Friday, 7 December 2007

Tell me, Chicken - have you met Egg?

According to an article in the Guardian this week, patients in mental crisis are not getting the NHS help and treatment that the Government has promised.

Here's why I think this falls under the category of "No shit, Sherlock!"

During the summer, I was referred to the local mental health team for CBT. I managed the initial appointment, and blogged about it here, and in fact, the original purpose of this blog was to chronicle the course of my treatment. This, as you may have noticed, quickly fell by the wayside. Why? Well, further appointments had to be cancelled, because I was so sick I simply could not get there.

While in the grip of an agoraphobic period - for these things, as I've explained before, tend to wax and wane - no amount of cajoling, encouragement or even a stick of dynamite up the arse is going to get me out of my flat. This is not laziness, or pettiness, or stubbornness, or a reluctance to help oneself (which is how medical professionals tend to see it as they take out their big rubber stamp to label you as 'resisting treatment'), rather a deep rooted conviction that the outside world is a dangerous place, that setting foot outside one's front door, or in my case, my bedroom, will result in certain death. I can not tell you why it seems so dangerous, because by the time I get to the point where I can not leave my room, the deep rot of clinical depression has set in into the degree that I can not form a sentence. But it seems to be that some kind of survival instinct kicks in and keeps me confined to my safe area, hidden behind some kind of invisible force field, within which it is impossible to sometimes do the smallest of things - take a shower, stand in the kitchen for any period of time to prepare food, visit the corner shop less than 100 steps away to buy that food to prepare - let alone to take a trip across London to explain to someone that I can't do these things.

All things considered, I should be one of the lucky ones. I live in London and my local mental health centre is two miles away, at the other end of two bus rides. Yet still, with that degree of illness, I couldn't manage this; someone living in, for example, rural Devon, where the nearest mental health centre may be 25 miles away in the next town or city, has no chance.

I wonder how many people are in this position. Why should agoraphobia be the poor relation of the mental health family?

Is it, perhaps, because people with agoraphobia are still unwittingly stigmatised as the Miss Haversham figure with filthy net curtains and an almost impossible amount of cobwebs in their houses - the strange, reclusive figure to be mocked, ridiculed, filed under 'eccentric' rather than 'genuinely ill', and left alone to die?

But back to the article, and the problem at hand, which, I feel, lies in the definition of 'home treatment', where home treatment does not actually mean home treatment, rather a government buzz-word to refer to any treatment in the community that does not fall under the category of 'admissions to hospital'.

What the NHS has then, when considering the treatment of agoraphobia, is a chicken and egg, Catch 22 situation. The patient can't get the help she needs because she's too sick to get the help she needs.

How can that be right?

Has anyone in the NHS even thought of this? Why isn't there some kind of home therapy service? People in crisis are being forgotten, their healthcare needs are not being met, and therefore, it is desperately needed. I've never heard of this kind of thing. Have you? Should we be lobbying our MPs and suggesting it?

1 comment:

seahorse said...

You should be able to get home visits from a CPN trained in anxiety management. It should be available to you, as it has been for me. I live in a big city too, my mental health clinic was 10 minutes away. I couldn't make it either. Yes, there are my physical problems too but I know many patients with a variety of conditions who have been seen at home. Please ask them. Sod under-resourcing, just ask. If they say no, get an advocate.