In this guest blog, Rae Ritchie writes about how for mental health service users, waiting is an integral part of their experience and the effects it can have.
Last week, the duty worker in my care team and a social worker from the crisis team came to visit me. I was having a bad week mentally and desperate for extra support. Quickly, we agreed that a tweak to my medication would be the most helpful step to take. The problem was I hadn’t seen a psychiatrist since moving care teams three months ago, thus getting a change to medication authorised over the phone wasn’t possible. The wait to see a psychiatrist in person is up to six weeks – this waiting list also being the reason I haven’t seen one yet in the first place.
This week I have to attend a psychology assessment. I’m apprehensive because the session is with a male psychologist. Due to the issues involved, I’ve always preferred to work with women practitioners but I won’t ask to switch as I’ve already waited 10 weeks for this slot. Once the assessment is complete I will go onto another waiting list for the appropriate therapeutic treatment. At this stage no-one is prepared to indicate how long that wait might be.
The writer in me wants to go back over the last two paragraphs and alter some instances of ‘to wait’ or ‘waiting’. The service user in me knows there is no point. Whatever the synonym used, waiting is still waiting, and this is as integral to the UK mental health system as SSRIs, cognitive behavioural therapy and plastic chairs.
I’ve swallowed down frustration as often as I’ve choked back tears. They can visit in four days, ring back next month, fit you in at some point but they are not sure when. I – and many others – hear these statements and nod patiently, smiling warmly at the nurse, OT or doctor in front of me. Of course, I understand there’s nothing they can do. It isn’t their fault. The problem is systemic; it’s historic.
I save the wailing until I’m back at home, or at least in the car, banging my head on the kitchen worktop or the dashboard out of sheer desperation. Four days, next month or some point in the indeterminate future is no good when even surviving the evening feels impossible.
We may rationally understand that this is not personal, that it’s a macro problem that engulfs our micro struggle, but when you’re wrestling mental health demons, rational does not always win the day. Other suspicions come to mind: ‘They don’t believe me’ and the equally pernicious ‘I’m not ill enough’ or even ‘I’m not ill at all – I must be imagining it’.
Responses to such thoughts swing from ‘maybe I should try harder to pull myself together’ to ‘perhaps I need a louder cry for help – then they will believe me and do something about it!’ How serious do plans to kill oneself have to be? How distressed do I have to get?
Of course, there are times when waiting has its uses. Sometimes we have to wait for effects to kick in, whether that’s medication or new healthy behaviours. On other occasions the waiting time may even allow a problem to resolve itself; what seems urgent and pressing when you’re in a well of despair may be forgotten about when your mood lifts a few days later. The trouble is that these useful pauses are usually not conscious decisions made by the service user and/or professional; they simply arise because we were having to wait for an appointment or visit anyway.
Waiting is central to experiences of accessing mental health services. It also characterises the experience of mental health more broadly. As a concept it can dominate how we understand our struggles. We have difficulties but wait to see if it’s a passing phase. Alistair Campbell, who has spoken openly about his battle with depression, claims that he rings his therapist if he has three bad days in a row. I am certain that many of us wait much longer – three bad weeks, three bad months, maybe even three bad years – before seeking help.
We wait at the start then find ourselves waiting in the midst of our episodes too. The usual delays in access to services combine with our own sense of feeling trapped, stuck, in limbo. We avoid making plans or taking decisive action either because we can’t or we sense this is not the right time to do so. We defer so much to the mystical time when we are feeling somehow better, postponing social plans, holidays, getting married and parenthood. In short, we are waiting to get on with our lives.
One day, sometimes, we find ourselves emerging out the other side. The clouds lift, the anguish subsides, we settle on a plateau. We realise that we feel stronger, calmer, perhaps even happy. Our lives resume; they are different now but at least they have a sense of moving forward. We socialise again and take that longed-for trip, plan the wedding and have the babies. We may even reduce the medication or finish therapy. All seems to be thriving. Well-meaning family and friends speak of our previous struggles as a blip, a past aberration that we’re best to forget about. If only it were so easy! We may long to forget and move on but in truth we are still waiting, just as we have been all along. Now we are waiting for the seemingly inevitable relapse.
The waiting, you see, never ends.
About the author
Rae Ritchie worked as a historian for a decade before leaving academia to become a freelance writer and coach. Whether in the past or the present, she is fascinated in how people make sense of themselves and their lives. This professional interest has undoubtedly been encouraged by her own wrangling with depression, anxiety, post-traumatic stress disorder and borderline personality disorder. These struggles are ongoing but writing about her experiences – and the not necessarily related topics of gender, fashion, beauty, women’s magazines and mindful living – is saving her soul.