Not Falling Over: Post 6: Asking the NHS for Help

A series following a professional woman’s experience of reoccurring suicidal thoughts and what she does about them.

TW: Suicide, Suicidal Ideation

I feel a bit conflicted writing about my experience of asking the NHS for help with suicidal ideation. The NHS is amazing. Care is free at the point of access and the staff work incredibly hard for not enough money. If you’re ill or injured you don’t have to think about whether you can afford to seek help, you just contact your GP (General Practitioner) or rock up to A&E and they’ll sort you out…eventually.

There have always been waiting lists for operations, long waiting times in Accident and Emergency departments and it’s not always easy to get a GP appointment, but since the pandemic and Brexit that seems to have exacerbated quite a bit. I’m not interested in talking politics because this is a blog about mental health but in case you didn’t know, the NHS is struggling. It has low budgets and not enough staff and is really, really stretched right across the country, both financially and with staffing levels.

When I went to see a GP the other week to talk about suicidal ideation and whether HRT would help (see previous post) she also referred me to my local Access and Crisis team. I’d never heard of this service before despite having had a couple of previous appointments with different doctors over the years to talk about my dark thoughts, but the Crisis and Access Team are the single point of contact for mental health services in my area. Following a triage appointment, they’ll referral you on to the relevant area of the NHS and provide short term follow up care.

I was given an early morning phone appointment which I’d allocated enough time for, but it came 17 minutes late and the person I spoke to got cut off once and then had computer issues. Once we finally got started, the phoneline repeatedly broke up so I couldn’t hear all that was said but we got through most things until I had to end the call because it ran over into a zoom meeting I was due to have with my boss. Before I left the call, we talked about how I was feeling, how I was currently managing my ideation and how the NHS could help and what they could offer me.

It turns out, nothing.

A few days ago, I received a letter from the person who had conducted my appointment which outlined my personal management plan — and it listed three things:

Referral to NHS Talking Therapies for CBT.

The number of a 24 hour helpline.

That I was aware I can go to A&E if I’m at risk.

There was then a slightly random list of resources which included the names of 8 apps (with no details of what they did or what they were for), 4 telephone numbers for third party helplines including the Samaritans, and a list of general websites for information and groups which I may find useful. One link was for the NHS advice on sleep and below that was a link to a local group with no other information given, but from its URL it was quite clearly a group for men.

It was absolutely fine (actually ‘fine’ is never a good word in my vocabulary) but it read like a cut and paste job and not specifically written for me or my needs. It felt like a box ticking exercise and to compound that further, the end of the letter informed me that “as agreed” I had been discharged from the Crisis and Access Team (did we agree that?) and that the person writing the letter would like to take the opportunity to wish me all the best for the future. That’s the kind of thing you write in the leaving card of the colleague you’re not mates with when they get a new job. I’d have preferred it if they had ended the letter with Yours Sincerely or maybe even Don’t die!

All the best Emma. Wow.

But at least I had the CBT stuff to look forward to, and despite having reservations about it because of my autism I was keen to give it a try. I had told the Crisis Team person that I didn’t do CBT with the counsellor I pay to see once a month and when I suggested that having a counsellor already might mean I couldn’t access NHS Talking Therapies he assured me I could do both and that the CBT could help me with the other stuff I’m doing.

So it was a bit of a surprise when I got a letter from my local NHS Talking Therapies department to tell me that my referral does not meet their criteria. When I read the letter my first thought was that surely thinking about killing yourself would be fairly well up there on the list of reasons you’d need mental health support, but the explanation given was that I am “currently receiving private counselling and it is not possible to have two therapy services concurrently.” It went on to say that “However, once Emma has concluded her current therapy, she can always self refer to NHS Talking Therapies in the future.”

What confuses me slightly, is that whilst I do use my monthly check-ins as part of my ideation management, I don’t spend much of my private counselling sessions talking about those feelings. That’s why I went to my GP to try to find a solution, and that’s why my GP referred me to NHS mental health services.

I started receiving counselling years ago to address a serious sexual assault I had experienced but more lately my counsellor has been helping me with the diagnosis for autism I received two years ago. She has some experience with neurodivergence so is a good person to talk to about it and we’ve been navigating my new diagnosis together where she’s been helping me explore all kinds of things from sensory issues to potential adjustments that may make life easier for me. I did tell the person from the Access and Crisis Team this but it would seem you can’t seek help for autism and suicidal ideation at the same time. Who knew.

It’s a curious state of affairs. Not being able to have two therapies concurrently makes sense if mental health services are stretched to breaking point and their main goal is to limit what they provide but that’s really the only reason I can think of. The two therapies wouldn’t have caused a clash in treatment efficacy or been a conflict of interest and I wasn’t asking for two NHS therapies as I pay for one myself. And me paying for some counselling isn’t because I’m Mrs Moneybags — I go without other stuff to make sure I can pay for those sessions — and I pay for them because I need the help. The only way I can apply for NHS help — which could come with a very, very long waiting list — is for me to stop accessing the regular help and support I currently rely on. That feels a bit reckless.

I assume the same approach isn’t taken across the whole of the health service. If someone needs physiotherapy and podiatry I’m guessing they can have both, but maybe not, who knows? I do have a colleague who told me that her GP will only let you mention one thing when you come for an appointment (after I told her I went in one time with a bit of a list after not being able to secure an appointment for months) so maybe that’s the only way the NHS can function now. You can only choose one thing to be treated for and if you already pay for a treatment in the same ballpark then that rules you out altogether.

I told a friend about this. I wasn’t upset, I was just slightly incredulous. My friend had encouraged me to seek help beyond my counsellor so I showed him the letter outlining the outcome of my endeavours. I told him that whilst I recognise how resilient I am and how well I am managing all this, there are people out there who aren’t like that and how on earth do they cope if the NHS says no?

As an autistic woman I can mask really well and I’m also super organised but I’m also around 8 times more at risk from suicide because of my neurodivergence. My local mental health team knows that. They also know I have no family anywhere near me apart from my teenage daughter. But I don’t fit their criteria and so not only am I managing my autism diagnosis (which was privately paid for incidentally) with no NHS aftercare or support (and I have asked for it) but now I’m managing suicidal ideation on my own too. My friend said I could truthfully say I am receiving no NHS mental health support and he’s not wrong.

This sounds pretty bleak but wherever you are in the world don’t avoid asking for help from medical professionals. I still strongly recommend talking to someone who’s medically qualified or trained in listening, even if your outcome might end up like mine. So please seek help, reach out, advocate for yourself or find someone else who can fight your corner with you. Talk to trusted friends and try to get professional help too but also know that your journey might not be easy at times, so have a plan in your pocket about how to keep going if the help you need isn’t as available as it should be.

Helpful resources:

Samaritans (UK) https://www.samaritans.org/ 116 123

988 Lifeline (USA) https://988lifeline.org/ 988

International Suicide Hotlines https://blog.opencounseling.com/suicide-hotlines/