Just imagine. You meet your GP with some worrying signs of physical illness. He agrees that you need to be assessed for a service, but there is a long wait because it's overstretched. This treatment was pioneered in the UK, is recognised and recommended as an effective treatment by NICE, is frequently recommended by people who have received it, and has been proven to be cost-effective. But in your area it is not available at all. There is an outcry - therapy not available, the papers carry the story of a national shame and a personal tragedy. People ask why not?
I'd love to see more headlines like that for mental health - just imagine! In mental health services this scenario is all too frequent. I'm a clinical psychologist in the NHS and one of the most saddening aspects is explaining to people in crisis that the form of help I think would be of most benefit is simply not available, or that they will have to wait.
Sometimes the conversation is poignant; at the end of a period of psychological therapy when someone realizes that, had they had access to this when they were in their 20s and their difficulties were just beginning, the course of their life must have been very different. Learning to live with loss and regret is sometimes the work of therapy - but when the loss and regret are caused by underinvestment in key health services, it's a bitter pill to swallow. Just imagine.
Psychosis refers to a spectrum of experiences where a person's individual reality becomes out-of-step with what others experience. It includes hearing voices - as if someone is speaking aloud when no-one is present, and powerful beliefs and fears including paranoia (the fear, for instance, that friends or family members are conspiring against you, or that government agencies are tracking your movements), or 'grandiose' (the belief that you are special - a messiah or someone with a very special purpose).
All of these experiences, as well as other perceptual differences and a tendency to see connections between events which others would see as unrelated, can make psychosis a frightening, socially disconnecting experience, often accompanied with anxiety, fear, or depression - or can lead to behaving in a way which raises the concerns of others. Just imagine.
One of the main diagnostic terms used to name these experiences, especially when they are serious and ongoing, is schizophrenia, but there are a whole range of different paths which people's experiences can take: from experiences which are not distressing or perceived as a spiritual or creative gift, through those who experience only a single episode and make a full recovery, to those for whom these experiences become tragically disabling.
Rethink Mental Illness, to raise awareness of psychosis and to highlight the gaps which still exist in services for those who experience it have an excellent film (at https://www.youtube.com/watch?v=Jjmn7qAjco8 ). It tells the stories of people who have experienced psychosis and have come through it.
Overwhelmingly they talk about the importance of comprehensive services, and choice between treatment options.
Thankfully, there is cause for optimism. The concept of "Parity of esteem" - equality - for mental health services, has gathered ground, and with it the strong economic argument for investing in mental health services.
The introduction of well-defined care pathways for stroke and cancer, with clear access standards has led to significant improvements in outcomes and the same approaches are being applied in mental health care. Earlier this year the Royal College of Psychiatrists and Rethink published detailed work to define what "good" looks like in psychosis services (https://www.rcpsych.ac.uk/pdf/Pathways_to_Recovery.pdf ) and April 2016 will see the introduction of new access standards, issued by NHS England, for early intervention services in psychosis.
These services, founded on a multidisciplinary model and offering a range of interventions including talking therapies, family therapy, and employment support, alongside medications have been in existence for some time, but investment has declined in line with overall underinvestment in mental health services. Now there will be clear targets for access time (treatment started within two weeks) for comprehensiveness and quality of the service.
Optimism on World Mental Health Day? Just imagine.