The NHS and the Institutionalisation of Hopelessness

Roughly a year ago I attended a two-day mental health active listening training course; and an advert by Mind, a British mental health charity, was played in one of the talks. The video itself was fairly innocuous, I doubt it even registered as notable at all to anyone else in that room. Yet I had a fairly strong knee-jerk antagonism to this video, it got under my skin like a mosquito bite that you irritatingly scratch for the following few days. It followed a rather standard formula for a mental health advert: person is having a difficult time, person goes to “seek help”, person returns home better. The sharpest twist of the knife for me always was the snake oil platitudes spewed out at the end like “We’re here to listen to you” or “You're not alone” in that duplicitously sweet “Trust me, I am so very compassionate” tone.

What aggravated me so deeply is how the societal framing of mental illness as popularised by such adverts combined with an utterly dysfunctional mental health system led to institutionalised hopelessness, since it frames recovery as exclusive to seeking professional help - something which commonly is unfeasible in the UK. By perpetuating the monopoly of healing to professionals, it inches mental health recovery further out of the control of the individual creating an emotional dependence on the NHS, which is a process so utterly sadistic that it could have been intentionally designed as a soul-crushing torture chamber. An ideal is created which simultaneously cannot be upheld by our current healthcare institutions, yet disempowers the individual from changing their life.

The Image

One of the core factors propping up this disempowerment of the individual is the pathologization of emotions, in the sense that if a person has been chronically unhappy for a year, people would tend to suspect a clinical illness such as depression rather than one's lifestyle or a physical illness as the cause. And like any other physical illness, you are required to get a diagnosis from a doctor, who can then prescribe medication and therapy to start healing - both of which necessitate the support of the NHS. I wish to make abundantly clear that I do not wish to suggest that this is a negative development or even an inaccurate one, but that the implication such a conceptualisation creates requires an understanding of these foundations to be addressed.

This notion is then entrenched throughout practically every online resource and community that I ever encountered. One of the more intrusive manifestations is the frequency with which “go and see a therapist” is advised, even in response to relatively general problems. Primarily however the advice to seek professional help is the cliche response in mental-health oriented forums and websites. I’ve always found this peculiar. If seeing a professional was a realistic option, I probably would have done that rather than post out of a random subreddit out of desperation. Regardless, the sentiment is pretty uniform, “there ain’t anything we can do buster, or that you can do on your own, better pack your bags and be on your way!”.

And is precisely the implicit underlying narrative found within these advertisements. First of all, the focus of the ad is the motif that making the decision to reach out and get support is the turning point for an individuals struggle with mental health, followed immediately by some bright and smiley b-roll and a gradual reduction of the inevitable greyscale filter. Less explicit is the message that the path to recovery is presented in a straight-forwardly clean manner, with the ability to access effective support never even noted. This idea then is pervasive; both within general social environments, and as advocated by mental health institutions.

The Reality

I’ve never had much faith in mental health professionals. From year 8 onwards, I saw god knows how many CAMHS workers as a result of anxiety that interfered with my school life, of whom I almost always saw a single time to fill out the same old quotient - just to never to hear from them again. Yet even out of those few times I saw someone repeatedly, it would always revolve around the same sort of useless task which did nothing to help. On one GP visit they were even preparing me to go on ADHD medication, until for some mysterious reason that just didn’t happen. Hell, the only professional during this time who I benefited from seeing in any capacity was a private hypnotherapist I went to - since she taught me some basic breathing and relaxation exercises. And yet I always remained hopeful, once I finally get the support I need, I will finally be alright.

I’m sure you’ll be utterly shocked to discover that never happened.

I began to doubt my faith when Childline sent the police around to talk to my parents whilst I was at college because they suspected that I was going to kill myself, and how even then no support of any substance came about. Whilst in hindsight I don’t disagree with the decision to break confidentiality per se, the absolute incompetence of the execution is inexcusable. I was never warned in advance this had happened, only putting two and two together when I saw a slurry of missed phone calls upon leaving music class, but I was completely blindsided by the complete exposure of my privacy. So off to the A&E I was taken, with neither the Childline nor the police having the foresight that potentially it might have been a good idea to inform the hospital itself about the situation. So after an hour of waiting I’m called in to be interrogated by a random nurse inquiring what brought me to A&E; which wasn’t a smooth or enjoyable process for either of us, considering overwhelmed suicidal teenagers forced involuntarily into deeply uncomfortably situations from aren’t exactly the most chatty about how they’ve been gradually drawing an increasingly detailed plan on how to hang themselves for the past months. Eventually I got a shiny brand new CAMHS referral which inevitably went nowhere, and was allowed to return home as if nothing happened. But it did mean I got Chinese takeout for dinner, so you know, swings and roundabouts!

End of story right? I also thought so, up until the police decided to show up again to my house the day before my birthday. Turns out Childline, in another display of spectacular incompetence, somehow accidentally messed up and sent the police my address in connection to a report of a girl being sexually assaulted. At least the mistake was quite physically evident, so I only had to relive the events from a few days prior rather than attempt to persuade the police I wasn’t in danger. Then they demand that through my parents, I hand over my Childname login information so that they can resolve the issue. So now after having my secrets exposed ruthlessly against my will (for no real reason either, since Childline didn’t seem to extend their care past calling the police on me), I now had to reveal my suicidality further to my parents by allowing them access to Childline account, all of which was based on the notion that if I don’t cooperate then I am responsible for a girl continuing to be sexually abused - which they held no qualms with using as a tool to pressure me with. Oh and the police threatened to confiscate my electronics, but at this point they could have pissed in my drawers and filmed cock and ball torture porn in my room and it wouldn’t have been any worse.

Sure, the mental health services may have been useless bar giving me panic attacks for the next six months whenever I heard the doorbell ring. But I was only heavily suicidal, when I would actually attempt there’s no way that could be ignored…

Just kidding! They forced me to wait seven months before assessing if I was eligible for therapy, and which I was then rejected from. Personally I’m of the opinion that when someone with a long documented history of mental health illness intoxicatingly calls the police on themselves to warn them that there’ll be a dead body under the bridge in approximately ten minutes, that this probably a better indication that they need therapy more than some bullshit Buzzfeed-tier test - but hey, I’m no psychologist, so what do I know? Keep in mind this assessment only even happened after waiting through a six-week long low-level CBT course occupied with basic information that every veteran of the system knows, and multiple emails repeatedly questioning “Why the hell is nothing happening?”.

Even after my hope of actually receiving support had been quite thoroughly shredded by all attempts of reaching out being whacked down, I remained emotionally dependent on the NHS as I couldn’t see recovery without professional help. Explaining why despite being let down time after time, I continued to convince myself that the one line they surely couldn’t cross is preventing access to care after a suicide attempt.

Turns out I was wrong once again. I did receive a care coordinator, and yet I’m still not entirely sure why. They hyper fixated on the idea of me being autistic to the point of ignoring my primary symptoms. When out of desperation I message them because I was panicking about bizarre paranoid intrusive thoughts, they didn’t really help in any way. And because it is so absurd it justifies repetition - they left me alone for seven months without pursuing support, just to reject my access to therapy. There were more meetings, which as per the norm didn’t go anywhere, and I could never receive explicit answers whenever I asked about what was actually going on and when I was to start receiving support. And then in a scene which could be straight out of a dark comedy, when someone came to check up on me in the days after the attempt, I told them directly I was going to kill myself. The first tactic this women utilised was to almost persuade me into telling her that I wouldn’t kill myself, because she wasn’t able to leave until I said I would be safe. When that failed she admitted she didn’t know what to do so stepped out to call her manager, after which the decision was made to just straight-up leave the actively suicidal person who had made a suicide attempt days prior.

Institutionalised Hopelessness

Why did I write these experiences in such graphic detail? Well apart from the fact that trauma is an excellent way to pad out the word count, you need to understand how utterly vulnerable the mindset of those who approach the NHS to be able to see the devastating consequences of the interaction between healthcare and culture. Vulnerable people struggling to get the attention they need isn’t the sole issue - this is not merely a failure to provide assistance. But the destruction of hope itself, which anyone with even a cursory knowledge of the literature on suicide and mental health should understand the severity of hopelessness. And yet people are constantly bombarded with messages telling them that they will remain broken until saved by a professional, even when reaching out requires lying down in the hellfires of a flaming bureaucracy and praying that this time it’ll work. I have genuinely had fears that the NHS is proof that we live in a simulation, since the utter sadism of constantly dangling the carrot of healthcare infront of ill people to see how much mental torture one will justify withstanding for the slightest chance of help is so cruel it defies explanation - except as some twisted scientific experiment crafted by Dr House.

Who wouldn’t become helpless after endlessly trying to reach out for help, like everyone advises you to do, and getting nowhere? Trapped in a system that even when you swear that this time you’ll do everything perfectly, so there is no possible way it’ll fall through, you can never get anywhere. Who wouldn’t become helpless with that pseudo-calming tone and voice, comforting you with assurances that all will be will, yet knowing its complete bullshit because you’ve been there long enough to already have anticipated the act. Who wouldn’t become helpless after repeating the identical assessment quotient for the fifth time; since you have to fill-in this new professional who you’ve never seen before, and never will see again, because there is no communication ]between the revolving door of doctors you’ll talk to. If you’re lucky you’ll be hit with a two year waiting list, during which you better be settled down, since moving GP will reset the timer. But more likely you just won't get anywhere, through a perpetual series of pointless meetings like driving around a roundabout. And you better not quit the service out of exasperation at any time, or else you’ll have to suffer all the way from the beginning if you crawl back to the NHS like its an abusive partner - considering nobody thought it prudent to inform the NHS that people with mental health issues might struggle somewhat to handle such extreme and drawn out emotional strain.

And where do you go from there? There is no elsewhere. You are mentally ill, you require professional help; these two mantras are drilled so thoroughly into your understanding of your emotional difficulties that you cannot see anything else. Do you want to know what the most aggravating reminder of my utter helplessness was? Those damn Samaritan signs which continue to be plastered at every bridge and train station. I had never doubted there were people who were available to talk to, but I didn’t want to talk to anyone - I desperately needed someone to actually help. All the care and attention and concern was irrelevant because it did nothing, I could scream and cry and cut myself all night wishing that some divine intervention would save me from feeling this way and it’d do nothing. Every conversation with a suicide hotline was a prayer that this time I would get a different response, and everytime being greeted with the same sanitised wooden persona who’s entirely role is solely to funnel you back to contacting the very NHS that abandoned you. And then be constantly reminded that help was never coming by these inescapable signs, so you can never divert yourself from the knowledge that the only control you have left is in death. I confess that even now I continue to feel a sense of discomfort upon seeing these signs, I may not have been alone, yet I felt most isolated as a result of reaching out.

The cherry on top is that the NHS systematically encourages self-harm and self-sabotage. The logic is simple: you will be denied access to care unless you reach a certain level of dysfunctional, therefore you must ensure you remain dysfunctional or else be left to dry. Mental illness often manifests in episodes rather than a perpetual struggle, and its effects can be managed through coping strategies and healthy living. And yet if at the time of your assessment (Which almost ubiquitously is done through quotients - which are borderline identical to online ‘which mental illness are you?’ Buzzfeed quizzes) you're not crippled by illness, then you’ll be ignored, rendering the underlying condition unresolved. Consciously and self-consciously it becomes actively strategic to make yourself miserable since anything less than abject suffering and you don’t deserve support; well you’ll probably be ignored then regardless, but this just creates even greater pressure to harm yourself even more significantly. First do no harm - then why did you clearly tell me with your requirements that my only hope is to be found in harming myself?

Reclaim Control

Since all of the events detailed, practically all of my symptoms of illness have evaporated. Whilst approximately a year has passed, this rehabilitation occurred at the very most within a six month span. Not only was this entirely without professional assistance, but in a substantially faster time than the waiting lists I was on merely to merely begin the process of receiving a diagnosis. Now as any good clickbait advert would have me do, I am about to expose the one simple trick that doctors don’t want you to know!!! (Psychologists hate this enby)

I told the NHS to fuck off

Whilst this was the defining turning point for myself, I must stress quite heavily that this was a radical move, and I am not trying to give out medical advice. Some people quite literally need medication because of biological issues, and it’s clear that many (if not the majority) of people have genuinely benefitted from NHS engagement. The aim of this article is to make visible some of the negative implications of the current medical institutions and culture, not necessarily to deride these as net negatives themselves - even if the influence of my utter hatred of the NHS, and my twattish love for sarcasm, might make this unclear in my tone. But I realised for myself the facts were as such: in all of my voyages through the mental health system I have without fail been worse off for attempting to get support than if I hadn’t bothered, and that it was clear this last attempt wasn’t going to get anywhere either. So if it ain’t helping, why continue to bash my head against a concrete wall?

When I left the NHS I was taking complete responsibility for my own health, therefore there was no reason to continue self-sabotaging myself. Even upon realising that I was the predominant cause of allowing myself to be miserable, it took me years to cut off these shackles of mental self-harm, since it was so thoroughly ingrained into me that the worse I was mentally that the more likely I was to get fixed. I also had a handy excuse for why I was miserable, I mean I had this mental illness that I needed a doctor to treat, how could happiness possibly be in my control? This was benefited by another revelation that took years to accept; that it was completely irrelevant who’s fault it was or if my ailment was unfair, the fact is whether your right or wrong is irrelevant to your suffering.

Upon taking complete responsibility, I began to stop justifying stupid and self-destructive behaviours. Sure I could fixate on my depressive thoughts and how everything sucks, but when has wallowing in self-pity done me any good? I absolutely could just stay in bed and mindlessly scroll through Youtube videos all day when I have a bunch of work to do, but then what kind of self-worth can I justify myself as having? Whilst I may have a very real reason to be angry at this list of people who may have wronged me and led me to misery, but how does holding onto anger resolve what has been done, and how much guilt should I feel for all the suffering I have pushed onto others if they hadn’t forgiven me?

A significant outcome of this mindset was to redirect my focus from the internal to the external. On a purely pragmatic note, how much time do you have for negative thoughts if you're solely concentrated on what you have to accomplish for the day? Happiness never arrives if one goes seeking it directly, and you certainly have no defence against misery if there’s nothing to keep you busy. You can continue external goal-oriented behaviour regardless of mood, but if you are excessively focused on introspection then any negativity will spiral severely. And part of that is it encourages movement towards a genuinely healthy and fulfilling lifestyle, itself supporting mental health.

Regardless of whether you’re in the healthcare system or not, the most vital truth to understand is this: you alone are responsible for controlling how you handle your mental health, and the only person who is affected if you do a poor job. You always have some control, and yet with that comes a weighty responsibility to manage yourself well. But that no matter the circumstances you are always capable of improving your situation, and this is the only option there can ever be and you should ever focus on - focus entirely on repairing what you can fix.

- Benjamin Steer

Contact at: steer432@gmail.com