Up Front by Emma Hart


Good Counsel

by Judith Fursdon

I very much wanted to blog about this issue, but I felt I couldn't without betraying too much personal information that wasn't mine. I put out a plea for guest posts, and Judith was good enough to volunteer. Please treat her with the sensitivity for which our community is known. ~ Emma.

 Sunday's New Zealand Herald ran a story about cuts to the availability of talk therapies in both the private and public sectors. This seems utterly wrong-headed to me.

Several years ago, after my daughter was born, I got a bit depressed. Ok, maybe it was more than a bit. I got catastrophically depressed. I was unwell enough that I don't remember much of what happened very well, but this is what I can remember, with a bit of help from the people that helped care for me.

I stopped functioning. So I was taken to the doctor (I had to be taken, because I wasn't functional enough to take myself anywhere). He wrote me a prescription for citalopram. I took it religiously for six weeks, before going back and telling him it wasn't helping, that I was still fundamentally unable to get up off the couch. I was suicidal, I wanted everything to just stop existing. So he packed me off to the hospital mental health team.

I don't remember the crisis team that treated me. I don't remember which drugs they added to my regimen - I remember than I was on two or three at least. What I do remember was that they sent me to the Acute Day Programme. This was a step down from being an inpatient in the mental health unit, where you would attend a programme at the hospital every day from 9am to around 3pm. In the mornings were group therapy sessions, and in the afternoon were activities of various types.

I hated the group therapy, with a passion. I didn't want to open up to a bunch of strangers. But over the course of a few weeks of these daily sessions, I started to. And I started to find my reasons for

living again. I was helped up out of the pit and started to see the sunshine again.

I have always wondered if things would have been different if I had been able to talk to someone when I first started spiralling down. Maybe I wouldn't have gotten so very unwell. I will never know. Counselling was not available to me until I was very, very unwell.

I have been a mental health patient for more than ten years now, and one thing I have discovered is that SSRIs do not work for me. It's always been the front-line treatment, to write for whatever SSRI the doc of the moment preferred, and they simply do not touch the deep, black depression that I suffer. So the idea of just writing an anti-depressant prescription seems wrong-headed to me. The boast that I've seen is that they work 70% of the time. That means that 30% of people will continue to suffer, and they will have to play medication roulette until they find something that works. Having the option of both medication and talk therapy running concurrently would seem to me to make so much more sense. But counselling is expensive, and many antidepressants are cheap - fluoxetine (Prozac) is three cents per pill, as is citalopram (Celexa). Three to six cents a day seems very attractive when compared to the hundred-plus dollars it costs for each counselling session.

Sovereign are planning to cut counselling sessions for their clients, because it's too expensive. If they were saying that chemotherapy was too expensive, and that they wouldn't pay for it for cancer patients, people would be screaming. Chemotherapy, radiotherapy, and surgery are all parts of a treatment plan, and taking one away because it was too expensive is compromising people's care, and increasing the

chance that they will not recover. It's exactly the same with mental health treatment plans - all options need to be open, and the best one selected for a patient's needs.

These issues come from a fundamental misunderstanding of mental illness. People, medications are not magic bullets. They don't just make everything better. Mental illness is complex, and requires some combination of medication, self-help, and talk therapy to recover. Talk therapy is slow and expensive, and it's not as sexy as a magic potion that solves everything, but it can be the basis of life-long wellness, as people learn better ways of thinking and dealing with what life throws at them. Taking that option, and those tools, away from people is wrong.

Judith Fursdon blogs at Drop Bear Exterminator

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