How the lack of mental health support in Wales is endangering lives

“Austerity has shredded the community resources that prevent people from being admitted.”

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It’s 5am on a Friday morning, and Tuesday Turner is vacuuming the small square carpet in the room of her hostel. To her right, four empty bottles of disinfectant litter the floor. Although her hands are rubbed raw from hours of scrubbing, she still believes the pristine carpet is contaminated with germs.0

Twenty-nine-year-old Tuesday, from Bridgend in South Wales, has lived with the debilitating symptoms of obsessive compulsive disorder (OCD) for most of her adult life. She has also been diagnosed with bipolar disorder, emotionally unstable personality disorder and psychosis. Despite several attempts at treatment, Tuesday’s OCD has never been regulated to a manageable level. She controls her symptoms by dousing herself in weekly showers of bleach. 

“My legs are covered in burn marks,” she says, pointing to skin blistered white from years of chemical exposure. “Bleach is the only thing that reassures me there are no germs on my body.”

Tuesday lives in supported accommodation after constant arguing with her mother, who also has OCD, drove her out of the family home. She tells me that a man in the hostel is “80 per cent burns” after setting himself on fire. “No one is seeing a psychiatrist regularly or receiving the right treatment.”

According to the charity OCD UK, around 36,000 people in Wales had OCD in 2017. Yet despite this figure, Wales currently has no specialist treatment centre for the disorder. Waiting times for cognitive behavioural therapy (CBT), one of the most commonly prescribed treatments for OCD, are approximately 18-24 months, with no guarantee it will be issued by a specialist. The Welsh ministers budget is expected to continue growing, largely due to extra health spending by the UK government. However, researchers at Cardiff University predict that expenditure on public services will not return to pre-austerity levels until 2023.

While Tuesday carries the physical scars of her illness, Bridgend town centre bears the burden of nearly a decade of austerity. A walk down the high street reveals a familiar array of betting shops, off-licences and boarded up buildings. Discussions over the town’s fate came to a head last month after Ford announced the closure of their engine plant in 2020, a move which is predicted to cost Bridgend 1,700 jobs.

According to Ian Cummins, a senior lecturer in social work at the University of Salford, the increased demand for services in areas with high levels of unemployment creates a “huge strain on services”. “We are seeing shortages of beds, longer waiting times and record numbers of people being admitted to hospital out of area,” he says. “Essentially, austerity has shredded the community resources that prevent people from being admitted. The system is creaking.”

Wales lacks the Improving Access to Psychological Therapies programme (IAPT) that was introduced in England by the Department of Health in 2008, and allows patients to self-refer over the telephone. Instead, patients must obtain a referral from their GP to progress into secondary care.

In practice, says Dr Stephen Davies, a consultant psychiatrist based in South Wales, “Secondary care only sees patients with psychosis, plus the most severely depressed patients. Most people with OCD would be turned away.”

Tuesday found herself placed on a three-year waiting list for one-to-one therapy at their local Assisting Recovery in the Community (ARC) centre, a day service that is jointly funded by the NHS and the council. “I kept writing to them saying we were waiting,” says her mother Lesley, as we talk over coffee in a small café in Bridgend. She wipes her cup repeatedly with a tissue to ensure it is free from germs. “We finally got through and were promised eight weeks of treatment. It lasted three weeks, before the nurse stopped answering our calls.”

Another counselling session, which involved a six-hour round bus trip to Neath Port Talbot Hospital, proved so distressing that Tuesday attempted suicide that night. She was later sectioned in the Princess of Wales Hospital.

Lesley has become so frustrated with the lack of treatment that she penned a letter in May to the Welsh Assembly, begging them to help Tuesday: “I wrote, ‘please help my daughter, because she’s going to die’.”

A spokesperson for Bridgend Council said that the county’s mental health services have been “recently reorganised to make it easier for people to access them”. It has pledged to spend £70.8m of the 2019-20 budget on social services and wellbeing.

Yet the problem is not only access to therapies, but quality. Martin spent eight years battling the mental health system in South Wales to find a treatment that managed his daughter Olivia’s OCD. (Their names have been changed to protect their identities.) A round of “woefully inadequate” CBT at their local Child and adolescent mental health services centre in Cardiff left the family with no choice but to pay for a private assessment. When the psychiatrist decided not to take Olivia on due to the severity of her symptoms, it took almost two years to get funding for an appointment with OCD specialist Paul Salkovskis.

By this point, Olivia’s health had rapidly deteriorated. Ten days before Christmas, she was admitted to Llandough Hospital, where she stayed as an inpatient for over two years.

“We got stuck in an eternal loop of fighting, and it put a huge strain on our family. Olivia dropped out of school and barely left the house. She missed out on her teenage years,” said Martin.

Now 21, Olivia is finally receiving treatment through a community placement for pathological demand avoidance, a sub-type of autism that is believed to trigger her OCD. The family is still fighting to get her referred to England for specialist OCD treatment, a complicated process due to the devolution of healthcare in Wales.

“Wales is a small country, and we haven’t got the centres of excellence. We need to be able to have much easier channels to refer back into England when needed,” said Martin.

Norman Lamb, the MP for North Norfolk, became well acquainted with the UK’s fractured mental health system after his son was diagnosed with OCD at the age of 16. He maintains that in order to improve access to mental health services, the government needs to replicate what was done with physical health and introduce “comprehensive waiting time standards”.

“Someone with complex OCD should have the right to start treatment just as much as someone who is experiencing psychosis,” he said. “In Wales, some of the specialist services for OCD are not as well developed. Although it’s still pretty awful accessing specialist support in England.”

Yet with each promise that drifts from the chambers of the Welsh Assembly, Tuesday loses a little more of herself to a bottle of bleach.

“I’m too far gone,” says Lesley, a solitary tear brewing in her eye. “But Tuesday’s monster is getting bigger. We need help.”

Alice Hall is a freelance journalist.