Measuring the severity of mental illness
The indicators that mental health services use to decide whether people can receive support are a barrier to treatment for many vulnerable people.
People with mental illness are often deemed 'not sick enough' and turned away. But there should be better access to treatment that keeps you out of crisis. The current system tends to only take notice when it's too late.
You wouldn’t tell someone with a broken leg to just keep walking. You wouldn't say ‘yes your leg is broken but it’s not broken enough’. But, when it comes to a mental illness it’s not rare to be told: ‘you’re depressed, but you don’t fit our criteria for treatment’ or ‘yes you have an eating disorder, but until you reach this BMI we can’t offer you help’.
Just because someone hasn’t presented at A&E in the past week, it does not mean that they are not in crisis. Just because someone is not a certain weight, it does not mean that they are not critically ill with an eating disorder. Somebody can be acutely suicidal yet not have a ‘plan’ to end their life. Personally, I have never made a ‘plan’ to end my life – it has always been very impulsive.
Every case is different. Two people could fall under the same diagnosis, yet be polar opposites in symptom, behaviour and experience. A 'one size fits all' approach is never going to work.
I never present myself in A&E nor do I tell someone if I am going to hurt myself. Some services would look at my lack of A&E visits and conclude that my case wasn't severe. I feel that these are outdated and unsafe ways of measuring the severity of mental illness. As a result many mentally unwell people go without the help, support or treatment that they need and their condition deteriorates, often to a point of crisis (at which point services do intervene).
There are also variations in how mental health conditions are supported in different parts of the UK. In Scotland, borderline personality disorder is not recognised as an acute condition in the same way that it is here. Whilst I was at Edinburgh University last year, I was practically begging for support, running back and forth between the university GP service and the local NHS mental health service. I was initially promised a psychiatrist and long-term weekly appointments with a key worker. Having hung on (just about) for several months for my first appointment, I was told I was only being offered 6 weeks of occupational therapy (not suitable for my needs) and that a GP, rather than a psychiatrist, would suffice! My mental health was deteriorating: I was self harming several times a day to the point of needing stitches (which I didn’t get because I feared how medical staff would react); didn’t eat for over a month; barely left my room; and became suicidal. Despite all of this, Ballenden House, told me to my face “we can’t do anything for you until you present in A&E and then we can offer short-term crisis support and patch you up”.
I felt that the lack of support I received was shocking. The sad thing is, my experience is not a unique one: this is the reality of how many people are treated. Worst of all, if someone kills themselves, their death is too often attributed to them ‘being suicidal and too ill’, rather than people holding their hands up and saying “you know what, with the right treatment and support their death could have been prevented and they could have recovered. The system failed them; we failed them”.
I had to withdraw from Edinburgh University and come home; this was a very difficult decision but I know it is the best decision I could have made. My experience has also made me realise how incredibly lucky I am to have the support I do here in Islington.