I’m lucky. I can afford private mental health treatment. What about those who can’t? | Deborah Orr

Experts know how to help me, and thousands of others. But the NHS just doesn’t have the money

Almost one in 10 14-year-old boys have symptoms of anxiety and depression. Which is awful. But almost a quarter of 14-year-old girls have such symptoms. That is such a sad and miserable statistic that one barely knows where to start. The worst thing of all is that it isn’t really surprising. There is so much in this world of ours for a teenage girl to feel worried and hopeless about – not least that the advertising of such sensitivity can easily attract the sneering epithet “snowflake”.

Twas ever thus, though. Bullies find sensitive people like wasps find jam. It’s easy to get carried away with the idea that such statistics are the creation of modernity, thereby assuming that 14-year-old girls were less anxious and depressed back in the old days when rape wasn’t legally possible in marriage, domestic violence was not a term there was any call for, reliable contraception didn’t exist, and many people thought childbirth was the extremely dangerous reason for female existence. Back then, anxious women were called “hysterical”, depressed women were called “sullen”, and childless women were called “barren” or “spinsters”. Good times.

In fact, there is even a positive light in which to view this baleful news of teenage suffering. The interior lives of 14-year-old girls are nowadays acknowledged and considered. It’s been a long time coming, but it’s progress. The difficulty now is in finding a way to address the problem. Or, as is so often the case, finding a way to recruit and retain the army of skilled professionals needed to address it. A paradox of the current era is that our understanding of how to help people with mental health difficulties has never been greater, while the infrastructure that ought to be providing such services has never been more stretched.

I’ve been sorting out my own mental health issues over the past year and a half, as long-suffering readers will know, after I was diagnosed last year with CPTSD – complex post-traumatic stress disorder. I’m lucky. I can afford – just about – high-quality psychotherapy in the private sector. Christ, I wish I’d had it at the age 14. It took me 50 years to realise that being duped and robbed of my gold christening bracelet the first time I ever left my home alone, at the age of three, was traumatic. Of that 50 years, only about 40 minutes was spent discussing the incident and taking part in the eye movement desensitisation therapy (EMDR) – a treatment aimed at expressing traumatic memories and turning them into ordinary ones – that finally allowed my ancient trauma to bugger off out of my brain’s amygdala.

The incident is a bad memory now, not a jumble of repressed feelings that fire up my fight-or-flight reaction every time they get a chance. And I count myself lucky. Early traumas can develop into pervasive personality disorders, some of them serious – such as narcissistic or antisocial personality disorder. Or a combination of both, which pretty much makes a person function as a psychopath.

Not long ago, when CPTSD hadn’t been recognised, sufferers sometimes used to be told they had borderline personality disorder (which is diagnosed far more frequently in women than in men). It’s not hard to understand why. Trauma, left untreated, tends to start colouring every emotion, encouraging hyperarousal at every turn. What’s more, you tend to keep on re-enacting early traumas in all sorts of situations, trying to replay the scene and get a better result. Which never happens. Instead, again and again, you hand over the metaphorical bracelet, along with another little bit of your selfhood. For me, a lifetime with a dodgy fight-or-flight mechanism meant a tin ear for danger and risk, leading, of course, to further trauma. EMDR continues, as and when. There’s still a big, messy pile of stuff to tidy up, and just sifting through it is a large task.

Early research suggests that EMDR is particularly effective in treating children. This makes sense, because you don’t really have to understand the context of your feelings too much to get them corralled off into a more sensible part of your mind. The case for timely intervention when trauma has been suffered is unanswerable, and EMDR should most certainly be part of the lexicon of possible treatments. On the NHS, however, I wouldn’t have got near EMDR, or even heard of it, and I doubt that many 14-year-olds would either. It’s very hard to get beyond your GP, for mental health issues. I know. I’ve tried. I’ve written about that before as well.

Having asked my GP to refer me to a psychiatrist, after a couple of new doses of trauma earlier this year, I was eventually seen by a social worker doing triage. He later arranged for a GP I’d never met to prescribe citalopram, an SSRI – selective serotonin reuptake inhibitor – with which I was entirely unfamiliar. I wrote about how powerfully my symptoms intensified in the first few days, and how unprepared I’d been for this, even though I’d read the instructions carefully and looked the drug up on the internet. I’m glad to say that in time the drug settled down quite nicely – as far as I know. Obviously, I didn’t keep a control copy of myself not taking citalopram, so who can say how I’d be doing now without it? I certainly don’t feel better now than I did before May, when I toppled so hard off the trauma-recovery bandwagon.

I am sure, however, that I feel entirely on my own with this drug, because I am, pretty much. The GP who referred me to the mental health team has moved on, so I have a new GP now. I still haven’t ever met or spoken to the GP who prescribed the pills. The mental health social worker did one follow-up call, said I didn’t reach the threshold for a psychiatric consultation and, with a passive-aggressive “Do you agree with us that this is the right thing to do?”, signed me off.

I said that I accepted, rather than agreed: not being privy to the full spectrum of other cases that my own was being weighed against. Because that’s the thing: the knowledge that there are so many people out there in need so much greater than mine, with resources so much less plentiful. I hope very much that I was stood down in favour of a 14-year-old girl, who is even now beginning to thrive.

• Deborah Orr is a Guardian columnist


Deborah Orr

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