We love the NHS?

Do we love the NHS like we used to? Recent events suggest that it's still as close to our hearts as ever says Laurie Penny

Since its foundation in 1949, the National Health Service (NHS) has provided care and support to the majority of people in the UK. It is always there, ready for us to use when we need to. The people of the UK have had a 61-year relationship with the NHS, and for all that we complain about it, there are few who would like it to disappear completely.

In August of this year, political events in the US sparked an impassioned outpouring of feeling about our NHS that surprised many, on both sides of the Atlantic.

US versus UK?

In the United States, healthcare is not free (see page 15). Millions of Americans cannot afford any treatment when they are physically or mentally unwell. August 2009 saw president Barack Obama's first attempts to reform the US healthcare system. His proposals included the introduction of a form of public health insurance that opponents suggested had some similarities to our NHS.

These American opinion formers and politicians used the NHS as way of arguing against healthcare reform, saying the failures of the NHS should act as warnings against the dangers of a socialised healthcare system. Some of the media, such as Fox News, labeled the NHS "evil", claiming that it allows the elderly to die untreated.

Unsurprisingly many Brits were offended by this negative portrayal of the NHS and some showed it in an unlikely way.

Twittering proudly

The global social networking site Twitter allows people to share messages of 140 characters, similar to text messages. After the controversy was covered in the UK, Twitter was flooded with messages of support for the NHS and personal stories of good NHS treatment, all tagged with the phrase '#welovethenhs'. Twitter was overwhelmed by hundreds of thousands of messages (known as 'tweets') from ordinary people and celebrities, including the prime minister and his wife - so many that on the 13th of August, the website broke down. People are still contributing now. Go to Twitter.com and search for '#welovethenhs' to see what people have been saying.

Do #welovethenhs?

But do we feel the same about NHS mental health services? One in Four asked people involved in the Twitter campaign to share their stories of mental health treatment on the NHS - the good, the bad and the weird. Here are just a few of the responses we received.

I'm a novelist and this year I found myself barely able to get off the settee, never mind attempt to write anything. Eventually, I went to my doctor, although deep down I didn't expect to be taken seriously. What I received was a revelation. My GP asked questions that made sense, and he treated me seriously. He explained the different approaches I could take, and asked which I was comfortable with. I was prescribed a low dose of medication, which has been gradually increased over several consultations, and a meeting with a therapist, which has led to Cognitive Behavioural Therapy. It's the little things that have made most difference in my NHS treatment. I return to my GP every few weeks so we can evaluate my progress. He checks how my work is going. At every appointment, I feel like my quality of life is being looked at and taken into account. - Steve Mosby, 40

I was relieved when my GP agreed to get out of my way and give me medication. When I see the same doctors for physical health problems, I get much more of a sense that they are willing to work with me. - Sam, 32

The NHS is very well-meaning, but over-stretched. I've been trying to access services for some time now, and I have had to tell my entire story from start to finish about five times already. Sometimes I've found GPs very helpful as gatekeepers - the GP at my university was very sensitive, but the service she referred me to had a very long waiting list. Waiting lists are a real problem, because circumstances can change very fast and sometimes what you need is immediate help to stop a decline rather than waiting six months for longer-term help. The crisis teams are great, but they're so over-stretched. - Toby, 23

There comes a time when you realize that you're vulnerable and in danger. In my case, it happened when I attempted suicide. I arrived at A&E early on a bright Saturday morning. I was afraid I was going to be laughed at and told to go and pull myself together. I felt ashamed that I was wasting everyone else's time. I felt I didn't really deserve any help, but help was what I got from the NHS that day. Finally, I was being listened to, and there were no stern judgements. I received real care from that moment on. When I was most in danger, when I was least capable of looking after myself, there was a safety net for me. It's not going too far to say that knowing it was there saved my life. Finally, I could embark on a path to recovery. Instead of being nothing, I am something. And I owe that to those people who devote their lives to helping others. - Richard, 35

I had a breakdown at university in 2005, in my final year. The NHS was brilliant. We went to my family doctor because I wasn't sleeping or eating, and I was drinking too much. She gave me some mild sleeping pills to see how I got on. When this didn't work either, she put me on temazepam for about four months. She didn't just fob me off. She got me an appointment with a psychiatrist, who diagnosed depression and put me on anti-depressants. I ended up on these for about six months. I also had follow-up home visits from a counsellor. The treatment I received from the NHS was quick and effective and did its job well. As far as you can make a 'recovery' from depression, I did. - Kate Limond, 26

My anxiety reached uncontrollable levels last year, and I went to my GP who referred me to the mental health service for professional assistance. They got in touch very quickly for the initial assessment, then I didn't hear from them again until I had my first face-to-face appointment with a psychiatrist. There was then a lengthy delay of seven months before I began a course of 10 CBT sessions. I've been really happy with my therapist, who's been nothing but nice, understanding and helpful, and I've certainly noticed a difference to the way I'm thinking and behaving. I do wish I'd been able to see her earlier. I guess that's what's going to happen when you deal with the NHS. Apart from that, I have no complaints at all. - Helen, 29, journalist

The NHS has always been there when I've needed it; it's far from perfect, but I love it anyway. When I was 14 I went to the doctor to ask for help, because I struggled with social situations and anxiety and I felt miserable all the time. At first I was dismissed. When I was 18, I repeated the same complaints, and was prescribed anti-depressants, which did not seem to work. After many years of trying and failing to find effective treatment, I finally saw a doctor who referred me to a local computerised Cognitive Behavioural Therapy course. I start this soon, and for the first time in my life I feel like I'm actually being listened to by the NHS. - Alex, 26

Some years after seeking basic mental health treatment on the NHS, I worked as a temp for a local care in the community centre. That made me realise just how stretched the system is. The NHS is full of amazing counsellors, therapists, social workers and nurses who have gifts for making a positive difference in people's lives - but they are overwhelmed by paperwork and just don't get time to do their jobs, because funding for administrative staff is being cut as bureaucracy increases. - Helen, 25

I've been treated for depression, anxiety and an eating disorder by both private and NHS services. The worst thing about the NHS is the waiting lists. If I have a referral from my psychiatrist to see a psychologist or to another doctor it typically takes weeks or months for it to come to fruition. A few years ago I booked an appointment with my GP and told him I was relapsing and needed help. Eventually I was referred to a counsellor, who referred me on to a psychiatrist; I was told to expect a letter with an appointment time. Six weeks passed, by which time I was so low that I took an overdose and ended up in the local A&E. After an angry phone call from the A&E's psychiatrist to my GP, I was eventually 'rushed' through the system. Despite all this, the care I receive is genuine and helpful. It's a stuffy, overly bureaucratic system tied up with red tape but I truly believe it is doing its best. - Laura, 23

The NHS and mental health

The National Health Service was set up to give everyone the right to see a doctor, and to receive health care if they need it, whether or not they can afford to be treated privately.

When the NHS was created in 1949, there were already large asylums in many areas of the country. The NHS oversaw the central administration of these asylums. From the mid-1950s, as the British economy improved, the NHS also invested large sums of money in building new, smaller day-care centres and residential hospitals.

By the 1960s, opinion turned towards giving patients more control over their lives and their treatment. At the same time, effective psychotropic drugs had been invented, making most conditions more treatable. The number of beds in mental hospitals reduced from 150,000 in the mid-1950s to 80,000 by 1975; today there are under 25,000 beds in mental hospitals, despite the growth in the overall population.

The Mental Health Act of 1983 gave patients the power to refuse compulsory treatment. The Act also advised that people be treated in their own homes where possible, a policy that came to be known as 'care in the community'. Now seen as the brainchild of Margaret Thatcher's first government, the idea originally dates back to the 1959 Mental Health Act, which abolished the distinction between psychiatric and other hospitals and discouraged the isolation of people with mental health difficulties in asylums.

Many people were critical of care in the community, believing it would leave people with mental health difficulties uncared-for in the community. The Community Care Act of 1990 contained legal sanctions to make sure that local authorities carried out proper assessments of local people's needs. Today, if you have a mental health difficulty you will probably be treated in the community, and an admission to an inpatient unit is normally short and voluntary.

See the interview with Andrew Roberts for more about how mental health treatment has changed.

This feature appears in One in Four issue 7. For information about purchasing a bulk subscription for your group or organisation or buying an individual copy please see this page.

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