
In the eating disorder unit - fern12
https://www.lrb.co.uk/blog/2018/01/09/hannah-brown/in-the-eating-disorder-unit/
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amyboyd
> "Some of the help and therapy I eventually received was excellent, but as
> much as my recovery was supported by the NHS, it was also fuelled by my
> determination never to have to rely on it again."

When I read this line, it hit home. I've been in and out of NHS treatment for
years for other (not anorexia) issues. I never ever want to rely on the NHS
again. They failed me so much I now avoid having to interact with anyone in
the medical field. I deliberately avoid going to my GP for anything. Mental
health care in the UK is so bad that you really wouldn't believe without
first-hand experience. It needs to be scrapped and started again. I don't want
to rant here on Hacker News too much (almost never comment) but this hit a
nerve and I'm angry just thinking about the mental health care the NHS
pretends to provide.

~~~
toomanybeersies
People love comparing countries for their non-mental healthcare (physiological
care?), but I never seem to hear about countries that actually have good,
functioning mental healthcare systems.

New Zealand has what could be described as a well-functioning (most of the
time) healthcare system, if you break your arm, it's not a worry at all. But
the mental healthcare system is a complete shitshow.

It's an absolute disgrace, especially considering that NZ has the highest
youth suicide rate in the world.

~~~
klank
Perhaps it has more to do with us (i.e. humans) not having a deep
understanding of mental health treatment? I mean, we really don't understand
the mind very well at all.

It's not just a clinical understanding either. We culturally approach mental
health differently than other health. Get cancer and everybody rushes to your
aid. Have anorexia and people ask questions about why we should pay for "self-
inflicted" injuries (devil's advocacy couched, but still the question is
posed).

Thankfully the cultural stance is changing. It wasn't long ago that the
question about "self-inflicted" injuries wouldn't have even had to be couched
in devil's advocacy.

~~~
lickedydiff
I'm a clinical psychologist in the US, and it is a complete total shitshow, a
combination of stigma and bigotry from outside the system, and self-inflicted
nonsense from within.

People misunderstand and have trouble thinking of mental health to begin with,
so you end up with general attitudes of "people just have to pull themselves
up by their bootstraps" or "just get over it," not understanding that the
problem is often that people lack that ability. Other times it's just sheer
lack of empathy for people who have had to deal with more difficult
circumstances (or even just different circumstances). And then there's the
recurring idea that behavioral sciences should just be like all the other
sciences, or that it's not worth paying attention to because we don't have it
all figured out like basic Newtonian physics.

On the other side, within the field it's a mess too. There should be many more
professional models, for example, and a lot more to offer, but territorial
battles screw it over for everyone. Psychologists, for example, shoot
themselves in the foot with bullshit licensing requirements for reasons I
don't understand (maybe to appear more rigorous? to keep competition from
entering the field?), requirements that are even more stringent than for MDs
in certain ways. There's also no reason psychologists shouldn't be able to
learn to prescribe--many people enter clinical doctoral programs with as much
natural sciences as premeds, and leave having all sorts of neuro-genetic-
chemical-physiology coursework and research experience, often more than MDs in
the area of neurobehavioral sciences per se. But psychiatrists bristle at the
competition, and certain segments of psychologists want to control the field
with their romanticized idea of what psychology "should be," again, for
reasons I don't understand.

On top of that, there's various trends in treatment that have led to screwing
clients over, to put it bluntly. I can't tell you the number of times I hear
colleagues (not all, but a sold number) argue that treatment should be limited
for its own sake, to prevent dependency or to encourage change. Sometimes
that's true, but you wouldn't say that a cancer patient in need of treatment
should have their treatment stopped just to teach them a lesson. And drugs are
great for some people, but not for others, and in general, the administration
of those drugs has become divorced from any kind of real monitoring of
peoples' situations. Add to that the fact that many people's problems derive
from the collapse of societal safety nets, which also means lack of funding
for mental health services, and, well, you get the point.

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adwf
To play a bit of devil's advocate here:

At what point does a socialised health service with limited resources, stop
providing care for "self-inflicted" injuries?

In a busy hospital, the doctors have to triage and make priority decisions
over where to apply resources and who to treat first.

Much like an alcoholic would never be at the top of a liver transplant list,
at what point would an anorexic - who in this case had already been through
over 30 mental health sessions - start to be denied care? At what point is it
more ethical to spend those resources treating someone else, who might
actually respond to treatment?

Again, just playing devil's advocate here. My personal opinion is that the NHS
is critically underfunded at the moment and that should be fixed first. But I
thought it worth pointing out the ethical debate over treating self-inflicted
injuries in a socialised healthcare system is quite tricky. Especially
considering that almost all mental health issues can fall under "self-
inflicted" if you want to be callous.

~~~
Klathmon
I think the analogy is a bit flawed.

The whole reason they are there is the mental health issue, so denying them
because it's not fixed is more like denying a person with cancer any more
treatments because they haven't responded well to the first 30 treatments.

A mental health problem is no more "self inflicted" than cancer is.

It doesn't really change your ultimate question though.

~~~
adwf
Yeah, I think that the mental health part confounds the issue. When it's a
chronic physical illness, it's a lot easier to give someone pills to take for
the rest of their life. Whereas mental health is vaguer and potentially much
more expensive.

There are plenty of cancer drugs that the NHS will refuse to prescribe due to
their expense. If you want them, you'll be told to go private. If mental
health is so expensive, do we say the same thing?

~~~
QAPereo
It’s worth looking at patterns of homelessness and mass violence in the US
before you take the leap. Mental illness can’t really be ignored, and
untreated mental illness is dangerous for the sufferer, and the commmunity.

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pjc50
It's desperately under-funded:

"The hospital itself was old and seemed to be in the process of being shut
down around us. Half the wards were empty, including the one opposite – a
strange sight to those of us who had nearly died waiting for a bed. In winter,
when it was too cold to be taken to ‘the bench’, we would instead be taken
down another, deserted corridor, to sit for 15 minutes in a disused waiting
room. When the five-bed rehabilitation house for patients leaving the
inpatient unit was threatened with closure, doctors started to send patients
there at a lower weight than advised, to secure its funding. Funding
applications had to be made for each patient every two weeks, and I remember
at least one patient being discharged suddenly and prematurely, because she
had reached a weight beyond which her Primary Care Trust wouldn’t pay for
treatment. Others, including me, had to prove that we weren’t ‘chronic’ cases
and therefore worth funding. "

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d33
> (...) the overstretched staff didn’t have much time to support me, and I was
> often left crying on my own. Sometimes my tears were taken as evidence of
> ‘non-compliance’.

This, on its own, is already outrageous. What could lead to forming this kind
of attitude?

~~~
DanBC
Eating disorder is often comorbid with what's called "personality disorder"
(usually what's called borderline PD).

People with that label experience significant levels of stigma and
discrimination from health workers, including mental health workers.

~~~
yipopov
That said, it should not be underestimated what an immense strain those people
are on mental health workers. I wonder how much time those institutions
dedicate to debriefing their own staff, I think that would make a big
difference in how the patients are treated as well.

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jostmey
Quote: "The advice was not encouraging."

What would be encouraging to hear?

~~~
zelos
"There's another 30 hours of counseling and therapy available"

(which at ~£50/hr is presumably a lot cheaper than a stay in ICU)

~~~
frabcus
This is what drives me mad.

Professional therapy that actually works and can help patients solve the
underlying self-esteem issues from childhood isn't easily available to people
suffering from anorexia.

More generally, I would argue that if we increased tax and gave everyone as
much therapy as they need, the money would be saved by reducing sick days for
businesses, reducing other healthcare costs, and increasing productivity of
mental well people.

I think we should do it even if it wouldn't save that money, but intuitively
it feels like it would, so it makes not doing it even crazier...

Does any country already do this? It would seem a humane and powerful way to
beat other countries / lead the world (pick whatever motivates you).

