Challenges
Despite new treatments, therapies, and a wider range of services, recovery from mental ill- health can be obstructed by barriers. For instance, physical trauma resulting in disability, and chronic psychological conditions, including PTSD or C-PTSD, bring their own challenges.
Not everyone who experiences trauma suffers long-term and, with the support of family and friends, most people do recover. However, it is estimated that one person in three suffers long-term, resulting in a condition now known as post-traumatic stress disorder (PTSD). A person with PTSD can experience a range of problems, which may include re- living the traumatic event through unwanted memories, vivid nightmares, or flashbacks, and they may experience intense reactions, such as heart palpitations or panic, when reminded of the event. They may have trouble sleeping or concentrating, feel angry or irritable, take risks, be easily startled or constantly on the lookout for danger. People with PTSD may try to avoid reminders of the trauma by shunning particular places, people or activities or anything that brings back thoughts, feelings or memories of the event. This can lead to the person becoming isolated and withdrawn, and they may stop pursuing activities they used to enjoy. They may lose trust in others, or feel anger, guilt, horror and/or shame, and experience additional mental health conditions, depression, or anxiety. Some may self-medicate with alcohol or drugs to try to escape their thoughts and feelings, and PTSD can affect people’s ability to interact or communicate with others, or to relate to their family and friends, retain employment, or perform everyday activities.
People who repeatedly experience traumatic situations, such as severe neglect, domestic or sexual abuse or violence, war, or torture, may be diagnosed with complex PTSD. Repeated childhood trauma can result in severe C-PTSD and affect a child’s development and whole life experience. The symptoms are similar to PTSD but may not develop until years after the event; they may also include deep feelings of worthlessness, shame and guilt, and have problems controlling their emotions. People with C-PTSD may find it difficult to connect with other people, or to make or sustain relationships with friends and partners. They may experience long periods when symptoms subside or are less noticeable, only to worsen again; this can manifest in unpredictable behaviours which can be frightening to themselves and others.
Additional barriers to effective mental health treatment and access can include:
Sadly, when mental ill-health goes untreated, ability to carry on with family responsibilities, studies or work is compromised, so it is important that people have access to mental health care. Removing the barriers to such care can significantly reduce or eliminate the risk of self-harm, suicide, substance misuse, family disputes, unemployment, or legal issues.
"Sometimes it comes into my head (being robbed twice) but I try and put it at the back of my mind, you know."
“As I say, it’s deep in the back of my mind (being robbed twice). So, I just try and keep it there, you know. And don’t think about it. Just think of the positives of what’s going on just now.”
Interviewer asks the respondent if he likes making social contact. Respondent replies that he does but only when it’s outside. He finds he gets anxious about his social skills in large gatherings. He goes on to say it varies from day to day.
He describes some anxiety he felt at a concert he attended recently. Interviewer asks the respondent if he has been prescribed any medication for his anxiety by the NHS. Respondent replies that he has not got any medication for his anxiety. He finds that the support from GRACE has really been helping him.
Interviewer asks if his anxiety is a mental health illness or does he just live with it.
“I think I just live with it (anxiety). You know. I try not to let it take over myself. You know. I don’t have, you know. I don’t have the usual…they say you’ve got certain kind of thoughts. So, I don’t have any of that so…which is a blessing.”
Interviewer asks the respondent if he thinks anxiety stays for life or if it eventually goes away. Respondent responds that he thinks it will eventually go away. Interviewer asks the respondent if men use alcohol or drugs as a coping mechanism Respondent replies that it depends how serious the trauma was. He also says that drink and drugs do seem to be things that people can turn to in these situations. Interviewer asks the respondent what he thinks about people with addictions being dismissed by society.
“They shouldn’t think like that. People should have a caring attitude, more or less, because it is an illness (addiction). If they’re taking a drug because…even though they’re addicted and they can’t get off it; it’s an illness. And it’s mentally as well, you know. They could be depressed or…and that’s why they’ve went that route.”
- Ricky A
So, basically, I spent my whole day, in those situations, dealing with literally whatever came through the door. And at the same time trying to help people become more confident in dealing with their own life. And dealing…vocalising their own needs and expressing what they wanted and getting it. Cos we were fighting against a lot of very entrenched traditional beliefs. And at that time in the [19]80s a lot of the services for people in any sort of care were still run by people who were very traditional. A lot of care situations came about through people who were…who had money, who were moneyed in care situations. For example, the first supported situations in the community for people with learning disabilities were funded through church organisations by wealthy patrons for their children. So, they tended to come with, shall we say, conservative ideas about what happened. So, it was very, very difficult to even get…I remember a trustee of one of the organisations being appalled that someone would be left alone in their own house. You know-What you mean there won’t be someone, what you mean, they can’t…they’re not allowed to be left alone. Person was perfectly capable. So I would spend a lot of time, as well, trying to counteract that sort of stuff.
- David A Allan
University…this is going to sound a bit geeky. But actually, I got a lot from going to university. I studied immunology and pharmacology and I was really interested in that sort of thing. I also finally made some really good friends who…I would say they were actually quite close friends. And they know…and we have a lot more in common. So, sometimes, we would, you know, after lectures we would meet up, go for dinner or we’d go to the union and play pool. So, that was a nicer part of it. Although Uni is always stressful. And there were challenges, you know, because I struggle with my mental health and I had to go from full-time to a part-time student. But I still got there in the end and it gave me a sense of purpose.
- Amanda
The lessons I’ve learned are…If you’re able to in the moment or if not yourself somebody who can speak for you. To really say what you’re hoping for from the person that’s treating you. Whether it’s a psychiatrist, a psychiatric nurse, a person in the community, an organisation like GRACE…I think at some point to say what you feel you need. And to say that no man is an island. And I think it’s important to seek help and not be afraid of seeking help. Not leave it until it’s a crisis which is often what does happen. To try to recognise when things are starting on a bit of a slope. Have people who…also, around you who recognise that. And to take what help is available. To trust in it but not a blind faith. Don’t have a blind faith in anything. And as soon as you’re able to…Well, it’s almost like… stand up for yourself as best you can. To make it clear what your needs are rather than somebody else determining what they believe your needs are and what’s appropriate for you. When everybody is an individual and what works on paper, or in a text book, or in a pharmacopeia isn’t necessarily going to work for you.
- Margaret Bradley
I think it’s changing (stigma around mental health issues). It’s changing because people are talking more about it. And obviously you’ve got Prince William and Prince Harry who are big, well known people… And it’s good when they can talk about it. But yes ,there’s still a stigma about it. There’s a stigma around anything thing that’s not the norm. Not seen as the norm. Whether it be alcohol or drugs there’s a stigma. And, again, that’s because people are too quick to judge. Because some of the nicest people I have met are alcoholics or they’re drug addicts. And they would give you the jacket off their back. You know. Because they’ve been there. They’ve sensed what it’s like. They know what it’s like to be rejected. To be victimised. And I always try to go out my way to talk to somebody that’s like that. If I know that they have got an addiction of any sort.
- Catherine Buchanan
The only thing about the counselling is that, as far as I’m concerned, there are too many constraints in counselling. i.e., You get twelve weeks and that’s you. You’re cured. No, you’re not. That’s where you need organisations that you can go to, who can support you after that. You’ve made the start on the journey. But you need somebody there to keep you going. Help you along the way. Keep you on the right track. And hopefully you’ll get there. And I believe I’m getting there.
- David C
Oh, well and truly (The River Centre, Edinburgh helped her). Well, first of all the diagnosis and the team there with the psychiatry and the psychologists. And the person that I was very fortunate to have most of my treatment with was Gill Moreton and she just happened to be the lead person on blue responders. On your fire safety and all that. So, she was very good in terms of understanding. I felt listened. I felt that I wasn’t like…they totally got what I was saying. I wasn’t trying to explain it or that it was this fictitious thing or it was…You know… these things were very real. And I did know that a lot of what I had been experiencing for all those years was the manifestation of the PTSD or the Complex PTSD. And they listened and then they were able to support me the best way that they could. So, the years waiting from when I’d had assessment until the actual treatment, I’d say that was difficult. But they tried their best one hundred percent. And they also did like an information… sort of how to manage your symptoms in the meantime sort of thing or an awareness of that. They were… Yeah, they just…And quite…And quite maybe externally with either my work in Manchester the organisation I was with…Occupational therapy, going all through those things…A lot of people didn’t get it but I realised that that’s ok because I don’t necessarily get it myself so I don’t expect others to get it. But do you know what- between me and the hospital they get it. So, I’m alright with that. And I’m going to listen to the professionals not listen to other people’s maybe opinion and-‘you don’t need to be talking about that. It’s all in your head.’ That’s the problem. That there that is the problem. I can’t just escape it. I can’t just get over it. I can’t just do something about it. I’ve been trying to do that for as long as I’ve been trying to do that. And it just wasn’t working.
- Jill CC
Good question (what do you think are the main causes of mental health issues?). Sometimes it’s conditioning. Sometimes it can be how you’re brought up with your parents. And your parents are victims of victims themselves. They only know what they’ve been told and what they’ve been taught. But some parents live their lives through the expectations of what their children could do. So, maybe they didn’t go to dance school so they’re going to put all the pressure on the daughter to go to dance school or whatever. So, sometimes people can grow up with that burden, I think, expectation of what their parents would want them to do. So, I think that; The burden or expectations growing up. I think the whole society of people… Especially young people but now it’s all ages trying to fit in. People on social media have the, inverted commas, perfect life. I’ve only recently joined Facebook but I’m very rarely…I very rarely post things it’s usually for groups. But I think young people when I was growing up…So, I’m fifty one. We aspired to be like the tennis players, Chris Evert or Tracy Austin. Whereas young people now twenty odds in their teens aspire, some of them, to be reality TV stars. And think they need to look a certain way. And I think a lot of young girls do look the same. Which I think is such a shame. And on nights out they’re taking pictures and posting on social media. Why don’t you just have a good time being out? And I think the pressures of that can bring on mental illness, definitely. And also, now, after COVID and with all the inflation. And people genuinely at the brink of-how are they going to pay their rent, how are they going to pay their bills, working two jobs. And there’s no end in sight. That’s definitely going to affect your mental health; worrying about money, you know.
- Jill Connell
It’s (hypnotherapy) not something that you would get on the NHS. So, but then, CBT’s (Cognitive Behavioural Therapy) forward focused, solution focused which is great. I like CBT. They can do it down to say six sessions. And they believe that that’ll be the magic wand that fixes everything. It’s cost effective out of all the therapies because person centred can be long term. Other types of therapy can also be long term. Whereas when they brought CBT out it was more structured; to be given that bring you to the present and move forward. Give you some tools. And for me I don’t think that always gives the answers to everything. Because a lot of the time we can have strategies and tools but we don’t know why we fall off the wagon. If I knew why I fell off the wagon at the time that I did I would have saved myself a hell of a lot sooner than I did. But I was dealing with a lot of dark stuff that was being masked by my lifestyle. So you probably need to help people get to the root cause. And for me I like hypnotherapy for all of that. Because it can be solution focused, forward focused…It can take you to the future where you want to go; See it, feel it, hear it. And know that it is possible for change. And equally go back to a place where you once were in a safe space and heal yourself. Cause it’s only you that can do that now. And I don’t think it gets enough validation from a…If we look at say the NHS. But, and it’s an entity of its own. It’s well established in its own world of therapy. So, for me I use it as part of my model. So I do mentoring and coaching as well and I put it all together. Because we need more than therapy. Therapy will help you move through the trauma, the past, the healing. That’s great. But who’s moving us forward? Who’s pointing us in the right direction? Who’s saying-there’s a door open for you right over there now that you’re in a good place. Most therapies will just take you to the place where you feel good in the here and now. That’s brilliant because all you’ve got is right now but you also need to know a wee bit of what’s ahead. Cause what else have you got to go after? Cause otherwise you’ll fall back. And equally you might look forward, get so far and keep giving up and not know why. It’s cause you haven’t dealt with your stuff from the past. You haven’t worked through what’s holding you back. So, yeah, I think hypno’ deserves more is all I’ll say. It needs more research done on it but I believe it to be, in my opinion, highly effective and it has been for my clients.
- Deborah Craig
A lot of the other organisations (other than GRACE) had people in employed positions that had never experienced anything like what I had been through. Couldn’t imagine anything about trauma because they maybe had not had the misfortune of having a traumatic experience in their own lives. They either were reading it, googling it or referring to a booklet. There is no way to learn about trauma. You’ve got to experience it. And regardless of what trauma…I think that’s the most important thing. Each trauma is different but the elements are the same. Where you experience trauma you experience despair possibly next. I’m not quite sure of the order but then you would go into a recovery and then a support capacity where you’re able to explain your journey to others. To hopefully give them some hope of their own journey.
- Clare Littlejohn
Well, I think we’ve come a long way. I mean I’m…I’m talking at the moment as maybe as the old school. And I mean after…I’ve left nursing; the nursing system, you know, twenty four years. Right, so, there’s a lot of things that even in the last twenty four years, right, and there was a lot more awareness of mental health than ever there has been. Right… And there’s always…You know, sometimes we look at a television programme and say to ourselves-Oh no, I would have done that a different way. But we’re all different, you know, and you know, you have to treat the person as an individual, right, because as I always say- you can have two people with physical illness the same. They’re both given the same antibiotics. One survives; the other dies. There’s maybe no answer to it, right. You know…It’s just whether it’s part of our chemical makeup or whatever. You know, that’s how things are.
- Ivor McClure
I think, actually, the wrong style of therapeutic intervention, the wrong talking therapy or the wrong…If someone isn’t skilled enough to identify that they don’t offer what someone needs I think it could be quite unhelpful. Not everybody wants to or has a childhood issue that maybe has created their problems and some therapies…It’s just because I’ve had people say to me, you know-‘You’re the only one that’s really listened to me. Because they kept taking me down this route of like, ‘Oh, when you were a child…’And she’s like, ‘Nothing happened then.’ So, I think it just wasn’t helpful. So, I think being really aware of your own skill set as a therapist or a hypnotherapist or whatever you do…That you know that you could offer the right support to someone. Because I think the wrong type of therapeutic intervention, the wrong talking therapies could potentially…I don’t want to say cause more damage but they could open a wound that someone may not be prepared for as a client. And as a therapist unprepared on how to help them heal that wound. So, I think that’s where therapists being aware of their own skill set is really important. I sometimes have some clients that come to me and say. You know-I’m on this medication. I got that medication.’ And I wonder are we just masking everything with one medication over another? And how effective is it when they’re all blocked together like that? And I don’t want to dismiss the importance of medication cause I do think it’s definitely got a place. But I wonder if people were really given the chance to work through it without the medication. They may end up realising that they don’t need it or as much. So, I don’t know maybe too many different types and combinations of medication rather than actually getting to the root cause of the problem might be unhelpful. Because it can be just masking what’s going on. Rather than actually letting them ever figure out what it is, heal it, overcome it so they can actually move past it, cause then when they stop medication you’ve not dealt with it. You’ve just maintained a way…You’ve just been able to maintain calm, calmness or whatever it is or…But I’m not taking it away from medication because I know that sometimes there is a need for it.
- Deborah Craig
Ah, I was sent…Along with getting my anti-depressants I was sent for six weeks, one hour a week CBT (Cognitive Behavioural Therapy). At that stage, my tablets hadn’t kicked in. I didn’t know which way was up or down. And somebody trying to retrain my thoughts and behaviour, I wasn’t even on the same planet as that. I think they offer it far too soon. They need to wait till you’re stable on tablets before they give it. Because that was worse than not offering it at all. Because it failed, I felt as if I had failed.
- Lynnie
No, I felt that I… I had ECT (Electroconvulsive therapy) when I was in hospital. I had medication and when I was discharged I was still on a lot of medication. I don’t think they helped enough with the problem. I think they didn’t see me as a whole person; And all the things that I was dealing with. I don’t know if that’s down to time. I think it partly is the system. I think they don’t have the time. They don’t encourage you. Once they’ve done their bit, as they see it, they send you home and that’s it. I have been under the care of the community health team ever since. I still am under the care of the community health team.
- Maggie
I think you’re always on the journey of recovery. I don’t think anybody’s ever recovered. And to say that you are recovered I think can be not very open minded about what you’re processing daily. Anything can trigger you. Anything can bring it back. I can still get jumpy around unknown circumstances or situations. I now have a process that I would go through to figure out if I would attend an event for instance. To make sure I had safe travel, safe people round about me. Safe escape plan. Whereas before you would go into a situation and just take it as it would maybe go. The trauma has meant that I have to be realistic with my own expectations. It’s never going to leave me. It’s part of who I am now. But, I’m functioning and I’m very happy with the fact that I function. And quite pleased with myself on some days when you think of what you have come through. But, at the same time, it doesn’t define me. I’m not allowing it to define me is maybe the term. It’s part of me.
- Clare Littlejohn
Sometimes long-term physical illness can really bring about a lot of… Because you’re incapacitated in some way. Your ability to do things you know…So, you’re watching your dependence solely on other people to help you along your life’s journey. And sometimes that can be very difficult for the recipient, you know, because sometimes they would love to do things. You know… I many times thought I would love to walk a day in their shoes and give then the privilege that I had. But that’s not the case. We can’t do that. We can only walk in a person’s shoes so far. And then…But having the sense to walk out of those shoes and carry on with your own life. Because you’ve got another life outside your caring profession.
- Ivor McClure
Yeah, I mean, all through my drinking and my gambling I did have acquaintances. People that I spent time with but they were all doing the same thing as me. And so, they weren’t friends they were just somebody...company to drink with or company to gamble with. So, they weren’t really friends. But, yeah, I mean that’s an important part of it all. Like I say, I think at heart underneath it all I am quite a people person and I want to have, you know, kind of real friends. And do the things that I feel that I’ve missed out on in life. Just to be happy and just to do normal things. And, kind of, change how I feel. Change how I behave as well.
- Paul
But, having spent that six years… Five years of education, one year of internship getting experience all round India. We went to drought affected poor places to go and work as doctors. And you learn that you went there with food packages and basic hygiene material to give out to people. They were eating the soap they were that hungry. Children were so malnourished and flies sitting all over. And it was that horrible experience…Was humbling, equally humbling to see how some humans are just so unfortunate, unlucky. And that…Mumbai was so ok but the rest of India was so poor. And to be poor is not a choice. You didn’t make yourself poor, you know. You didn’t…And I remember one teacher was saying that-when you’re born you don’t decide to come to this world. Somebody else makes the decision. So, you’re either fortunate or you’re unfortunate or you’re somewhere in between. And that’s…that’s something that you have no control on. It never used to make much sense to me then. As I grew up, I always remember…Even now I remember how some of us are just unlucky and you have to make the best of your life. And then along came…Like I even now remember mothers used to say that-I’ve got three children I haven’t got money for feeding them. And they’d rather die. Because to see them suffering is so painful that if it ended the pain would end. ‘Because I’m helpless I haven’t got money. My husband’s dead’ Etcetera, you know…And those stories really…They were really bringing the understanding of human suffering, human life. And that those who can do something for them make a difference in their life. Whichever way; whether you have knowledge you share or whether you help them…It became very obvious to me that everybody can make a difference in somebody’s life. And I was very much influenced by my Dad, too, he was very much for community, supporting community, helping community, building community. And I always…Even now I remember his words that-the whole world is lots and lots of community. And you help each other and you make trusted people and you become trusted friends. Then everyone would be good to each other. And if people are good to each other, they will not harm each other. They will support each other. And he was one for always saying-Help the local business or help the elderly lady. I remember he used to say-You’ll get food if you go and help the aunty. See, she cannot walk properly. So go and put her shopping, and all this, wherever she wants and then come back home and you’ll get your food.’ So, this situation was not to punish you but to make you understand that you’re better so you share your ability to help somebody. And I think this whole thing, sort of, got into my head from a young age. More supporting community, supporting human beings.
- Indira Pole
I think it’s hard. One of the things I found helped me a lot. But because it was short term…It didn’t…That’s kind of like it helped short-term. Cause, I always found that I’m…I always feel better when I talk about things. Even if it is literally like half an hour an hour just chatting. Cause, then what I find is I build up or hide a lot of things that I’ve not even realised I’m doing. And it’s not till I start chatting about it that I realise…Which is literally what’s happening right now. I’ve not thought about a lot of this for a long time. Or, spoke to anybody about it for a long time. So, I definitely think that yeah, counselling to an extent is always a good thing for me. But to get access to things like that is always…One, it always has to be short-term because it’s third party and two, I can’t afford to pay a private counsellor. Cause, that’s the only way I’d ever be able to guarantee it every week. I can’t afford to pay that every week or every month or whatever. But I definitely think you…I think the ability to chat, the ability just to have that conversation with a non-family member. It’s the outsider bit that helps me. It doesn’t need to be somebody that I don’t know type thing. But, yeah, it needs to be out with the family. Do you know what I mean like my family are aware of everything that happens, and that, but I don’t know…I just don’t …It’s like I say if that’s their job to sit and listen then…There’s always that worry with family, and things like that, of judgement or them saying something to you that you don’t want to hear. Like-Stop being a whine. You know, that’s where the anxiety would come in whereas having just a person that it’s their job to listen to you ramble is probably a bit easier for me because of my anxiety Yeah, chatting’s good for me. I think it’s just the way I work through things. It’s always been the way I work through things; which is why when I don’t do it that’s when I tend to have meltdowns.
- Dawn Smith
I had two years’ experience there and it was different it was chaotic. It was a local district psychiatric unit in Ayrshire. The consultants had a different view on things. They had different priorities. Carstairs-you have a captive audience. You know you’re going to have the guys for a long time so you can, you can work away. The general mental health side. You were trying to stick a plaster on it. Get it well, get them back out again. It’s…I think to this day it’s still pretty chaotic. I don’t know if the mental health service we have in general settings really meets the needs of the folk that need the service. Whereas I can say that Carstairs did.
- James Calgie
