*Apologies for any bad language – a slight personal rant included. Mentions self-harm & suicidal thoughts*
I don’t know if I’m just not understanding the meaning, but there seems to be something very misleading about ‘IAPT’ services…. ‘Improving Access to Psychological Therapies’ – how exactly do they do this? I had access to them for four sessions. Okay I did a twelve week group as well, but that’s very different to working on your own individual issues with support. Four sessions to fix not only the problems I had before the group, but just the one to resolve issues that were awoken by the group. So yes, I had access, but now I don’t.
I feel that by ‘improving access’ they mean it’s accessible to everyone – in other words you can refer yourself. And you will get seen because it’s such quick turnaround. They see you for a couple of sessions and then ship you off to a group course to keep you occupied, before signing you off of their books, and shipping the new recruits in.
In a word, it’s a FACTORY.
There was something I saw on Twitter recently about IAPT and the burnout rate for Psychological Wellbeing Practitioners and High Intensity Therapists. This made me stop and think about the pressures that the staff are under to reach targets and provide the service they do. They may not have the training they need and the funding, to help those in need, and perhaps they feel powerless. But I had it pointed out to me that that’s not my problem.
I shouldn’t have anything to do with that side of things. I should expect top-notch care from people whose job it is to keep me safe and well. And if they failed me, they failed me. I shouldn’t feel sorry for them, that they are struggling too. I shouldn’t feel like a burden or like I’m too complex for them. I cannot help having the mental illness I have. I cannot help the fact there’s no support out there for people like me. I’m in need of help, and I should take up whatever help I can get – and it’s their job to provide that help. If they couldn’t do that, they’re not up to scratch, and that’s down to them.
Yes there are massive gaping holes in the NHS and mental health services. Something needs to be done about this. The staff are doing the best they can. They’re likely stressed and unsatisfied with the state of things too. But the difference is they are able to quit if they want. They can leave their jobs if it gets too much. I don’t have that luxury. I cannot quit my mental illness. I wish I could but I can’t. I need the help of people like them, in order to try and pull myself out of it. I rely on them. So I need them to do their best to help me.
And unfortunately in my experience I don’t feel all of them did their best. Even my doctor seemed disappointed in them. She knows how hard it was for me to keep going back to the group after my self-harming incident… that I pushed myself through the last few weeks of the course, to get the support at the end, and didn’t receive it. She herself had said weeks ago that the service was unlikely to abandon me at the end of the course, as clearly I’m not well……… that’s obviously not how the service works!! It seems they get rid of you, regardless of what state you’re in.
I wrote something about my incident so that the facilitators of the group, and my therapist would be aware of it. I believe those running the group read it, though I could be wrong – not sure I trust anything now, regarding this service. But I believed my therapist had it passed on to her. However it seems it was ‘added to my notes’ – which she clearly had no interest in reading. What was the bloody point?? I had already harmed because an encounter with one of the facilitators had left me feeling powerless, and that had made me question what the point in using the skills was, since they wouldn’t allow me to do so…. so to have my therapist, on top of that, make me feel like I wasted yet more of my time, I just think there’s no point trying with them. It’s not even like I’m a difficult person, refusing to co-operate! I was eager to learn, and to try things… I had knowledge and was pro-active. But it seems I was ahead of them in some regards. I knew what they could do to help me, but they didn’t seem to have a clue.
Is this my problem, or theirs? Is this a lack of training? Is it a lack of experience with someone like me? Am I too demanding? Am I too clued up about my own mental illness? Is it lack of funding to actually offer me real help? Is it apathy towards me?
Whatever it is, it felt like I was screaming out and pleading for their help, and they refused to give it. I felt like ending my life at times, as it would be doing them a favour, as I’m clearly a burden to them, just as I am to everyone else. I honestly thought they wouldn’t care if I did end my life, and they would’ve left me to get to that point. I actually considered doing this at one of the sessions. I harmed myself in a dangerous place, not caring about the consequences. But I was interrupted before it could go too far. I patched myself up and carried on as if it hadn’t just happened. They never knew this, and never will unless by some miracle they happen upon my blog and know it’s me.
At one point I spoke to one of the facilitators, and he said that if I’m struggling with the course and can’t go on with it, I could be offered a different therapy… I asked if that was through a different service somewhere else, and he said no, through this service. But me being a glutton for punishment, I chose to see the course to the end, and see my therapist. Now, if I hadn’t finished the course, would I have been offered this magical different therapy I wonder…? Because I sure as hell wasn’t offered it at the end. I don’t even know what it would have been!
I thought IAPT was about accessing different therapies – I thought it would open doors to recovery by being referred on to people who could help me… I thought it was this ‘stepped care model’ and with me being ‘Step 3’ I could be ‘stepped up’ to the CMHT if necessary. So do I assume that my therapist didn’t think I was ill enough to require this level of help? She clearly didn’t think I needed ANY help, as she discharged me! She thinks I need to help myself now. Well thanks a fucking lot! It’s not like I’ve been trying to do that for the last five years of my life!
Do they honestly think a twelve week course will help someone like me, and then that’s it? In a normal circumstance then perhaps… but given the disruption to my learning I experienced during that course, because of self-harm and transference, it’s almost impossible to feel I’ve benefited from the course, like others may have. So to treat me as a normal case, thinking I should be able to cope on my own now, because I’ve learnt the skills, taking no responsibility for the individual difficulties I faced because of this service, it’s not on. It’s not good enough.
And I hate to be someone who complains. I hate to seem ungrateful. It’s particularly hard, because one of the facilitators actually patched me up after I harmed myself, so I feel grateful to her, and the other one I admired greatly and felt emotionally attached to, so to slag off this service after the work they put in makes me feel really guilty.
But I think it is possible to be grateful for the help I did receive, to feel the way I do about one of them, and still say the help I received was not enough. It was a bad experience. They could have done more. And should have done more. I’m trying to come to terms with this conflict. I am grateful, I liked the facilitators as people, I feel strongly about one of them still, but as a service they let me down. And in fact each member of staff I came into contact with let me down personally in one way or another at some point. But people make mistakes, I know this. They are only human.
I don’t know if I’d use this service again. If I did I’d ask to see a different therapist, as I feel like we didn’t really gel. In fact I didn’t like her attitude at all. But right now I just need to recover from using this service. In the new year I hope to look at my folder from the group, and really reflect on what was discussed, because right now it’s a blur of emotions when I think about it. But otherwise it’s just business as normal – I have had to survive on my own for years now… no, I shouldn’t have to… I should get the support I need, but obviously that’s not going to happen, so I have to continue on as before, just with more psychological scars to contend with. I’ll give it my best shot… either I’ll sink or I’ll swim. I’ll either recover on my own, or I’ll reach the point where I can no longer be denied the help I need. That’s the sad state of the mental health services now… you have to be on death’s door before they’ll even contemplate helping you anymore. Either that or you have to be mild / moderate to be helped by IAPT. Unfortunately I’m more complex than that, despite what this service’s paperwork indicates (they said I had something like moderate depression and mild anxiety – you can’t diagnose me from that piece of paper, let me tell you that! It doesn’t cater for people like me). But the thing is I’m not actively trying to kill myself, therefore I’m not ‘ill enough’. So I, like many other people, particularly those with BPD, am stuck with nowhere to turn. That’s why being abandoned by this service now is a kick in the gut. I’m isolated because there’s no suitable help out there for me.
IAPT obviously isn’t geared up for those with BPD. But is that my fault? No. When I was discharged from the CMHT I was told that this service I’ve just used, is my option. In fact they’re my only option. So that’s why the doctor told me to speak to them. They’re most suitable for those with depression and anxiety, and hooray – I have both, but I have more than that too, which they can’t help me with. But does that mean I cannot have help? Since I don’t have an official diagnosis of BPD I’ll probably never get the level of help I need. I’ll probably never be able to see a psychiatrist to even be given the diagnosis now, so I am well and truly screwed. I, like many others with BPD, appear to be a casualty of the system, yet again. Not well enough to be treated by IAPT, and not ill enough to be treated by CMHT. Yet we as BPD soldiers, are most at risk to ourselves, so how it can be allowed that we suffer on our own I really don’t understand. At times I feel we’re deliberately being left to fend for ourselves, so that we will become part of the statistic, of ‘1 in 10 dying by their own hand’ – perhaps they want that particular statistic to grow. Maybe society wants us gone. Maybe I am a burden. Maybe they want me to kill myself as I am deemed ‘weak’. Like survival of the fittest, and although we’re stronger than most people will ever be, we’re viewed as ‘pathetic’ and ‘beyond help’… whilst those at either end of the scale for mental health are ‘worth saving’.
The damage that is being done to those of us who already have in-built beliefs, that we are worthless, a burden, unlovable, and we fear rejection and abandonment, is off the scale. I’m screaming inside ‘WHY WON’T ANYBODY HELP US?!‘ Do we not deserve help just as much as someone with mild depression? Have we not got as much to offer the world as someone with moderate anxiety? Does my life mean NOTHING??
Mental health services should be there to fix these beliefs we have about ourselves and life. They should be helping us to feel worthy. To make us realise we’re not a burden and we deserve love. They should be supporting us and encouraging us, not neglecting us and abandoning us after a couple of sessions. Many people with BPD, though not myself, have experienced neglect or abandonment as a child – to have that replicated by mental health services in adult life, is shameful.
I feel I was neglected in this process. And now I’m on my own again… with more negative beliefs lumped in, just to make it all that more difficult. I feel resentful towards them.
But the only good thing I feel right now, is a unity with all those other people out there with BPD, who cannot get the support they need, and are just as desperate as me. That gives me strength right now, to fight for justice for them, if not for me. The mental health services may not think my life matters, and I might not think my life matters, but I believe the lives of other BPD soldiers matter. And none of them should be let down like I have been let down. So I will keep speaking out for them. They are the only people who understand how I’m feeling right now. They are the ones who know what it’s like to constantly be at war in your own head, and to feel like your heart is screaming in pain, and exploding silently in your chest. The only ones who know the battle to get up in the morning, and pretend that a night of crying and harming yourself didn’t happen… we live to fight another day, with no hope in sight. They are my family. And they matter in this world. If mental health services can’t see it, then at least I do.
I know the strength it takes to ride this rollercoaster every single day. I know the ‘highs’ that aren’t actually all that high, and I know the lows, as low as Earth’s core. I know the feeling that we will never fit in, and function in this world like ‘normal’ people. I know the self-hatred. I know the intense emotions and the emotional and physical scars they leave us with. I know the despair, the fear and the loneliness. I know the pain of just living. Whilst others enjoy their lives we simply exist, and try to survive. We deserve more than this. But we can’t do it alone. We need mental health services to help us. That’s their job. So unless they want blood on their hands, it’s about bloody time they do it.