I had a rather sad conversation online yesterday in a peer support chat room. The guy I was talking to asked the room whether it’s best to be honest with his GP about the state of his mental health. From what I gathered he has been struggling a long time without any help; I asked him if he had a diagnosis and he replied ‘nothing official, just a fucked up psyche.’
His main concerns seemed to be being locked away and losing his job – two things I can truly identify with; when I first started seeking help I tended to play-down things in fear of the psych ward and lost a job over my mental health when it was at its direst point. But the truth is that most health systems – or at least those that are run by the state – actively seek to provide support to keep people out of hospital, and as for workplaces, in most cases the person is protected by anti-discrimination laws.
A quick Google suggests a figure of around £350 a day to treat someone in hospital on the NHS whilst intervention outside of the psychiatric wards costs far less (although I couldn’t find any concrete figures). There is also the consideration that internment in a mental health unit causes considerable stress to the client; the wards are far from peaceful, recuperative places. In most areas here in the UK there are specialist teams for acute care outside of the clinical setting; Home Treatment Teams (HTT) are able to visit clients in their homes to help with medication and provide someone to talk to; they also have 24 hour phone services so even in the middle of the night a nurse will be on hand to discuss concerns.
There are also many care homes in the UK that usually support long-term residents in transitioning back into the ‘real world’ which have ICBs (intensive care beds) for shorter term stays. I’ve been in two of these homes and they proved to be incredibly therapeutic environments; space to recover, freedom to come and go and 24 hour support from trained staff. Whilst staying in the homes, clients are supported by their own psychiatrist and care co-ordinator so there is no variation in treatment plans or any stress of seeing staff that are unfamiliar to someone who is in a fragile state.
Hospital is a last resort here; there have been only two occasions when I’ve been threatened with a section and both were when my ability to keep myself safe went beyond the scope of what the earlier interventions could cope with. This is despite suicide attempts and self-harm; despite drinking to cope. There was a real push from the NHS staff I dealt with to keep me out of the psych wards until it was an 11th-hour situation; even then I remained out of the hospital thanks to redoubled efforts from the HTT and care homes.
The guy I was speaking to online was concerned about the security of his job if he wound up needing to take time off sick for his illness. This was in part due to the nature of his work; he had passed psych clearance tests in order to secure the role in the first place. With a little discussion I discovered that he was nervous that his employer would indirectly find ways to push him out of his job; despite my reassurance of discrimination law he remained convinced that he would not be able to stay employed if he sought help and treatment.
The fact is that most countries have solid disability discrimination laws; if the illness is significant and long term. Essentially – in relation to the workplace – they lay out a requirement to allow reasonable adjustments that ensure the employer facilitates the needs of their employee and also a requirement to treat their employees equally despite their disability. These laws are the backbone for activists to be able to speak out openly about their illnesses and go a long way towards true equality and the end of stigma.
I sincerely hope the online chatter is honest with his GP and gets the help he needs; he seemed desperate for someone to hear him and assist him in his recovery – unfortunately there is still such stigma surrounding mental illnesses that it remains difficult to speak up in confidence of not being judged for something we cannot change.