Sometimes People Just Need More.

Not because they're needy, or greedy, but because their mental health is suffering and they've been surviving for too long on less.

I've been watching Jason Segel and Harrison Ford’s collective comedic brilliance in the Apple TV Show Shrinking. I won't include any major spoilers here, and I should state the show is a comedy and so the level of relevance to those of us living in real-world mental turmoil is not a fully accurate representation.

However, for those of you that haven't watched it, Jimmy (Segel) is a CBT therapist who recently lost his wife. You might say naturally—or at least understandably—his tolerance towards some of his patient’s first world problems begins to wear thin. As he grapples with his own grief, he struggles to get through to the people he's trying to help —his patients. Deciding to take matters into his own hands and abandoning his training, Jimmy begins a more unorthodox approach to therapy. He starts by befriending patients and blurring professional boundaries, ultimately creating what his boss Paul (Ford) calls ‘dual relationships’.

What struck me during the show was a line from Jimmy to Paul in response to Paul’s chastisement of this methods, he says: ‘You know what, Paul? Sometimes people just need more.’

And while there are obvious and necessary boundaries in therapeutic relationships, this hit me right in the feels.

Needing more

In 2021 I suffered a severe—and terrifying—perinatal mental breakdown. My intrusive thoughts were laced with the unspeakable and I was terrified. I began the fruitless task of asking every single person I knew for reassurance, seeking it out like it was air. I begged for anybody around me to tell me I wasn't my thoughts and that I would recover. The need to have this external validation felt like I was constantly jonesing for a fix. And like all drugs, it worked the first two or three times and then I needed more and more reassurance, none ever being enough to tame my insatiable appetite for self punishment.

From the week after my son was born in the summer of ‘21, through to May 2022, I saw a community psychiatric nurse weekly. I also saw a psychiatrist and a specialist perinatal nursery nurse, also mostly weekly. As well as engaging in a twelve week group course of dialectical behavioural therapy.

These people, this team of professional strangers, became my village.

They held me when I felt alone. They helped me deal with long buried trauma from my childhood, past mistakes that I had never been able to forgive myself for, and they gave me the tools required to whittle the building blocks that would eventually help me to move forward.

Back then, (I believe it's changed now) perinatal teams only worked with mothers for a maximum of twelve months. Once your time was up, you were discharged back to your GP where you might be referred for more mental healthcare if appropriate.

When my time came, the truth is, I wasn't ready. I was terrified. I didn't feel confident in my ability to live a life where that village of support wasn't available. I needed more.

It took me almost as long as I’d the support in place to get over not having it anymore. My GP,—while very supportive—could only really help me from a prescribing point of view.

It wasn't enough. I had these new tools that had allowed me to be vulnerable but I wasn't done opening up.

What happened next (and at the time felt like a stroke of luck) was, my GP practice brought in a mental health nurse of their own on a pilot scheme to support members of the community with mental health struggles. Her job was to talk through concerns and signpost them to further services if necessary. I started talking to her but she wasn't my team, and it took me a while to open up.

Still, I had hope that maybe this would be enough whilst I was finding my feet out in the world again as a disabled mother of two. A mother whom had just to come to terms with losing her professional support system while caring for two children, on top of living with debilitating chronic illness, and the return (and worsening) of PMDD postnatally.

And then…. Just as I allowed that hope to build…. the pilot scheme was pulled. No more mental health nurse on hand for a quick chat when I needed to talk something through. I felt let down.

After the year with the perinatal team it was agreed I wouldn't be referred back to the bog-standard six session talking therapies service that everyone gets when they go to their GP for mental health support. The main reason being that I have been through that service at least 4 times and could (respectfully but truthfully) run the phone initiated CBT sessions myself.

Instead, I gave it some time while trying to get my act together, but simultaneously becoming more disabled, trialling all kinds of hormone treatments for PMDD—which made my symptoms worse before they ever made them better—while starting to realise that it was also very likely I had ADHD.

I've digressed a little here, but the point is, I needed more and yet it felt like there was no ‘more’.

I tried to lean on the tools I'd learnt. I tried to remember all of the things my old CPN *Tango had taught me, but it all felt so far away. My son was ageing but I still felt stuck in the same place I'd been when he was born. Lost and alone.

My GP knew I needed more support and she referred me back to community mental health services where I was offered another ten week course of online DBT.

Because of my health at the time—a recent ADHD and Functional Neurological Disorder diagnosis, chronic migraine attacks that had me in bed for up to a week during an attack—I explained how hard it would be for me to commit to a ten week course. However, in my mind I was committed, to trying. I wanted to remind myself of the skills I'd learned during the perinatal period. I was committed to getting better.

The course started off well, I was engaged, I showed up, I opened up, and then I was taken ill for two consecutive weeks. I was experiencing the worst flare up of my life with my physical health. I couldn't see, movement made me nauseous, I was in status migrainous and looking at screens was impossible.

When on the third week I felt well enough to return, (I should add that I had done this exact course before and had kept up with modules I had missed) I got a phonecall from the mental health team to say I could not return to the group. That missing more than two sessions meant I would be discharged from the service. Despite explaining my circumstances, again reiterating my disability and explaining that I hadn't missed anything crucial as I was familiar with the method, I was told there was nothing they could do, and that I should try getting referred again when I felt I could commit to all of the sessions.

After months of email complaints, me telling them I may never be able to one-hundred- percent commit to weekly sessions because of the deterioration in my health and it's unpredictability, I was worn out. I was told there was nothing else the service could offer me and that this group was the offering.

I felt as though I had been abandoned, again. When I needed more. I had been abandoned by the service that I was relying on to help me. Because of my disability I was out of work and couldn't afford private therapy, nor could I bear the idea of opening up to someone only for them to leave, or take a six month vacation.

It's Mental Health Awareness month this May, it's also Maternal Mental Health Awareness Week right now in the UK, and I can't lie, I'm angry.

Not at the perinatal team who saved my life. I will forever be grateful to them, and god I miss them. But they set a precedent by being so fucking brilliant that the services on offer elsewhere pale in comparison.

I would love to write that there is always help available, and perhaps there really is always someone willing to listen…. But WE NEED MORE.

We need more stability. We need more than texting with an AI chatbot that has no accountability. We need more than rigid time frames based on guesswork instead of real life actuality. We need care that caters to the needs of the individual. Care that transcends race, gender and disability. We need care that works.

Now, I don't profess to know how to make this happen, but I know it comes from a place that well meaning providers rarely have access to, and that's the problem.

My old CPN, Tango, and Perinatal Nurse, *Cash, were the best of the best, but even they were confined to work within the constraints of a system that's designed by people who know nothing about those of us who actually need more.

I hope you're not in a place right now where you feel lost, I hope you still have the energy to fight for better care because you deserve that. We all do.

In the event that you need emergency help please go to your nearest A&E department. I've left some numbers and websites below that might also be of use.

https://pandasfoundation.org.uk/ for every parent, carer or network affected by Perinatal Mental Illness.

https://www.apni.org/ Support for women experiencing postnatal depression.

https://www.mind.org.uk/information-support/helplines/ Mind’s support line is a safe space for you to talk about your mental health

https://www.iapmd.org/support PMDD support groups.

https://www.samaritans.org/ Call 116 123 to speak to the Samaritans.