Age at interview: 39
Brief Outline: Mandie became severely depressed and found that anti-depressant medication did not work for her. She felt unsupported by the NHS and had a long wait for talking therapy. Mandie considered having ECT when nothing was working, but she decided against it.
Background: Mandie is married, works as a business coach, has two children and described her ethnic background as White British.

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Mandie said that things in her life felt that they were going well. She had a daughter in December 2003, had just moved into a new house and her husband had a good job so she said that things were going ‘really nicely’. However things changed. One evening she witnessed her cat being run over and the next day she just carried on as normal. She was due to go on holiday to France and she remembers she panicked about going on a boat, something she had previously not worried about. She realised she felt highly nervous all holiday. Eventually she went to the doctor as she felt there was something ‘really wrong’ and she was prescribed anti-depressants. Mandie then went into a “bad place” where her weight fluctuated. She was prescribed more and more medication, and she began to self-harm. She felt the drugs made her worse and she tried to kill herself on a couple of occasions. 

Mandie went to her GP and asked for talking therapies. She was put on a long waiting list and nothing happened. Her health declined significantly during this period. She found she was fearful of everything in the house. Mandie went to a charity to help her deal with a very severe phobia of spiders which made her life difficult. However she felt there was an underlying issue that wasn’t being addressed. She felt she was ruining the lives of the people around her. Anti-depressant medication wasn’t effective and in addition she put on a great deal of weight. 

Mandie felt desperate for some improvement around the time ECT was suggested to her. She researched it and found a lot of evidence for and against it. She really wanted to have the treatment and felt she couldn’t afford private talking therapies. She discussed it with her husband and thought she would go and talk to staff about it. She found the hospital a terrifying place and when she walked in she saw someone being manhandled. The hospital said that she would have to stay in after her treatment but the her husband felt that seeing the kids and him was the one of the only reasons she was still alive. Mandie felt staff at the hospital didn’t relate to her as a person and they both left having decided against ECT. She felt unsupported by a mental health team who offered her drugs but no other support. However, through a charity she accessed counselling and found she slowly improved. She had a ten-week course of therapy through the NHS 14 months after she had asked for it. She found that type of therapy difficult, and different to the CBT she was having through a charity.  

Mandie was scared that “bits of her mind” would go if she had ECT. She was concerned she would no longer be herself. Mandie had little information about ECT from the NHS but managed to do her own research. Even nine years later, she still felt relieved she didn’t have ECT. Mandie would like a health service that provided a supportive environment, where someone would be available to talk to and would understand. She felt that ECT is offered to too many people, and that they might feel like it’s their only option.

Mandie was prepared to have ECT 9 years ago after doing some research, but visited the hospital and found it scary. Even now when she drives past the hospital she is relieved that she didn’t go there.

No, I was given no help by the NHS. I really feel that they’re on their own agenda, and you’ve got to fit in their little box. And if you won’t fit in their little box, “Then we can’t help you.” Well, people don’t fit into boxes. You know, we are all, you know, incredibly unique and different. So, no, I got all my research offline. As I say, I was looking at Harvard research papers, and Sweden’s got a very good reputation for a lot of, mental health stuff, as has parts of Australia. So, I was reading up about, round the world, and, you know, how they were using it. And that was what was driving my desire to go forward with it. Not really what they said. No, they weren’t really, they didn’t really explain it, to be perfectly honest.

And then, obviously, it wasn’t so, it wasn’t so much the treatment that put you off as the surroundings…

The environment.

…and the aftercare that was offered?

Very, very scary environment, yes. I mean, I have to drive past the hospital quite often, and I have this sense of relief, you know, nine years later, that I didn’t go in that place. Yes. I just remember going in there, and it just was not inviting, at all. It just instantly was, and the people in there weren’t particularly, I was expect-, I suppose I was expecting someone to be very ‘hold your hand’ kind of attitude, “Come on now. I know you’re in a bad place. Let’s, let’s sit down and talk about your options here, and why we’re considering this option for you, and why we feel it could be the right move forward.” But it wasn’t. It was very, “Well, you know, this is what’s on the table. If you take it, you take it. If you don’t, you don’t. And if you don’t, there’s nothing we can offer you.” “Oh, thanks very much” you know. I, as I said, I’ve said before, I was actually told by, one of the mental health team, that as far as they were concerned. And my father had come to this appointment with me, and it was just before I was going to go for the ECT, because they were desperate for me not to do it too, so I was going against the whole family, I’m part of a close family. And he said to the doctor, “There must be something you can do.” And she said, “You must remember as far as the NHS is concerned, it’s classed, the British NHS is a sinking ship, and even the rats are leaving.” And that’s what they told a mentally ill person. Which is nice [laugh]. “Thanks for that,” [laugh]. “What country do you suggest then?”
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Mandie wishes she had “stopped listening” to the NHS sooner and she doesn’t think they “listen to the individual“. She decided not to have ECT and made a recovery without it.

And again you said that you made a recovery and that recovery took some time. In retrospect, do you feel you made the right decision not to have the ECT at that time?

Yes, yes, I just wished, ironically, I wished I’d stopped listening to the NHS, earlier. I wish I’d really listened to myself earlier. When you’ve got a mental health illness, you can’t listen to yourself, because you’re, you don’t know what you trust about what you’re saying. But, so I suppose I had to get, that low and feel completely out of options, to go the direction I did. But, no, I think I would have got better a lot quicker if I had not listened to the NHS, a lot sooner. 

I just do feel very strongly, that I’ve had experience of it, on many occasions, with friends and members of family now, and with myself, and the NHS is not learning its lessons. And it isn’t about money, I really don’t think it’s about money. I think it’s sitting down and listening to that individual, and understanding that person better. Because if we, if services become, “Well, we listen to the individual” then I think we’ll get a higher success rate, there’ll be less drugs being handed out, with far fewer side effects. So, it will be a less strain on the NHS, and people will be healthier, and hopefully we’ll lose less people, to illnesses that we just shouldn’t be.

Yes, and I think that kind of goes back to what you were saying about the time when you were thinking about ECT and looking at having ECT, that you felt you weren’t being treated as an individual?

Not at all. I in fact, just saying that, reminds me I used to say, “You’re just trying to put me in a box all the time. I don’t fit your box. 

Mandie turned down ECT because she didn’t want to be admitted to hospital. She was put off by seeing the ward and felt she would be better off at home with her children.

And it was my husband that convinced me out of it. I think the main reason he convinced me out of it on that day, there and then, rather than us coming home, was because the hospital was set up in such an unpleasant way. It was just an instantly frightening environment, you know, there was gates and locks. I remember walking in, and I’ll never forget this to the day I die, there was a woman being manhandled, by three people, and she was screaming at the top of their voices. And she was the first thing I saw as, and the reception just ignored her, and she just said, “Can I help you?” “Not really.” And I was already panicking, sorry, already panicking, thinking, “Oh, I can’t be in this place, I can’t be in this place.” And then we went in and she said, “Well, let’s come and have a talk about it.” And so my husband sat and talked to this woman. And I think, it all got a bit bizarre really, because they said, “Well, when, as she has this treatment, she won’t be allowed to come home.” And that’s what really annoyed my husband, because he said, “The only thing that’s keeping Mandie alive is me, her love for me, and her children. She feels, she loves her kids but, you know, there’s no connection.” And, and he said, you know, “If you take her away from her kids, you’re taking away the only reason she has to live.” 

And I remember thinking, “But I walk on the beach every day.” However tough a day it was, I would take the kids for a walk on the beach, even if it was for five minutes, throw a few stones in the sea. It, and it didn’t feel good, but I knew I was doing the right things. And I thought, “But you’re going to lock me in a room. How is that going to help?” “Oh, because we have to monitor the drugs you have to take, and all.” So I could understand that. And so then we said, “Well, what about if?” Because we were still going through this, “Well, let’s go for this.” So, we were saying, “Well, what about if we took Mandie, if, I’ll bring Mandie in at 4 o’clock in the morning, if you like, so she can have her medicines, and then we’ll take her home again. So you can monitor, and make sure her heart’s coping, and all the rest of it.” And they said, “Well, no, she needs to be here to be part of the therapy.” We said, “Well, what therapy?” And they said, “Well, during the day she’ll get to do some art.” And that’s when it all went a bit bizarre really, because that’s when they lost us, because we went, “Art?” And he, “Yes, and she can make things.” And [husband’s name] went, “Well, do you make a basket perhaps?” And he said, “Well, no, because it’s good for them to have therapy.” And he said, “Right, so you want her to sit in a room with people like that woman out there doing art as opposed to a 2-year-old, and a 4-year-old doing art?” And that’s when we, they lost us, because they had no connection with me as a person. They didn’t want to listen to who I was, they didn’t want to listen to what helped me, or had been helping me, for over a year. They just wanted to do what they wanted to do, in the environment they wanted to do it.

Mandie described different approaches taken by counsellors and psychotherapists. Psychotherapy on the NHS came too late for her and “[ripped her] open”, whereas counselling was “looking for solutions”.

But, you also said, that you’d been waiting for psychological therapy and, but you didn’t actually have that?

Ironically, I finally accessed the NHS’s psychological therapy, I was offered a ten-week course, just as I knew I was getting better. And I remember phoning them up and saying, “Look, I’m not being funny, I’ve waited like fourteen months for this. This would have been good, a long time ago.” And they said, “Well, if you turn this down, and if you ever got ill again, you wouldn’t get any help.” And so I then, went through their therapy as well, at the same time, which was really difficult, really, because they had a very different, their approach was looking back, and, “Where in your past has this been caused by?” Whereas the counselling with the CBT, and CAT, was very much about looking for the solutions, to help me adjust my thinking, so I could live in a better place. I mean I think the first thing the charity did, was they helped me understand that this is an illness, this isn’t me being lazy, or selfish, or can’t be bothered to clean up the house, or something, this is me. They used the analogy all the time, “This is like a broken leg. You wouldn’t try and drive a car with a broken leg. Stop trying to do it now.” And the NHS’s therapy, I remember saying to her one day, I said to her, “I’m sorry, but I’m finding this harrowing.” And she went, “Harrowing? That’s interesting. Do you know what the word harrowing means? Do you know what harrow means?” I said, “Well, it means to dig deep and break things up.” And she said, “Well, harrow does.” She said, “It means to turn the soil completely over.” I said, “Yes, you’re ripping me open, and opening me up.” And what was interesting, was at the end of the ten weeks, they kind of went, “Right, we’ve gone really deep.” And I went, “Yes, but you’ve broken me open. You’ve not fixed me.” “Well, you’ve had your ten sessions.” “Right, okay, well, I must be fixed then.” Whereas with the charity it was never, there wasn’t, I wasn’t on their agenda, they were on my agenda.
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