South Wales has been the focus of lurid mental health headlines over the past few years, from the tragic string of suicides in Bridgend to the Daily Mail’s assertion that Blaenau Gwent is “hooked on happy pills”. Just last month Pontypridd MP Owen Smith denounced our mental health system as “terrible” after his brother waited on a hospital trolley in A&E for over a week, instead of receiving specialist mental health treatment.
In the UK, one in four of us will experience a mental health problem at some point in our lives. The South Wales suicide rate has been significantly higher than England’s since 2010, and is now the leading cause of death in people aged twenty to thirty-four. Some of our towns have the highest rates of depression in the country, and if the Daily Mail is to be believed our countrymen in the Valleys are popping anti depressants like tic-tacs.
So how poor is our mental health? Why are certain areas affected so drastically? How is the mental health system letting us down? And what is being done to improve these damning statistics?
With regards to depression and anxiety, the area served by Cwm Taf University Health Board is a black spot on the Welsh landscape. A report published in 2013 by The Welsh Institute for Health and Social Care found Cwm Taf to have the worst profile when compared to the Welsh average, suffering from economic deprivation, a lack of job opportunities, a lack of resources, poor transport and a risk of premature death. A high proportion of the population have no qualifications, jobs or training. Unsurprisingly, this area also has the highest percentage of anti-depressant users.
In towns like Merthyr Tydfil, Aberfan and Pontypridd, the reliance on anti depressants is worrying, with one in six regularly refilling their prescriptions. This level of prescribing is wholly unsustainable, and does little to tackle the very complex reasons why people in the South Wales valleys are suffering so acutely.
These areas were badly hit by the recent recession while they were still trying to recover from the economic problems of the eighties and nineties. The communities, networks and social clubs built around the pits have steadily disappeared, leaving people isolated with little support, while poor transport has led to further isolation. Poverty often leads to poor mental health, whilst poor mental health leads back to poverty. Little has been done to break this cycle, and so the people of Cwm Taf are left in a perpetual struggle, relying on their prescriptions to provide lasting, meaningful improvement. As effective as anti depressants can be in altering brain chemistry, they cannot improve poor circumstances or correct the deep societal problems presented by deprived and isolated communities.
There are some very effective ways to alleviate depression that is caused by poor living conditions and low prospects, such as talking therapy, but getting access to talking therapy is far more difficult than it should be. David Bailey, a GP from Caerphilly, admits that doctors don’t always have access to talking therapies, even though the majority of the depressed patients he sees are experiencing financial hardships, poverty or relationship problems, which could be greatly helped by therapies in talking or mindfulness. Even if a patient gets added to the waiting list, they could be waiting for two years or more. Sometimes patients aren’t added to the list simply because the list is too long, and the enterprise is deemed ‘not worth it’. Unfortunately, research has found that the longer the wait for talking therapy, the worse the outcome for the patient.
Although Cwm Taf is the area most affected by poor mental health, the rest of South Wales is struggling too. In July, the charity Gofal published a report about primary mental health. The report found no improvement in patient outcomes since 2012, and while medication is prescribed in 77% of cases, cognitive behavioural therapy is offered in only 22%, and talking therapies 32%, while waiting times to see a psychotherapist often hit the six month mark.
During those long and lonely six months, how many people lose all hope? It’s an important question to ask considering the growing rate of suicide in South Wales. The 2015 statistics show the highest number of suicides in a decade, with Cwm Taf having the highest rate. When faced with this, it is important to remember that behind these statistics are people, faces, personalities, all choosing to end their lives through sheer hopelessness. The reasons why people decide to leave this world are complex, but the state of the economy and high alcohol consumption have been flagged as the prevailing reasons in Wales.
It is said that middle aged men are most in danger of committing suicide due to their risk of ‘falling through the cracks’ but unfortunately every suicide is a result of falling through the cracks. Perhaps these people were waiting too long for a talking therapy, maybe alcohol really was the problem, or their marriage, or the loss of their job. But one of the reasons why people commit suicide is that they feel unable to seek help in the first place, and often this is through a fear of stigma.
We have a real problem with mental health discrimination in Wales. According to charity Time To Change Wales, 46% of Welsh people believe that if you’ve suffered from depression then you shouldn’t be able to teach at a primary school. One in ten people believe that individuals with mental health problems should not even be able to have children. The charity also asserts that stigma is the main problem preventing the take up of services in rural areas in Wales. Luckily, Time To Change Wales is devoted to battling stigma through awareness campaigns and community projects.
Charities throughout Wales are attempting to resolve some of our most complex problems, in our worst hit areas. In response to the pervasive problems in the valleys, The Samaritans set up their South Wales Valleys Pilot Project, aiming to support the community and reduce suicide. They have devised a four-step plan to reduce the instances of suicide by promoting mental health, embedding suicide prevention plans in communities, tackling alcohol abuse and dependence, and by striving to make their telephone service free.
Another Welsh charity, Gofal, has had great success in helping people recover from mental health problems, offering courses to develop independence and confidence. Their focus is on crisis intervention, home and family support, skills, employment, and community wellbeing.
But despite the fantastic efforts of these great charities, many people with mental health issues simply want a reliable, empathic, quick and effective mental health service. They don’t want to wait two years to talk it out. They don’t want to be fobbed off with anti depressants when their problems go beyond the biological. They want a system that serves them properly, a system that works.
Charlotte Jones, a spokesperson for the British Medical Association in Wales admits we have a problem. “It’s unacceptable” she remarked, “It’s not right for the patients of Wales. We need to see more investment, we need to see a true commitment to resolving this once and for all.”
In an attempt to tackle the situation, the Welsh Government has devised a three year plan designed to improve the mental health of people in Wales, with a further £16 million a year being invested in mental health services.
Is a s £16 million cash injection a ‘true commitment’? I suppose we’ll find out in three years.
But three years is an awful long time to wait when you can barely face tomorrow.
words VICTORIA O’HAGAN