Is it really ok?

‘It’s ok not to be ok’. I can’t remember when it started, but it certainly picked up steam. It’s now the standard social media friendly, I support mental health awareness tag line. I know it is well intentioned, but increasingly, it doesn’t ring true.

Of course, in theory, it is true. It is normal to experience mental health issues. It’s fine to admit that you struggle. It is important to normalise mental illness. If you say it out loud, I am not ok, what happens next? If you’re lucky someone listens; someone cares. Maybe they ask what you need. Perhaps you get that help. The first time. Maybe.

It’s ok not to be ok in orange text with green quotation marks

What happens when the person you tell has no idea how to respond. What if you spill your guts to a doctor who doesn’t take you seriously. Or who does want to help you, but only has waiting lists to offer. Around 70% of those referred for mental health assessment in Scotland wait at least 18 weeks*. That’s a very long time to feel helpless, especially when there is no guarantee of treatment. What do you when the not ok doesn’t go away? Or if it keeps coming back? You try really fucking hard to be ok. You do the therapy and the meds and the hard work. It takes a long time. It’s gruelling and painful. All the time you know lots of people aren’t getting any treatment. You feel guilty that your receiving assistance that others aren’t. Even more so when the help hasn’t helped. You’re aware that the people who love you are scared. Your hurt hurts them. They want ‘ok’ as much as you do.

And you want it for them. When it slips from your grasp it’s harder to say it again. People have their own lives. Sometimes they might be struggling. Or they may be fabulous; enjoying some well deserved happiness. Everyone has stresses and responsibilities. Our lives keep us busy with the good and bad. Everyone must earn a living, manage their relationships, have fun. Who wants to be the person who complicates that? Not me.

When you’ve already done everything you’re supposed to do it’s hard to know how to banish the cloud. If the expert advice doesn’t do the trick how can well meaning friends help? Even when you really want to reach out there’s always an impediment. You don’t want to add extra strain when they’re in trouble. Nor do you don’t want to darken joyous life events. Sharing begins to feel less a problem halved & more a problem spread.

Very few mental health problems are a simple fix. None of the big issues in life are that black & white. When you fall back into the grey it’s terrifying. Especially when you know you’ve already had your shot. Ask anyone who has tried to access mental health services after discharge. It’s almost impossible. Drs will say you aren’t sick enough for referral. The NHS lacks the resources for early intervention. Access to talk therapy is limited. Almost 40% of those who received treatment reported that they did not have sufficient sessions**. Cognitive Behavioural Therapy is by far the most frequently offered intervention. Not because it is the most suitable, but because it is the cheapest & easiest to administer. Recovery is hard enough with appropriate support. When treatment is bungled it can do more harm than good. As already stated, re referral is doubly hard.

While you wait or fight for professional help (that may never come) your life is disintegrating. Friends who were initially supportive fade away when you never quite get all the way better. Employers sprint. They’ll talk a good game; train a mental health first aider or make a donation. Test their commitment with sick time or requesting accommodations & watch them run. You are left with the people who care enough to stay. Your predicament remains. You don’t want to worry them. You don’t want to ruin anything or be the thing that tips their bad news scale. It’s never the right time. We all want to believe that catch phrases are enough, but buzzwords will never cut it. What happens after I say I’m not ok?

The truth is, more often than not, nothing. The pandemic has only increased strain on an already buckling system. I don’t have all the answers. I do know that a cute Instagram post during an awareness month isn’t it. We need huge institutional shifts. More money, more training, more oversight. Our political representatives need to know that we want action. 1 in 4 adults will experience mental illness in their lifetime. Telling them that’s ok isn’t enough. We have to be advocates.

If someone in your life is suffering without help you can contact your Mp & express your concern.

Find out how long waiting lists are in your area & ask you Mp what they’re doing about that.

Stop voting for people who are actively defunding our health service.

Be proactive. Ask loved ones what specific help you can provide.

Use your social media to contact politicians directly. Ask questions publicly. Embarrass those whose voting records go against their constituents interests.

Accompany a friend to appointments if they require support. Insist that interactions are recorded in medical records.

We have to demand more of ourselves and of those with the power to make changes. Truthfully, it doesn’t feel ok, not to be ok.

Open shouting mouth with the text your voice has power

* Information Services Scotland ** SAMH

Talk is cheap…

It’s Mental Health Awareness Week, which is, in theory, a good thing. Since all it seems to involve is people on social media saying ‘talk about it’ it is not actually all that helpful.

We absolutely should talk about mental illness more. We should educate our kids about symptoms & how normal it is to experience them. We should put better training in place for teachers, emergency services & NHS staff. We should all try harder not to judge or shirk away from people who are struggling. Employers should be flexible with staff dealing with mental illness. There should be more information, more understanding, more honesty. Yes, we should talk about it. Asking for help it definitely a good idea. All of these things are important & valid, but there’s still something missing from the conversation.

What happens when you do speak openly & no one listens (or seems to care). Can we talk about all the people who gathered all their courage &!swallowed their pride to ask for help and didn’t get any? Can we address the fact that as hard as is it to say ‘I’m not ok’, it’s a million times harder to hear ‘tough luck’ in response.

We do need to talk about mental illness, but we also need to listen and act. Funding is of course part of the problem. The NHS is chronically underfunded & mental health is the poor cousin. For all the political talk of parity between physical & mental illness, there has been little change to waiting times or scarcity of vital mental health services. Very often waiting to even be assessed by a mental health team is a long process. In my area the wait for psychologist input is 4months (that’s relatively short), in practise you’ll be waiting longer because you will first have to be referred & assessed before anyone even adds you to that list. During all this waiting time people can have no professional support.

Then there are the multitude who are deemed ‘not sick enough’. To be fair this has always been an issue due to stigma & ignorance. Lack of funding exacerbates the problem. When services are so stretched, access to those resources become limited. Lots of people who seek help for mental health problems are basically told to manage it themselves. Get some exercise, reduce your stress, get out more. When you summon your strength to talk about things that frighten you and are told it’s no big deal, it’s hard not to feel even more pathetic. It is difficult not to feel shutdown. Repeat that scenario more than once & people give up. Likewise for those who are informed that they’re not quite ill enough to warrant intervention. All that talk of early warning signs & speaking up doesn’t translate into much action. Having a professional ask you to wait & see if your health declines before they will help you is a kick in the gut. When you know that getting worse means your entire life falling apart, it’s not unreasonable to prefer to be proactive. When you don’t know what’s happening to you all, it is terrifying. So, yes, we do need to talk about it. I will always encourage people to ask for help. I will always strive to remove the shame of admitting you need assistance. I’ll also continue to demand that we talk about what happens after you take that step. We cannot ignore the fact that asking for help does not guarantee receiving it. We must acknowledge all the people for whom no treatment has been forthcoming & stop pretending that the problem isn’t much, much bigger.

People die because they did talk about it & nothing changed. Can we start talking about that?