I feel like I need to clarify something. My last post, about the sorry state of our mental health services, has gotten quite a response. I’ve had people contact me sharing similar, if not worse experiences, and every other day there seems to be a new horror story in the media about someone else’s dealings with psychiatric services. Our mental health services are taking a serious verbal beating at the moment, and rightly so.

But what I’m concerned about right now is the frontline people, those actually providing the services. They are not at fault. I’ve been so frustrated over the years with trying to get access to my psychiatrist, or having to deal with constantly changing doctors. However, I can’t blame her for that, I blame the system she works within. Resources are far too scarce on the ground, and completely over stretched. I realise how lucky I am to have been able to see her more or less consistently for the last few months, and I think it’s that consistency that has brought me as close as I currently am to accessing dbt.

Massive, sweeping changes are needed to improve service provision for people, to stop the kinds of crises we’re hearing about almost daily from even having the chance to develop. Perhaps now more than ever there is huge need for support – people are far more willing to talk about mental health, and the stigma around it is slowly being chipped away. But the upshot of that can only mean that demand on services will continue to increase.

We need affordable, timely access to talk therapy. Not of the time limited, 6 session variety, but as long as it takes. For some, 6 sessions is plenty. For others, myself included, it’s nowhere near enough. If anything, it’s actually more damaging than nothing because it risks opening wounds that won’t have time to close before the end of therapy, and that has the potential to leave someone in a worse state than when they actually started. I was recently turned away from a service because I was told that given my history, 6 sessions would do more harm than good. While I get the rationale on a practical level, it did leave me in a fairly serious quandary – yes, the service in question most certainly agreed that I needed support, but they weren’t going to be the ones to provide it. They couldn’t tell me who would either.

We need support within the community. There needs to be someone to call when there’s a crisis, other than a helpline, particularly for those of us who are already engaged with services. There’s no joined up thinking – if I have a serious crisis and call, let’s say, the Samaritans, the only way my psychiatrist finds out is if I remember to tell her. Given that appointments can be months apart there’s a strong possibility I wouldn’t remember. But she needs to know what’s going on. There needs to be someone at the end of the phone who can join the dots, and make sure the right people know what’s going on.

I guess what I’m really trying to say right now is we need to be careful about where we’re laying blame. My GP, Therapist, my psychiatrist – everyone who has been involved in treating me over the years has, I believe, done so to the best of their ability, and have more than once gone above and beyond. I cannot begin to imagine how stressful and frustrating it must be for them to work in such a broken system, and it’s the chronic limitations therein that are causing the problems.

I don’t know what I can do about this other than keep shouting. Maybe eventually we’ll be heard?

This article has 3 Comments

  1. I agree with you that accessing services is the biggest problem in this country. There’s never been any long-term investment so therapists don’t really update their skills, find out about the latest therapies to help patients. You mention DBT- it’s been available in the UK for years, was available in the US for years, was only brought out In Ireland relatively recently. St Patrick’s Hospital in Dublin is a Centre of Excellence in mental health but it requires health insurance.

    People on lower incomes have to access low-cost counselling and it’s usually carried out by student therapists and/or newly qualified therapists. It’s obviously better than no counselling at all however I wonder if the standard of therapy is the same as someone who is able to pay for a psychologist. People are also reliant on charities like Aware etc and that’s hardly ideal either.

    There was A Vision For Change in 2005 but none of those policy changes were implemented by the Fianna Fail government of the time. It stated that each mental patient should have a psychiatrist, psychologist, GP, and psychiatric nurse..actually get a team of people working to help them get better.

    There’s also a lack of legislation regarding therapists-anyone can call themselves a therapist, even if they’ve just done a 2 day course. A lot of patients aren’t aware that there’s a difference between a counsellor and a psychologist and that difference needs to be outlined to patients from the outset. There’s also so-called “life coaches” offering services-some may be helpful however I’m deeply skeptical of their efficacy as they don’t really have the necessary qualifications and may just be taking advantage of vulnerable people in need.

    1. Yup, to everything you said! Low cost services have their place, but for someone in my position, working with a trainee would not be advisable. I tried Aware groups a few times and it just wasn’t for me, I tended to come away feeling worse than when I went in!! In hindsight that could very much be bpd related as I tend to take on whatever emotion is around me, and at the time I attended those groups I thought I was dealing with ‘just’ depression. I feel like what it keeps coming back to is it’s ok not to be ok, if you’re a little bit not ok. If you’re a lot not ok then you’re fecked.

  2. Hi there,

    I participated in DBT program in St Pats and felt it was ok but certainly not an answer nor indeed a cure for my own BPD. Have been to cluain mhuire in south dublin and that helped a little at the outset but they are limited in resources and have no problem discharging you irrespective of how sick you are !

    There are many online groups for DBT that teach the skills and review on a weekly basis. I guess if you are considering attending the DBT program in pats you need to know the following:
    1. You will attend the group with a mix of inpatients and outpatients – my experience was great, met some really nice people and found I could really relate to them.
    2. The group is not a therapeutic group i.e if you are upset / struggling – you have to deal with it and bring it home with you, there is no psychological support – something I found was very lacking with the program.
    3. The price of the program is scandalous – you will need health insurance cover and when I did it several years ago it cost in excess of 7 grand – shocking really.
    4. Skills are thought and then repeated a total of 3/4 times from what I remember.
    5. The course I did was really a watered down version of DBT, yes the skills are covered but there is a lot more about DBT that was not discussed or indeed taught – refer to Dr Marsha Linehan’s books or videos.
    6. There was little to no support after the course, and like anything else, if you do not practice the skills you are wasting your time (trust me).

    I went into this course naively expecting to be “cured” of BPD, how wrong I was. My advice for what it is worth, go in with an open mind, learn some skills and practice them. skills are really designed to stop self harm and regulate your emotions.

    For people who cannot access DBT, I suggest you keep up therapy, purchase one of the many skills books on DBT, and most of all sign up to a mindfulness course, preferably mindfulness based stress reduction.

    wishing you the best
    Craig

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