changes and unintrustive assistance can get you back on the right track in a jiffy. In many cases, this is absolutely correct. What’s troubling is that the NHS is already overstretched, especially within the field of mental health, and so this non-diagnosis gets applied across the board.

Suddenly, the burden of proof is back on the sufferer, and this time it is not the employer that is demanding it. Recently I have heard stories from people who, by all accounts, seem to be feeling really rather bleak, displaying all the telltale signs of depression. Their GPs’ suggestions? Yoga. Cycling. Even spirituality.

Diagnoses aren’t handed out these days. They’re seen as unhelpful, and as adding to the already fierce stigma surrounding mental health problems. If you’re clinically depressed, people see you as sick, different, mental. If you’re just a bit down in the dumps at the moment, that’s perfectly normal. That’s what happens to people. There’s an idea that diagnosing someone with a mental illness creates a self-fulfilling prophecy. If you don’t have a diagnosis, the theory states, then you’ll feel more optimistic about your outlook, and that in turn assists those attempting to recover.

But the man in Leeds will now have to convince his doctor to diagnose him with clinical depression if he wishes to take any legal action against his employer. Which, clearly, he should be doing. And it has a knock-on effect for those seeking treatment, too. Therapies with high efficacy rates are being held back from people who need them, simply because they don’t have a diagnosis for which these treatments are available on the NHS.

Oddly, even a diagnosis doesn’t necessarily cut it any more. I know someone with a diagnosed personality disorder. When this person went to their GP, saying the symptoms of this disorder had worsened and they would like to seek therapy once more, they were told that first they should try doing some exercise.

Now, of course, lifestyle changes can make a great deal of difference. But in cases beyond a spot of the blues, they can only be effective in combination with other treatments. It has been demonstrated.

Knowing this, the person stressed that they had a history of mental illness, a diagnosis, and recommendations from previous practitioners that they should continue with therapy should the situation worsen. The GP sneered that diagnoses ‘aren’t helpful’, and suggested that they would struggle to find the treatment they were seeking within the local area.

Pushing for some sort of treatment anyway, this person was told to expect a call back within four weeks. After this time, they contacted the GP once more. It turned out that the promised referral had very intentionally not been made, the doctor having noted that the patient hadn’t contacted them again after the initial assessment, and so probably wasn’t really in need of the requested treatment after all.

I’m sure this is an especially bad case, but these sorts of incidents appear to be fairly commonplace, and even in a brief chat on Twitter today I came across several people telling similar stories. They’re all the more troubling because of the stigma surrounding the illnesses. Sufferers often find it extremely difficult to approach GPs about these sorts of issues, for fear of being seen as weak, immature, needy. Responses like this only confirm these fears.

If you do get therapy for your depression, it’s probably going to be cognitive behavioural therapy, because that has the highest general efficacy rate for anxiety- and depression-related disorders. Yet that rate is only 40 percent. I spoke to my own mental health practitioner back when I was receiving therapy for similar issues, and she admitted that the NHS trusts are reluctant to offer anything but CBT, even though they know other treatments may be far more effective for a specific individual. Why? Because the services are already stretched to the limit of funding. They’re pushing CBT because it’s a relatively cheap and easy way of attempting to cure people – even though, in the majority of cases, it does nothing of the sort.

We need to be prepared to stand up and say that this is unacceptable. That doesn’t mean slamming the NHS and saying they should pull money from where the sun don’t shine. Every area of the NHS is having its funding cut year after year; the issue is not isolated to mental health. The difference is that, with mental health issues, there is no ‘one size fits all’ treatment. Each case demands tailored techniques to help a specific person through their own specific issues. And as our understanding of this increases, it surely seems like an area we should be focusing on improving – not merely settling for a system that’s better than the one we had in the ’70s.

In essence, our current system assumes that the mentally ill, unless they have a serious condition, will simply ‘get over it’ if they try hard enough. And while ever the system thinks that, popular opinion is never going to change.

One response »

  1. There is so much stigma in mental health. I try very hard to be honest with people about my diagnosis of bipolar disorder and invite people to ask any questions they might have on mental health. The vast majority of people accept me for who I am and those that don’t can bugger off.
    Excellent post


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