Professionals across the system aren’t always good at identifying poor mental health.
People can wait years for a diagnosis, or their condition can be misdiagnosed or misunderstood. We spoke to Hannah, who told us her anxiety was labelled as a "behaviour issue" in her teens. We also spoke to Ursula, who didn't receive a proper diagnosis until adulthood:
I saw my psychiatrist when I was 7 years old because I was self-harming from the age of 7 but I wasn’t properly diagnosed until I was 33 when I found out I had Borderline Personality Disorder (BPD). I went home and googled it and I ticked all the boxes. It was like a whole world opened up to me because I realised what was wrong with me.
People wait a long time to be seen and it is difficult to get seen in times of crisis.
Leigh and Hannah told us about a gap in support for people who haven't yet reached crisis point, having to wait until they get to that point before they can seek more significant help. When Billy needed an emergency appointment, he told us about the wait he faced for Children and Adolescent Mental Health Services (CAMHS):
Finally, I was referred to CAMHS emergency list but it was a 7 months waiting list which we didn’t know at the time. During this time I was really struggling and refused medications because they made me sick.
There are issues with the communication between GPs and other services.
Hannah’s GP didn’t know about her therapy treatment or her hospital admissions. Billy's mum Sarah told us that his referral wasn't made at first, as the GP, hospital, and CAMHS hadn't been communicating:
We decided to take Bill to A&E to speed up the CAMHS referral but the doctor said there was nothing he could do except write to our GP. He discharged Bill and wrote the letter; we later found out that the original referral by our GP had never been made.
Different treatments work for different people but choice is sometimes not offered or available.
This was a significant issue for many of the people we spoke to. Kelly told us she wasn't happy that her GP just offered her antidepressants. On the other hand, M told us that Cognitive Behavioural Therapy (CBT) wasn't right for him:
I was offered CBT but it didn’t work for me. They jumped into my past and childhood which was traumatic like family death and stuff like that. It was too much for me to deal with.
Services aren’t delivered with sensitivity to different cultures and to individuals with particular needs.
People told us that services needed to understand them as an individual - this includes a person's race, nationality, religion, upbringing, and more. For people who didn't feel they received this, it has made their journey more difficult. D told us he wants a therapist he can relate to: "My anxiety around racism and discrimination would be more understandable for people of colour." Ursula tells us about her experiences as a black woman on an inpatient ward:
I was seen as more angry and more violent than the other non black people on the ward. Where the white people’s behaviour on the ward was passed off as passion and anxiety, I was labelled as angry, threatening, and aggressive. But I was anxious as they were anxious.
We have made recommendations to the people who design, pay for and deliver mental health services across the city.
Some key recommendations are about joined up working and communication between the services involved in a person's care.
We also want to see an increased focus on providing care that is right for that individual. This means involving people in decisions, providing different options for support, and increased awareness of the importance of culturally sensitive and culturally appropriate care.