In, out, shake it all about – what now for us, our patients and CBT in this post Brexit world?
A week is a long time in politics or at least it was in Harold Wilson’s time. Fast forward to summer 2016 and it seems that with every passing hour the tectonic plates of our political geology undergo a shift. I’d be pretty confident that at least one person is now writing a thesis on the psychological effects of the recent EU referendum result but whilst you’re waiting there is no shortage of articles written since the Brexit vote about the emotional tumult experienced by remainers struggling to come to terms with living in a divided country .
We are told that in places like Camden, North London where 75.2 % of voters backed remain the response follows a grief trajectory that needs to be worked through. “What’s important is that you have your feelings. You have to do the denial, the raging, and the depression. If you let it unfold, and grieve, you’ll get something solid out of it eventually,” says Lucy Clyde a counsellor and psychotherapist.
Predictably voting revealed a clear generational and geographical split which in some instances (mine) has divided families and placed relationships under strain. Almost all of the patients I’ve seen in the aftermath have wanted to talk about the referendum in session although interestingly only those patients that voted to remain. I have found comfort in being able to share their pain and I hope that they felt similarly. To be honest I’m not sure how I would cope with a patient arriving for a session with a bottle of bubbly and champagne flutes intent on celebrating the result. For me it is definitely too soon.
It has been distressing to hear some patients describe their experiences of being on the losing side. The teacher from Germany for example who having established a family and successful career in the UK now finds that he has lost the automatic right to work here and is issued with an invite by unthinking colleagues to a Brexit party or a young student whose OCD is triggered by a fear that the Bill of Human Rights will be scrapped.
The faint hopes of staging a second referendum have faded and we now have to deal with the reality of a devisive decision that appeared to have no coherent Plan B. What we do know is that the damaging effects of austerity on mental health are likely to be exacerbated by recent political events. GP, Zara Aziz recently described her work in a diverse urban practice in Bristol whose list includes many different ethnicities including those from EU and non EU countries. She described how GP consultations for depression have risen since the financial crisis and that she has seen an increase of patients presenting with worsening anxiety and depression following the Brexit vote. This increased need is not supported by access to mental health services and she details the now familiar story of long waits for CBT and more shockingly no dedicated CPN attached to GP practices as routine.
There was a time when the presence of a CPN in primary care was standard practice. At the risk of sounding like a fossil I am reminded of another life working as a CPN at The Maudsley Hospital. This post included an attachment to a local GP practice providing mental health assessments, treatment and access to secondary care services . This was over 25 years ago mind, when CPN’s worked alongside psychiatric social workers sometimes sharing the same office space providing an invaluable link between primary and secondary care services . It was a hugely rewarding role and highly valued and respected by other disciplines. Sadly, according to Aziz her practice has only just been allocated a CPN as part of a 12 month pilot and whether funding will be secured in the long term remains to be seen.
How depressing that an innovation that was launched decades ago still needs to be piloted. This idea has been tried and tested for pity’s sake, it flew. Unfortunately with nursing recruitment in crisis, vacancy levels averaging 10 per cent and a shortfall of 25,000 posts coupled with the Government’s decision to scrap educational bursaries for student nurses the situation is only going to get worse. It is argued that the impact of these changes is likely to be felt more acutely in the mental health sector where recruits tend to be older and will struggle to afford the fees and student loan debts.
According to Howard Catton, of the Royal College of Nursing, “This is a massive roll of the dice. Health is a people service and if you are committed to improving the service you have to have the trained people in place and the numbers speak for themselves. There have been laudable statements about parity of esteem for mental health and the idea to move some services away from hospitals to the community or close to home is to be supported. But we don’t see this happening. We are closing the acute beds but don’t see the services or people being put in place in the community which ultimately leads to people needing emergency hospital admissions or detentions under the Mental Health Act.”
All this presents our newly appointed Prime Minister a gargantuan task in pursuing the parity of esteem pledges made by the previous encumbent. There is understandable anxiety about how committed politicians remain to this ideal and on the day Theresa May took office the campaigning pressure group 38 Degrees invited people to sign an open letter asking the PM how she intends to protect the NHS.
As heartening as it was to hear May in her inaugural speech acknowledge that :”If you suffer from mental health problems, there’s not enough help to hand”, her pledge to deal with the injustices of poverty, inequality and discrimination are not particularly supported by her voting record, a sample of which include:
Generally voted for reducing housing benefit for social tenants deemed to have excess bedrooms (which Labour describe as the “bedroom tax”)
Consistently voted against raising welfare benefits at least in line with prices
Generally voted against paying higher benefits over longer periods for those unable to work due to illness or disability
Generally voted for making local councils responsible for helping those in financial need afford their council tax and reducing the amount spent on such support
Generally voted for a reduction in spending on welfare benefits
Generally voted against spending public money to create guaranteed jobs for young people who have spent a long time unemployed
And with regard to social issues generally voted against laws to promote equality and human rights, add to this the a barely audibly announced inquiry into moving to a ‘pay NHS’ and it’s difficult to maintain a sense of optimism.
Whether those in power are genuine when they talk about reaching out to the most disadvantaged in society remains to be seen but we do not have to rely solely on their goodwill . We can accept that there is a lot of work to do in the world and to find a away however small to take affirmative action. The challenges I have set myself in these turbulent , uncertain times is to ensure that I keep doing the little things that promote my own well- being and to take some action through political protest and volunteering. These positive actions are supported by author and journalist Oliver Burkeman who reassures that staying happy whilst the sky is falling in is not impossible. He quotes Derrick Jensen, a writer and co-founder of the radical environmental movement Deep Green Resistance “There’s this idea that if you know how bad things are, you have to go around feeling miserable all the time , but I’m not miserable; I’m quite a happy person.” Jensen goes on to acknowledge the importance of action despite feeling unhappy with a situation and echoes the many conversations I have had with myself, colleagues and patients when he responds to why if the world is in so much trouble he is committed to living.
“The answer is that life is really, really good. I am a complex enough being that I can hold in my heart the understanding that we are really, really fucked, and at the same time that life is really, really good. I am full of rage, sorrow, joy, love, hate, despair, happiness, dissatisfaction, and a thousand other feelings. We are really fucked. Life is still really good.”