One hour before deadline for this column, I had a panic attack.
Panic attacks aren’t sudden bouts of fright, as the name might suggest, but episodes of acute, debilitating anxiety.
Your heart palpitates, you struggle to breathe, and you break out in a cold sweat. You feel dizzy, nauseous and your hands and arms are gripped by a numb tingling. First-time sufferers usually believe they are having a heart attack.
In half an hour or so everything will be fine but for those 30 minutes your brain is telling your body that you are dying. It is a frightening experience and one that seizes you without warning. I’ve had panic attacks in the middle of the night, in the dentist’s waiting room, walking along the shore at Cramond, in the queue in M&S, and even in the Press gallery of the Scottish Parliament.
In some sufferers, there are obvious stressors that set off an attack; in others, it seems to happen for no rhyme or reason. I am in the latter category.
I have written before about life with depression and anxiety and was touched by the many kind notes I was sent in response. This isn’t a ‘poor me’ column, though. There are many going through far worse.
It’s a column about Scotland’s mental health crisis, about how poorly we are handling it, and about the consequences of complacency. It’s a column about what we expect from the NHS, how it measures up, and how we can make it better.
My anxiety episodes were once rare but they have become first a monthly, then weekly, and now daily affair. I have stared at the floor of so many GPs’ offices while awkwardly mumbling some variation of ‘help’ that I can describe entire carpet patterns from memory.
Every time, the result has been the same: a sympathetic smile and an offer of stronger antidepressants. Occasionally, there’s a leaflet to take away, which gives me something to do on the bus home besides silently berate myself for going in the first place.
Two months ago, I asked a GP about cognitive behavioural therapy, which has shown promise in treating anxiety. I was told it wasn’t an option — the waiting list was 18 months.
Months. Not weeks, months.
Last week, after another deterioration, I went to another GP and asked — no, insisted — that he refer me to ‘talking therapies’. He eventually agreed but quoted the same length of wait and told me not to get my hopes up.
He sighed: ‘I’m really sorry but the Scottish NHS is very bad at this, NHS Lothian is even worse, and this area [Edinburgh] is the worst part of Lothian for it. People come up from England and they can’t believe there’s just nothing there.’
With that, he gave me a list of private sector therapists and suggested I try to find help there.
I don’t enjoy writing about this, or myself. It chafes against my Catholic self-abnegation. But the statistics tell me there are others in my situation and instinct tells me many more are not picked up by the statistics. People send me their stories and some report positive experiences but many more could recite a tale just like mine.
When it comes to mental health, the foundational principle of the NHS does not apply. For some of us, the service is not free and the point of delivery never arrives.
One in four Scots will suffer at least one episode of mental ill-health in any given year. This may be brought on by trauma, such as bereavement, divorce, redundancy or becoming a victim of crime, or it can come about through substance abuse, loneliness, genetics or simply because the neurotransmitters upstairs don’t want to play along.
The Scottish Government’s target is for 90 per cent of patients to begin treatment within 18 weeks of referral. Just two health boards in the whole country meet that target (and one of them is NHS 24). In Lanarkshire, one in five wait longer; in Lothian, one in four; in Fife, one in three; and in Forth Valley, almost half.
When I say that I feel uneasy about the quasi-religious festival that is NHS at 70, I am not being contrary. Universal healthcare is one of the hallmarks of a civilised society and its achievement merits celebration. The spasms of benediction in recent weeks from politicians, patients and the BBC are of another order. I view such behaviour with suspicion. These are people who clap when planes land.
My experience of the health service has never been better or worse than my experience with the local council or HMRC or the Passport Office. I can count on one hand the number of doctors who have given the impression of taking mental health as seriously as physical health. I appreciated them but it didn’t erase the memory of the others.
We have an unhealthy relationship with the NHS. Reverence is no mindset in which to approach a public service. Scepticism quickly becomes heresy; ask an awkward question and you’ll be chided for talking in church. Instead of commending the NHS on its successes and confronting its failures honestly, we convince ourselves that there is nothing ailing the service that cannot be cured by more investment.
This is a fallacy. Scotland spends £2,332 per head on health, the highest ratio in the UK; just over 78 per cent of patients referred for psychological therapies are seen on time. England spends £163 less but operates an Improving Access to Psychological Therapies (IAPT) programme, which sees almost 99 per cent of referred patients in under 18 weeks.
Money itself will not improve how the NHS treats mental health. It requires a change in attitudes and priorities. I hope new Health Secretary Jeane Freeman and mental health minister Claire Haughey will grasp that and lead the transformation.
Until then, I will take my little list and shop around for healthcare. ‘Going private’ still sounds scandalous — as though you’re skipping the queue for the communion wine — but for some of us ‘going public’ isn’t an option.
Complaining about underhand tactics at Westminster is like lamenting problem gambling in Vegas but Tory chief whip Julian Smith’s skullduggery marks a new low.
‘Pairing’ is an arrangement between a government and an opposition MP not to vote when the other is unable to. Tory Brandon Lewis had such an agreement with Jo Swinson, who is on maternity leave after the birth of her second son, Gabriel, in June.
Smith ordered Lewis to break his deal with the East Dunbartonshire MP to help the government win a crunch Brexit vote last week. Tory whips insist this was inadvertant rather than a deliberate ploy but their explanations stretch credulity.
There used to be an old-fashioned Toryism — stuffy but decent — that believed in honour and nobility and a gentleman’s word being his bond. No more, it seems.
Jo Swinson has learned the hard way that the Tories are willing to rip up the rulebook to scrape through a Brexit that won’t tear their party apart.
Israel has rescued more than 400 members of the White Helmets, the volunteers fighting to protect Syrian civilians from Bashar Assad. The daring mission, carried out under cloak of darkness and at the request of the UK, has saved these men and their families from certain death. Perhaps the UN could take five minutes out of denouncing Israel to say thanks.
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Originally published in the Scottish Daily Mail. Contact Stephen at firstname.lastname@example.org.