One of my favourite news stories came back up again this week. Did you know, that exercise or a nice walk is very effective in raising self esteem in depressed people? I’m not disputing the efficacy of a nice walk. I’ve had the benefits myself on a number of occasions – the solitude, the peace, the fresh air. It’s a good thing. However, what none of these reports ever mention is how, exactly, someone suffering from depression (even ‘mild’ depression) is supposed to go and do some exercise if they can’t even summon up the willpower to cross a room? To get food to eat? Get dressed? Lift the remote control to change the TV channel? A jog around the block should pose absolutely no problem! So we get the stories about the lovely farm ("ecotherapy") as much better alternatives to pills. Mmm. Tell me, how exactly do you intend the patient to explain to their boss (assuming they’re still at work) that they need a week off sick to tend some plants and feed some pigs? And how exactly is that going to help the patient when they leave the lovely farm and return to whatever environment they were originally depressed in? What if the patient lives in the middle of an urban estate and has no lovely parks to go walk in, or that they’re all full of dog shit? What if it’s the middle of winter and streaming with rain?
We also keep getting told of the benefits of CBT and talking therapies. The government is very keen on CBT mainly, I suspect, because it provides a quick ‘fix’. It deals with the symptoms, but not the underlying cause. The patient may be back to work again, but will probably relapse because even though they’ve been taught to think differently and cope with negative thoughts, whatever caused those negative thoughts in the first place hasn’t been dealt with (and let’s not even start on people who get depression through genetic and chemical imbalances). What’s actually needed is a large psychiatric staff within the NHS that are experienced and professionally trained to recognise and deal with underlying problems. But that large psychiatric staff doesn’t exist. Long term back-up systems for schemes like the lovely farm aren’t there, there’s precious little for the patient to fall back on. Mental illness isn’t like physical illness, you can’t do an operation and voila! It’s sorted. What’s needed is regular psychiatric treatment over a long period of time, and medication to get the patient through the initial, critical, phase (when someone with depression first goes to see a doctor, it’s usually pretty damn critical).
The psychiatric services that do exist are suffering major cutbacks, so you’re fucking lucky if you can ever get to see someone who knows what they’re talking about in the first place. Three years ago I got an appointment with a psychiatrist at the Royal Free within weeks, just to check out my GP’s assessment. Now, as I work on a hunch and try to get a re-assessment of those original assessments (more on this in a couple of weeks – hopefully), I find myself waiting weeks for an appointment with my ‘Community Mental Health Team’, which actually meant 45 minutes chatting to someone who didn’t even have the authority to refer me on to a psychiatrist without checking with her boss (Dr Crippen’s verdict on CMHTs pretty much falls in with my experience). What else is a GP supposed to do, when faced with a patient breaking down in front of them, but prescribe anti-depressants? When getting a psychiatric consultation can take three months? When talk of alternative therapies and exercise and lovely farms is so ridiculously impractical and inappropriate for someone in a total state of meltdown? (Even with so-called ‘mild’ depression.)
I get so angry whenever I see these news stories. To me, they fall into the "you know, if you just pulled your socks up and made an effort you’d be fine" camp, which displays a total lack of knowledge and understanding. "If you could just go for a walk or a run you’d be fine." Well, exactly. "If I could get off the sofa, I’d be fine. But I can’t." QED.