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Wednesday, May 13, 2015

"The evidence is clear, on every side, piled high and wide, about how..."

"... lately I've let things slide."

Mental Health Awareness Week, May 11-17 2015

No one, alas, was home when the police scoured then smashed their way through the front-door – perhaps both luckily and unluckily.

Only neighbours returning that moment to their next-door apartment, within a lobby of four facing flats, looked on bemused - doubtless embarrassed as well as alarmed for the surrounding plastering.

A stroke of luck, however, came when those poor PCs working a Sunday lunchtime shift shredded apart walls and floors to find, not a body, but instead a stack of business cards perched on a tumble dryer.

Oh, and a message scrawled on a stray A4 page which had been glimpsed from outside by well-meaning health visitors and presumed to be a suicide note – hence the call to Colindale cops to take over.

Bathetically, the sheet was merely a mundane set of requests to a cleaner due to turn up as scheduled two days later, rather than the final dying thoughts of the homeowner.

Who was, incidentally, at that very moment diligently if occasionally a little distractedly scrutinising newswires in an office across town – unhappy, sure, yet ignorant of the panic and police raid inadvertently initiated.

It was only when abruptly, confusedly taking a tentative phone call from those business card-reading cops, offering an explanation just short of an apology, that he learnt what had happened.

But it was on later arriving home, confronted by a chaotic mess both inside and outside, that the extent became clear of what had been brought about by ... merely seeking help.

And - having attempted to remain pragmatic enough during previous weeks of mounting despair, sudden sobs and suicidally grisly visions - that he now just hit the ripped-up floor and dissolved.

A career-long preference has been to avoid using, let alone over-using, the personal pronoun in articles – even if that might then necessitate awkward syntactic contortions.

And yet in this case perhaps that personal rule should come to an end, albeit briefly.


Apologies for the duration of this, honest. Because, dear reader, I was that (not-so-brave) soldier.


It was my private counsellor who instructed my GP, who referred me to Barnet NHS’s ‘Crisis’ service, who in turn called the police, who had the admittedly-unenviable role of turning up to discover a suspected suicide.

Apologies have followed, not just for the failure of health workers to call my mobile or any of the other friends’ and family numbers they were given before blundering in.

The ensuing days also brought more worry, with promised calls and visits delayed for hours, apparently cancelled without warning and once called off because the scheduled health worker ‘got lost’.

In retrospect, much of this seems understandable and fair enough, knowing just how pressurised such staff must be - how many other similar cases, and worse, must be met elsewhere.

But at a time of near-suicidal anxiety and disorientation, the extra stress hardly helped - and hardly provided much confidence in the very structuring and resources of those in such responsible roles.

Budgets for mental health services in England have been cut by eight per cent in real terms in the past five years, with the equivalent of 200 full-time staff lost since 2012 - despite demand rising by 20 per cent.

GPs will typically not only prescribe anti-depressants but refer patients to the NHS-run IAPT scheme - standing for Improving Access to Psychological Therapies.

Up to 16 sessions of cognitive behavioural therapy are recommended - and yet the burden of referrals is such that one in ten patients wait a year simply for assessment and one in six attempt suicide while on the list.

As many as one in five suffer depression at some point, one in 20 A&E cases are said to be due to mental health problems and failings in the system are estimated to cost the NHS £3billion per year.

And a stigma remains, preventing sufferers from seeking help and leading to misdiagnoses or misdirected assistance even when professionals are alerted.

Meanwhile, figures show 62 per cent of Disability Living Allowance and Employment Support Allowance claimants facing sanctions for not working are mental health patients, despite these making up just half of all applicants.

The newly-trounced Lib Dems may be little-mourned by many but their pledge to increase spending by £3.5bn on mental healthcare may be missed far more.

Nick Clegg and new leadership contender Norman Lamb also pushed mightily, while in government, for mental health treatment to be subject to the same focus and targets as physical healthcare.

Of course NHS services of all kinds are overwhelmed. Yet mental health bears an even heavier, if less visible, burden.

This was not (honestly) meant to be the over-written, over-wrought whine of a privileged person shocked by a rare confrontation with such services needed by so many thousands, millions, far less fortunate.

Although ‘over-written’ and ‘over-wrought’, guilty as ever as charged...

Depression had long been a humdrum background, well, hum in my life, from first seeking help as a self-harming student struggling with low self-esteem, anxious ambitions and stifling shyness.

Later came years of alternating between different antidepressant treatments with sporadically more damaging slumps and, in recent years, promises of GP contact towards NHS talking-therapies.

These failed to come, but as a functioning and accepting individual, that seemed fair and fine enough – anti-depressants, for all that some see their use or (over?)-prescription as harmful, felt harmlessly stabilising here.

Better just keep on keeping on, with their help, while waiting for anything further.

Crisis point - and Crisis referral - came after weeks, maybe months, of deterioration in mood, spasms of sobbing, increasing listlessness at home and at work, plus growing preoccupation with past and present failures and how to avoid the future.

On friends' advice, and having been kept waiting for a year for referral to talking therapies, I began seeing a private counsellor based locally - in sessions that swiftly become less about tackling long-term self-esteem issues than coping with current collapsing.

Friends and family and colleagues had expressed worries already about moods seeming bleaker than those usual long-held depressive tendencies.

And, in fact, although wary of admitting this to anyone, even loved ones, I was beginning to admit alarm to myself at how often and easily I would break down in tears not only alone at night, or alone at my desk, but in company.

Not only suicidal ideas but plans occupied my mind, prompting searches for diagrams as to the best and most effective knots for a noose – several of which I tried at home with dressing-gown cords which, once finally satisfied, got kept to hand at all times.

Not just knots – the research took in scrutiny of angles, weights, timings.

Displacement activity, I would tell myself when mildly blither moods settled – better to focus on a goal while knowing it will remain unfulfilled, than simply drift into oblivion in which anything could happen.

And yet, and yet ... The knowledge I would be better off dead, and wish to make it so, would usually clash against the awareness of how others might react – that is, close comrades, especially those who, alive to potential dangers, made emotively clear their potential horror.

And thus, I not only felt hatred of myself and a desire for death, but also immediate guilt at the thought of what that might involve – not for me, but for others. And guilt that they should feel so concerned about and prospectively affected by someone so unworthy.

In dreary sleepless nights, whether struggling to doze off due to swirling emotions or else the body refusing to do anything but cliché-like twist and turn, at times an instinct to recklessly swish across myself with a blade felt tempting.

Several times I did succumb to what felt most like curiosity, searing a razor across arms that for many years had settled into mere griddles of white lines but now became newly-scarred with fat and angry red welts.

Just as much to explore whether, well, doing so did anything. Could this provide some relief – some self-expression – some punishment?

For all that family and friends have offered well-meaning rejoinders, one response that sticks in the mind from someone once close is that I indulged too readily in self-pity.

And yet that too, equally - albeit differently - to compliments, felt jarring and unwanted.

Rather, not self-pity, inviting sympathy, but instead self-fury, expressing scorn.

And yet the self-harm, even if it still occasionally feels appealing, nevertheless came across as unsatisfying.

Not that it actually really hurts when swiping – the main pain follows in the days ahead, each scar however well-tended tending to sting to every touch.

But the familiar old necessary rigmarole, of cleansing, dressing and clearing up, barely felt a fulfilling use of an evening.

Then there came the same old sense of abashment the next day, with potentially ahead the awkwardness whenever exposing arms, say, in changing-rooms or to a new partner's curious scrutiny.

Once finally put in touch with the right people, at the right time, and with no sledgehammers in hand, some tentative progress began to be made last autumn.

A month of very useful sessions with a Crisis team psychotherapist provided clear goals, techniques, patterns of thinking and behaviour - supported by extremely sympathetic and supportive employers and colleagues.

A recent survey by AXA PPP suggested seven out of ten bosses do not believe mental illness merits time off work.

Yet everyone at Metro and its parent company have gone beyond the call, setting up medical help, allowing time off and offering plenty of sympathy and understanding throughout.

Deaths in the family and other difficulties have led to lapses over the months in between initial alarm and the current tentative efforts at recovery and returning to something like normality.

But since that confused initial response from the authorities, individuals have gradually been better co-ordinated - and there was even a recent end to a dragging wait for the next, post-Crisis stage of IAPT assistance.

Having often been struck confronted by the barely-believable stoicism of those forced into refugee camps, Aids clinics and famine-stricken subsistence in other parts of the world, I know all too well how blessed I have been.

Lucky in the love of family and friends, the sympathy and support beyond all measure of bosses and colleagues at work, in a way other employers may have not been so accepting nor encouraging.

And lucky in, for all the glitches glimpsed in these over-crammed and under-resourced National Health Service systems, the eventual assistance and sensitivity of friendly folk doing their bit, doing their best.

And yet, and yet...

Looking at the numbers involved, whether for funding or patient demand, cannot help but fuel fears for so many more who neither get the proper timely help in the first place, nor the right sort of fought-for follow-ups.

And so either stay silent or silenced.

I feel fortunate to be here, grateful for all support.

Guilt at being here, burdensome to be accessing such support.

And fearful for all those missing out much more – and for whom that over-emphatic police knock on the door might follow an alarm not false but too true, and tragically too late.

6 comments:

  1. What a heart-breaking piece. I hope your recovery continues and that you are being well looked after.

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  2. Ah, thanks, that's too too kind - to read, let alone reply... Cheers very much, and best regards back at you.

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  3. An incredibly moving piece that had me welling up. You're an amazing talent, Aidan. Good luck with your continuing recovery and, please, keep on keeping on.

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  4. Thanks very much, for reading and responding so. Far too daftly generous, but cheers muchly - oh, and will try to do so.

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  5. It is a shamefully unrecognised illness mate, thinking of you from over here in Eire

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  6. I've pondered how to reply/respond to your blog since clicking on the link (via Twitter and your piece on the shortcomings in community MH care.
    I am sort of in awe that you've so publicly shared your depression. Whenever I've done this I generally regret doing so and have at times deleted what I've said.
    It's so encouraging to know that your employer is supportive and understanding. I think we all compare ourselves not just to those who manage with the day to day basics that we ourselves at times can't but also to those who manage/live/survive with incomprehensible suffering and loss. In the depths of depression this just further enhances feelings of inadequacy and uselessness.
    I'm here because police bashed down my door. I have a permanent injury as a result of my suicide attempt (which wasn't my first but will have hopefully have been my last).
    I have a great keyworker and my current cons psych is good too. I'm lucky. Others aren't. There are so many factors in play including pre-conceived ideas, personality clashes, mixed diagnosis which impact on care. Care is a mixed bag; the time of day or night it's needed, level of crisis perceived/assessed, local services available, staff numbers, staff morale. It's endless, yet some poor individual- a person, a human being, who is suffering is left in despair trying to
    Explain that they can't get themselves to A&E and then wait for the MH worker on call while barely being able speak through gasps between crying.

    Your openness is appreciated beyond what you will imagine. You have given the gift of hope and helped people to understand what they could not imagine. You have empathised with those who can imagine or who have experienced something very similar.

    I admire you very much. You're helping to make things visible that people are unable to see or refuse to see.

    Very best and warmest wishes,
    Sarah

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