In response to Suicide Prevention Day, Annika Kapp considers how current support services in the UK are failing.
Content Warning: Contains references to suicide, OCD, and depression.
10 September marked the annual Suicide Prevention Day; the time of the year when social media tells you to check up on your loved ones and awareness campaigns urge people to speak up and seek out help. In theory, it’s great and important that this day exists. However, when you look at the current state of the UK mental health system, observing Suicide Prevention Day feels a little cynical to me. Because what actually happens when people do take the courageous step to reach out for help? Often, the answer is quite disheartening: not much, and certainly not enough. Being from Germany, I do not have personal experience with UK mental health services, so I spoke to some people who do.
Charlie is from Greenock, a town that has recently been ranked by the Scottish Index of Multiple Deprivation (SIMD) as the most deprived area in Scotland. When he went to see his GP several times for low mood and depression, there were no NHS services available to him. Instead, his GP gave him links to websites with mental health resources and told him to self-refer to a mental health charity in his community. “It was a very long waiting time”, he told me. “I applied in April, and I got my first appointment in December.” He ended up getting eight sessions, which weren’t sufficient. “There were useful self-help techniques that I learned, but at the same time, I don’t think it really helped much. It was like a quick-fix.”
Nikki had a similar experience. She has been struggling with Obsessive Compulsive Disorder ever since she was 15. When she first sought treatment, she was told that the waiting time would be 18 months. “But I thought I would not be around in 18 months’ time. By scraping every penny I had, I somehow managed to see someone privately. I genuinely didn’t think I’d make it to 18 months.”
A chronically under-funded NHS and an encouraged reliance on charities whose resources are just as strained makes it difficult to believe that the UK mental health care system actually has proper services to prevent suicide. Getting support before an issue gets out of hand is often impossible, and the option of voluntarily self-referring to a rehab or retreat program without the potential of being sectioned doesn’t exist. As Nikki put it: “Either you’re well enough to wait a year and a half, or you’re so bad that you need to be sectioned and institutionalized. There’s nothing in-between.”
What is even more disturbing is that the system not only doesn’t manage to prevent suicide, but also fails in the case of this acute crisis. A few months after his sessions, Charlie was in the hospital after a suicide attempt. When he was discharged, the psychiatric liaison team referred him to a psychiatric clinic in his town. “I had a half-an-hour appointment with them,” he told me, “they said that they weren’t gonna offer me any services because they didn’t believe that it was something that would develop into something more severe. So they just referred me to counselors again.” There was no follow-up – he was simply told to see his GP when moving to Glasgow.
There is virtually no aftercare once you have completed your treatment. “Once you are out of the system, you are completely on your own. There’s no one checking up on you”, Nikki said. Coming from Germany, comparing the mental health support in these two countries has been quite shocking to me. Of course, our system is far from perfect, but there are some significant differences. From my own experience, I know how important the connection between you and your therapist is, and that it takes time to form that relationship and build up the genuine trust that is needed to do the hard work. It doesn’t happen in five sessions; which is often the amount that you will be given by the NHS. In Germany, you can either go to your GP or self-refer yourself to a therapist. Not only can you decide which therapist you want to work with, but you can also choose freely between five different types of therapy that are covered by public health insurance, including Cognitive Behavioural Therapy (CBT), Psychoanalysis, and Eye Movement Desensitization and Reprocessing (EMDR) therapy. Depending on the type of therapy, you get a certain number of sessions (eg 24 up to 60 hours for CBT), after which you can apply for an extension. Before you even start the actual therapy, you get up to five “probatory” sessions, which are intended for diagnosis and to see whether you want to work with that therapist. These are free and need not be approved by your health insurance. If my friends back home are struggling, I can direct them to our mental health services with a good conscience because I know that even though they might have to wait a bit, they will get the help that they need. Here, it feels like sending them off onto an uncertain path.
Since funding for actual therapy is so limited, we see campaigns telling us to reach out to family members and friends. And as much as these campaigns mean well, I feel that they are shifting responsibility in an unrealistic way. Of course, our family and friends can be there for us, they can listen and offer emotional support. But in the end, they can only do so much. They can’t treat severe depression or anxiety, or manage an acute crisis. That is what we need mental health professionals for.
Awareness campaigns on Suicide Prevention Day simply aren’t enough. Telling people to reach out and then leaving them alone when they do so is cruel. If this government truly cares about preventing suicide, the answer is funding, funding, funding.