Accessing mental healthcare is a privilege, but it shouldn’t be.
CW: self harm, suicide, child abuse
It is estimated that around 20% of the world's children and adolescent population suffers from a mental health disorder (1), and although mental health problems are very common, it is still very stigmatised and so very difficult for people to access support for their mental health. I was diagnosed with severe depression and complex PTSD after leaving my abusive family, and I was able to access the help and support I needed because of my privileges.
The first time I came across the term “depression” I was 11/12 years old. The school psychologist gave us a presentation about mental health, and I felt a wave of anxiety wash over me when she described the symptoms of depression. She emphasised that depression was different to common feelings of sadness because it involved feeling sad and hopeless all the time, and I felt like I finally found the word I was missing to describe how I was feeling. My family had always complained that I was constantly crying and unhappy, but instead of finding ways to help me get the help that they knew I needed they just spent their time making me feel guilty about how I was feeling. I cried every day, and a day without tears was a luxury I was unfamiliar with.
After explaining what depression was, the psychologist spent the rest of the presentation informing us of the resources available to help us if were struggling with our mental health and encouraging us to reach out and ask for help. I knew I was depressed and I wanted to get better, so when I went home I told my mother that I thought I was depressed and asked if I could start speaking to a therapist. Of course, my abusive mother refused and laughed at me. Over the years, I repeatedly asked if I could speak to a therapist, but my mother continued to refuse, and one time she even angrily asked me why I wanted to talk to a therapist and what I wanted to tell them. One of the most important rules in the household (this was repeatedly drilled into us) was “what happens in the house stays in the house”, meaning I could not confide in anyone about the abuse without disobeying and disrespecting my parents, so the reason my mother did not want me to speak to a therapist was to make sure that no one would find out that I was miserable and suicidal because of their abuse.
Culture definitely plays a role in the stigmatisation of mental health, particularly since in Arab culture struggling with a mental illness is seen as bringing shame upon the family and potentially ruining a family's reputation. Our culture prioritises potential gossip and public appearances over our actual wellbeing.
I realise now that even the fact that I was able to recognise and label the signs that showed that I was struggling with my mental health is only something that I was able to do due to the mental health awareness education at my school. Children and teenagers without that early education regarding mental health may be struggling without even realising it.
The first time I slit my wrists I was around 13/14 years old. I wanted to die. When my mother found me, she did not show any concern for my wellbeing; she merely complained that I was wasting towels to stop the bleeding, and asked me if I cleaned the knife after I finished using it. I was not taken to a hospital and I was still not allowed to speak to a therapist to try to get the help I needed for my mental health. Mental health was a privilege that my abusers deprived me of. I had to go to school the next morning like nothing happened, and we never spoke about it again.
It wasn’t until after I left my abusive family that I was finally able to access mental healthcare and start to heal from the trauma I was forced to endure. The problem was that even though my abusers were no longer preventing me from accessing the mental health support that I needed, there were many other barriers in place that prevented people from accessing that care. Thankfully I live in the UK and the NHS offers free psychotherapy, however, many other people do not have the privilege of living in a country in which free therapy is available. Even countries, such as Kuwait, that offer free healthcare do not include mental healthcare as part of the services they offer, because mental healthcare is so stigmatised that it is not even perceived as real health. In other words, mental health is not believed to be as important as physical health, so it is repeatedly ignored and overlooked. Mental healthcare must be prioritised in order to ensure it is destigmatised, because the stigma surrounding mental healthcare is the first barrier that prevents people from asking for help.
Although mental healthcare is free to access via the NHS in the UK, there are very long waitlists that delay vulnerable people’s access to the care that they need. These excessively long waitlists could be a result of budget cuts to the mental health sector, leaving mental healthcare providers to be underpaid and overworked. A UNISON survey in 2019 revealed that 45% of staff members were considering leaving their jobs. This highlights the consequences of staff burnout, and this is at least partly due to the budget cuts.
Here is an excerpt from an article on UNISON’s page:
‘Her own son has personality disorder and has waited 18 months for treatment, she told delegates. “My son’s life is on hold. He is in desperate need to start treatment. It’s not just my son who’s waiting, but many other service users, which is putting strain on families and carers and frustrated staff.” She said that “it’s the system that’s failed, not staff,” blaming the government for “lack of funding, lack of care, lack of understanding of users and staff.”’
I have had personal experiences with the NHS’s excruciatingly long waitlists, but I was still protected by my privileges. When I reached out to the NHS for mental health support, I was put on several long waitlists for a variety of issues I needed help with. Even though the state of my mental health was quite desperate, mental health services were stretched so thin that I could not receive the help I needed when I needed it. Since I was financially privileged (as a result of my scholarship from the Kuwaiti government) I was still able to afford private therapy while I waited to receive therapy on the NHS. Back then, when I still had my scholarship, I was able to afford private therapy sessions once a week and it wouldn’t seriously affect my living conditions. Now that I no longer have my scholarship, I have to choose between affording my groceries and affording therapy. Considering that 1 in 5 people live in poverty in the UK, millions of other people are experiencing this too. This is the norm, but it shouldn't be. Mental healthcare is essential and life-saving, and access to this care should not be exclusive to the financially privileged.
Being able to survive the NHS waitlist is also a privilege. Those who are struggling with suicidal thoughts and even suicide attempts may not live long enough to finally receive the care that they need. Someone dear to me was struggling with suicidal thoughts and confided in me that they were going to end their life. After I had convinced them to try to get help, the state of their mental health became even worse when they were told that they would be put on a waitlist for over a year. They became hopeless once they realised that there was no one willing to help them. People who want to end their lives do not have a reason to wait that long to receive care and support, and if they cannot wait that long and try to call a suicide hotline, they are again prevented from accessing the care that they need. I have been put on hold every single time I’ve called a suicide hotline, but still, I was privileged enough to be able to afford private therapy. It sounds ridiculous doesn't it: for a suicide hotline to put people on hold when they call. This is the reality that we live in.
Another way that wealth aids people on their journey to achieve mental wellness is that those who are financially privileged are able to take time away from work or studies and solely focus on healing. I was diagnosed with severe depression and complex PTSD, and my symptoms were debilitating and had significantly impacted my productivity and my ability to focus on my studies. I decided to interrupt my studies and take a year to myself and dedicate that time to my healing. I was able to afford take that time to myself without an income because I had financial savings that I could rely on, but many other people are not that fortunate. Now that I am living below the poverty line, I know that I would not be able to afford to take time to myself again without any income.
Even having a diagnosis is a privilege. Men are more likely to commit suicide, but less likely to be diagnosed with depression. Patriarchy and toxic masculinity are literally killing men, since the societal roles assigned to men have encouraged them to stay silent about their emotions and suppress any signs of "weakness". In the UK, 75% of all deaths by suicide are men, and general primary care consultation rates are 32% lower in men than women. Men are afraid of being perceived to be weak, and society punishes men by demeaning and humiliating them when they express that they are struggling. As a result, it is more difficult for men to seek help for their mental health. In order to lower suicide rates, we need to take symptoms of mental illnesses in men more seriously and to encourage them to seek help. By labelling, or in this case diagnosing, mental illnesses we make it easier for people to seek help for what they are struggling with.
I have been very fortunate up to this point. My privileges have protected me and I’ve been able to access the help that I needed, but wealth should not be a prerequisite to mental wellness.
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