At a time when one in four young women in the UK are reporting mental health problems, Prime Minister Theresa May has admitted that support services across the country are "patchy" at best. And, unfortunately, the recent case of Girl X – in which a judge condemned the decision to send a suicidal 17-year-old girl home due to a lack of mental health beds – is just another black mark against the current state of public mental health care.
Seeking help when it comes to mental health problems is fundamental but, for many in this country, it is not always possible to access the treatment, or combination of treatments, needed. From long NHS waiting lists to super expensive private psychiatrists, what's someone struggling with their mental health supposed to do if they need help right now?
Stephen Buckley, head of information at the mental health charity Mind, tells us that “although talking therapies such as cognitive behavioural therapy (CBT) and counselling are becoming more widely available – as part of the Improving Access to Psychological Therapies programme – they still aren't available to everyone who needs them." He continues: "Earlier this year the EHRC report found that many people are waiting 90 days in England to receive treatment – partly due to constant underfunding and an increased demand.”
So what if, like many of us, you can't afford to go private? Your first port of call, of course, is to seek advice from a GP. They are the gateway to any available – and free – local service, whether run by the NHS or non-profit groups. But if you end up on a long waiting list, there are some additional, affordable ideas to try.
Online therapy may be an option, Buckley suggests, as some websites offer free counselling from the safety of your home. But he warns: “If you are thinking of seeking non-NHS support, you want to be sure that the service you are accessing is safe and professional." He advises asking your GP for a recommendation in the first instance.
Going deeper into the internet, it may be worth considering peer-to-peer support. There are many forums available; r/mentalhealth and r/getting_over_it on Reddit are worth a visit, and Mind runs a network where sufferers can discuss problems and potential solutions with others who are going through similar experiences.
“Speaking with other people who had mental health issues definitely made a difference,” says Hayley Smith, a 29-year-old PR director.
Hayley was diagnosed with depression in her early 20s, and her GP first referred her to weekly CBT classes. Within five sessions, though, she felt they weren’t helping and decided to quit. Ever since, she’s been looking for affordable alternatives to manage her mental health, with the support of her doctor.
“[I have been] researching a lot, reading books, and then I talked to my doctor and they gave me ideas of what to do and what I might need,” she says. “Your GP is there to help you, although sometimes it may not feel that way. If they recommend or put you on the waiting list for a particular therapy, go and research it. I just wouldn’t always take the first option.”
Back over at Mind, Stephen Buckley mentions that GPs are increasingly looking to prescribe options such as exercise and refer patients to alternative therapies such as arts therapies, which are potentially effective for depression and anxiety, and are recommended for more severe mental health problems like schizophrenia and psychosis. “Arts therapies are conducted with a trained therapist in a therapeutic environment and differ from taking part in craft or arts activities outside of a therapeutic context,” he says.
To Hayley, exercise and meditation have been crucial: “I go to a free [meditation] class, and I exercise at the gym. These things can really help clear your mind.” But although physical activity and being outdoors may boost our mood, improve our wellbeing and help relieve everyday stress, they aren’t appropriate strategies for everyone. Exercise, for instance, may become an issue when trying to recover from an eating disorder.
Tom Quinn, director of external affairs at Beat, the leading eating disorders charity in the UK, says: “In general, we always advise people who are worried somebody they know might suffer from an eating disorder, to take some steps by talking to their relative, partner or friend and invite them to seek support from their GP.”
Early intervention is key to ensure a full and sustained recovery and, taking this into consideration as we look at the wider picture, Quinn says more work "must" be done at a national and local level to improve waiting-time figures year on year.
Hope Virgo, a 27-year-old author and charity worker, was diagnosed with anorexia at 16, having lived with it since the age of 13. Her family and school intervened, and she spent a year in the outpatient child and adolescent mental health services, attending weekly therapy sessions. Unfortunately, her condition worsened and, at 17, she was admitted to a mental health hospital for one year. “I have managed my recovery pretty much ever since,” she says.
Hope is satisfied with the package of inpatient care she received, but many people don’t get that kind of support or may not be able to access it, because of responsibilities such as work and family. “Quite often we don’t have services in place to prevent people from getting unwell, so it’s all about waiting until someone hits rock bottom before you can get any help,” she says sadly.
To anyone seeking support, she recommends “badgering” your GP until they actually do something. But it can be exhausting, especially if you're unwell. She suggests: “If you talk to the people around you and you’re struggling to go on your own, get others to come with you.”
Beat’s website offers helpful information and guidance, and the charity runs a helpline service with trained support workers to explore feelings and thoughts, receive information, and discuss potential treatment options for eating disorders.
“I think people just assume that you can get help only when you’re really unwell. If you’re kind of functioning, they feel they may not need it or won’t be taken seriously,” Virgo adds.
Sarah Jones*, a 27-year-old receptionist, has been on a waiting list for CBT for over three months, after going to her GP to get support with anxiety.
“I appreciated being put on the waiting list but what I was looking for was to know that I wasn’t making it up, that the anxiety was real,” she admits. Having a health professional validate her experience was somewhat helpful, but she still hasn’t accessed any service available out of office hours that's compatible with her 9-5 job.
“What I would suggest to friends in a similar position is: go online and look for charities that offer counselling options,” she advises.
That’s what she did, in 2016, when she contacted Anxiety UK, which has a national network of therapists who deliver interventions such as CBT, counselling and clinical hypnotherapy at more affordable rates. Within a few weeks, she started therapy at £35 per weekly session, for about six months.
In terms of other useful, free, available resources, Cal Strode, a spokesperson for the Mental Health Foundation, points to the guides on the charity’s website about looking after mental health and preventing problems. “Physical exercise, eating well and taking regular breaks from our routines can all be beneficial. Doing what we can to ensure a good night’s sleep is crucial, and mindfulness can help to build our resilience to better cope with the challenges life inevitably throws at us,” he explains.
Obviously, if someone is already unwell, these things can be difficult to do – and sometimes even detrimental. Mindfulness, for instance, increases awareness of thoughts and feelings, and can initially make some people feel worse. If you're panicking in that moment, trying to focus your mind can often make feeling better hopeless.
One last idea comes from Jackie Crofton*, a 30-year-old writer from London. Having struggled with anxiety since childhood, she recently found herself signed off work due to severe and prolonged panic attacks. During these attacks, the only thing she found helpful was the step-by-step guide on Mind's website, which would get her through the particularly tough-to-manage hours.
"I never thought sitting under every pillow and blanket I own, followed by a hard session of jigsaw puzzles would be the thing that got me through the night, but here I am. Now I recommend their guide to everyone with anxiety."
Of course, when it comes to mental health, there is no one-size-fits-all approach, but a good support network makes a significant difference. As Strode reminds us, at difficult times we might need the practical support of our friends and family to make sure we’re looking after ourselves, as much as reasonably possible.
*Name has been changed to protect the privacy of the interviewee.