At the end of 2021, I paid £380 for the privilege of a psychiatrist telling me I have Obsessive Compulsive Disorder. This was a huge relief, particularly as the same compulsive, overthinking tendencies that led to the diagnosis had also convinced me that I was making it up. The psychiatrist pointed out this was exactly why I should accept his professional opinion and suggested I try a high dose of a common antidepressant I’d not tried before. It had been found to have anti-obsessive effects and, in his opinion, was a good option for me. After two and a half years of therapy, going sober, meditating twice a day and regularly exercising, it was the only thing I hadn’t yet tried.
This is not normally the way it goes. When people are having serious mental health struggles and seeking support in the UK, medication is often the first and only port of call. But I was one of the lucky ones — this psychiatry session with someone new was a “luxury” I could now afford, as my parents had been funding the other therapy I’d needed since 2019.
A lot can be (and has been) said about the benefits of seeking mental health treatment, particularly therapy. But the fact that in-person treatment is so often inaccessible and unaffordable doesn’t seem to often factor into proclamations that people should “just go”. The ugly truth is that the best way to access meaningful support is generally to pay for it. NHS support is limited. To access support you must be referred by your GP who will assess what, if anything, is the best course of treatment for you. That can include a prescription and a referral to a waiting list. For depression and anxiety there can be long, debilitating waits to access the NHS Talking Therapies. Though NHS England recorded success earlier this year in meeting waiting list targets around Talking Therapies, experts dispute the idea that the rates of people attending therapy are improving. Only 38% of those referred for treatment actually complete their recommended course (generally a series of six to 12 hour-long sessions), with the rest dropping out.
The National Audit Office (NAO) also found in February that millions of people in England are not seeking NHS help, saying: “NHS mental health services are under continued and increasing pressure and many people using services are reporting poor experiences.” The Guardian reported that under-18s, the LGBTQ+ community, minority ethnic groups and people with more complex needs are most likely to find the system inadequate.
In July a damning parliamentary report into the state of NHS mental health services aired concerns about staff shortages and “increasing pressures” on those in the workforce. 17,000 (12%) staff left the NHS mental health workforce in 2021-2022, up from 13,000 (9%) the previous year, with more staff citing work-life balance as a reason for leaving. Though the mental health workforce actually grew by 22% between 2016 and 2022, patient referrals rose by 44%, meaning the gap is still significant.
Without treatment, as anyone who’s experienced a mental health crisis can tell you, the descent into a breakdown is precipitous. Though my OCD first showed signs in February of 2019, I didn’t seek any help until June that year. By then I couldn’t function without the looming fear of a panic attack and was in a constant state of debilitating terror. It was destabilising my relationship, jeopardising my career, and making day-to-day life unbearable. I couldn’t afford to not deal with it. The problem was I was making £28,000 a year (and would do so until 2022) and I was spending around 60% of my salary on rent and bills alone. When I called my work health insurance they told me they couldn’t help because this was a “pre-existing condition” (I had dealt with anorexia and depression in my early twenties). In June that year I went to my GP who prescribed me an antidepressant that had previously worked for me and put me on the Talking Therapies waiting list. That medication didn’t work, so I went through the withdrawal mid summer before trying another one. That did nothing for me either. I stayed at that GP and that address until June 2021 and never heard back about the waiting list.
When I began therapy that year, paid for by my parents, I was lucky to find a therapist who really understood me from the first session. That, again, is a privilege. If we hadn’t clicked I would have had the luxury of trialling sessions with other therapists until I found the one that worked. This is another important and expensive part of finding mental health support that is particularly difficult for marginalised people – if you are disabled or dealing with intergenerational trauma or navigating your gender, it’s crucial to have support of someone who will actually support you rather than denying or exacerbating your struggles, and that is far from a given.
Because talking therapy is harder to come by, antidepressants, an option I came back to after exhausting every other avenue, become a first port of call. While my experience with my current medication has been life-changing, I do not attribute that to the medication alone. After trying two other different medications and giving them up in 2019, I had done the work to understand where my OCD was stemming from and how to quell spikes in anxiety. I was managing it and doing a good performance of being mentally well, but the panic was always lurking at the back of my mind. The medication let me remember what it felt like to live without the fear that any thought could trigger a relapse. It was a circuit breaker that solidified all the other work I’d done, rather than the solution itself.
Antidepressants are fundamental to the UK’s mental health support system, with 86 million antidepressants prescribed in 2022-2023 to around 8.6 million patients. Trial and error in finding the right one for you is not unique either: different people respond differently to medications. They can even stop working, a horrible experience jovially named “pooping out”. Going through withdrawal is part of finding the right treatment, not just the process of ending it. But guidance through withdrawal, like everything else, is hard to access — the 2023 GP Patient Survey found that 37.1% of patients seeking appointments for any care were unable to get one. Paying for a psychiatrist to hand hold you through that process is yet another luxury. And they work best when used as part of a wider course of treatment, not the only option.
People find it difficult to “admit” when they have benefitted from the “bank of mum and dad”, as it’s known. I find this to be insidious. Masking the fact that you have to be extremely lucky to have this support glosses over the fact you must be wealthy (either personally or generationally) to deal with a mental health crisis. It’s how you end up with campaigns that focus primarily on destigmatising mental ill health and a focus on platitudes over providing options for people to actually “talk to someone”.
Money gives you the opportunity to actually treat the condition rather than being given one solution and hoping it’s the one that works best. It allows you the space to invest in your long term wellbeing. I will always be grateful for that. But I do not “deserve” this more than anyone else. I can be a silly, spiteful person but I would not wish the agony of OCD on anyone. And yet, because of the current system, the way I found is often the only option.
People with privilege shouldn’t gloss over these advantages. If you can, donate when possible to funds that help other people access therapy, support mental health charities and fight for the NHS.