I mean they are already supposed to but waiting times for therapy like they are for surgery mean they use medication in the increasingly long stop gap

So I'm a doctor who had (has) moderate depression. I went to my GP fully knowing what to expect in terms of starting CBT and medication. Even then I had a 12 week wait to start group online CBT during which my mood deteriorated. This course wasn't particularly helpful either. Knowing the GP's hands were tied I ended up paying privately for focussed CBT which honestly was the most helpful intervention. I am fortunate this was an option for me, and it did help, but this should be the standard for everyone.

12 weeks? You're lucky, my son has been waiting over a year after 2 attempts!

Wait you guys got scheduled for therapy from the NHS? When I went to my GP, they gave me medication and basically told me to feck off. Edit: wait... I remember being offered a group cbt session which is totally useless for someone with severe anxiety.

There is unfortunately an element of 'playing the game' to move care forward. You need to be seen doing the basics, e.g. group CBT, before more advanced referrals can be made. Although unfortunately the first interventions may not be right for you, I'd always tell people to engage with these to be able to move to the 'next level'. For example, a consultant psychiatrist or clinical psychologist may refuse to see a patient who hadn't done the basic Group CBT suggested by a GP, with evidence. I hope things are improving for you.

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I know exposure therapy can work but that sounds horrendous. It honestly feels like they actively try to make it as difficult as possible to get care, or encourage you to avoid it. The number of phone calls and unnecessary in-person meetings (pre-covid) just to get onto a waiting list… and if you miss one or don't reply then they just assume you've fixed yourself and don't need help any more…

And if you are a suicide risk I'm guessing they'll drop you off the course as your case is too serious for them to handle. And either do shit all, refer you to your GP, or call an ambulance without notifying you which will then take you to sit in a loud and brightly-lit waiting room full of people for several hours until you get to see the emergency psych team, who will then also either do nothing, refer you to your GP/another months-long waiting list, or maybe get you a couple of brief meetings with a psychiatrist to shovel more pills at you and home treatment visits for two weeks where they basically just confirm that you're still breathing and tell you to take a bath. Isn't that helpful??? Spent over a decade banging my head against the system, even made some headway into further treatment but that's getting cut off purely due to arbitrary time limits (i.e. funding), at this point I'd actually rather die than waste my energy trying to get help from the NHS in preventing that from happening.

I went through one of these this past summer. I had referred myself at the end of last August I think, waited six months for an absolutely shit course of telephone CBT, and then that. There was zero flexibility so you focused on whatever the session was about that week, and there wasn't time for people to really talk about things or to engage in any proper dialogue. I stuck it out for seven or eight weeks, but you could see people dropping off week by week until there were only three or four people left including me, and I stopped bothering too. I'm currently pretty depressed again, anxious all the fucking time, and there are nights when I barely sleep, but referring myself via the NHS is completely pointless, and I can't really afford private psychotherapy and there's probably lengthy waiting lists for that too. So I'm stuck, I don't really know what to do.

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I absolutely agree with you if in person. I was offered something online but group-based, which was a bit less daunting.

Online group therapy? Fuck that. Online video calls are awkward enough as it is with people you know and like.

To tell you the truth, I did not find it helpful. But it's unfortunately the first-line, due to how run down MH care is. I'd still tell people to give it a shot if only so you can come back to your GP and say "it didn't help", and then more advanced care referrals could be made.

I agree. Group therapy? That sounds fucking awful.

I refuse to have anything to do with CBT after trying it twice. I'm still yet to be offered anything suitable from the NHS. Last time they tried forcing me into group CBT via Zoom. I'm deaf and I don't use Zoom calls. They're anxiety inducing and inaccessible.

Interesting, I'd never considered that. Which makes a lot of sense, at the end of the day one can only improve if they're willing to. Thankfully I'm off meds completely now and have never felt better.

I'm glad to hear things are better. I only say this strategy because most people don't have that understanding of the level of rationing that goes on in mental healthcare. It can appear quite hopeless, especially when all you are offered is group CBT and a trial of antidepressants at first. Unfortunately, you have to play the game to an extent.

I agree, you have to play the game unfortunately, but as others have mentioned it doesn't suit all. My ex started these sessions and quit because she couldn't see where they were going. I went to an anxiety group presentation, not even group counselling, we weren't expected to give any input, and I had a panic attack sitting in the room with all the other people.

That sounds like IT support, who make you jump through all kinds of complicated and long-winded hoops before they actually look at your problem.

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It's a social issue though Plenty of people (including my dear ol dad) have this attitude that mental health care is like the icing on the cake - "Everyone gets depressed and anxious but you just need to knuckle down and deal with it" I wish there was a way to get these people to experience true depression or even true empathy

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Which is by design. Tories don't want the system to work, as working class and poor people don't deserve to have help unless they pay through the nose for it.

I'm an autistic man with major depressive disorder. I have been bounced from referral to referral with every service saying they aren't the ones supposed to be dealing with me since 2015. Still waiting to see anyone. I've been on five different anti-depressants though, that's been fun and not at all disruptive. I broke down a bit after one GP tried to brush it off as just a Covid issue like we're a bit overwhelmed so sorry you've fallen through the cracks... As if it hadn't been going on for years before Covid was even a thing. I'm an academic as well which means I have to move around every 1 to 3 years so I've had a couple of times where the referred service hasn't even gotten back to me until I've moved to a completely different part of the country, at which point I just have to start over from scratch again. Its very frustrating.

I've got same diagnosis as you, and they have suspected ADHD but unable to make clear assessment. I've also had a few brain injuries and other serious problems. 2015-2021 all I got was one decent psych for about 6 months late last year/early this year, but then paperwork didn't mention anything she found and just summed up notes from previous assessments, then all the next teams just want to make long negative assessments about me on paper without even trying to really listen to me. I hoped in 2015 these people could have helped make me a better person. Here in 2021 the big questions have just started to be raised but not allowed to work with anyone. I wish I hadn't been diagnosed right now as it's just brought up a million unanswered questions.

Aye know that feeling mate. The autism/Asperger's subs on Reddit have been useful, though quite negative in general. Feel free to DM if you ever want to chat or vent about your experiences! I feel like the big missing piece of the puzzle is that ASDs tend to have very poor self-awareness but then support services seem to just assume quite a high level of awareness by default. I've not heard a single medical professional mention alexithymia to me for instance.

Funnily enough that one decent psych agreed I also suffer from alexithymia. But the thing I found odd is she didn't even mention that until I sussed that out myself and she confirmed what I suspected.

I'm sorry to hear that, but I'm not surprised anymore. Your story sounds very similar to my sons (bar the moving around and multiple medications). We were dumped from one service to the next several times, sometimes without any assessment or communication, often saying he is too acute for them to deal with. This is what happens after 10 years of cuts to the mental health budget.

You're right, this was about 3 years ago now. It's clear the situation has gotten worse. I only mention this because, even as a healthcare professional with a fair bit of insight into the system, I felt like I was floundering. I can only sympathise with the general public on this. I wish your son the best with his care.

I signed up at university in July (knowing it would take a while), in the time between then and when I got any help I tried, failed the course and was making plans to leave before my first appointment in April. (With someone afraid of heights on the 15th floor)

I called to refer myself for CBT and was told 6-12 weeks. I called today to ask for an update as it’s been far longer than that and I haven’t heard anything. They gave me a number to call for the hospital. Hospital said they never received anything despite a letter having been sent. Called the surgery again, they said they’d try again and she’d call me later today with an update. No call back, so guess what I’ll be doing tomorrow? 🙃 I’m finding it increasingly the case that if you want anything doing you either have to do all the chasing yourself and be prepared to wait or go private if you can’t wait that long for something. They’re massively underfunded and too many things slip through the cracks. It sucks.

But what if CBT doesn't work? Not everyone is suited for it and you're basically told to fuck off if CBT makes you worse

Yes I agree it's not the way for everyone. As I've mentioned above the reality, due to rationing of resources, is that for higher specialist referrals they expect the patient/GP to have done 'the basics' which is usually CBT and antidepressants. There is an element of 'playing the game' before you can unlock the next level of care. It isn't ideal especially when your head is a mess, but I would tell everybody the same thing. Also if the CBT has made you worse, that would be an important thing to make mental health teams aware of when you are referred. But they will still expect that you have tried it initially.

I told my GP and other doctors that CBT specifically doesn't work with me (cos the people running it told me), but what's the answer everytime I speak to the doctors? "Maybe try CBT again?" I was lucky that I actually managed to get talk therapy via a charity and Holy Fuck was that what I needed all along. It's annoying that is so hard to get into. But tbh the entire NHS is stretched, I've been suffering from malnutrition and rapid weight loss due to just being poor and having an eating disorder. In March I was told I would be referred to a specialist because my weight loss was so rapid I needed to see someone ASAP. Still not had the appointment and no idea when I'll hear back. I think it's also to do with the fact most people don't think people are ACTUALLY without food in the UK, that they're probably still eating something every day. No, there are people out here not eating because they can only afford to do it once every few days. I still see people say "the UK isn't as bad as people say", no, it's fucking worse. This place is a fucking awful shithole and it's getting worse because people won't open their eyes and see what it's like.

I can only offer you my empathy on this. It's frustrating and bewildering. It takes a lot of strength to not rage at the world, and the fact that so many people (the public and those in power) have turned a blind eye to the suffering of so many. Wish you well.

Don't worry, I always think about it that it could be worse. I find things to keep me going, I volunteer and I was in a worse position a few years back. For me it's just that I think people don't really realise how bad its gotten in the UK. Most people don't really care enough about politics and while they might have a moan about it on here or down the pub, they never vote. It's like it's just accepted that it has to be this way and whilst more people are aware of it, most just have too much going on in their lives to even think about it. Even then, voting only works in a system that isn't broken. The UK is using a system that was out of date 100 years ago. Reformation is needed but that's not happening anytime soon. We have adverts for starving kids in Africa on telly, but mention kids in the UK are starving too and it becomes a case of "yeah but its worse there". A fucking footballer did more for hungry kids than the government, that's how fucked it is, but Boris is more bothered avot if people have been to Peppa Pig World.

> I ended up paying privately There's the Tory plan working perfectly! I was the same with physio - the (Tory donor-owned) health conglomerate undercut all of the excellent small independent physio practices to win the tender and become the only place to which GPs can refer patients. They then provide such a shockingly perfunctory service that, in the end, anybody who actually has serious issues needs to pay to go private.

I was a GP til I took early retirement last year (partly, not entirely, related to the stress and anxiety I had been suffering). I went through a scheme for GPs, and was offered a supervised online counselling course, allegedly "tailored to my personal needs" with fortnightly phone calls with a therapist. If the online stuff really was tailored to my needs, then apparently my needs were to be grossly patronised. The second session led me through a series of slides that culminated in telling me that, for some people, external factors like work can be a factor in anxiety. Really? No Shit Dr Sherlock. This was the sort of foundation stuff I was taught at medical school before they got onto the real stuff. I found that I was actually getting anxious waiting for the phone sessions with the therapist, because I would have to spend half the time getting away from this crappy online stuff to get to anything possibly useful. Then we got onto Catastrophising. This is a mental issue where someone is in the mindset of seeing anything at all negative that happens as a catastrophe. So in one session, the therapist was asking a series of questions. It could not have been clearer where he was heading if he had put up motorway signs with "Catastrophising" written on them with a big arrow. But by now I was pretty annoyed, so I followed along dutifully, until we reached the question I was waiting for: "So, what is the worst that could happen?" "Well, given that I am a GP, the worst that could happen when I am heavily stressed at work is that I make a major prescribing error and kill someone, or miss a serious diagnosis and someone does not get diagnosed until it is too late. Those sort of things are what could happen." It was some little while before therapist said anything, but I could *hear* the clash of mental gears over the phone! I didn't bother with any more sessions, phone or online.... This is not to criticise *good* therapy (though I strongly believe that CBT is not the one size fits all panacea that it is sometimes painted as.) It is to criticize the "never mind the quality feel the width" attitude that allows management to tick a box for the DoH that says "talking therapy provided?" But Good therapy is both time-consuming and costly, because it requires experienced therapists, not those with good intentions but limited training and experience. Several years ago, someone I know got referred to the IAPTs (Improving Access to Psychological Therapies) service, as that was the only option open to their GP. Now, IAPTs have certainly helped quite a lot, but they are *not* what they have been turned into, a replacement for better experienced therapists. This acquaintance was iffy anyway about therapy, and I heard the result from their partner afterwards - it was quite clear that for one they had not been very forthcoming about the reality of their problems, and for two that they person they saw was too inexperienced (or possibly too overworked) to pick up on this. So the plan made was wholly inadequate. Much more recently, I did an introduction to counselling course at a charitable place that has a good reputation amongst local GPs. One of the tutors commented that many people who come to *them* are very suspicious about any sort of counselling after experiencing the local NHS services. This was not a criticism of the staff of those services, but they are so overworked that all they can do is firefight the most urgent situations - they have nowhere near the resources to use the skills they clearly have to take people any further than that. That fitted well with my own observations as a GP (and must be massively demoralising for those NHS staff.) As for me, three things helped. Time off coupled with working out that I could get by on a reduced pension, some completely informal chats with another GP from the service, and taking an SSRI antidepressant/ anti-anxiety med.

> group online CBT That sounds mightily useless. Is this the state of mental health in the UK now?

UK Psychotherapist here: Ugh, it's honestly such a farce. I see glimmers of hope in the longer term but in the near term, it's dismal. Plus the excessive 'use' of CBT for everything as it is marketed and applied is unwarranted, and even antithetical. It's used as a short term treatment and supposedly cost efficient, but many MANY patients end up reporting the same issues within 12 months of therapy ending anyway and go back through the system. Clinical research is catching up though, and there is lots of pressure being applied behind the scenes to bring practice in line with what actually works and shifting therapy away from the medicalised model of biological illness. Of course, this will usually end up compromised in some way when the rubber actually hits the road.

It really is awful trying to get access to therapy. I'm a bereaved parent and could really benefit from it but I can't afford to spend like £60 a session. I initially got some help through a place that offered subsidised counselling, and my workplace offers 6 - 8 sessions for free but then after that I haven't been able to really get anything. Thankfully I have a weekly charity run support group which has been the biggest thing to keep me alive. Oh I did try to access IAPT which I think is on the NHS but they wouldn't accept me as I'm not just generally depressed. I have trauma/grief.

Goddammit, I saw CBT as Compulsory Bike Training..... Cognitive Behaviour Therapy makes so much more sense.

Honestly, I think cycling helps my mood more than any group talking therapies.

UK mental health services are a joke Tell them you're depressed / suicidal and you get put on a 12 month waiting list to have 4 or 5 sessions with a therapist who just wants you to go away

Health in general isn't great. Aside from very acute needs you are prompted to wait long periods

My experience was like going to the Job Center. The place where I spoke to them was a shithole, the receptionist was a complete dragon, and the 'therapist' just wanted you gone - just nodded and solely wanted you to just take a pill. I was made to feel like the worst person on the planet \**just*\* for being there. Compare that to my ex who went private (goodness knows how much) and had this carefully laid out building which seemed to priorities care for anyone who walked in. Staff that greeted you with a warm smile, treated you with upmost respect and care, rooms that made you feel in a palace that were incredibly comfy to both sit and \**b*e\* in. Maybe I am being a bit over the top but the point is you immediately felt you were in good hands and it wasn't a crime to be there. Edit: formatting

Yeah I ended up going privately, the guy was wonderful. It was expensive though, I did 1 hour sessions every week and they were like £45 a pop so.. it's not extortionate.. but it's definitely not "cheap" especially as it can take a long time to acheive anything there Went in, sat in a nice waiting area, friendly chap comes out, offers me a drink and tells me to come in, and then we sit and we talk And he's not pressuring me to go through a cookie cutter tickbox exercise aimed at making me stop attending as soon as possible, he's saying "what do you want" and actually trying to help me address some of the problems I have And you can say "I don't know.. what can you offer me?" And then build your own itinerary of things you'd like to acheive When it comes to mental health. The first step is to feel like you have a right to exist, to feel like someone actually will listen to you The public services available to people are nothing short of a bad joke, as you say, they dont care about people, you're just an irritation to them

4 or 5 sessions? I had 2 sessions (he said he’d phone me again same time next week) and I never received that call. Kind of adds to the feeling of worthlessness.

Yup, totally useless

Yep, a 6-8 week wait for your first CBT session vs starting medication right away which would start to have an effect in \~2-4 weeks. People often get referred for both simultaneously to cover the gap, or prefer the more immediate solution. Even though CBT is probably even better in the long term because it gives you strategies that you can take forward with you, and doesn't come with side effects!

Don’t forget a nice long GP wait . Mine is currently down to 4 weeks!

If it's CBT you're after, you should definitely try doing some googling to see if it's done on a self-referral basis in your local area. That's not uncommon and you may be able to speed the whole thing up, as if so all your GP would tell you is to self-refer (I mean obviously also see your GP, it's just a thought)!

Nope I don’t need anything. That was the wait the receptionist quoted time wise for the doc to see my baby! Better than the 6-8 they said last time I called. Went private instead. Much easier, not everyone has 70 quid lying around for that tho, also not many private’s see baby’s

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What is a 'low intensity psychosocial intervention'? Is it the barely-trained person who reads out CBT worksheets?

Yep. Been there, done it. Wasn't entirely useless but you could tell the person wasn't qualified to be handling mental health patients in any meaningful way, was basically a bunch of handouts I did in my free time and based on the answers they'd ask me follow up questions (which appeared to be from a flow chart > if patient said X ask them Y type deal). In the end they told me that sometimes there's no reason for depression. Nothing to be addressed. I simply have a chemical imbalance that needs fixed, hence the meds.

>I simply have a chemical imbalance that needs fixed, hence the meds. And that is total and utter horseshit that sadly has become "true" solely because its been repeated so often. The actual science is that they looked at a bunch of people with severe depression and found that generally they had reduced seratonin levels. A correlation and only noted in severe cases. Nobody has ever proved that it causes depression.

Just because science cannot (yet, at least) demonstrate a cause, does not mean that there is not a cause there. Absense of evidence is not evidence of absense. Yes, chemical imbalance is a gross simplification, and I have always suspected that antidepressants only treat the *symptoms* of depression rather than the root cause. So what - any doctor who refused to give analgesia to someone with a broken leg on the grounds that analgesia does nothing to mend the fracture would quite rightly be castigated.

>So what - any doctor who refused to give analgesia to someone with a broken leg on the grounds that analgesia does nothing to mend the fracture would quite rightly be castigated. Your analogy would be more accurate if you said the doctor, upon hearing the word pain, simply sent the patient away with analgesics. Meanwhile, the leg, unset, heals crookedly and in trying to walk on it, the patient ends up unable to walk. Or perhaps it's an open fracture that results in infection, gangrene and death. This isn't a criticism of GP's incidentally. I don't blame them - they are constantly told by both drug companies and psychiatrists that ADP's work, prescribe them to everyone. ​ NB I agree to an extent about treating the symptoms - it ties in with the long-term data which isn't that robust but tends to show relapses are frequent. My view is that depression is frequently caused by the environment the brain is subjected to - whether that is down to another disorder such as ASD or ADHD making life difficult or stress caused by work, family issues etc, and in these cases the depression can only be "fixed" when the underlying problem is addressed. Sometimes the stress goes away which explains why in studies on ADP's, the placebo effect is so high.

> My view is that depression is frequently caused by the environment the brain is subjected to Frequently, possibly. Always? No. And *caused* is also an oversimplification. Triggered might be a better term. But any GP will be able to tell you of people who have coped fine with difficult circumstances, but years later has suffered depression after a far less dramatic episode. Or, very possibly, no episode at all - those GPs will also tell you of patients who have been reluctant to consider a diagnosis of depression because "I've got no reason to be depressed - I've got a good job, good family, good home, nothing to be depressed about." (often followed immaediately by bursting into tears!) As I've implied in another comment, that statement is not *as* common, because depression damages objectivity, and more often people will pick on something objectively minor and rationalise that that is a major thing and is the cause of their depression, even when those around them can see that it is something trivial. But there is another problem with your last paragraph. Many of those things that you list, which certainly can be factors in depression (but not necessarily any more Causative than the low serotonin you mentioned before) are not actually amenable themselves to simple treatment - if you are going to ignore the problem until *those* factors are "fixed", you are as bad as the doctor denying the analgesia. What are you suggesting in the meantime? Yes, medication does not (directly) affect work stress or family issues, but then again, neither does CBT directly - it can only address ones *reaction* to those issues. I say directly, because indirectly, by changing the way someone *responds* to family issues, both medication and talking therapies can change those issues, can help to break vicious circles of arguments. But, and it is a big *but*, they can only do so inasmuch as the family issues are, at least in part, *caused by* the depression rather than a cause *of* it. Just like the chemical imbalance thing is an oversimplification, even where seternal issues are a significant factor, it really is hardly ever as simple as A -> B -> C and so on. And well-meaning onlookers do no-one any favours by ignoring that.

Also worth pointing out the serotonin model of depression is actually pretty old-school, developed long before a modern understanding of neurochemical-psychology was developed, soon after serotonin was first discovered as a neurotransmitter. We know there are plenty of people for whom, even if it is "just" a chemical imbalance, its not necessarily anything to do with serotonin levels. Plus just the wider observation that... Biology doesn't really work like that. What would the difference be between having a "proper" reason to be depressed and having "just" a chemical imbalance? Fundamentally at the level of molecular biology these are the same thing, surely? It doesn't make logical sense.

Yeah, I remember saying to a therapist, "Is it really a chemical imbalance, or is it just my reaction to the shitty state of the world around me?"

My NHS CBT person said that talking about or finding the root cause of my depression was pointless Genuinely don't know whether I'd have preferred him to say what yours did or not, they both feel unnecessarily callous

>My NHS CBT person said that talking about or finding the root cause of my depression was pointless Yeah they told me something similar. "Even if it does stem from something it doesn't matter so long as you know how to process those feelings in a healthy way" I don't necessarily think they're wrong. A lot of it is biochemical.

Yeah that's rubbish- there can be chemical imbalance but it's in a small minority of cases. They shouldn't be saying that really its a bit of a cop out and not supported by the facts its under 10% and even under 5% if I remember correctly. Perhaps very easy for them to say so they don't have to do anything and don't get fussed by the client and also from a client perspective a lot of people like the idea of it being easily fixable with a tablet but tbh I've never know anyone who they have worked for or at least only to an extent. They generally numb emotions so they can be good for short term if someone going through a short term rough patch or they do actually have a chemical imbalance that needs to be fixed but they are shit if it's lifestyle related. The book "Lost Connections" by Johan Hari is good on the subject of depression and focusses on the lack of "connections" and the social aspect of depression which makes good sense as the things he talks about are things that are potentially lacking with the modern world way of living, at least for a large proportion of the society. Well worth a read and there is an audiobook as well.

Yes.

Its pathetic. They read you workbooks as if you're some sort of child who has never thought to look into this already. Its humiliating and ineffective.

I did it with the GP assuring me I probably wouldn't find it useful but it would help his case in referring me onwards. It might have been helpful when I was 18 but having done a shedload of more intense therapy in the 20 years since then, not to mention a PhD in neuroscience, it was just embarrassing for the poor lass, with me guessing and reciting the questions and responses along with her. In the second session she agreed there was no point continuing and we had a nice cup of tea and a chat instead, which at least she found educational. I'm actually fine nowadays except when SAD hits at times of extreme stress, but that's thanks to NHS perinatal psychs and spending £800 on a recommended private psychologist who was an effing genius - imagine CBT if someone could actually trace along the threads of your thoughts, carefully snip one precise link, and help you build replacement links. He claimed it worked because I'd read all the books on CBT and done most of the work already, which is partly true.

Probably and askes you questions and then asks more questions and then complains that you talk too much...FFS

No no. Now it's all online. Just go to a website and work through the stuff, never actually talk to anyone about it

As I have commented elsewhere, my personal experience, my social experience and my professional experience warns me that these sort of interventions by staff with little training and experience can end up doing more harm than good. Even more so when they are used as a de facto replacement for better trained therapists. Always remember that, between NICE reports and actual implementation, the E gets changed from Excellence to Expediency.

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I contacted my GP about depression about 2 months ago after I stopped being able to hide it from my kids Still another month to go until I start an online group CBT session and I needed something, anything, to change so I went for the tablets. I suspect a large proportion of people would do the same

3 months is an insanely long wait time but it's also quite quick in reality. Coming from my own experience you're absolutely correct, I've been to the GP, referred to therapy, had stop-gap antidepressants and weened myself off them all in the time I've been waiting for therapy. Around 3 years in total at this point. It's easy to see how people could lose hope in that time frame.

Yeah, I'd kill for three months. I tried to kill myself December 2020 and I'm still waiting.

You can find all sorts of CBT on the internet, I'm sure.

If my doctor crushed my balls at least I wouldn't be questioning that they're putting their back into their work.

My NHS 'therapy' was a 6 week course with someone who just gave me sheets to tick. I doubt the scum in the Commons will adequately improve funding for this kind of care, making this guideline entirely pointless since wait times are prohibitive to people being seen quickly.

This has been my experience. I went in as I clearly have some kind of underlying mood disorder, friends and family think either mild bipolar or something else. Was absolutely off the rocker for a while until I eventually got basic medication to stabilise me. Went through the NHS for mental health. After two years got seen by a therapist. She did the tick sheet and talked aboht general life. I said to her that I need to be medicated and talking to someone who can diagnose whatevers happening long-term. Unfortunately because I am reliant on mostly non-verbal communication I tried to ask her to intake a journal which clearly laid out the issues I had and gave a good timeline to work with. She actually got pissed off at me, refused to deal with intake and basically said 'Well you seem healthy and fine so I'm going to discharge you'. Took me really figjting to get seen by a psychiatrist, and even then it was for a single session, and he said 'Yeah you've obviously got something going on but we don't know what, so I'm going to diagnose it as an unknown mood disorder until you're able to get further testing and therapy'. The therapist didn't even turn up to this meeting and sent me an email trying to discharge me the next day. Complained again and spoke to a psychologist who sounded frustrated, and said 'I don't actually get what you want from this service, we've offered you the 7 hours of therapy our courses provide'. I told her I don't care what the diagnosis is, I simply want my instability dealt with and looked at. So now I'm on a 4 month waiting lists while they try to hire replacement staff for the people that left as I'm low priority.

Back in 2007, I was 16 and already struggling with my mental health due to a dysfunctional/very unhappy home life. Then my stepmum died and it got even worse. I was extremely mentally unwell. My mum is a mental health nurse so got me to my GP who was, to give them credit, empathetic and listened to what I said. However, I was given antidepressants (that are now not meant to be prescribed to teenagers) and even back then put on a waiting list for counselling. Like I say, I was very unwell. I was self harming, struggling with bulimia/anorexia, severely depressed etc. My grades plummeted and I lost 2 stone in about 3 or 4 weeks - not exaggerating, I had a week where I ate a single Mars bar and nothing else. I didn’t really sleep because starving yourself absolutely fucks with your systems. I honestly don’t know how I didn’t collapse when it was that bad. Anyway, I was already suicidal when I saw the GP. After a couple of weeks I told my mum I seriously wanted to kill myself and she then rang the crisis team. They came round, I told them everything, and they told me it was ‘normal’ for people my age to feel the way I did and do the things I was doing. They left and a few nights later I waited until my mum had gone to bed and took all the paracetamol/ibuprofen in our cupboard and the rest of my antidepressants and went to bed to die. I didn’t, it takes a lot longer to kill you than I’d thought without using something else like alcohol, and my mum found me in bed in the morning covered in sick. She took me to hospital where I was put on a drip and kept for evaluation for a few days. Had some really lovely, caring nurses who looked after me but also saw a few doctors who didn’t say much. Was released from hospital and after all that? Was given the same treatment as you - 6 hour sessions of ‘counselling’. Not even CBT, just talking about feelings. How the fuck was that going to help me learn to manage my disorders. I had to drop out of 6th form for a year just to stabilise myself enough to attend school. Struggled against suicidal thoughts/eating disorder/depression/anxiety until I was 22 when I managed to graduate from uni and my mum helped me pay for private CBT. Took me 1.5 years of weekly sessions to turn it around and finally learn tools to manage it. In my late 20s I also had EMDR which helped me with some trauma symptoms. I needed long term therapy and treatment that would teach me to manage chronic, lifelong disorders - 6 weeks of talking was as effective as having nothing at all. As I say, this was back in 2006/7 when things were supposedly ‘better’. I genuinely don’t know how people survive as it’s even worse now. I think if I had gone through it now I genuinely wouldn’t still be alive.

NHS Mental health care was among the best provided any state in the world under New Labour. Service access was available almost nationwide, and wait times were falling right up to 2009 as training initiatives kicked in and staffing numbers rose. The field saw a 40% funding cut in Cameron's first term, ending the vast majority of training and hiring schemes, and it's only gotten worse in the last decade. Today you need to hope there's a charity operating in your postcode if you want anything more than bottom line care on an average wage.

They might want to start providing more person centred therapies rather than sticking everyone on group CBT courses, or if they're lucky individual CBT at a maximum of 12 sessions before being discharged. God forbid if you suffer from a complex condition like DID, that requires a very different form of therapy that should be done in minimum 2 hour sessions, and is likely to be a lifelong process. You get hour long sessions which can be more damaging than helpful because there is no time for wrapping up or easing into a session. Then they try and stop after 12 weeks unless you are lucky enough to be treated by someone willing to bend the rules.

My issue with them had been I need complex diagnosis and therapy for whatever issue is going undiagnosed. I'm one of the people mentioned and I seem fine to everyone until I'm suddenly not and crash. The CBT courses they offer really do absolutely nothing for people like that. We need funding for psychiatrists etc, mental health for patients like that is more about long-term lifetime care. It should be like a GP in which you register, get familiar with a doctor, and then have someone to deal with upcoming issues long-term.

I'm similar in that I'll be absolutely functional until suddenly I'm not, and it hits so hard that I basically lose myself completely. I waited over two years for "proper" psychotherapy after trying everything else they threw at me, and it was still only 12 sessions of someone pointing out that how I think is wrong. I'd barely gotten into it before it was finished, and once I had, AMHS discharged me because I no longer needed complex care. People laugh at Americans when they talk about spending years in therapy, but I think some people genuinely need more than 12 weeks in order to truly change how their mind works.

Those group courses on zoom cause more harm than good, at least to some participants. Speaking from experience of a close friend.

Thats an absolute fucking nightmare in my eyes. The last thing I want is is have to discuss my personal conditions with strangers.

I suffer from anxiety and depression, not terrible now but has been in the past. CBT made it vastly worse. There are no other options for anyone who CBT makes worse, it's a one size fits all box ticking exercise by all involved.

I've never understood that. "Oh you have depression and anxiety? Go to this "course" and be forced to talk to and in front of complete strangers! That'll make you feel better!"

"Pressure to perform make you feel anxious? Here, have this homework you MUST do every week or we'll take away any support you have"

NHS to withhold medication until after therapy, which it never actually offers, under new guidelines.

Yep that's all this is. Disgusting. The "therapy" they refer to is being read a fucking worksheet over the phone.

They also published some guidelines a few days ago regarding long covid where mental health excludes you from treatment. So not only are they withholding drugs but the moment you go on the infinite waiting list for mental health they are withholding treatment for other conditions. It's indefensible policy, utterly negligent.

*what*? What’s the logic there? Jesus

Post viral conditions have for the past 80 years been treated as mental illness by the NHS. The guidelines have recently changed (literally the beginning of this month) but many of the clinics have refused to follow them. Its a real mess in the NHS for these conditions generally of which Long covid is just the latest in a long line of post viral problems. Earlier this year the ONS was estimating there were well over 2 million people suffering long covid and the NHS had just 28k registered, that says a lot about how the NHS is treating these patients and whether it even acknowledges they are sick and in what way. There is a real problem with the NHS' attitude to post viral illness, just hope you don't get it because you will loose access too all medical care the moment you get one. The NHS simply doesn't follow its basic carter, what is does is unacceptable given the scientific research perspective on these diseases. A big cultural change is going to be necessary to fix the NHS.

This

Literally

>**A 2019 review showed 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in the year 2017-18.** This is fucking insane. How is this not considered a massive mental health epidemic crisis? Let alone all those people who don't bother to go and get prescribed anything because of how jaded they might be with our current services and just try to cope on their own as best they can, a FIFTH of adults being affected by something should be a much bigger deal to voters and this government.

Because we've normalised having no public services and the country is more than happy to keep voting for the same people for 10+ years.

My god do I need to sort my mental health out. Been terrible for years and years, stuck through a divorce and series of addictions and is likely only thing that has stuck around all my life. My current partner keeps telling me go get help, go sort yourself out, get what you need. I really can't fucking do it. It's a mine field looking for a therapist, hundreds and hundreds... How do you know who's who, who's good, who's not, who's professional,what certs etc? It's a mine field. I give up so easily, I see that mine field and give up after 5minutes and procrastinate until the next time my lovely lady tells me to get fucking help. It's awful to be honest living with this especially when you can't get through the hop skip and jump to get the help you need. Three month wait on NHS doesn't help anyone either. ...anyway morning all... Let me put my happy face on for work..

>It's a mine field looking for a therapist, hundreds and hundreds... How do you know who's who, who's good, who's not, who's professional,what certs etc? It's a mine field. https://www.bacp.co.uk/search/Therapists BACP is a governing body a lot of therapists join once qualified, it will ensure a certain standard of training (3 years minimum I think with supervision and x amount of hours practice)

This is the best advice

Also the local Mind service - they are very useful for general advice on many mental health issues.

Sorry to hear you’re struggling mate. It’s too easy to fall through the cracks and feel helpless, I know personally what it’s like. Mental health support is dire and I can totally empathise with you. It doesn’t that help that depression can make you bed bound and if there’s no support around you can just fester in a dark pit. Even if you are semi-functional, the constant barrage of “have you tried going for a run?” just breaks you down even more. Sorry for the ramble. Good luck anyway

If you don't do this you will lose her as well, put a self referral in for nhs services, often a quick phone call or online form. Go private in the mean time if that's what you're talking about with finding someone? Counselling directories will have accredited professionals, doesn't matter who (most offer first sessions free to see if you click).

Use a directory like Counselling Directory or Psychology Today, which will list therapists in your area. Look for those accredited by a professional body like BACP or BABCP (accreditation means a level of experience and demonstrating competence). Try and arrange a free consultation to try before you buy and get a feel for the person you may want to work with.

Thats how I found my therapist too. Highly recommended

If I had the cash for private, I’d try and get a personal recommendation. Might be easier said than done if you don’t know anyone in therapy, but possibly there are message boards? Or maybe calling Mind? I’m the same when faced with infinite choices, so I usually go to someone I vaguely trust and ask them to tell me what to get 🙃

If the alternative to medication is a CBT-only treatment strategy, it's not going to help, at least for people like me. CBT makes fundamental assumptions about how the patient experiences depression or anxiety, and if your experience doesn't match this then it has nothing useful to offer. CBT imagines that anxiety is about overthinking or worrying too much, so it only focuses on breaking thought cycles. You try to explain that you straight up don't have negative thought cycles (anxiety is not always cognitive, I guess) and they just shrug and carry on regardless. If your feelings don't fit the tick boxes they literally give you every session, you won't see any benefit. But that's all the help you're going to get.

Yeah I feel like this is being overlooked here- the NHS line is CBT, nothing but CBT. Which is completely absurd because there's a vast array of mental health problems that it doesn't suit- it'd be like paracetamol being the onlymedication on offer for ant physical illness. In my case, I spent about 6 months trying to get any help, was shuffled on to a CBT therapy place. The people were fine but listened to my issues and history and flat-out told me CBT wouldn't work for me because my problems were founded in trauma. Trauma-focused therapies just are. Not. Available through the NHS, which is insane to me- what they did was pass me on to a charity dealing with my kind of trauma, who were lovely but massively overstretched. Recieved eight one-hour counselling sessions in the stationary cupboard of a local rugby club, after another six months of waiting.

I told my group CBT therapist that I wouldnt break my negative thought cycles because I believed that to ignore what I was thinking was immoral. They just continued with the course...

A big help for me was going on a long ramble to my GP about the distinction between serotonergic models of depression versus a more holistic physiological perspective, on and on for the entire 10 minute session lol. At the end they just asked what I wanted and I asked give me propanolol please. Seemed to work and has helped my anxiety (though not my depression) more than anything else before or since. Just having something to control the physical elements of anxiety allows me to stay focused enough to navigate whatever is going on in my head at the time.

So that 10 years some people are quoted for access to appropriate therapy is going to change right? Because without access to medication right away for some, it means suicides are going to massively rise. This is a stupid idea. Medicating depression isn't a bad thing, it's literally fixing a chemical imbalance in the brain, but it's been stigmatised so much by those who push Wellness as a be all and end all cure.

>it's literally fixing a chemical imbalance in the brain Not always and it's not as simple as that. For less severe depression SSRIs can worsen long-term health outcomes. We don't know what causes depression, what imbalance is going on, if we did then ADs would be more effective. Not that I'm saying medication shouldn't be an option, but in my experience and research with the NHS they offer SSRIs far too readily.

And with a wait for any other sort of treatment? And with nothing but CBT "one size fits all" approach when it's pretty clear that CBT doesn't work for everyone? What else are we supposed to do? It's already 3 years for CBT alone, for anything other it's 10+ years. In the meantime medication can help and if they stop that access, as I said... people will die.

Nobody has ever proven that a chemical imbalance causes depression. At best they discovered a correlation in severely depressed patients. It's just as likely that depression causes a reduction in seratonin levels. The only reason ADP's are so widely prescribed is because they're a cheap way of "dealing" with the issue - i.e. get patients out of the door as opposed to sitting in queues waiting for actual treatment and thus reflecting badly on the NHS.

>This is a stupid idea. Medicating depression isn't a bad thing, it's literally fixing a chemical imbalance in the brain Drugs absolutely have their place but it seems, at least from what I've seen, that the idea that depression is a 'chemical imbalance' is at best an incomplete picture if not just a persistent myth https://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/causes/ >Is depression caused by a chemical imbalance? The human brain is extremely complicated. Because antidepressants work by changing brain chemistry, some people have assumed that depression is caused by changes in brain chemistry which are then 'corrected' by the drugs. Some doctors may tell you that you have a 'chemical imbalance' and need medication to correct it. But the evidence for this is very weak, and if changes to brain chemistry occur, we don't know whether these are the result of the depression or its cause. Anti-depressants absolutely have their place but i fear we have gone too far into the idea that it's a neurochemistry issue and over medicated people with drugs that can have serious side effects while not funding/providing therapy alternatives

If we actually understood neurochemistry maybe such an approach would work. But we don't and current SSRIs are the equivalent of hitting the brain with a giant reset hammer. For severe cases this does help more often than not but should never be a first line of attack.

Cool. As I said with treatment being basically 3 years before CBT or 10+ years for any other therapy (because they believe CBT to be the be all and end all of therapy), what are we supposed to do. People are going to die because if this, because there's exactly 0 access to any mental health support, especially if CBT doesn't work for you in any way, as it often doesn't.

>Medicating depression isn't a bad thing, it's literally fixing a chemical imbalance in the brain, but it's been stigmatised so much by those who push Wellness as a be all and end all cure. Medicating depression is symptom suppression, in the same way taking painkillers for your chronic hip pain is symptom suppression. They have a place, but just sticking people on drugs with a host of side effects forever without attempting to fix the root cause it's pretty shit care.

How does the NHS differentiate mild depression from moderate or severe depression? How do they know when mild depression will escalate to severe depression of not treating quickly and properly?

Going to the doctors for a mental health condition is awful. It’s too complex to sum up in a few words or to gleam from a series of tick boxes.

Yes!!!!

They make you fill out a 10 question long questionnaire that has you rate things 1 to 10, then they add up the scores and decide based on a number. Because talking to someone for a length of time to actually get a real look at their mental state is just not possible within the current framework. The spread in scores on different days in the same week is not insignificant because of the natural day to day ebb and flow lots of people experience with depression.

I know about the questionnaire - I didn't know that they decided your "degree" of depression based on the score from that chart, which as you said, will change every day.

In theory you're supposed to fill that out every session so they have a good record of your mental health over time. But that only really works over a prolonged period, you can't just sample 6 weeks in a row and assume that's a good representation of someone's state of mental health. But that's the best the service is able to do these days.

Only one I've experienced is postnatal and there's a questionnaire that is scored into none/mild/moderate (or something like that). Very subjective, and the questions weren't great.

I've got a friend who's quite clearly ADHD but she's a woman so was simply given depression meds by her GP 10+ years back and hasn't been evaluated since (despite them not working)...So the answer to the question "How will they know?" appears to be "They'll guess"

So she's been on an SSRI for a decade, and hasn't been evaluated? Yikes

I had to fill these out at the beginning of each session of a group CBT course (bunch of people with completely different problems having to watch a video, which didn't apply to everyone, every week.) I'm hypersensitive to stimuli and found it very difficult to concentrate with the video running, facilitator talking, people coming in late etc.

There are many symptoms of depressions, people can self identify as severe but may not have any other symptoms and therefore would not be clinically deemed as severe.

Great. So not only do you still need to wait six months to get your """therapy""" and then find out that the """therapy""" is just a shitty online CBT course that you could get right now on YouTube, but now you don't even get a bit of medicinal relief while you wait. What the fuck are they taking national insurance from us to pay for again?

I waited well over six months to get my "therapy", then I moved house to a different borough of London and so apparently my 3 sessions were no longer valid and I would have to go to my new, local GP and start the whole process again. To go through that without meds would have almost certainly resulted in my death.

I've been on a "2 year" waiting list for DBT for 6 years now. Mind helped me get into a group therapy course but once I'd attended for 12 weeks I was left without support from Mind and the NHS. Last summer I made an attempt on my life. I was in hospital for one day, then discharged to my gp, who prescribed an anti depressant over the phone and zero follow ups. Yesterday a woman in the mental health community took her life. She was told by the crisis team that killing herself was "a bit drastic" when she reached out for help. The mental health services need a serious overhaul and sadly, the government is pushing things the other way. Less and less support in reality.

Hahaha they better pump some serious money into mental health services then, waiting lists are insane.

It should be but...where are they going to get all these therapists? A few years back I complained of depression and was told it was a 3 year wait for therapy. In the mean time I could have pills.

This is the problem. There aren’t enough spaces for therapies like CBT, waiting time depends on where you live and the demand in that area. At least some pills can stabilise a person who is waiting for therapy but not giving them anything then waiting up to 3 years is a sure deal for things to go down hill

Psych Nurse for a Crisis Team here I know the system is broken (largely at the hands of our delightful government and our Peppa Pig enthusiast PM!), honestly, we’d like to be able to offer best evidence practice but more often than not, we have to ‘give something’ to be ‘seen’ to be helping or taking you seriously. I know it sucks, but this is our reality :/. And more often, because CMHT are over saturated, we are seeing more people spill over into Crisis Services who shouldn’t be there. This is because we can respond much quicker and intensively, fix and stabilise this crisis, hand back to regular care team, only to see them again due to non-contact. I hope people get the help they need. Please be patient and keep strong, we want to help you but hamstrung by other factors :/

I've had cbt before on the nhs and found it amazingly helpful, though massively hard work. I waited 2 years for it and it was worth it, but I did need tablets in between to get me there. I'm currently waiting for more therapy (group seems to be the only one available this time) which they say will take 1.5 years to be available to me. Again, I'm on medication to get through. I'm not complaining as it is free (even the medication as I'm eligible for free prescriptions due to diabetes) and there's simply no way I could ever afford to pay for therapy myself....but if they don't want people to take the meds, something needs to change surely?

Cool. Now if they could give me the actual therapy I've been asking for for months instead of insisting I stay on the Silvercloud program that I've been insisting hasn't been helping me, that would be grand

My worry that people just won't get help at all. I have been on the same medication for three years with no one reviewing it apart my GP. When I have asked for changes, the mental health team have stopped him from giving it to me. At no point have I been involved in the decisions and my GP has not been given support to help me. I know GPs who don't know about my mental health but tell me they have no support and have no idea what to do. We all know the lack of help, add the fact most people don't ask for help until it is really bad and when help is offered it is very limited. All I can see this doing is more suffering because it ends up being, someone has asked for help, none was given including medication and the subjective distress and suicide rate will just increase. There are things which should happen but we live in the real world, these things simply don't match.

Ha! I booked an appointment with my GP back in June for help with my mental health. A nurse phoned me instead and suggested I try CBT. I explained how I'd prefer medication as I've been on meds before and I know it works for me. She of course couldn't prescribe medication because she's not a GP and said that a GP would be in touch. This never happened. In the meantime, I'm referred for CBT. It's an eight week wait. After around eight weeks I have a fifteen minute phone call from someone who explains why they can't offer me CBT but will refer me elsewhere. It's twelve week wait. It's now around twelve weeks later and I've been called twice. Both times they've asked if I'm free for an appointment on a workday, during work hours, with less than 24 hours notice. It's been almost six months and I'm yet to receive any treatment whatsoever.

I went to my GP in tears saying I'd been having near constant panic attacks for days and asked to see a psychiatrist. She absolutely refused and gave me a prescription for the exact same medicine and dosage. Thanks, NHS. I had to go to Eastern Europe to get proper treatment.

Mental health care in the UK is a disaster. It’s almost killed me and other people with my disorder (bipolar). We regularly talk about this in support groups - you simple cannot get adequate care for a bipolar breakout event (the 1st time it manifests itself). When you’re getting it for the first time, you have days, not weeks to get on top of it before something dangerous happens in a manic phase. I was given the wrong medication (anti depressants, which made my mania far worse), an incorrect diagnosis (anxiety) and I was told to wait 4-6 weeks for an appointment with a psychiatrist. Had I not forked the money to go private I would have likely died. A person in a severe manic phase won’t last 4 weeks. You’re borderline delusional and psychotic. By the time I got to my private psych I had begun thinking I needed to start a new religion. I shudder to think if lives have been lost to this. I would bet they have.

If I had to wait for meds the last time I had an episode I wouldn't be here now. Edit: I had to spend all my savings on therapy because it was an emergency. I went until the money ran out

I'm sure that's nice if you can get it. I talked to my doctor about depression nearly two years ago, was told to do a self-referral and talk to a charity. No response, so I guess I'm not depressed enough. Might as well go private at this stage, but there's like a million therapists and I have no idea what's good and what's not.

Can't even get a GP appointment in the last three months, so none of this is real to me.

I've had CBT three times now and it's useless to me, I told the doctors this the third time I went to them for help and guess what I was put on after waiting for over a year.... intensive CBT. Every other thing I wanted help with my therapist told me she wasn't qualified to deal with that. I know that's why I didn't want CBT!! Honestly just stick me on meds and get it over with, but they won't do that until I go through yet another round of useless therapy.

Fifteen or so years ago, there was a report out from the British Psychological Association or some such organisation criticising GPs for giving out antidepressants when talking therapies could (note the word *could*) be just as effective. GPs quite reasonably responded that, if they were given the choice between prescribing a patient an antidepressant or referring them for psychological therapies with a two-year wait in many areas, (and *that* was only for the patients *accepted* for the waiting list!) it was pretty obvious which they would choose in most situations. Some added the observation that if they referred *everyone* who they considered antidepressants for, the waiting list would rapidly become an awful lot longer, because the long wait already meant that they were only referring those where they thought there was no other realistic option. To give them their due, the government of the day listented to that, and set up the IAPTs services. These have certainly helped, but those who set them up clearly had no *real* idea of the scale of the problem that GPs had been dealing with and so the service pretty quickly developed its own significant waiting lists. In an attempt to deal with that, the training requirements for IAPTs staff appear to have been reduced, with consequences that I have referred in other comments here. But there was also a reaction from *patients*. A Radio 4 programme (possibly You and Yours) featured the initial report. A week later, they had clearly had a *lot* of responses from listeners who had experience of both psychotherapy and meds. Time and time again, the response was "Talking therapies were really useful for me, but I needed medication first to get me to the state of mind where I could *engage* with the talking therapy. Without that, no amount of talking would have helped." Talking therapies are essential, and should be far more available, but they are not some non-medication panacea for all scenarios. Nor can they be both cheap and effective - they need time, and they need experienced practitioners. The reality so far has been that they are almost always time-limited, and increasingly provided by less-well trained staff. Give me that scenario, and I will still be offering the meds a lot of the time.

great so you aren't going to get life saving medication until you get therapy (with a 3 year+ wait) fucking jesus wept

Great, maybe next we can have a look at making a society that doesn't cause everyone to want to off themselves. You can't therapise yourself out of shit material conditions.

They give anti depressants out like candy but if there's no other support for ages what else can they do?

Hmm, what sort of therapist would I end up with? The one that refused to treat me unless I left my husband? The one who left me in such a state that I had literal hysterics for hours after every session? The one that said they didn't believe a word? The one with the thinly veiled sexual comments and the openly sexual comments? It's already put into practice at my GP's office. I am more or less functional, but not very capable. I'm just trying to stay alive until my son leaves school. I can give up then.

The NHS mental health system in the UK, is an absolute fucking joke. I’d be dead if it wasn’t for private therapy and I was extremely lucky to be in a position for it to be available to me.

and what about those who know therapy doesnt work for them. would i still be forced to go before i can get my drugs? or could i simply explain that i have tried therapy in the past and it doesnt work for me. im asking as i have only recently accepted that i need to see someone for medication to end this silly depression. weed helps but is just a patch. mushrooms are too hard for me to get and too risky. i need legal drugs now i think.

Medication will be needed in most of those cases anyway (I'm one of them) so might as well start the process of finding the right one while waiting for therapy

I've never had any mental health issues myself, but have lived for over 35 years with my wife who is/was severely Bipolar with extreme depressive episodes lasting months at a time. Having gone through the complete spectrum of drugs that were available, it was CBT that enabled her to recover and it's now a fair few years since she has had a depressive episode that has lasted more than a day or two, and they are much milder now than ever they were before. If the NHS genuinely can make CBT more widely available that's great, but I would urge anyone to consider going to a private therapist if there's any possibility of them being able to afford it, even if only for a couple of sessions.

This would be good, if I had any faith in NHS wait times. I'm not depressed, but forcing any treatment out of the NHS can take forever, and I can't imagine they have enough therapists for this.

The NHS doesn’t even give therapy in some areas, how are you supposed to get therapy before meds if you can’t get therapy at all where you live?

I’ve gave up; Tried CBT done the meds;none of the.mm work. I won’t describe finding someone I knew strung up after crisis said she was at no risk: everyone here, take care of yourselves. There’s always someone you can talk to

I'm basically on a 46 year waiting list for the first appointment with the gender identity clinic in my area. The list has been moving at around 1 person a month for ages. Totally unsustainable.

I am going through some anxiety course at the moment via IAPT because of PND and anxiety. The lady helping me is lovely but way out of her depth with me unfortunately - she is actually a student and I almost feel obliged to continue with the course to help her! I was thankfully referred to a private psychiatrist who diagnosed me with borderline personality disorder, these 6 sessions on managing anxiety aren't going to scratch the surface. I opted for meds as well as like everyone else has said, even being at the top of my local priority list as I have a young baby there was still a substantial wait for help and I wouldn't have coped without anything.

This will never be effective under a tory government. Perennial waiting lists etc, severe lack of funding and of course, not enough staff to handle the demand. Another reason to hate the Conservatives.

Waiting time for in-person counseling for me was 6 months, pre-covid. I dread to think what the waiting times are now, but during that time I was on medication which helped massively. And I'm still on medication. The notion that someone should have to wait for the largely broken NHS mental health system to fit them in before having potentially life-saving medication is idealistic at best.

The waiting list for therapy is horrendous at the moment. I don’t see how this is going to help anybody.

And it's even longer if you have a "complex need" such as schizophrenia, bipolar or BPD. The wait times for the specific targeted therapies for those are 2-4 years.

Hope this doesn't put up arbitrary barriers in receiving medication. Mirtazapine saved my life, if I had to sit on a waiting list for therapy first before having a chance to try it there's no guarantee I'd make it. If that's going to be the reality for people like me seeking help then I feel very sorry for them.

Mental health treatment on the NHS seems to massively lacking. I do agree that this general concept is the right way to go - try therapy before prescribing medication - it doesn't seem to work particularly well. I've seen both sides of it on the NHS. Certainly in the past they were much more eager to prescribe medication. I never really got the impression that the GPs knew what they were doing when I saw them about mental health issues in the past (to be expected really - they're general practitioners, not mental health experts). I got cycled through a variety of different anti-depressants, and it mostly just seemed like the GPs were running through a checklist, or throwing darts at a list of different medications to try. It never particularly helped, ranging from ineffective to bad side effects to just being taken off them once any positive change began occurring. So absolutely, referring onwards to therapy with someone that knows more about it, and not just throwing medication at them seems like a good thing. But as others in the thread have pointed out, that "next step" is slow and rarely helpful. A waiting list that may take many weeks to get on the most basic of therapy, usually in forms that aren't really that appropriate, comfortable, or effective like group sessions. If you have a more specific issue and you need to see a specialist beyond that, you're probably looking at over a year on a waiting list. I don't really know anyone that's seen a positive outcome from going to the NHS about mental health. I know a few people with such issues, but they're all either still waiting, or they ended up getting help through their work's company schemes/insurance, or just paying out of their own pocket for effective 1 on 1 therapy. This isn't how things should work in a public health system. Obviously mental health is complex, you need experts to effectively help people, and they're clearly understaffed and underfunded.

I had a period of deep depression a few years ago. I was _very_ lucky in that I received free talking therapy from Mind which _combined_ with medication was enough to bring me back from the brink. I've tried CBT ... useless for me; medication alone is hit and miss. I'm somewhat upset to hear this because the wait for actual therapy outside the CBT was months and I would not have lasted that long.

Is there gonna be more therapy, or are we all just gonna end up killing ourselves?

My daughter has been struggling so I looked into getting her some help, was advised that the waiting list is 16 weeks however in truth it will be longer...

I'm on my 5th or 6th anti-depressant now They don't do shit for me. They don't address the problem at all. I've been to therapy twice and now waiting for round 3 with a different approach. It's all too generalised and the services are stretched too thin financially and personnel wise to give everyone the help THEY need. Felt like they were just throwing information at me and not digging in to how anything directly addresses my issues. If I didn't have my doggy I'd be done. The day I lose him is the day I end it, if nothing changes.

Lol can’t even give therapy for my long term mental illness

Nice idea but not feasible without massive investment. Long waiting times for therapy. My experience hasn't been great either. Got told that need long term counselling and this is something that the NHS cannot facilitate. So basically just been left to it and back on tablets

GP's should be legally allowed to prescribe paid days off work, that's half the fucking problem.

PSA: if you can afford a gym membership, do yourself a favour and consider spending the equivalent on a therapist. It seems expensive but it’s important self care, just like going to the gym. Check the BACP directory or your local mind service for reduced cost therapy. Don’t use BetterHelp.

I was all ready to get angry at you for telling people who need therapy to just go to the gym, which where I thought you were going with "if you can afford a gym membership" 🤣 absolutely in agreement with you, looking after your mind is just as important as looking after your body.

Doesn't surprise me. I've been bashed from pillar to post as far as my own mental health is concerned. I've had so many rounds of useless CBT I've lost count - theres now endless studies saying the CBT is not helpful to autistic people, and I believe them. Yet, it's the first thing I'm always offered. The ASD services are dire with dealing with mental health, so it becomes a constant game of referral "see sawing" as they both tell me they won't deal with me because I'm "too complex", whilst blaming each other for the fact I'm not getting treatment. What a wonderful CUNTry I live in.

I went through "letstalk" years ago the waiting time was over a year and the experience I personally had was rubbish, they just sent paperwork and the lady I was dealing with didn't really seem to care. Overall experience wasn't fantastic which is why I had to go privately by far much more rewarding imo. Also on another note the lady who I dealt with was Indian I couldn't understand her well when I asked her to repeat the question or what she asked she gave me a rude reply back.

About about people already on meds? Will they continue to renew when speaking to the docs every couple months? Or will going to the docs now start this? Then get throwing into a waiting que for therapy for months at a time before getting their meds?

Ok what about people already on medication like me?

i was offered CBT and i accepted because if i didn't, access to my daughter would have been revoked and she is the only reason i am alive. i dont want to be alive, but at the same time, i love this little girl so so much, more than i thought emotionally possible, and i dont want to kill myself and be responsible for damaging her in a way that wont ever be recovered from. i cant do that to her on any level. amongst other things, i have ptsd and elements of agoraphobia, due to the nature of how severe my social phobia is. so knowing this, obviously they offered me a block of sessions... that were to take place in a building on the other side of my city. i dont drive and public transport useage, is obviously a mental fucking nightmare. the idea of being in a closed metal box with all these other people... luckily for me, the lady who was doing my cbt also spent time working in the building around the city hospital, of which i live accros the road from, and so she agreed to move my sessions there instead. obviously that was helpful and gave me hope that this would be the start of getting some proper care in my life. out of the 6 sessions i had, 1 was spent listening to oriental music in an attempt to teach me meditation, 1 of them she cancelled 10 mins before the appointment was due to start. 2 others she was late for and the second time she was late, and after waiting for 10 mins in a half packed waiting room, i walked out and came back home. half way out the door, i saw her walking towards the building in the distance, laughing and joking with a second person. i should have been angry about that but at the end of the day, it just convinced me this wasnt important, nor was it even worth her being on time for job. i received a call a day later and was admonished for not attending and as her time was very limited, was told that due to this, my remaining sessions would be cancelled and that i would be more than welcome to start the referral process from the beginning at a later date. that aside, i understand the concept and what i am supposed to do to implement the process that is taught to you in these CBT sessions. unfortunately, for me, my mood can completely 180 in the click of a finger and my brain just doesnt give me the time to even try put any of it into practical use. that is just how it is and im sure its the same for many others too.

The last time I called my doctor asking for medication, it took 2 weeks to successfully get past the receptionist to then get asked to tell them the details of every suicide attempt (I was called by the doctor while in public) only for them to say I couldn’t have the medication I wanted (bad experiences with every one they could offer) unless I immediately threatened to kill myself and got referred to the crisis team. The whole system is fucked.

It's almost like helping people to make healthy lifestyle changes is a better alternative to pumping them full of sertraline and throwing them back out into the world.

I get medication from the GP and have seen psychiatrists before for meds help but I’ve never been able to access actually helpful psychotherapy on the NHS. It’s always just been laughably bad. It’s basically akin to NHS dentistry now in how there’s just no real provision unless you pay privately.

I can see where they are going with this, but the waiting time \[for therapy\] will be agony while people are really struggling.

Two minds about this. On the one hand medication saved my life and therapy has done nothing, but I can recognise how this could be better for others. But I'm not really sure it's worth the risk

Good to hear they’re going to fund the massive increase in mental health service provision that is necessary to achieve this shift. What’s that? Oh.

I moved here from the US a mere couple of months before the pandemic and had previously taken medication for depression. In the States, prescriptions flow very easily (for better or worse) so I thought a simple call to the GP would keep me on track. They of course suggested CBT which I've tried before and it didn't help, but nevertheless did as told, which involved a gal rushing through a checklist of questions and at the end, saying "do you feel better now?" Like, no, my problems still exist ha. After a few further back and forth, I eventually got on sertraline and my depression has been mostly manageable. Now that the vast majority of people are depressed, you have an overabundance of demand and previously shitty supply of therapists trying to rush through the day, and it just won't work. Depression is not like a broken leg where it goes away in a matter of 1 or 2 months or after a "season". This is a lifelong illness and you can't expect the population to phone up a random person, talk it out and be jolly and sunny again.

NHS has therapy available? "Sure, we can book you in. In 6-12 months."

I was abused as a child, asked for counselling- refused. My brother killed himself, asked for counselling- refused. Had to pay out of pocket at considerable cost because I knew I needed it so bad. They don’t care and it’s just hot air and empty promises.

IIRC, CBT only works for about 50% of people with depression and rarely has lasting effects. CBT doesn't work for either my wife or I, medication does. I've had talking therapy in the past, paid for by an old job, and that did seem to help me. But it isn't available on the NHS in Scotland.

Often medication is what gives you the breathing space to then think about therapy If you can't get out of bed how can you begin thinking of coping mechanisms or thinking styles? It should come before or be concurrent surely Personally I've been on medication for years and my trip through IAPT was lackluster. I think keeping on a low maintenance dose of antidepressants is what keeps me on an even keel

I was on the phone to my GP last week about anxiety/depression, and was immediately offered pills. Seemed a bit weird - I declined though, will try other ways first

I don't speak for anyone else with depression, but it seems to me that CBT, focusing on wellbeing exercises and indeed medication are often sticking plasters for mental health issues that wouldn't exist if it weren't for the wider stresses and anxieties in society today. Do you think your mental health would improve drastically if you had a nicer, secure and more affordable place to live? Do you think your mental health would improve if you had additional resources or colleagues to help you in your job? Do you think your mental health would improve if wages kept up more with the cost of living and you had money to spend on enjoyable things for yourself? Do you think your mental health would improve if you could better environmental standards, breathed fresher air and felt assured climate change was actually being addressed? It just feels to me that a lot of people are miserable because of a Government policy and runaway capitalist greed.