Right, let’s start with a joke: What do you get if you cross an NHS receptionist with a sound argument? Blacklisted. Although obviously a massive exaggeration, the underlying point- that there often exists an imbalance in power between the service user and the first line of defence in the NHS fortress of access- was at the forefront of my mind as I took a series of deep breaths at a mental health centre in North West London a few weeks ago.
Leading up to this, a few months ago I started to suffer from a particularly nasty spell of depression- a black dog of Rottweileren proportions- triggered primarily by stress at work. As I was an NHS employee at the time (working as mental health Employment Specialist), I was entitled to access the Occupational Health service and its well-equipped psychology provision. After an initial assessment I was offered six sessions with a psychologist, which I gladly accepted.
Having undergone therapy in various guises in the past without noticing any tangible benefits, I wasn’t massively optimistic. Despite this I really did feel like I wanted to talk things through, particularly as I had some important decisions to make (namely whether to keep my job or resign, to remain in London or skedaddle and whether to continue with a Masters course).
To my positive surprise, the sessions started to profoundly nurture some inner strength I had not really been aware of previously. My therapist – a psychoanalyst so purist he sported sandals – seemed to hit the perfect pitch in guiding me with purpose and direction through jumbled thoughts and ideas about how to get the best out of myself and tackle the listlessness and obsessive self-criticism that so hinder my ability to function. It takes two to tango though, and I now clearly see that importantly, I was now much better at receiving therapy; my ability to access my thoughts more clearly and with greater honesty had grown over the years.
During this period, I made the calculated decision to resign from my job. The sessions came to an end in any case, as the finite therapeutic offering ran its course. Having seen my GP, I was referred to a psychiatrist to assess my needs. We had a fruitful meeting and, as mutually agreed, I was then referred on to the local psychological therapies service. Primed through my recent experience, I felt ready to continue with the genuine therapeutic progress I had made. I would even go as far as to say I was excited.
Two months have now passed and I have not heard a peep from the service I was referred to. Filled with enthusiasm about gaining psychological input, four weeks ago I rang the assessment team to which Dr Psychiatrist Man belonged, enquiring about the progress of my referral. I was met with a blank expression (visible even over the phone), before a little muddled investigation confirmed that, yes my name really was Fabio Zucchelli and yes I really had met with Dr Psychiatrist Man on the 17th August (his real name actually- born for the job). I was told, without a hint of an apology, that the admin team had been downsized and as a result it had taken four weeks for his dictated referral letter to be typed out. Nice. ‘It’s ok though, the team is back to full strength now, so this shouldn’t happen in the future’. Brilliant. If I wasn’t completely gutted I would have appreciated the dark comedy. The letter had been sent though, and I would receive a copy shortly, I was told.
A week passed without receiving the said letter. I was interested to know whether the lag in time between my assessment and the actual referral had been noted in the letter, as otherwise I would want to make this known to the service. I was being proactive about receiving help as quickly as possible, in other words. I decided to pop into the assessment team centre (just down the road from me) to ask for the letter directly. Behind the perspex screen (bullet-proof, sound-proof and compassion-proof), a blank face. Ah, I recognised that perplexed expression; good to put a blank face to the blank name. My description of the scenario sent the duo of receptionists into a whirlwind of confusion, although they did at least seem to draw the clear conclusion promptly that any responsibility for the confusion was mine, despite my effort to present my situation as cogently as humanly possible. ‘No, there’s no letter. You’ve been discharged from the service’.
As I sought to request a phone number for the service I had (apparently, despite a lack of evidence) been referred to, only to be met with ‘No, you have to wait to hear from them’ I felt frustration morph into its next door neighbour, anger. As, on tip-toes, I leaned increasingly over the shoulder-high counter and forward beyond the semi-open shield that protects innocent staff from animals like me, I took an exasperated deep breath and gazed around the reception. In front of my eyes was a sizeable ‘We do not tolerate violent or aggressive behaviour from patients’ sign. The door to both the waiting room and the reception were locked with a keypad. The environment very clearly said: ‘You are the patient. We are the guards and we are in charge.’
Having worked in mental health services for six years, I am very aware of how forceful argument from service users is often construed, how easily the ‘difficult customer’ tag can be cast and how this can influence the attitude of treating professionals. I therefore fully retracted my neck back into my shell. I then also noticed that there was no information for service users on PALS (the Patient Advice and Liaison Service) in sight, which is pretty bad practice. Resorting to passive aggression, I asked for a PALS leaflet. Another blank face. Two blank faces in fact. ‘PALS? Oh yeah, I think I’ve heard of them.’ She ruffled through a folder hidden at the bottom of a cabinet and eventually emerged with a PALS leaflet, which I recognised as being at least two years old.
I have since managed to contact the IAPT (Improving Access to Psychological Services) team through a side door, although this has only added further to the confusion. I have yet to even receive confirmation that my referral has been acknowledged, let alone any information about a projected waiting time. I know that the services are under a huge strain and that many good people are working under very challenging conditions, but one little phone call or email giving me the slightest hint at what the fuck is going on does seem logistically possible.
Like so many around the country, I am not receiving help at the time when I so desperately need it and feel motivated to engage with it, and can’t afford private treatment. We know that the best indicator of success in therapy is patient engagement, and we also know that waiting long periods for therapy decreases motivation to engage. Boo. I will, though, continue to push my way through the gauntlet despite my growing despondency. I’d also like to keep you updated with my progress if you’re interested, as I fear this is a story too commonly experienced and too rarely told in a public forum.