STUCK IN THE SYSTEM

The following 7 sub-themes were found in response to the question “What kind of interactions did you have with Mental Health professionals?”

Figure 11: Sub-theme break-down of “Stuck in the system”.

5.1.1.2.1 Never ending hopelessness and readmissions

For all interviewees suicidal attempts and self-injury were never-ending and contacts with both medical and psychiatric services were inevitable and long standing. All interviewees recalled a revolving door of repeated acts of self-injury that led to admissions in Accident and Emergency Departments.

“Ending up in the psychiatrist’s chair on a lot of medication, in and out of the hospital, in and out, in and out” (Interviewee 2).

“I used to take a lot of overdoses, (which) I did for ten years as well as cutting. I dropped down to six stones, and I was in hospital for weeks trying to get my weight back up. It was all nerves, anxiety, and this hurt I was holding in, things I wanted to tell people but couldn’t get the words out… Without DBT I wouldn’t be here today.

That terrible hurt I am able to bring it all out. Whereas before I wouldn’t talk about the hurt, nobody knew anything about what I went through at home…It’s like when I’m in DBT (sessions) words just flow out of me. I have a mind of my own now, I am

Light at the end of the tunnel

Failure of the psychiatric services Disappointing Accident &

Emergency treatment

A sense of hopelessness and of being lost in the system was certainly easily identifiable in the accounts given.

“I had no life, to put it as simple as that” (Interviewee 10).

“I put all of my recovery down to the DBT team… DBT works, if it works with me, it will work with anyone. Because I was very low, disillusioned, angry and nasty about the system, I had right to be, but not, not after DBT” (Interviewee 1).

“Before I started DBT nearly a year before that, I was a goner. Very depressed, suicidal, and a drug addict” (Interviewee 15).

5.1.1.2.2 Veterans of the Mental Health system

Interviewees typically described coming to the DBT programme after much contact with a series of treatments and services and were largely cynical and not very hopeful for positive results from any intervention. Little had changed after many years of attending a variety of different Mental Health professionals. Many respondents felt rejected and let down by the Mental Health System.

“After five admissions they still didn’t look at any alternative. I didn’t think I was being taken seriously at that point. I felt that I got no counselling and no therapy.

Nobody seemed to want to know what went on in my past… I never heard of counsellors, it was something that was alien to me. It was just my life, and I had to deal with it. I really thought, before I went into hospital that the only way out was to kill myself, and I did make some serious attempts at that before I ended up in hospital” (Interviewee 6).

“I would have gone to my GP and he would have given me tablets, which I would have stocked them up (all), and I would have then taken them, which mostly happened when I was drinking…I would have been very disappointed with the services, because I was able to walk out of the ward onto the street, still feeling suicidal, feeling even worse because I’d experienced even more rejection” (Interviewee 15).

Many interviewees recalled being subjected to maltreatment and apathy by Mental Health Professionals. Some alluded to an “us” and “them” attitude of many staff members.

“You’re on a different level to people, you feel so different, these are normal people, I’m not” (Interviewee 10).

5.1.1.2.3 Failure of the psychiatric services

Numerous interviewees alluded to being given little time in psychiatric care by consultant psychiatrists and some mentioned that they would regularly be treated in a condescending manner.

“I had met condescension from doctors and sort of expected it” (Interviewee 12).

Some recalled appointments being as short as five minutes on a regular basis.

Psychiatric treatment was often judged to not offer answers or solutions, which contributed to heightened dismay, hopelessness and isolation.

“The doctors, you see them for 5/10 minutes maybe, they’re prescribing drugs, they are just treating symptoms, which I don’t agree with. In my experience I don’t think the doctors were treating the underlying problem they were just treating the symptoms” (Interviewee 2).

5.1.1.2.4 Ineffective drug treatments

Many took objection to the focus of psychiatric appointments being on pharmacological treatment, as they believed the underlying problems were not being addressed. Some found this regime to be a very rejecting and an apathetic experience, and would feel more disillusioned after attending a psychiatric appointment than beforehand.

“That really annoyed me. I felt when you went to the consultant you had ten minutes of their time, and shoved out… I felt they weren’t listening. You’d be telling them like

I feel suicidal and I’m having these thoughts, I’m very irritable, I’m thinking of doing something really bad. But increase your medication, go home… It’s like you’re not there, you’re a guinea pig” (Interviewee 3).

Many believed that they knew little about and were not consulted enough on drug treatment, and often they were oblivious to other treatment options. Drug treatment was extensively referred to as ineffective and criticised strongly – especially in terms of the multitude of side-effects and increasing potential to overdose. Some participants asserted that doctors should be more open about the effects of and length of usage of medication.

“Medication, I tried loads of things but nothing was working. It was just a cycle I was caught in…I just went along with what ever they did. I thought they (psychiatrists) were right” (Interviewee 9).

“Looking back on it, it’s scary! At the time I was in a fog, I was confused. So I just thought they were going to make me better, they were going to make the situation better, somehow it was going to work. But yeah looking back on it now it was scary, because I don’t think I would have recovered. Well all it was doctors and medication.

There was no real talking to me. There was no therapy. It was just drug therapy, that was it, which is not what I needed. At the time I believed them that this was the solution… it was just increasing and increasing. You know I was ending up doing crazy things” (Interviewee 2).

“I’ve always seen a psychiatrist, but for some reason it was just walking in, getting a prescription, and walking out. There was no counselling. That’s all I knew. There was no change, just uping dosing of tablets. Anytime there was something wrong, it meant more and more tablets. So it meant it was easier and easier to overdose. I never spoke to anyone about my problems… Basically nobody ever asked me what was wrong with me or about my problems. I just felt full of medication. I thought it would never end”

(Interviewee 14).

5.1.1.2.5 Lack of continuity

The psychiatric rotation system was censured, as it does not always offer a continuity of care and causes much frustration for clients who are under transient registrars’

treatment.

“I really didn’t like re-explaining myself, when doctors were only there for six months, there was no consistency there. I wanted my usual doctor. I know services are busy, but I think patients need the best treatment possible” (Interviewee 15).

In spite of all of these criticisms of psychiatric care, a minority of interviewees did speak favourably about their consultant psychiatrist, who in most cases was the professional who referred them to DBT. Interactions with these consultant psychiatrists differed as clients were offered an opportunity to collaboratively problem solve, were listened to, given time, taken seriously, and the consultant psychiatrist took genuine interest in the client. Such positive reports of psychiatric care were, however, the exception in this sample.

5.1.1.2.6 Disappointing Accident & Emergency treatment

Accident & Emergency staff members were universally castigated as offering minimal time and empathy for those who came in contact with the service after self-injury or a suicide attempt. A couple recalled instances of being ignored by staff, who they assumed disapproved of their behaviour. Little understanding or even attempt to understand the difficulties of these service users was reported.

“Then there is if you go into casualty, you just get treated like crap. You can be as distressed as you like, they’ll sit you in a corner, they’ll put you somewhere they can’t see you, they’ll try and loose you… They say ‘if you’re really distressed go to A&E , well you’ll just want to kill yourself more after being in A&E! Because you get the medical doctor coming up and saying ‘there is nothing wrong with you’” (Interviewee 8).

“You see the doctors in A&E …A lot of them haven’t got a clue why you’re in there.

They just dope you up and hope for the best” (Interviewee 11).

5.1.1.2.7 Light at the end of the tunnel

A sense of fortune was described to come in contact with the DBT team and sometimes the consultant psychiatrist who referred them to the therapy.

“To get the right professional help it did take some time. I think I was extremely lucky because I saw and met so many people a long the way that weren’t as lucky as me, I know they’re still in that whole system, they’re still there. I thought they would have similar stories to me, they had similar attitudes, they were doing similar things. But they’re still there, so I felt I was extremely lucky” (Interviewee 2).

Remarkably, many respondents referred to their DBT individual therapist as their only positive experience of the Mental Health system.

“The only good experience I had with professional people was with Individual Therapist” (Interviewee 10).