HOW DID NHS ENGLAND GET IT SO WRONG?
As an inveterate campaigner for mental health issues – in particular, for mental and physical health to be given parity of esteem, as promised in the NHS Constitution – it is always gratifying to see positive action being taken.
So it was with interest that I read of NHS England’s plan to help patients come off antidepressants, as well as set up a support network to help people manage withdrawal symptoms and find alternative succour. It’s not an unreasonable goal. When as many as 8.4 million adults in England have been prescribed antidepressants in the past year, to question whether it might be better to look at root causes rather than throwing pills at the problem is not just sensible, it’s overdue.
But then I read further. The plan is to help people come off antidepressants ‘and painkillers under an NHS drive to tackle addiction to prescription pills… [It] aims to avoid a US-style opioid crisis [and] recommends that patients be sent to art, music or gardening classes.’ At which point I fell off my painting stool and crushed my ukulele.
Where to start? First, the equation of a reliance on antidepressants with a dependence on opioids is at best boorish, at worst fatuous. The opioid epidemic is one of the worst public health disasters affecting the USA and Canada. As many as 600,000 people have died from opioid overdoses in these countries and the figure is rapidly rising. Opioids reduce pain, boost pleasure and often become highly addictive. This is not how antidepressants work. Indeed, the point is we don’t really know how – or if – they work. This is in itself a legitimate reason for caution and research, but to correlate the two just clouds matters further.
As someone who has used antidepressants, has come off antidepressants both successfully and unsuccessfully in the past, and is currently on antidepressants, I can testify to their uses and limitations. I have never felt a euphoric effect, though I have come to view them as virtual water wings. They keep me afloat and prop me up just enough to go about my business with agency. I certainly know it when I go without for a length of time, though I also know this is my own damn fault and that withdrawal is practicable if I do it sensibly.
I’ve never found myself jonesing for an SSRI fix. Though I certainly have craved therapeutic counsel at times and this isn’t always easy to come by. I fully understand the concern that GPs might be doling out pills indiscriminately and irresponsibly when a considered course of psychotherapy and medication is the more sensible option. But often the reason GPs reach for the prescription pad so readily is because the waiting time for therapeutic appointments is so long when the demands are urgent.
This speaks to the source of my exasperation with NHS England’s announcement in March. Namely, there is a fundamental misunderstanding of what mental ill health really is and how it manifests itself. Some years ago, Alastair Campbell touched on this for Men’s
Health. He recalled how the Prime Minister at the time had spoken of his pride that we now have waiting times for some mental illnesses, as we do physical ones. So, if you have psychosis, you should be treated within two weeks. ‘I have had psychosis,’ wrote Alastair. ‘I know that feeling of the mind exploding in a chaotic mess of confusion and fear.
The physical equivalent would be a body flying through the windscreen and left lying at the roadside. Imagine what we’d think if the waiting time for that was a fortnight.’
Which brings me on to my paint box. The recommendation that people pursue art or music or the outdoors as salves to mental stress is not without merit. Indeed, we recently reported on a Dutch study highlighting the links between playing a musical instrument and reduced stress levels. I regularly do all of the things prescribed in the NHS England plan and appreciate their therapeutic benefits. But are they a worthy substitute for the medication that allows me to go about my day with competence, accountability and satisfaction, rather than find myself reduced to a crumpled, unscrewed mess by a depressive condition that has blighted me for more than 25 years? I won’t bother answering that one.
Unfortunately, this reeks of too many well-meaning, woefully misjudged corporate wellness programmes, whereby the provision of mindful drawing sessions at lunchtime and biannual yoga classes in the cafeteria is seen as dealing adequately with the mental health ‘issue’. It’s not down to a lack of care, nor good intentions. It’s simply a lack of understanding. Until we correct that, the issue is going nowhere.