Can you talk a bit about mental health and when a patient should come and see a GP about it.

Yes. I mean lots of people come to the GP when they’sre struggling, when they’sre struggling with anxiety, with low mood, with stress. And then they will work with the GP to find out actually what can be done to help. Sometimes that will be in the form of counselling or some other sort of talking therapy, sometimes it might be to help with medication.

Okay because usually, from my understanding, is a GP would refer the patient to an IAPT service or someone else that can actually help them for a longer period because a GP can’st do that, is that true?

Often a patient will be referred on because, as you say, doctors only have usually fairly short appointments and patients may need a longer time, and also some different skills to help them through whatever that psychological problem is.

Lots of people come and see GPs when they’sre struggling, struggling with low moods, struggling with worries. And I guess the time to come is when that’s really having an impact on your life, when it’s difficult to cope getting on with your daily life. Many people will come, sometimes what they need is counselling rather than psychological therapies and usually a GP will refer on to somebody else to do that. Sometimes they may need medication. Sometimes they may need just a break from work because of the situation they’sre in makes it difficult for them to continue.

How do GP’s deal with the issue if a patient came in with mental health issues but it actually lead onto physical health problems where a GP would actually have to deal with it.

Yes, it’s sometimes difficult to know how much is a mental health problem, how much is a physical health problem. Some mental health problems lead to very definite physical problems. Things like eating disorders when people can become very ill because of their mental health condition. Sometimes people will have many symptoms, a lot of pain, a lot of headache, and actually the underlying problem may be to do with their mood, and some of those things are often a symptom of depression. So it often takes a lot of working out and many times GPs are having to pay attention both to the mental health and the physical health of their patients.

I knew I was in a state because it had been a really rough day at work, and I was crying an awful lot. But it was just when I started saying, “Oh I haven’t slept in so long,” that she [neighbour] went, “You need to go the GP about this, you can’t go back to work, and actually it’s not safe for you to go back to work.”

And it’s one of those things where it felt almost a bit like I was being silly before, you know; no job could ever be that bad. But it was when the GP, that first GP I saw, went, “It’s not safe for you to go back” as well, that I went, “Maybe it’s not just me actually, and maybe I’m being a bit hard on myself, and actually there is something really wrong here about how I’m being treated.”

So she made the emergency appointment. Was it your GP that you saw then or, do you know who your GP is, or is it different every time?

I have a listed GP, but I rarely see her to be honest. I have the same GP now every time I make an appointment especially if it’s about the medication I’m on, and generally how I’m feeling with my depression and my mood, and getting sick notes.

But for the first few appointments, because they were emergency appointments, I saw different people. But I think they were always really prepared to listen and they could see that, every time I thought about it, I’d start crying again. I’d spent so much time crying at the GP’s surgery. And I was never normally a person to cry, so it’s one of those things, they’re going, “Well this feels a bit silly and this is a bit ridiculous.” But it’s just one of those things where you go, actually you can’t help it. And they must be so used to seeing it, you really can’t be the only person who’s walked in and gone [crying noise].

I just wasn’t really myself; just feeling kind of quite down, that I was very tired all the time and I didn’t have any motivation to go and see my friends or to do any work, or even things like I normally enjoyed I just wasn’t enjoying them anymore. And it was kind of happening for so long. My sister was getting better but it wasn’t going away.

And so that’s when I kind of realised it wasn’t primarily based on that. I think it just kind of triggered it and actually it was something a bit more than that. And so when I was feeling just really low, and yeah, just not myself, that’s when I thought, ‘I’ll go and see a counsellor.

Yeah. Did anyone suggest it or it’s something that came to your mind, or did you look on the internet or discuss anything with anyone, or you just didn’t feel like talking about it at that point?

My friends noticed I was really reluctant to talk about it with anyone, but my friends noticed I just like wasn’t really hanging out with anyone and I wasyeah I was just really reluctant to do anything.

And so like I kind of confided in one of my friends I was just saying I’m just not feeling good about myself, and she suggestedshe said, “Oh I know someone else who’s used a counsellor and maybe that will help you out.” So, yeah, it was effectively from her who suggested it.

And can you tell me how old you were at that time?

Well I must have been around thirteen/fourteen I think.

Is there any message or advice you would give to someone who’s thirteen/fourteen, feeling a bit like that, they don’t know what to do. So, you know, looking back, in hindsight, is there anything that you would suggest to them?

Yeah. I definitely would say like talk to someone about it. It’s not embarrassing, you know, and it happens to a lot more people than you think. Yeah go and talk to someone about it, and also like make sure you’re making time for yourself because I think it’s really easy, in this day and age, to kind of get wrapped up in everything else and to be kind of completely overwhelmed in work and things.

But make sure, you know, obviously try to do your work but actually make sure you take out time for yourself and you do actually give yourself a break. And try and keep yourself healthy and know that actually it’s really important to do that. And kind of recognise that and just take out time for yourself, but talk to someone about it if it’s getting bad.

The way I think, I prefer to help others than get help myself. So, because my girlfriend at the time had depression, I didn’t want to off-load what I was feeling onto her because she was struggling with stuff herself. So I sat and helped her rather than try and help myself.

Yeah. Did you talk to anybody at all or no?

No.

No. Did anyone know you were struggling at all then, or they just thought, ‘Oh he’s doing alright; he seems to be doing alright.

My mum noticed attitude differences. I was a lot more short tempered and I was doing stuff that I wouldn’t normally have done, so…

Were youwere you at sixth form or school or college?

I was at college, yeah.

College, yeah. So you wereyou’re doing a course, yeah?

Hm mm.

And then how did it come about you mentioned family members said, you know you should go to the doctors. How did all that come about?

It came about just because ofwell I at the time I was having rather frequent nosebleeds, which I’m guessing would have been associated with the stress and anxiety and stuff like that.

So, with that going on, they went and said that I should go to the doctors to see if anything was wrong. And during that they essentially diagnosed me with depression, anxiety and stress. So, yeah, that’s how that came about and then the counselling started later on.

So, when you went to the doctor’s surgery that time did you go with somebody a family member or by yourself?

No, with the way my family works, my mum’s a single parent who works, and my sisters are at school and college.

So you went by yourself?

Hm mm.

I think it was when I was fourteen I experienced a really traumatic event. And then after that like I just went completely sort of off the rails. And then likeI think it was my step-mum that said, “I’ll take you to the GP.” But that wasn’t because of the other stuff [bullying], it was just because like it was just a brand new thing. So, the other stuff it was all just like stuff buried inside of me that I just didn’t let out, and nowand there, this was this completely new thing. But there wasn’t a time when I thought, ‘Right I can go and get help now. It was just, yeah.

When the traumatic event happened, did you feel at that point, ‘I’ve got to speak to somebody?’

No, I didn’t. I didn’t even think of it then. I just thought, ‘Do you know what, I should not be here. I clearlyeverything is saying to me that I am just nothing here. I should not be here. That’s all I was thinking. I wasn’t thinking, ‘Right I should go and talk to someone. I was just thinking, ‘Right, how can I not be here. It was other people that said like you need to talk to someone because they could just tell that I was just going completely downwards.

Who were the other people who thought you should speak to somebody?

Friends, different family members. They were just like, “You need to speak to someone.”

Did you feel like listening to them or did you not at that stage, it was too difficult to even listen to what people suggest?

I didn’t really care about what they were saying. I was just thinking, ‘You lot don’t want me here anyway, you’re just trying to trick me into something,’ sobut I did it to sort of shut them up. So, like I would go to these things but I would just think, ‘Yeah whatever, I’m not interested. And I would justI just didn’t care really.

About two years ago, I went cos like I was really struggling with my eating and my weight. So I went about like cos I was, after I’d eaten a meal, I was like making myself throw up. So I went about getting help with that. But I hadn’t lost enough weight for him to put me in the system yet. And then a few weeks ago I went with low mood and were diagnosed with depression and anxiety.

And when you went to see him that first time, did you go by yourself or did you go with your mum?

My brother took me.

Your brother took you?

Yeah.

Did you want your brother to come with you?

Yeah, my brother’s like the person I’d go to with anything.

So you felt more comfortable, a bit more reassured going with him?

Yeah.

Is he an older brother or younger?

Yeah, he’s older.

So did you feel comfortable talking to your brother, I think I need to go to the doctors? Or did other people say, Oh I think you need to go? How did that all happen?

My brother had found out like what I were doing. And he were like, I think you need to go and do, like just get sorted out and see what they can do for you. Cos there are things that can help to make you better. So he sort of pushed me to it. But he didn’t like force me. It were more my decision to go.

So he was the only one who knew at the time?

Yeah.

And he came with you?

[mhm]

So that made you feel a bit better, not a huge –

Yeah, not shitting it.

I was still living with my mum then and I tried to set the house on fire because I thought it was full of devils. And they rang the doctor. And the doctor just came and he was like, She’s really, really ill. She needs to go to a psychiatric hospital. And he was actually really nice. He was a nice man. Cos I wasn’t that nice to him. And he’s still my doctor and he’s still really nice. And he was just calm, but he was shocked I think. He’d never seen anyone quite like that I don’t think. Like somebody who was really trying to burn down the house, yeah.

So he was the doctor. He came to the house?

Yeah, my mum rang him cos she was like, Something is seriously wrong with my daughter.

So you said you were getting ill at school but nobody realised what was really happening?

No, they always thought I was being like kind of really cheeky and naughty. And it’s like when you go into school and you genuinely think that people are trying to kill you and stuff, you’re going to be a bit naughty and aggressive. And it got completely misconstrued. And they expelled me and they expelled my best friend as well. And they had to apologise. They had to, like, write a formal apology for it. Which made me feel quite good. They, yeah…

Did you, what did you feel at that time? Did you feel that something’s not quite right? Or did, did it

To be completely honest, I had the same boyfriend for almost three years. And then we broke up when I got in the sixth form. I just started, I mean I’d always been a person that got wasted, but I just did a lot of intoxicants really. And lots of Ecstasy, stuff like that. And it just tipped me over the edge like properly. I mean I don’t think drugs are good. I think they’re bad for you. I don’t think they’re good for people. But at the time I didn’t really know the severity of what they were doing to my brain.

Regarding my mental health issues, I was in the hospital for a month which is where I was first diagnosed with mental health problems and all my diagnoses took place. And thenBut before then I was seen under CAMHS [Children and Adolescent Mental Health Services] just as a counselling service, if you know what I mean; just as like a support and just talking service. But then after I’d been put into this hospital for a month, then I’d been referred to the adult mental health service team, so yeah.

Was there a big difference between that transition to the adult mental health team from the, you know the children’s or young people’s?

Yes, it was, because I was getting cognitive behaviour therapy at the time, and unfortunately my therapist got ill and unfortunately she couldn’t do it anymore. But they said they wouldthey said as it was so close to that changebetween that period of change over, between the CAMHS and the adult, they said thatthey said it would automatically start up again when you come in the adult. But things didn’t work out and I’d been on theI’d been in the adult mental health services for almost two years and I’m finally getting my first CBT appointment next week.

So you’ve been waiting for a good?

Two years, almost two years yes.

Have you been able to access any similar services at all in any other way?

I’ve been no, not really. I’ve beenmy care co-ordinator’s great, but she’s not a therapist really. She’s just like a care co-ordinator because she gives more practical advice on what to do and how to cope and stuff, but therapy is, I think, everyone says it’s a way forward, so yeah, so…

So the care co-ordinator is this through the GP or the hospital?

It’s through I first startwell I was in a CAMHS mental health unit when I was in hospital, so then I was diagnosed, so I had a formal psychiatrist up there, and when I got out and everything. But then my psychiatrist switched me to adults because I was over eighteen, I was getting to the age of eighteen, and so yeah so…

I got put in the psychiatric hospital and…

So first your doctor came round?

Yeah, my GP. I just remember I said to him, something like, You don’t understand. You’ve got to let me burn this house down. We’re all gonna die if I don’t. And he, and I had a big bottle of pop, a big bottle of lemonade, and I poured it on him. I’d been really ill, yeah, I’d been really ill.

Yeah, yeah. So do you remember what happened after that?

Yeah, the ambulance people came and I just refused to go with them, point-blank refused. And they were like, You’ll make it like harder for yourself. You don’t understand that we will get you to a psychiatric hospital. I was like, No, you won’t. You can’t force me to go to hospital. You’re talking crap, blah, blah, blah.

And then after that the police came. And they’d been saying to me, If you wait for the police, you’ve got no choice. They can handcuff you. They can put you in the back of an ambulance. And I just thought they were talking rubbish. Cos, because I thought, Well, I’ve not really committed a crime. But then they came and they put me in handcuffs and just like proper bundled me into an ambulance and took me to hospital.

In the last ten years for three and a half years I’ve been there overall. The first time I was in, I was in for about three months. And then I came out. And all my friends were either going to university or getting jobs or x, y, z. And I was just unemployed and really, really miserable and didn’t know what to do with my life, yeah.

And you were on and off then, on and off?

On and off, I was on and off for years and years. Then I got well for about, I’m crap with like time and stuff, but I got well for a really long time. And then I got really, really ill again. Then I got well for about four or five years. And then last winter I came again for two months into hospital.

It was a combination of self-harming and the tablets, and I ended up having some friends that I know call me an ambulance and essentially be carted off to hospital for overnight assessment, which wasn’t fun at all, so yeah.

So your friends were around were they or they came over or something?

They drove over just because we were helping each other out with that sort of stuff.

So they knew what you were going through?

Hm mm

They had gone through something like that as well, or were going through it?

Yeah.

So did you find that they could understand a bit more then? How, you know, having gone through that, or did you find everyone’s experience was so different?

It was different in a way because the people, my friends that came round, they had divulged this stuff with their family whereas I didn’t, so it was varied in that respect. But other than that it was mainly the same stuff, and it actually helped having them there because they knew the ambulance crew that came to pick me up, so it was a lot more personal and informal and stuff like that.

So their families knew what was going on with them, but you hadn’t talked to yours, no, because it’s somethingit’s very hard to talk about these things. And you went to the doctor. Was that the first time then that your family kind of realised what was going on or….

Yeah, because my friends said that they needed to take mephoned for me and called my mum just because next of kin and stuff like that. So, I ended up with my mum driving to the [name of] hospital, and I had to tell her there and then thatwhat I was going through because I couldn’t exactly hide it anymore because I was in a hospital bed.

And then you would havedid youyou stayed overnight; you said you had tests and things like that.

Hm mm.

And that wasn’t a nice experience?

No.

Were you able to come back home the next day or did you stay in for a few days or more than a few days?

I stayed in from six o’clock Friday till four o’clock in the morning on Saturday, so I was home within a couple of hours. But because of the experience that I had with the hospitals it sort of, I guess in a way it haunts me just because I have nightmares of the hospital machines and noises that they make because I had to sleep there. So I guess it affected me psychologically of the noises that the machines made.

Can you remember how many times you went to see the GP at all?

Oh I’ve lost count; I don’t know, just loads.

So what could havewhat could they do, GPs, to improve the situation there?

They need to realise that people aren’t going to tell you everything in ten minutes. They’re trying their best, like it takes a lot of courage to go to a GP and say, “Like this is sort of what I’m experiencing.” So I would always say like don’t take likewhat they’re sayingalways assume there’s more to it and always provide them with something even if, you know, they’re not going to get help through the NHS, thenlike helplines, charities, something likelike just never just let someone walk away because that could beit could be so bad like you just never see them again. Like you cannot ignore anyone.

So a young person comes to see the GP, they might not tell everything that they’re thinking or feeling. So you would advise that there may be more behind the appointment?

There always is, yes.

There’s always more behind the appointment. How canwhat could a good GP do in these situations? Say their ten minutes is coming up and they’ve heard a little bit is there anything else that they could do? So they could give telephone numbers of helplines; could they follow-up again, maybe phone the person or

Yeah, I had a really good experience of a GP like a few months ago which was like my first ever good experience of a GP really. She was really, really nice. She spoke to me on my level, on my terms, and what she did was she said which day she worked at the practice. She said that I could go back whatever time if I just want to chat. I think maybe just remind the person that they can come back, like they’re not a waste of time, yeah.

For the first four weeks it was one 50 milligram every day. And then a few weeks ago it went to 100 milligram every day.

Did you feel that they were helping at all?

I do now, but not at the beginning. Like when I first went on them I couldn’t notice a difference at all like. But those particular tablets in some people can cause like worse self-harm thoughts or suicide thoughts at first until they kick in properly.

And did you feel that’s what was happening? Or did you feel like —

Yeah, like —

— changes or?

Before I went on the tablets I was self-harming but it wasn’t really bad. It was sort of capable, copable. Is that a word? Copable, yeah.

Yeah, manageable.

Yeah, manageable. After that like, when I were on tablets for a few weeks, like it started getting worse. But I’d wake up in the morning thinking, I need to self-harm today.

And when you were thinking about self-harm, was it like being sick and…

Some of it was being sick, some of it was like cutting.

And could you, when you were at home, did you talk much to your brother? Or did you feel you just didn’t wanna talk to other people?

I didn’t wanna talk about it. I just wanted to stay in bed and, not really with anyone, just be left alone to stay in bed and sit and just think.

And if someone else was in that very same situation that you were in, is there any, now, any advice that you would give them?

Just stick it out cos the tablets do kick in eventually. But they do take a while. So you’ve just got to stick with it as long as you can.

And how long did it take in your case?

Six or seven weeks for them to properly kick in. Like they’ve only just started working properly.

So it could be as much as six or seven weeks?

[mhm]

Just be patient with it.

Yeah. Don’t forget a dose either. Cos I have to set reminders on my phone to make me take them, cos I’m crap with remembering stuff.

The way it went about was just she ended up introducing herself, not as Dr, it was, “Hi, my name is Ashley [not real name].” I can’t actually remember her first name because I know her by sight now. But yeah she set it out very informal, and then instead of it being a table in-between us, it was next to each other looking at the screen to check if there was any options, which eventually there was because, with her help, I got involved with the crisis support team and also [a local service], which is another counselling service.

Yeah. On the very first appointment that you went to see her, what kind of impression did you get of her?

I could tell that she’s been affected by mental health stuff in the past just because of the way that she talks about it, because you could tell that there was empathy with it. So she knew what she was talking about and she’s also experienced it, so I think that’s why I got on with her so well.

You mentioned you had counselling with her?

Hm mm

When did thathow did that all start up?

It wasI guess it wasn’t professional counselling. It was more informal counselling just because we both talked about what was affecting us and stuff, which was good because I could offload what was affecting me with the depression and stuff like that. And she could say like trivial matters because she wasn’t affected by depression at that current time. So it was like I wasn’t just giving everything away. There was some give and take with what was being said and stuff, which helped a lot because it didn’t feel like I was essentially being forced to comply everything that had happened to me.

So it almost felt a bit more like an informal chat?

Yeah, more a conversation than counselling I guess, yeah.

I think I used to go a lot because, like now, I used to have like colds all the time and I think my mum thought it was, you know I had some kind of long term cold or something. But yeah I remember going with them. Yeah it was, it like, seemed pretty normal then, so…

And then going forwards can you remember other appointments as you got older?

Yeah I went I kind ofyeah I use it normally so not that often. And then for a while I ended up going quite a bit because they kept turning me away and I kept going back. But now I’m just kind of using it less regularly, so…

So, at one point, you were going quite regularly and they were turning you away?

Yeah.

Can you remember what was happening at the time?

Yeah basically it wasthis must have been about like three years ago I’d been referred to my GP from the counsellor at school. But they said I didn’tI wasn’t kind of high up enough on the list to be referred to CAMHS [Children and Mental Health Services]. And so they basically said come back in, I think it must have been about four/six weeks. And so I’d go back and like I still wasn’t feeling well but they kept doing the same thing, like they’d just be like, “No, we don’t think anything’s wrong with you” and turn me away.

It wasI think it was mainly just because I struggled to speak to them about how I was feeling and so they kind of took it as though you don’t really need to come here. So I ended up going about, it must have been about six or seven times before they actually did something.

Since then I’ve been pretty good. Like I’m really, really trying to keep well now. And that makes a massive difference.

What’s helped most?

Quite a lot of things really. The people I love. Had some amazing people just stick by me, like all of my family and my friends. Some friends left, like some friends didn’t, but the ones that stayed, it’s like they’re worth their weight in gold. But good stuff sometimes to a certain extent and self-motivation. But I’d say more than anything not taking drugs. I’m not a person that can take drugs.

So every time you got ill between the years, was it cos of drugs? Or were there different reasons or?

I think there were different reasons. But the different reasons always had an undercurrent of drugs, yeah.