This year, after a lifetime battling physical and mental health issues that exacerbate one another, I finally feel like I actually have some control of my mental health. What’s worked for me? Well, it’s what everyone will tell you works: exercise, therapy, prioritising my health, finding a safe place to live, taking a break - all things I’ve finally managed to do because I now have enough money.
Don’t get me wrong, I am by no means a high earner, but my life is more comfortable than ever, and being able to do these things is a privilege. Getting to this point has been not just a case of trial and error but of getting over immense barriers to accessing care.
We have made huge positive shifts towards destigmatising mental health issues of late - just take the recent surge in people joking about their therapists online or recommending that “everyone needs therapy” as an example. No doubt this made people who can access a therapist feel better about needing it, but it doesn’t help those who can’t. We talk about self-care, too; about luxuriating in baths or buying ourselves nice treats to cheer ourselves up. These things just aren’t possible for many.
I was first seen by a GP for my mental health in my young teens during a period of frequent self harm. He told me to get St John’s Wort. Defeated, it took four more years to take the responsibility to ask for help aged 17, after my battles with an eating disorder and OCD reached a breaking point. I joined a waiting list. I saw someone for CBT who dropped me for being uncooperative when I found it difficult, after 20 years, to immediately give up my rituals.
The nine years between then and now are mostly a blur of coping alone. The NHS is hugely overstretched, and the Tory cuts made to mental health services have decimated a lot of people’s potential to get help. Mental health services receive just 13% of NHS funding, and for many people, free help is their only option. It’s been proven time and time again that poor mental health is linked to socio-economic circumstances.
I grew up in a poor household and left home at 19, but money wasn’t my only barrier. As a teenager and young adult, I was working full time as a bartender alongside my studies, and couldn’t afford or spare the time for private therapy. The way healthcare works traps poor people in a vicious cycle; free help costs time, and convenient help costs money. My schedule was unpredictable, and I literally couldn’t afford to commit to a set time a week and risk losing a shift. Aged 24, immediately before a massive breakdown, I contacted my GP and several low-cost therapy services. They were overstretched, and I had to wait weeks to be told I wasn’t eligible.
This year, finally, I secured low-cost therapy. I pay £15 a session on a sliding scale through Fresh Start Psychotherapy and they’re understanding if my schedule means I need to skip it. It’s by no means perfect, and it also takes three hours out of my day, every week, a luxury I could not afford either financially or time-wise were I still a bartender. It took time and resources to research the therapy, to take initial meetings, and to travel.
I am freelance, which is not possible for a lot of people, but my wellbeing is entirely dependent on it. Of course, financial insecurity has its own negative effects on mental health, but it does mean that I can take time off if I need it and spend time daily in the gym. Poor physical health has been proven to make mental health worse, and exercise alleviates my joint pain and chronic migraines, which has a knock-on effect on my mental health. I feel guilty for being so lucky, and it feels disingenuous to recommend exercise or therapy when I know firsthand the barriers between ordinary people and support: it is no coincidence that the first mentally healthy year of my life is also the most financially comfortable. Feeling able to talk isn’t enough. I feel lucky that somehow - not for lack of trying - I didn’t die in the years between realising I had problems and actually getting the appropriate combination of help.
So what can you do if you’re struggling to access care? NHS waiting times are at an all time high, especially if you aren’t presently a danger to yourself. But still, it’s worth going to your GP for an initial diagnosis, to get on a waiting list, and to ask for advice. In the meantime, while you wait to be seen or to find something that better fits an unforgiving schedule, search for free therapy in your area. If you’re London-based, South East London Counselling offer a list of sliding scale therapists. You can find more information on accessing cheap therapy in the UK here. These therapists are sometimes in training or working as part of charities, which means they’re often not equipped for more serious problems, but it’s worth trying. If you’re on benefits or a low income, let them know. I personally would recommend, if possible, reaching out to as many of these services as you can at a point when you’re in better mental health – when I had a breakdown, I found myself lost as I waited weeks for a reply.
When you’re struggling to access help it can feel like nobody cares, but there are charities dedicated to supporting people without resources. I spoke to Stephen Buckley, the Head of Information at mental health charity Mind, who told me that they’ve been pushing for GPs to be offered more mental health training. Stephen mentions that the NHS Long Term Plan comes with funding for mental health services, and should result in GPs being able to refer patients to talking therapies and alternative treatments. He believes that we need to acknowledge wider barriers to accessing care, “it’s important to look beyond health services to people’s broader experiences, which medication can rarely help with. Recognising the psychological impact of factors such as poor housing, debt, unemployment and benefit issues is key.”
While Stephen believes that self care, “should be seen as complementary to mental health services, such as counselling or cognitive behavioural therapy,” he does recommend some practical self care, like, “getting enough sleep, logging off, physical activity, getting outside, making connections, and learning something new”. He believes that connecting with people is important, but in situations where we may lack IRL friends, he recommends forums like Mind’s Elefriends, where people can talk about their problems and discuss potential solutions. Mind also offer helplines, where you can discuss your options with their experts. “People can and do recover from mental health problems with the right support, but there is no quick fix,” he adds.
If your workplace is inflexible regarding your mental health or needing to leave for therapy, it’s worth knowing your rights and having a conversation with your boss. As someone who has spent years working in insecure 0-hour jobs with no contract, however, I know that this might be impossible. If your life leaves you currently unable to speak to someone in person, many people offer therapy, even for free, over the phone. Finding low-cost, non-NHS therapy isn’t an exact science and it requires a lot of research to find something that’s right, but it’s one option. There are also apps that will enable you to track your mood or even develop safety plans in the case of emergency. Secondhand self-help books, YouTube, and even therapy-themed Instagram accounts also offer some education on mental health. While it isn’t the same as speaking to someone, it’s important to have the tools to understand yourself.
It is unfair that the burden of care lies with us, that good mental health is only accessible if you can afford it. Not to mention that women and working class people are prone to feeling guilty if they take time for themselves. We tell people to work on themselves, to ask for the support, to not be afraid to speak out. But in doing so we ignore the reality: the NHS cannot offer dedicated care, and so many people cannot afford either the time or the money to look after themselves.
The years I was working too much to take an hour out of my day for myself were the most mentally damaging, but I did not have a choice. Money and survival were my utmost priority. My health had to come second, and the moment that it couldn’t anymore – when I was assaulted as a bartender, for example – was far too late to get on a waiting list.
I feel so lucky, and so embarrassed, to admit that the only reason I’ve spent the longest stretch of my life not suicidal this year is because I have more money. I hope any of the things I have learned help, but I know that it isn’t enough. Focusing on destigmatising mental health and ignoring the innate privilege in being able to look after ourselves is dangerous and does poor people a disservice.