I didn't know it was World Mental Health day when I booked a rare GP appointment last autumn. I found out later, after I'd emerged from my ten allotted minutes with the clock-watching locum, clutching a prescription for Citalopram and feeling surprisingly peaceful at having finally said it out loud.
"I'm not OK. I think I need help."
Anxiety for me is usually a low-level hum, always there to some extent but often a useful spur for me to resolve a problem or to improve some aspect of my life. Having control over the things that make me anxious is usually the key to managing my anxiety.
Nevertheless I've learned you can't control everything. Sometimes shit happens. Within a short space of time, our family home was threatened with a compulsory purchase order; I was put at risk of redundancy in a job I'd had for less than a year; my mother was critically ill and facing open-heart surgery nearly 2,000 miles away and I became the recipient of unwanted attention from a workplace bully. Yet still I held it together for the next two years, the time it took for each of element of this anxiety clusterbomb to be gradually defused.
It was at the point that everything was OK again that suddenly I wasn't OK at all. The physical manifestations of my anxiety, previously only experienced sporadically and in isolation, had become overwhelming and debilitating - IBS, trichotillomania, nocturnal panic attacks, palpitations, irrational anger, sweating. I made the appointment.
I wasn't keen on the idea of pills. I have a lot of happiness in my life; I don't want to be anaesthetised. I asked the doctor for cognitive behaviour therapy (CBT). I rationalised that I can't stop shit happening, but I can change how I react when it happens. He agreed to refer me and told me to come back in two weeks to review whatever side effects I would be experiencing from the Citalopram. I went home, Googled the potential side effects of Citalopram, and then threw the prescription in the bin with gusto.
It was some weeks later that I found myself waiting, in the foyer of a building that stank of both rancid feet and death in equal measure, for my initial assessment with the Talking Therapies team with the North East London Foundation Trust. After some confusion, I was eventually sent to a building that thankfully just smelt of cabbage. A Perspex screen on the reception desk slowly whirred back electronically after I'd been waiting awhile. "What do you want?" a woman barked at me. I explained, she tutted, the screen slid back and I continued to wait. The reception area filled up. I felt self-conscious. I don't want to belong here, I thought, starting to panic.
An hour after I had arrived, an apologetic nurse finally appeared and explained how they couldn't assess me that day after all. The nurse who was supposed to do it was off sick, she explained, and everyone else was too busy. She asked me to reschedule my appointment. I wanted to shout at her, do you know how difficult it was to ask for help, to come here? Instead I sputtered something about finding it hard to get more time off work and tapped resignedly on the Perspex screen. It slid back, and I asked to reschedule. "Not here," barky woman barked, "the other building." I saw everyone in the reception area was now looking at me, felt a swell of anger and humiliation, said "Fuck it," and walked out.
Of course, I immediately regretted this flounce and after some awkward backpedalling I returned to the Cabbage Unit before Christmas. I explained how I'd been feeling and why. The nurse explained to me that it wasn't a given that I would be allowed access to CBT. Apparently I would need a further assessment from another nurse at a later date to "assess suitability". I asked if I would see a doctor; she replied that I wouldn't, as I had chosen not to take medication - only those that do get to see the doctor. This method of triage felt imperfect to me, but I didn't question it.
Shortly after New Year's Day, I received a curt letter telling me to contact NELFT to arrange the second assessment, if I felt I still needed it. The letter informed me that I had 7 days from the date of the letter in which to do so, otherwise NELFT would assume I no longer wanted to access talking therapies and my case would be closed. I looked at the date of the letter - 22 December 2016. It felt like the NHS equivalent of the delivery driver that taps once on the door when you're on the toilet, shoves a "Sorry We Missed You" card through the letterbox and roars off in the van with your parcel as you topple, despairingly, down the stairs with your trousers around your ankles.
I complained, and after some bickering my case was reopened and Assessment 2.0 arranged. I wonder if I would've felt as able to persist with the process if I were suffering from depression rather than anxiety, or spoke English as a second or other language.
The second assessment was done on the phone. The nurse explained that she would ask me a series of questions, and that I should base my answers on how I'd felt in the past two weeks. I queried this, it felt too short a snapshot. The first set of questions were about depression; I told her I wasn't depressed and at the end of the section she concluded the same, in an oddly disappointed, weary tone. I wondered if, like the time I reversed into the back of the test centre at the start of my driving test, I had already failed.
We then went through the anxiety questions, which focused largely on social anxiety. I have a wonderful circle of friends, I told her. They've noticed that I'm more uptight than usual, but I still enjoy seeing them regularly. "Maybe you should be talking to them, then." That tone again.
I explained that I didn't much want to discuss with them about how I frequently wake up screaming, or about the urgent need to evacuate my bowels if a letter from the local council appears on the doormat. We talked about my symptoms and she said, with more empathy, that it sounded like my mind and body hadn't caught up with events and was still in fight/ flight mode. She concluded that I did indeed have "a bit" of anxiety. I asked her if it was enough for me to access CBT. I was told I'd need to wait until the following week to find out, and that she would call me at 4.30pm the following Wednesday. I was due to go on holiday for a fortnight from the Thursday, I said, and fretted aloud that Wednesday afternoon was "cutting it fine". She promised again that she would call at that time. She didn't.
Another letter from NELFT was waiting for me when I arrived home after my holiday, dated the day I left the country, informing me that they had made three attempts to contact me - presumably when I was on the plane - and said that unless they heard from me by a date that was now in the past they would assume that I no longer wanted to access talking therapies and my case would be closed.
There was no indication in the letter whether or not they had eventually deemed me mental enough to access mental health services, and I didn't bother to find out. I gave up.
I get that every single clinician I spoke to is trying their best to meet the impossible demands of a horrendously overstretched and underfunded NHS, really I do. My life remains on an even keel and my brain and body appear to be finally catching up to that fact. If I find myself in crisis in future I am in the privileged position that I can afford to pay privately for CBT if I need to.
I will be OK.
How many others won't?Suggest a correction