Talking Heads reporter Lisa Rashleigh's recent experience of trying to book a GP appointment prompts her to explore the issues faced by individuals suffering from mental ill health when attempting to seek support.
It’s 8:29am on Monday morning. I’m poised and ready to make a phone call to my local GP to book an appointment for a fairly innocuous health issue (a funny-looking freckle to be exact). Eight-thirty am rolls around, the surgery opens and I start to dial. I’m unable to get through the first time, so I try again. I can’t get through the second time, so I try again, and again, and again. In fact, it takes me over thirty attempts to finally have the receptionist answer my call. Unfortunately, after all of this effort, I am told that all of the appointment slots have been booked for the day. The receptionist then goes on to tell me that I also cannot book an appointment in advance to see my GP. I am told that I will need to ring again tomorrow.
Initially I ended the phone call feeling very annoyed at the inconvenience this presented for me as somebody who works a standard 9-5 job. I also couldn’t understand how a GP, located within one of the most populated areas of Glasgow, had such a flawed booking system. This then got me thinking; if I, a persistent and fairly ‘confident at making-phone calls’ kind of person, finds it nearly impossible to get a GP appointment, then how difficult must it be for somebody who may not have the means to be as confident and persistent as myself? Furthermore, how anxiety-provoking and challenging must it be for people with mental health issues, particularly those that may be in a place in which even making a phone call is hugely difficult. The more I thought on the issue, the more I could see the barriers that this system put in place for people that may be trying to access mental health services through the NHS, as a referral from your GP is required. Though this barrier may seem small and insignificant, it is a barrier none the less and it actually represents a far larger problem, being the systemic discrimination against mental health in Scotland.
Unfortunately, in both my personal and professional life, I have seen a disconnect between mental health services and the people who are trying to access them. Though a stigma against mental illness undeniably exists, more people than ever before are opening up about their issues and seeking support. However, it seems that many unnecessary, and potentially harmful barriers are still preventing people from accessing this support. For example, a friend of mine was told by an occupational therapist, via letter, to “just keep exercising and cooking” after they had their sessions cancelled with no further explanation, except that they did not meet the criteria for further support, or for referral to a mental health service. Another close friend was told by a NHS gatekeeper, after having already stated that their personal choice was to not take medication, that their only options were to be prescribed medication, or wait close to 3 months for an initial appointment. There was no mention of signposting, nor reassurance or basic empathy given to this individual that was in the midst of a very challenging time. It seems that some systems take advantage of the fact that many people do not understand their rights, including their right to the highest attainable standard of physical and mental health, so these decisions and gatekeeping processes are remaining unchallenged and therefore unchanged.
A further area of disconnect, particularly within Glasgow, are the barriers against people with problematic alcohol and drug misuse issues that are trying to access mental health support. For example, NHS mental health services are of the view that if somebody is not detoxed sufficiently, then they are unable to access a mental health assessment. This of course makes sense in terms of determining an accurate diagnosis, however, it doesn’t take into consideration the overarching problem of what it was that came first; was it mental health issues or alcohol and drugs? Although, if an individual is lucky, there may be the option of detox and long-term rehab, but this may not be able to address underlying mental health issues. Furthermore, many people in this situation have difficulty even accessing interim support, for the fear from certain services, and I quote from professional experience, “of opening up a can of worms”. These individuals, whom are often desperately trying to find a helping hand, are then left to manage their mental health in whichever way they can in order to cope.
I’m not attempting to insinuate that there is going to be a quick and easy solution; funding and resources are not easy to come by. But with all of the hard work that organisations such as the Mental Health Foundation, See Me and many others are doing in regard to reducing the stigmatisation against mental health, there needs to be a more concentrated effort into the evaluation of referral pathways. There also needs to be a deconstruction of overly stringent gatekeeping methods, particularly in regard to those that also do not provide signposting. These barriers, whether they are as seemingly small as a flawed GP booking system or something bigger, are disadvantaging people through structural and systemic discrimination. This is undoubtedly contributing to further morbidity and premature mortality in Scotland and that is unjustifiable. It isn’t right that vulnerable individuals are being utterly left in the lurch due to the disconnect between themselves and the services that are supposed to be helping them.
by Lisa Rashleigh
Lisa is a 25-year-old Australian living in Glasgow. She has a background in youth work and homelessness, and is currently working as an independent advocate. Lisa is passionate about both mental health and the Glaswegian music and art scene. Follow her on Instagram @bin_leisel or on twitter @LisaRashleigh.
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