Today, Twitter was inundated with urges to Please Talk. This happens every few months, often at a time when poor mental health has affected someone in the public eye, and resulted in tragedy. Spurred on by the tragedy of the event, masses of people surge towards Twitter to express their upset, and urge anyone also suffering from mental illness, to make sure this does not happen to them. #PleaseTalk. This is the advice given to them.
I am a long term sufferer of chronic depression and an anxiety disorder. To those of you urging myself and others suffering from similar diseases to just talk, I want to know; who are you suggesting I talk to? What do you think I should say to them? What action would you advise this person to take? And what do you think would be a positive outcome? Seriously. When you advise me to “Please Talk”, what do you actually mean? Talk, and then what?
I have been talking for years.
Let’s make it clear from the start, that talking only constitutes a tiny part of the solution to poor mental health. A real solution requires massive economic, social, and cultural shifts in the provision of medical care for mental health. Centring the narrative on the importance of victims simply “talking” about mental health, moves the responsibility and blame to the sufferer, and away from the society and social policies that so often inhibit their recovery. It places the impetus for recovery on the victim, not on the services, support and treatment they require and should be entitled to, that are too often, simply not available to them.
It is tempting to reassure a vulnerable person that if they only just seek out help, that there will be an abundance of help available, help that is financially accessible, broadly available, and of a high quality. However, this undermines the fact that there is a huge deficit in the quality and accessibility of support available. We need to be able to say that services and attitudes in relation to mental health are catastrophically inadequate, whilst still reassuring the vulnerable that they can get better.
Urging the mentally ill to talk is absolutely not enough. By simply encouraging people to talk and not thinking about what the consequent aftermath of this is, we are essentially ignoring the entire fraught process of recovery.
Let’s talk about that.
I talk regularly to my boyfriend, parents and close friends about my condition. I’ve spoken with them about it for quite a while. They are supportive and kind and I appreciate that very much. But what are they meant to do? My boyfriend is not a medical professional. My parents are not medical professionals. My friends and co-workers are absolutely not medical professionals. And none of them are in any position to administer medical treatment, for my medical condition.
Naturally the next port of call would of course be to speak to actual medical professionals. This is a much more difficult thing to do than just “talking” however, because medical care for mental health in this country is really, really expensive.
I am 23. Like many people my age, I work in low-paid, unsecure, administrative and service work, but I do have a full time job. My weekly earnings are €16 too much to be eligible for a GP card, but paying for treatment is a huge strain that sometimes I can’t afford. I now pay for GP visits and my monthly prescription of sertraline. I used to go to counselling too, but after applying for an overdraft to keep up with payments for the sessions, was no longer able to go. I still haven’t paid off the overdraft.
Just because someone is employed, and thus not eligible for a medical card, does not mean they can afford even basic medical treatment. A huge proportion of those living in poverty in this country have jobs.
The economic realities of austerity and poverty in which many young people find themselves, are huge contributing factors to poor mental health, but they are also the barriers that can block off any viable hope of professional medical treatment. There are free and low cost services available like Pieta House and the Samaritans, but these are emergency, temporary solutions, and do not necessarily aid in day to day recovery.
Let’s imagine economic inequality was no barrier, and we could all comfortably afford to receive all the medical treatment we require. Unfortunately, this would not mean that this medical treatment would be administered in a professional manner, in line with best international practice.
Provision of care for mental health is too often left up to the GPs’ own personal biases and beliefs, without any solid grounding in actual medical experience. I have encountered GPs who have been aggressive, flippant, and completely reductive when dealing with mental health issues. My own experience, and that of so many of my peers, has been of full-on dismissal when discussing mental health with a GP. I have been to several GPs who could not understand why I was depressed. As a young person, they expected me to have no major reason to be mentally ill, despite being a 20-24 year old male, and thus within the one of the most at risk demographics for suicide in this country.
I have been to too many GPs who don’t really think mental health is a real thing. I have been to too many councillors more interested in opening chakras or passing judgement than in following best psychotherapeutic practice. There is a proud tradition in Irish medicine of not following best international practice, but instead, following the individual “ethics” of the practitioner or institution. This has been particularly evident in maternity care. My own experience has led me to believe it is true of care for mental health as well.
My worst experience with a GP was when after confiding in him that I was suicidal, he brusquely prescribed 3 months citalopram, and told me to make sure I didn’t “top” myself before I returned.
At the end of this prescription I did not have enough money to renew it, and the GP’s behaviour had badly dented my trust in medical support. Because of this, I did not try to seek any help elsewhere. I stopped taking my medication, and went into a period of breakdown, where I found it extremely difficult to get out of bed or leave the house, and seriously considered suicide. This was not because I was too afraid to talk. It was because, economically, I was not in a position to continue treatment, and the treatment I had received was poor, disrespectful, and completely contrary to best medical practice.
Who is responsible for this? What standard of care can we expect? Who regulates this? What’s the protocol?
I am aware that there are some excellent GPs out there, capable of providing outstanding care to those suffering with poor mental health, but frankly, I do not earn enough money to be fucking around with multiple GPs, until I find one in a position to provide an adequate level of care. GPs need to display a minimum level of sensitivity, empathy, and knowledge when it comes to mental health issues. There is no room for error or individual “ethics” on this.
I am not discouraging those suffering with poor mental health from reaching out and talking about it. I would absolutely encourage it. But we need to get specific and pragmatic about what we mean when we say to these sufferers, “Please talk”.
What I am saying is, I am talking all the time, and have been doing so for years.
But talking does not improve the availability and accessibility of proper medical treatment. Talking does not in any way alleviate the economic and social barriers to receiving this treatment, and talking does not ease the access to pragmatic, medical information on how to cope with your illness. Talking does not guarantee the quality of this medical service, and it does not guarantee best medical practice and non-biased attitudes from the GPs and other professionals who administer it. Talking does not suddenly mean that your friends and family will have access to the information, expertise, sensitivity and strength to adequately support you in your illness, and it does not mean they will even chose to support you at all.
Talking is not always the issue. I have been talking for years, and I am still as sick as I have ever been. I am talking right now. Now what?
Again, I am not in any way suggesting that people suffering with depression and other mental illnesses should not seek help. What I am calling for is a massive and collective improvement of the services and support offered to those victims when they do seek help, and a re-evaluation of the patronising and reductive attitude of those who see “Please talk” as a solution that is in any way adequately befitting of the problem.
What I am calling for is a redistribution of focus away from simply urging people to seek help, but to ensuring that there is help for them to seek in the first place - help that is immediately accessible, of exceptionally high quality, and available irrespective of the patient’s financial position. It takes a huge amount of courage and strength to seek help for mental illness. When anyone does so, it is imperative that the help they seek is provided.
- Oisin McKenna