BARRIERS WE FACE THAT STOP US TALKING AND EVEN ASKING FOR HELP WHEN FACING MENTAL HEALTH ISSUES.

A perspective from lived experience.

We’ve all heard the saying ‘It’s OK not to be OK’, and ‘it’s OK to talk about our mental health’, but is it really?.

My own experience of being able to openly talk about how I ‘wasn’t’ coping was far from delightful or cheery, if anything it was quite the opposite, it was painful, degrading and damn right embarrassing.

Being asked the question ‘How are you?’ was actually one of the most difficult questions to have to try and answer three years ago, for many reasons, firstly, would the person asking know how to respond to ‘well actually I’m really unwell, I have unresolved trauma going on from when I was a child, a drug addiction started when I was 14 years old, then there’s the trauma of losing a sibling when I was 15 years old, trying to figure out why my parents rejected me, and why they divorced when I was 16, I have insecurity issues, commitment issues, borderline PTSD, high functioning Anxiety, Depression, I’m in severe debt, I’ve tried to end my life by suicide on three occasions and I’m homeless’, I very much doubt it, unless they have been trained to answer this type of response, I would not want to put this kind of burden on anybody, and not least anybody I thought may judge me (which turns out to be most people), it was so much easier to just say ‘I’m good thank you’, and lie than be brutally honest.

It’s taken three years, and therapy to get this far, processing trauma takes time, so does acceptance.

I recently posed the question ‘What are your barriers to getting help when suffering with poor mental health?’ in one of my online peer support groups with Eight thousand members, it was interesting to read the responses as to why they felt they couldn’t.

Here are just a few;

‘Shame but also people thinking I negative and moaning (like my mum does), not wanting to be a burden’

‘When I was working, then any hint of an idea of mental health issues, meant that it is on your medical records and I was worried that my employers would ask for access to these at some stage. In those days, any form of issue, other then physical would have been seen as a weakness.’

‘There was always a stigma attached. As if you were unstable, mentally deficient and 'not right in the head'. It wasn't seen as an illness, more as a personal defect that made you inferior. A lot of that has changed. I am quite open about having struggled with depression and about currently being on anti depressants.’

‘When I had M.E. and my mental health was shot to pieces, I tried to articulate what was going on for me. But it didn’t make any sense to anyone. It was like trying to explain the galaxies of the universe to a goldfish. So I stopped talking about how I was feeling. I gave up trying to explain it and went back into my shell. That was my biggest barrier to talking about it. “No one gets it so what’s the point” kind of thing’

 ‘Just one word, fear’

‘I think it does depends who it is. The end of last year I was signed off with stress and anxiety and went to counselling for 6 weeks and found this useful, I also learned (big time) who I could and couldn’t talk to without being judged. I am surrounded by people in my team at work that take the mick or think mental health is “pathetic” “an excuse” the list goes on, it’s horrible to hear them talk about it like this but I’m in a better place now and don’t feel ashamed to say I have suffered and still suffer with mental health. I still believe there is a huge stigma around mental health and think this is so so sad. 

'The biggest challenge I found in the beginning was I was embarrassed and ashamed of myself and thought I would never feel any other way than what I did at that time’

‘I just struggle to understand it myself so, I find it impossible to explain to anyone’

‘Failure. Stigma. Weakness. Being judged. Not understood.’

‘ Feeling weak, people not understanding, people change their attitudes towards you once they know, people not believing mental health issues are a ‘thing’!’

‘Not being able to understand it yourself. Why do you feel so low? Not wanting people to question your feelings, label you or judge you. Talking out loud about it makes you realise it's really happening when all you want is for it to disappear.’

‘Originally I was fine with talking about it. But then you realise the world isn't as accepting as you thought. I wanted to join the army, that was a no because I've suffered with depression, civil police, again a no. Now I realise how employers will judge you based on your mental health it's made me more cautious. It frustrates me because mental isn't a one size fits all. My depression was completely based on family/environment factors and pursuing a career in something I was passionate about would have actually improved my mental health.’

‘Having your own situation belittled - "Life's tough for everyone" or "You're not the only person to find things hard - you just need to get on with it like everyone else does". Makes you feel guilty for not coping better AND guilty for bothering the other person. And if you are the person who is usually offering support to others, sometimes people don't like it if you are the one asking for help for a change and make you feel bad for not being the one offering to help them. And you're already feeling bad for asking for help anyway!’

Is it really any wonder why more people are trying to find alternative therapies and help?

In 2016 I wrote a report with assistance from a friend working in the NHS outlining the condition of our mental health services in Britain, and why people felt they were being let down by the services, you can find the report here: https://mindcanyon.co.uk/blogs/f/mental-health-and-homelessness-report it makes for quite a harrowing read.

Excerpt taken from the report.

‘There is still a lack of sympathy, understanding and empathy for those in the workplace, this is a general reflection on society’s thoughts on mental health in this present day. This is despite the Disability Discrimination Act (1995) being introduced, this says that it is unlawful to discriminate against employees with a disability. It is supposed to offer protection; however, changes in attitude are distinctly slow to develop.

For those who are unemployed the issues are greater. A report called ‘Social Exclusion Unit 2004’ published by the Mental Health and Social Exclusion group, found that out all the people who suffer from a long term dilapidating mental health illness, fewer than ? were employed. However, there are many people who cannot work because of their illness because the nature of their illness fluctuates unpredictably. For these people, welfare benefits are their main source of income.

It has been found that there is a very complex relationship between unemployment, employment, mental health and suicide rates. During the recession it was found that suicide rates rose in those in employment, and decreased in the unemployed. But “one UK study found that the risk of common mental health disorders increased in those who had been out of work for three years or more.” (Dr Knott, L. 2015)

“1 in 3 people with a serious mental health condition are thought to be in debt.” (Dr, Knott, L. 2015). This is a factor which comes up regularly when discussed with people. The stress of day to day living, keeping a roof over your head and food on the table is hard to deal with when you are living on the minimum wage. The cost of living is going up, and the lack of affordable housing adds to the pressure. There is also a need to have mod cons and the latest gadgets. You could call it the “keeping up with the Jones’” syndrome. People feel that there is a social pressure to have certain items which may be out of their budget. Without these items, people have a fear of being excluded and “looked down upon”. This is particularly prevalent in families with teenage children. Parents find themselves under pressure to give their children the very best, simply because they fear peer pressure, and want to help prevent their child becoming a victim of bullying.

People who are socially disadvantaged are found to be more likely to suffer from a common mental illness, such as depression and social anxiety. The gulf between affluent and poverty areas is increasing, with a worry that there will be an increased threat to health. Research by the National Equality Panel (2010) found that the richest 10% of the country’s population are more than 100 times richer than the poorest 10%. Health survey for England published a graph (Appendix one) which shows that people who in the poorest fifth in the country, are much more likely to develop a mental illness compared to those on an average wage, and those in the highest fifth income. The graph shows men and women separately, showing that women are more likely to suffer a mental health crisis.

There are still associations between health and social class, despite there being improvement across the whole health sector. For some people, the failure to rectify this completely is disgraceful, and highly unacceptable. For others, they are happy that changes are happening, and therefore feel that nothing is to be worried about. However, the Office for National Statistics reported that despite the NHS being available for all for 67yrs, there is still a void in health care across the social classes. There is no specific area which is affected either, as can be seen in the Graph produced by the Health Survey for England (Appendix 3), which shows that the risk of a mental health crisis is similar across England. It is a nationwide issue.

Who is affected and what help is available:

Mental Health Services are free on the NHS. But in most cases, a GP referral is required. According to the NHS choices website, you can also refer yourself using the referral form for help with self- harming, substance abuse and some psychological therapies (IAPT). As well as this, the site also gives you useful information on mental health organisations you can contact. This is good for those who need help or someone to talk to straight away. However, out of the list of 15 major organisations they have given as a point of contact, only two are 24/7: The Samaritans, which is a Freephone service and Men’s Health Forum a 24/7, text, email and chat service.

Also on the NHS website, is a mood assessment quiz. The questions are answered on a scale basis and from there it gives a rough calculation on where a person is in terms of depression and anxiety. It will then give advice and links to access services which may be of help. It is based on test that a GP would ask and is useful for monitoring moods. However, it is not a diagnostic tool. The draw back from using this is that as a nation, we are becoming more and more into self- diagnosing…which appears to be encouraged thanks to the wealth of information available on the NHS website alone. But also, the person using the assessment tool needs to be honest, which as most people who suffer with mental health issues can verify, is not something which is easy to do.

Advice is also given on mental health issues caused by stress at work. It is advised that the employee should speak to their employer who will put them in touch with the occupational health services. This gets mixed reviews however, with some people saying that their employer really helped and was very understanding. However, some employers, like those in the health sector for example, encourage the employee to access help via the health insurance they receive, and others recommend going to their union. Whilst some people have said that they could only access help once they had been back at work for four weeks after being signed off with depression.

After the GP referral, it is said that a waiting time of 18 weeks is more than likely for non-urgent cases. However, under the ‘right to choose’ campaign a person can request to be referred to a different hospital if it is felt that the waiting time is too long. But, things are improving. According to the NHS Choices site, 75% of people who have been referred to Improved Access to Psychological Therapies (IAPT) are seen within 6 weeks of being referred. Whilst 50% of people who experience their first episode of psychosis, are treated within 2 weeks, with a NICE approved care package.’

There are many services throughout the United Kingdom offering some form of help to the mental health sufferers and those who are homeless. But there is too much bureaucracy for anybody dealing with either issue to navigate or to qualify for help. The one thing I sincerely applaud Scotland for is abolishing the Priority Needs.

looking back I remember the one place I felt wouldn't judge me was the church, after all the good lord was a saint by all accounts, and I needed love support and guidance.

My journey of acceptance and self discovery actually began in church.

I felt like I was being accepted, and at the time my belief was that I was being look after by a higher power.

Acceptance is one of the biggest challenges we face when going through poor mental health.

After all, most people struggle when it comes to asking for help, and admitting something isn't right.

I for one am overly joyed that organisations such as MHFA are introducing mental health first aiders into workplaces, as this will allow more people to understand that mental health is no longer something we just sweep under the carpet, it affects every single one of us, and the more we realise that at some point it’s almost now inevitable that at some point in our lives we are going to be affected, or will know somebody close to us that is, mental health first aider are not the overall solution though, this is just part of a bigger picture, but it’s a bloody good start.

It’s clear that some of the main barriers to asking for help (including myself for many years) come down to the fear of being judged, not being believed, lack of understanding, empathy, compassion and overall education in regards to mental health.

Another disturbing revelation is that the suicide rate in Wiltshire has risen slightly over the last three years, new figures show, bucking the trend of lower rates across the country, Mental health charity Samaritans welcomed the national decrease in suicides, but said that “one death by suicide is still one too many”.

My focus is on bringing mental health education, mental health recovery, and suicide awareness prevention education and training to my home town of Swindon, because figures from the Office for National Statistics show that there were 116 suicides in Wiltshire between 2015 and 2017, at a rate of 8.9 deaths per 100,000 people. Local rates are measured over a three-year period. Between 2012 and 2014, there were 8.8 suicides registered per 100,000 people.

Last year alone, there were 35 suicides in Wiltshire.

Of 5,821 suicides registered last year 4,382 were men, a rate of 15.5 deaths per 100,000 men. However, the male suicide rate was at its lowest level on record in 2017. Samaritans said efforts to reduce stigma around male mental health may have contributed to the reduction, but added that men are still three times more likely to take their own lives than women.

Times are changing, and so are people’s attitudes towards mental health, is enough being done? No, I don’t believe so, I believe that more could be done, but for now, something is better than nothing.