A Poverty of Help: inadequacies of support to vulnerable persons in the UK healthcare system

This is the start of a collection of experiences of government-funded mental health service and medical service encounters conveyed to me by patients over the years.  I will add more in time.  Because of their prevalence, I thought I would start putting some of them together as an illustration of some of the bad practices that continue to go on in the UK and how they can negatively impact people who present in a vulnerable or distressed state of mind.  Typically, the individuals involved came away from the experience of having been humiliated, shamed, stigmatised and feeling that they were at fault for presenting as they did.  When in fact they were merely normal people in a vulnerable or distressed state seeking help from a system built on archaic practices that continues to be passed off as mental healthcare in the UK today.

One question we might ask is whether these cases represent what many now term ‘iatrogenic harm’?  Namely, treatment that is harmful instead of helping patients.

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Angela’s Decline

Angela had been a sensitive, very intelligent A-student all of her life but had isolated herself increasingly as a teenager, eventually leaving school after failing several exams and scraping a pass on three others.  She was depressed.  The school hadn’t addressed the sudden change in Angela’s grades or her depression.  She had been an unwanted pregnancy for her mother and grew up in an unsupportive family in which her mother had abandoned her as a baby for several weeks, running off with another man.  The family had scapegoated her ever since, blaming her for whatever went wrong around her. If her sister did something wrong, it was Angela’s fault for not taking responsibility and looking out for her little sister as the older sibling.  Angela was scared of the world, chronically shy and insecure and retreated to her bedroom to avoid her father’s bullying and her mother’s scapegoating. She had elected to stay at home whilst both parents and her sister went on holiday, so in need of peace was she, despite longing to be away somewhere different herself; somewhere sunny by the sea.  Angela was finally diagnosed with ‘clinical depression’ and initially felt hope for treatment and someone to talk to. She was given anti-depressants, saw a psychiatrist for what she thought was psychotherapy and was told at the first meeting “You’re only here so that I can monitor your medication”.  The Doctor suggested she bring him her poetry to read next time. She brought several pages of it to the next appointment and handed it over.  The doctor never mentioned it again.  Angela attempted suicide some months later.

S drawing
“It is highly unusual for a service user to be asking so many questions and having to explain myself!”.  This was Sandra’s experience of a Consultant Clinical Psychologist in the NHS, whilst presenting with Complex Post Traumatic Stress Disorder and a victim of Narcissistic Abuse.  Many vulnerable patients using NHS mental health services report similar experiences of being brow-beaten where they fail to conform to a passive, subservient role to the ‘expert’ practitioner

Janice Took A Knife

Janice took a knife and cut her arm at the elbow joint.  She was a shy teenager, withdrawn from her family and had declined in her mood and self-view gradually since age fifteen.  At nineteen she was still living at home, isolated in her bedroom and had just broken up with her boyfriend after a week into a new job that she hated and that made her feel like she was a freak because she was unable to relate to her coworkers, who gossiped about one another as soon as backs were turned.  On the Friday night of the first week she drank half a bottle of whisky in one go, took the blade and sliced deep into her vein, the blood pouring out like a fountain under the covers of her bed.  Finally, she thought, I can find some peace.  She awoke in the hospital with a drip in her arm, and some vague memories of paramedics taking her down the stairs in her house, half conscious, whilst commenting that they thought she was pretending to be asleep. At ward rounds three doctors came by early in the morning, the lead doctor with a condescending smile on his face as he asked “How did you do it?”.  “A knife” Angela replied through gritted teeth.  Sensing her anger, the three doctors moved on without a word.  A few hours later, Angela was assessed by a psychiatrist, told the psychiatrist she’d been depressed but had made a mistake and wouldn’t harm herself again.  She was sent home an hour later with no follow-up support or other intervention.

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Tom’s Panic

Tom was taken to Accident and Emergency following an inability to breath properly that happened whilst out for a drink with friends. Tom had been struggling with depression and low self-esteem for some years and had been confronted by his boss late in the day, who had criticised him for ‘not being a team player’ by not mixing with his colleagues at work during lunch hour each day.  After a couple of beers Tom had experienced shortness of breath and a tightening of his chest and had passed out.  An ambulance was called and he was taken to hospital where he regained consciousness and began to hyperventilate once again.  Unable to calm himself, the doctor treating him lost patience, exclaimed “I’ve had enough of this!” and walked out of the room, leaving Tom and one of his friends alone. Tom eventually regained his composure and left the hospital, humiliated and shamed without any further contact from medical staff or any explanation of what had happened to him.

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Kevin at 3 AM

Kevin had been with a woman who repeatedly abandoned him whenever they’d had an argument, running to another man that she had kept in her life, and whose background presence in her life had been the cause of most of Kevin’s objections and their subsequent arguments. Kevin felt that his partner had been using the other man to undermine their relationship.  Kevin was a sensitive man who simply wanted an exclusive, faithful relationship.  His sense of self-worth declined gradually as he attempted to struggle with escalating anxieties and insecurities in this relationship.  His partner’s secrecy, lies and unwillingness to remove the other man from her life had been ruinous to Kevin’s mental state.  He had awakened at 6 am in the morning to find her gone from their bed.  He discovered her texting the other man from the bathroom. Kevin had discovered secret mobile phones that she had kept in order to be able to maintain contact with the other man.  After arguments about this behaviour she would typically disappear for several hours, unreachable by phone, during which time Kevin would agonise about her whereabouts.  She would return, lying about where she had been; Kevin later finding out that she had been with the other man seeking solace from him.  This went on for years, with breakups for a month or two and the woman begging Kevin to come back, which he did, only to experience a resumption of the same pattern.  Kevin took an overdose of sleeping medication and was rushed to hospital.  After explaining his circumstances and the reasons for his overdose he was discharged at 3:30 am and had to find his own way home by taxi, still drowsy from the effects of the sleeping tablets, with no wallet or money to pay for the cab.

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Nikki’s Stigma

Nikki had accidentally overdosed on her pain medication after a three day migraine and was dropped off at A and E on Christmas Day by her cousin after she had spent a freezing Christmas Eve sleeping in her car due to a falling out with her flatmate.  Medical staff had assumed that Nikki had deliberately overdosed since she had an earlier history of self-harming behaviour and depression.  Staff were dismissive, short with her and clearly inconvenienced by a young woman who was now homeless.  After a sleepless night on a busy, noisy, over-heated ward with a drip in her arm Nikki tried to speak to a member of staff in order to arrange to leave.  No-one was available to speak to her, so she decided to get dressed and left the hospital quietly.  The hospital called the police when they discovered her missing.  Police called her on her phone and said they just needed to check that she was safe.  She agreed to meet them whereupon it became apparent that they had lied and wanted to take her back to hospital to be formally discharged.  She was escorted back to the ward by police, like a common criminal, in full view of patients and a hospital staff team staring at her as she walked down the corridor, then once all paperwork was taken care of released late at night on Christmas Day eight miles away from her car, with no buses or trains running due to the holiday period.  Two weeks later she received a hospital discharge summary which described the event in the most negative terms possible, clearly stigmatising Nikki who was described as ‘unemployed with a history of deliberate self-harm who had absconded from the ward’.  This letter now forms part of her medical record.  Nikki remained homeless for the next four months.

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Jennifer’s Secret

Jenny was shocked one day, upon requesting a copy of her medical records, to discover that she had been given a diagnosis of personality disorder some twenty years before whilst she attended an outpatient clinic for depression.  No-one had ever discussed this or any other diagnosis with her at any time, other than to convey to her the understanding that she was suffering from depression.  Upon reflection, the pejorative diagnosis had made sense to her – not because it was valid or supported by evidence – but in explaining the often strange, aloof attitudes that she would encounter whenever she visited her doctor or had a hospital appointment, as it became obvious that she was been viewed and judged through the lens of this secret psychiatric diagnosis.  None of these professionals, including her own family doctor, had ever mentioned the diagnosis to her, even though it sat on the front page of her medical records.  And so, for the past twenty years she had carried an invisible label and psychiatric stigma that, rather than bringing her assistance and support, had instead served to reinforce her feeling that there was something deeply flawed about her value as a person and that medical professionals, by their condescending or suspicious demeanour, could see it in her each time she consulted them for help.  They were, in fact, viewing her through the filter of a misdiagnosis that Jenny, after a lengthy and somewhat begrudging administrative procedure on the part of the NHS, was later able to have annotated as being ‘unsupported by sufficient evidence’, but not expunged from her notes.  Jenny remains of the opinion that it is like having a criminal record for a crime she never committed; an unjust and unjustified stain put upon her identity for simply asking for help from the NHS when she was young and in a vulnerable state.

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Sally’s Trauma

Sally had a difficult childhood where she was forced into the role of the family scapegoat by two unloving parents.  At age 18 she was abducted at gun-point, gang-raped and left for dead in a field. Her parents refusal to get her the help advised by her doctor left Sally with post-trauma symptoms. Immediately after matriculating from boarding school and moving back home Sally was locked in her bedroom for several weeks, only being allowed out to use the bathroom.  Her siblings were instructed not to speak to her. She was informed by her Mother that this exclusion was punishment for bringing shame on the family. It was during this period of isolation & exclusion that Sally decided to fore-go further education and to find work instead to save up to escape her confinement and family persecution.  After a period of hardship and housing insecurity, Sally found a new GP who dismissed her post-trauma symptoms as depression; prescribing her anti-depressants and sleeping tablets on top of co-codamol for pain relief for a broken arm she sustained in a fall. After collapsing and being taken to hospital by ambulance, Sally ended up in a psychiatric unit for the weekend, against her wishes, where she was medicated with drugs she didn’t want to take, which left her disoriented. After being discharged, Sally made her way to the bus stop feeling dissociated and panicked by unfamiliar landscapes, with no follow up from her GP or any other services. Sally had no idea until last year that “Drug Overdose” formed part of her GP medical record. Sally now believes this is why she has continually faced dismissive & disrespectful attitudes from numerous GP’s over the past two decades.  To date, some thirty-five years after a vicious gang assault, she is still trying to cope with long-term CPTSD symptoms and dissociative states, faced with one obstacle after another by NHS mental health and psychological services as she attempts to get the help and understanding she so desperately needs.

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A photo taken by Sally of a view that, in her words, captured her experience of foggy thinking, bleak outlook, fear of the unknown, isolation, and being lost in the wilderness

Conclusions

It’s my conclusion from these and other cameos I’ve been privvy to that the common approach by public health services to mental distress is often experienced by vulnerable patients as crude, insensitive and harmful in some cases. The medicalisation of emotional and mental disturbance is, in my view, the first fundamental error as it strips troubled human beings of the meaning implicit in their distress, replacing it instead with an abstract notion of a clinical dysfunction.  The second being staff members who turn their role of service to the public into one of master, often behaving defensively when their opinion or authority is questioned even on reasonable grounds. This latter point is, in my view, a reflection both of service culture and individual ego, both of which must evolve if medical, mental health and psychological services are to be more realistic, compassionate and effective.

In most cases, there is little or no medical basis to most mental distress.  And yet, the allied professions have relentlessly subjugated what are essentially human emotional experiences arising from existential, social, political, economic, familial and relational circumstances which are then held under the inappropriate paradigm and codification of medical diagnosis and ‘treatment’.  Typically, medical staff presented with emotionally disturbed persons the content of whose experience they do not understand in human terms, reach for the handbook of medical and pathology models of understanding that reduce the suffering person to the status of object to be acted upon.   Instruction manuals with established protocols for labelling and subduing distressed states in people are, after all, more convenient to services shaped by budget than the time required to listen and fully comprehend the intrinsic meaning in such people, and thus help them in ways that are actually helpful to them.

Difficult human experiences are, unfortunately, however, in reality not easily ordered and managed in a medical way, other than the obvious bludgeoning of emotional and behavioural expression by physical and pharmaceutical restraint.  This is not a cure, but a relatively cheap means of containment.  The resulting sense of alternating between professional helplessness and crudeness of forced control results in vulnerable people being disrespected and dishonoured by a system that purports to care for them.

In my view, services that are set up to deal with human distress need to be radically redesigned to render medicine merely a useful adjunct, subservient to the patient’s needs for social support and emotional care in therapeutic environments designed specifically to refuse all forms of stigmatisation, disenfranchisement and disempowerment.  And instead to provide tailored multi-disciplinary care to human beings in need of a human-, not a clinical-, response to their suffering.  This necessity arises in the context of a society that has allowed real community cohesion to be eroded by the pursuit of individualistic concerns and government over-reach.  In such societies care for the vulnerable has gradually been handed over to ‘experts’ and other professionals, turning human distress with discreet patterns of aetiology and development, into ‘conditions’ and quasi-illnesses, when much of our human distress originates in an absence of real family and community caring, love and support which the professions and broader economic concerns have usurped to the detriment of those whose greatest need is often to be treated with simple kindness, respect and compassion, all three of which cost absolutely nothing in monetary terms.

*Names have been anonymised and photos do not show services referred to in the text.

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3 Comments Add yours

  1. Distressing. Your concern for people hurt like this is obvious.

    Liked by 1 person

    1. Stephen says:

      Thank you Anna. It’s difficult to hear what many people have had to endure just to try to find help

      Liked by 1 person

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