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Nikki

Brief Outline: Nikki has had some very difficult times with mental health issues, including self-harm, and often felt that GPs didn’t listen or take her concerns seriously. Things started improving when she started college, made new friends and moved house. Campaigning for better mental health services has also helped.
Background: Nikki is a student and lives with her parents. Ethnic background / nationality: White British.

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As a child Nikki felt ‘quite unhappy’ because she was bullied, and had counselling at various times at school. At the age of fourteen a traumatic event caused a ‘massive downward spiral’. Nikki’s family and friends advised that she speak to someone about it – she eventually saw a GP but it took over six months to get the help she needed.

Nikki has ‘lost count’ of the number of GPs she has seen for mental health issues such as self-harming, and unfortunately most of her experiences have been very negative. The first 
GP she saw said her problems weren’t ‘severe enough’ and she would just have to ‘get on with it’. Other doctors advised that she should ‘go for a walk’ or ‘get some more exercise’. These suggestions didn’t help and Nikki felt ‘pushed away’ and ‘rejected’. At the time, her mental health felt ‘like the worst it could get’ and she wondered ‘how bad’ things would need to get before she was taken seriously and given support. 

Eventually Nikki told the school counsellor that she was also hearing voices and the counsellor advised her to see a GP. It wasn’t until she told the GP about the voices that her concerns were taken seriously. Nikki feels that, although what she was experiencing was as serious as self-harming, the doctors only took notice because they look for ‘particular buzzwords’ like hearing voices. 

More recently Nikki had what she believes was her ‘first ever’ positive experience with a GP. She met a female doctor who spoke to her ‘on her level’ and made her feel respected, which ‘made all the difference’. She felt that this GP genuinely wanted to help, was patient and took time to listen. The doctor let Nikki know what days she was working and told her that she could come and see her any time, even if she just wanted to have a chat. Nikki feels more comfortable speaking to a female doctor and that male GPs are less open to speaking about mental health. 

Nikki would like GPs to take mental health issues in young people seriously and understand that many young people are unable to tell them everything in ten minutes. They should ‘always assume there is more to it’ and ‘always provide them with something’, such as information about charities and helplines. Nikki would like GPs to know that it takes a lot of courage to see them about a mental health issue, that it is important to be patient and listen to these concerns with respect, and to remind young people that they can come back if they need to.

There have been a number of times when Nikki saw a GP with a parent and talked ‘a complete load of rubbish’ because she felt uncomfortable. She believes that doctors should ask young people whether they would like to speak to them by themselves if a parent has come to the appointment with them. 

When Nikki was self harming, including overdosing, she went to A&E (Accident and Emergency). She believes that A&E services could be improved in many ways, including having a specific service for mental health issues. 

After some very difficult years, things started improving for Nikki when she started college, made new friends and moved house. Campaigning for better mental health services has also helped, and Nikki now runs a peer support group too. She was diagnosed with emerging borderline personality disorder, and has found group counselling helpful.   

Nikki feels that it would be a good idea to have a weekly mental health clinic for young people so they wouldn’t feel as though someone with a physical problem is ‘more important’. She also thinks that a text messaging service could be helpful because some young people would find it ‘less daunting’ than speaking to a health professional.

For Nikki it is important that mental health is part of the school National Curriculum. At a young age she ‘didn’t have a clue’ that she could speak to a GP about mental health and feels that young people should be told about this as early as possible. Nikki now sees the GP every few months and has her medication reviewed. 

Nikki was involved in  'A film made by young people: Evolve - mental health and peer support' (See our resources section)
 

The first doctors Nikki saw seemed to care mainly about physical health. They weren’t ‘sensitive’ and she felt that their advice was ‘ridiculous’.

The first doctors Nikki saw seemed to care mainly about physical health. They weren’t ‘sensitive’ and she felt that their advice was ‘ridiculous’.

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I've always gotten ill a lot because I think it's because my immune system is quite weak.  I've always gotten ill, like I always get colds and stuff so I was always going to the GP to get like antibiotics or whatever. Yeah so I did, I've always gone to the doctors quite a lot.  I just don’t…no one's really interested in the other side of it when it comes to mental health; it's just physical health they care about mainly.

Do you think many young people know as well that they can talk to the GP about these things, or do they often think, 'Oh the GP's not going to be interested, it's not a physical problem.'

Yeah, I don’t think people have any idea.  I mean I didn’t have a clue that I could talk to my GP. But then even when I did…someone told me that I could, like GPs they're often quite… not sensitive about it. So I'd just be like, "Oh OK you can go for a walk or you can take this medication, what do you want?"  Like, it's just ridiculous. So I think, even though people have no idea, so they need to know that they can, but then at the same time GPs aren't very good at it.

So when you were going to see the GP for physical problems – coughs, colds, or any other things like that – were you usually going with your mum?

Yeah, I was going with like my mum or my dad or whoever, but yeah.

And what did you think about the GP at that point – just someone you see for physical problems, a short appointment, that kind of thing?

Yeah, I had no idea that their role was to deal with any issues; like I had no idea about that.  I just thought they was there only if you had an infection, and that’s it. And they just give you some…they just check that you actually have it so that you don’t like…so that people don’t just lie to get medication; then they give you some medication, then you leave.  I didn’t even know it was about other physical health issues; I just thought it was just for like infections and stuff.

So how could that be improved for younger people especially?

Well, if mental health was on the National Curriculum then they could say it through there, like you can tell them that they can go to their GP if it was on the National Curriculum I think.

So, in those lessons, just more awareness that people go to see the GP not just for physical problems, but all sorts of emotional problems?

Yeah.
 

Nikki didn’t care about anything and didn’t want to be alive. Other people suggested she see the GP but she thought they were trying to trick her into something.

Nikki didn’t care about anything and didn’t want to be alive. Other people suggested she see the GP but she thought they were trying to trick her into something.

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I think it was when I was fourteen I experienced a really traumatic event. And then after that like I just went completely sort of off the rails. And then like…I think it was my step-mum that said, "I'll take you to the GP." But that wasn’t because of the other stuff [bullying], it was just because like it was just a brand new thing. So, the other stuff it was all just like stuff buried inside of me that I just didn’t let out, and now…and there, this was this completely new thing. But there wasn’t a time when I thought, 'Right I can go and get help now.' It was just, yeah.

When the traumatic event happened, did you feel at that point, 'I've got to speak to somebody?' 

No, I didn’t. I didn’t even think of it then. I just thought, 'Do you know what, I should not be here. I clearly…everything is saying to me that I am just nothing here. I should not be here.' That’s all I was thinking. I wasn’t thinking, 'Right I should go and talk to someone.' I was just thinking, 'Right, how can I not be here.' It was other people that said like you need to talk to someone because they could just tell that I was just going completely downwards.

Who were the other people who thought you should speak to somebody?

Friends, different family members. They were just like, "You need to speak to someone."

Did you feel like listening to them or did you not at that stage, it was too difficult to even listen to what people suggest?

I didn’t really care about what they were saying. I was just thinking, 'You lot don’t want me here anyway, you're just trying to trick me into something,' so…but I did it to sort of shut them up. So, like I would go to these things but I would just think, 'Yeah whatever, I'm not interested.' And I would just…I just didn’t care really.
 

It’s hard to talk about feelings in a short appointment. There’s usually more behind the visit. GPs should give information about helplines and charities.

It’s hard to talk about feelings in a short appointment. There’s usually more behind the visit. GPs should give information about helplines and charities.

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Can you remember how many times you went to see the GP at all?

Oh I've lost count; I don’t know, just loads.

So what could have…what could they do, GPs, to improve the situation there?

They need to realise that people aren’t going to tell you everything in ten minutes. They're trying their best, like it takes a lot of courage to go to a GP and say, "Like this is sort of what I'm experiencing." So I would always say like don’t take like…what they're saying…always assume there's more to it and always provide them with something even if, you know, they're not going to get help through the NHS, then…like helplines, charities, something like…like just never just let someone walk away because that could be…it could be so bad like you just never see them again. Like you cannot ignore anyone.

So a young person comes to see the GP, they might not tell everything that they're thinking or feeling. So you would advise that there may be more behind the appointment?

There always is, yes.

There's always more behind the appointment. How can…what could a good GP do in these situations? Say their ten minutes is coming up and they’ve heard a little bit – is there anything else that they could do? So they could give telephone numbers of helplines; could they follow-up again, maybe phone the person or –

Yeah, I had a really good experience of a GP like a few months ago which was like my first ever good experience of a GP really. She was really, really nice. She spoke to me on my level, on my terms, and what she did was she said which day she worked at the practice. She said that I could go back whatever time if I just want to chat. I think maybe just remind the person that they can come back, like they're not a waste of time, yeah.
 

When young people want an appointment about their mental health, they should be seen quickly. It takes courage to ask for help. They’d only phone if they really needed it.

When young people want an appointment about their mental health, they should be seen quickly. It takes courage to ask for help. They’d only phone if they really needed it.

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How about making appointments – was it easy to phone up and make an appointment or was that sometimes off-putting or.... 

Yeah, sometimes it really was off-putting because sometimes like I needed to see a doctor, like I wanted to see them as soon as possible, and if you say…like if you say…if they say like, "Oh it's in a week's time" or something, then you say like, "No, I need to see someone sooner than that." They say, "Well why?" And then it's just like, “Oh no, what do I say now?” And you try and say like, “Oh it's…like it's like I'm stressed and stuff.” And they just sort of think, 'What are you on about?' and then they just say, "No, just come in a week." So they just…so that just sort of shows you that they don’t really care much. So it is really off-putting, yeah.

Is there any way that could be improved?

Yeah, because I think if someone's going to ring a GP and say like, "I really want an appointment about anything to do with mental health," then take it seriously. It takes a lot of courage and strength to get that far – don’t ignore it. Take that seriously and give them an appointment because clearly they need it otherwise they wouldn’t be [coughs] putting themselves out there to get, to try and get help.

And say somebody wanted to see the GP for mental health reasons, they might not feel comfortable to say the whole reason. So, if they say for a mental health reason, do you think that should be enough for them to think, 'Ah this is an emergency?'

Yeah, I think so, it should. Because people don’t go to GPs unless they're really struggling with their mental health. So I think if anyone ever says it's to do with their mental health, then it should be taken very seriously, because people just don’t go unless they really realise that they need to.
 

It’s hard to talk openly about depression and self-harm in front of parents and the GP. Doctors should ask young people about the help they need.

It’s hard to talk openly about depression and self-harm in front of parents and the GP. Doctors should ask young people about the help they need.

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Should the GP ask, "Would you like to speak by yourself?" or things like that. Any thoughts on that sort of thing?

I think definitely they should always ask like if they want…if the person wants to speak to the GP by themselves, because like there have been times when I've went with my parents…with one of my parents, and then I've talked a complete load of rubbish because I did not feel comfortable about talking about anything realistic at all. 

But then it, the times when I went by myself and that was still difficult as well. So I think the GP, or the health professional in general, should really just ask the young people what they feel like they need.
 

Nikki felt that the different GPs she saw didn’t take her concerns seriously. It was hard to ‘tell them everything in ten minutes’.

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Nikki felt that the different GPs she saw didn’t take her concerns seriously. It was hard to ‘tell them everything in ten minutes’.

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I think I saw quite a few different ones [GPs]. I think the first one I saw was a woman and she was nice. But she said like, "Your problems aren’t severe enough. We can't really help you. Like you just have to get on with it," sort of thing. But she referred me to like a charity but she said like, "We can't provide you with any support because it's nothing we can deal with, like you just have to get on with it," sort of thing. 

And I saw other GPs and they just sort of said like, "Why don’t you go for a walk?" Or, "Why don’t you get some more exercise?" Or, "Why don’t you take a couple of tablets and then you should be alright."

What did you think about that sort of advice?

I just thought, 'Right this is even more evidence to say that no one cares and I shouldn’t be here.' So it was just like if…I was just thinking like if this is how bad it is…like this is how bad it is, and you're being told this is the situation. And if that’s not bad enough, then how bad do I have to be to get help? Like this is like, it was like the worst it could get; they just didn’t…you can't tell them everything in ten minutes. So it was just like, this is the worst…how bad do you want me to be? Do you want me to be dead before you help me? Like it's just ridiculous. 
 

Knowing that there was one person that Nikki could talk to helped. She found it hard to trust a counsellor in 12 sessions. More time would have been better.

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Knowing that there was one person that Nikki could talk to helped. She found it hard to trust a counsellor in 12 sessions. More time would have been better.

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So when you were at school, at one point you saw a counsellor. Did that help in any way?

I think like sometimes it did because a lot of the time I felt really alone, like I had absolutely no one. So knowing that there was one person there that I could talk to once a week for a little while [coughs], that did really help because it made me feel like there was one person that wanted to listen. And that was, I think that probably helped a lot, but yeah. I can't remember what I was going to say, sorry.

So that helped. Did you feel that you could trust this other counsellor that you were talking to?

I didn’t feel I could trust them, but just knowing that there was someone there that was listening, even if I couldn’t trust them that helped a lot, just knowing that there is someone there. Because a lot of the time people just feel so like when they're being bullied, or there's issues at home and stuff, they just think, 'I'm completely on my own and no one cares about me at all.' So then knowing that…even if you don’t trust them, even if you can't talk to them – just knowing that there is someone there, it can be a lifesaver.

What would have helped to build a better trust with that person, what could have helped?

I think if I had more time. Like they give you a very short time period, which is absolutely ridiculous because people are different. They have different needs that are complex. To say like twelve weeks, this is what you get, like deal with your issues, now go, like it's ridiculous. So I think if I had more time to get to know her or something like that, then maybe it would have been more helpful.

To build that trust over time knowing that you didn’t just have a short slot.

Yeah.

And you could have as long as you needed.

Yeah.
 

It’s important to talk about mental health openly. When it’s discussed realistically in TV soaps, it can help people understand more about it.

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It’s important to talk about mental health openly. When it’s discussed realistically in TV soaps, it can help people understand more about it.

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I think there needs to be people going into different organisations like youth clubs, stuff like that, anything; or just like having …or like a high street having a store so that people can approach them and talk to them. Or like…or the people there can approach other people. Just having open conversations about mental health, it's like saying, "Oh hi like, what do you know about mental health; what do you know about mental illness; do you think you have mental health?" And if they say no then you say, "Oh we all have it, it’s like physical health..." It's just…it's really simple little things just like showing that mental health…it's OK to be open about it and talk about it.

How about on telly?

Yeah, I think that’s really important as well. I think what I found is that, especially with young people, like soaps, when they portray mental health stories, and when they do it like in a good way, that makes a huge difference. Like with Eastenders, Hollyoaks – when people there experience mental health issues, and then they get help, like in the soap or something like that, [loud background noises] that makes a huge difference. 

And people realise, 'Oh I can do that.' Like it's actually helped a lot of…like I think…but also on the other side, TV can portray in a really negative way and that can create more stigma. So I think the ones that have done it right, I think they’ve spoken to different charities about how they can portray their storyline in a realistic and fair way. And I think when TV shows do that, it helps a lot.
 

It might be daunting for people to go to a mental health clinic but reassuring to know that they’re ‘not going to be alone’.

It might be daunting for people to go to a mental health clinic but reassuring to know that they’re ‘not going to be alone’.

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What if they had specific clinics for mental health, so once a week or, you know, two hours in the evening, you know every few days. How would you feel about that?

I think that would be a really good idea. Like they need to do stuff like that cos they need to focus on it a little bit more because I think everyone's going to experience a mental health problem at some point in their life because that’s just really the nature of life. But I think they need to do stuff like that. 

It might be a bit daunting for people to go to it, but then at least they know that they're not going to be alone when they go there. It's not going to be like…they're not going to be compared to different people with physical health issues because it's just going to be like.... Like whenever I go to somewhere that’s the same for physical health, I always think, 'Oh, well they're going to see this person as more important than me.' So maybe when it's just for mental health, maybe people won't feel like that.
 

Nikki often found it hard to talk about mental health. She found an organisation that she could text and they’d text her back with coping strategies.

Nikki often found it hard to talk about mental health. She found an organisation that she could text and they’d text her back with coping strategies.

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Would any other ways be good for people, whether that’s being able to email a GP, or drop in clinics – anything like that?

Yeah I think… like a lot of the time people use social media, messaging and stuff, a lot. And one of the services I used to use, I could text them and that was like really, really helpful as a young person because I find it difficult to speak on the phone. Sometimes as well I find it difficult to speak to people face to face, so texting was really good. So I think maybe if they…it might be difficult to do but maybe if they like sort of made it a bit more relevant to young people, like texting or something, that would be really good.

Can you tell me what was really helpful with the texting? So with the organisation, could you text them a question or what would you…how did it all work that was good?

So I would text them if I needed something, if I forgot when the next appointment was, if I… if I needed some sort of support or anything. And then they would be really, really helpful and they'd say, "Why don’t you try this?" Like they would text like one of the coping strategies I could try for example. It just really helped because sometimes like you just…you can't get it out in words, like so it's just a lot less daunting to text sometimes.

So you could text how you were feeling and they would text back straight away?

As soon as they could, yeah.
 

If the opportunity came up, Nikki would be happy to run a support group at a GP surgery for young people going through mental health issues.

If the opportunity came up, Nikki would be happy to run a support group at a GP surgery for young people going through mental health issues.

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And the kind of peer support group that you run in the church, is that something you would feel interested in running in a GP's surgery if they were looking for people to run it?

Yeah.

Peer to peer support kind of thing.

Yeah. I mean I would be interested in doing pretty much anything because I just really want to help other young people or just anyone in general, regardless of age, to feel like they're not alone because no one is. Like I don’t…I hate it when someone comes to me and says that I feel really alone because it's just like…like I know how that feels and it's horrible. 

So I think I would run a peer support group at the doctor's surgery, anywhere that young people want it. Like anyone wants it because these sort of things really help; they make a difference and it's worth it then.
 

Telephone consultations are ‘a good compromise’ when someone needs a GP appointment but can’t get out of bed because of depression.

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Telephone consultations are ‘a good compromise’ when someone needs a GP appointment but can’t get out of bed because of depression.

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So you’ve never heard of telephone consultations?

No.

Would that sort of thing have been helpful or be helpful now?

Probably yeah because when you're really ill, sometimes you just don’t want to leave the house, and so you might miss an appointment or something like that, and that’s like really…that’s a good compromise like in the middle; like when you need to go but you can't feel able to get out of bed sometimes. So I think they should really promote that a bit more really, yeah.

So that you can phone in the morning and say, "Could I have a consultation with the GP?"

Yeah.

And then they, at that point, whatever time it is, they phone you back while you're at home.

Yeah.
 

GPs shouldn’t be afraid of asking people about mental health and self-harm. It’s hard for young people to talk about everything but there’s usually ‘more to it’.

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GPs shouldn’t be afraid of asking people about mental health and self-harm. It’s hard for young people to talk about everything but there’s usually ‘more to it’.

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I would just say like don’t be afraid to talk about it [mental health and self-harm] because I think a lot of the time doctors can be scared to say the wrong thing or whatever. But it's just like, just sort of like…it's just you don’t have to be afraid to talk about it because it might be a bit daunting asking someone, "Have you hurt yourself; how do you feel?" But if the person isn't comfortable talking about it, then they just won't and it's fine. It's better that they just ignore it. 

Like my advice would just be to just never ever ignore anything. If you're ever worried then go for it; just tell someone, like never ignore anything because that could be really dangerous. And I'd just say like always assume that there's more to what they're telling you because people are never going to be able to tell everyone their whole life story in a few minutes that they get with you, so just assume there's more to it. And just do what you can. Like, yeah just do what you can.

So when a young person is saying to their GP that they're hurting themselves, should the GP assume that there's much more behind that, and they're maybe hurting themselves more than what they're telling the GP?

Yeah, I think so. Like, or just be… assume that there is more to it. Like don’t just take what they're saying at face value. Like there's always going to be more to it. Like cos I mean if you was going to a GP you can't tell them everything in ten minutes, it's just not possible. So maybe if they gave you an hour or something, then you would…then you could take what they're saying and not assume there's more to it. I don’t know, like…but always just like think what else is there that I can help with. What else are they experiencing that I could potentially give them some support with like…yeah.
 

If you’re depressed it can help to write things down, or call or text the Samaritans. There are people who want to listen and help.

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If you’re depressed it can help to write things down, or call or text the Samaritans. There are people who want to listen and help.

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If you're feeling so depressed and you don’t want to talk to someone, like maybe try other ways – like write it down, send a text, call a completely anonymous people like Samaritans or something. Like there is…or whatever makes you feel better. Or I don’t know, listen to music, try and express it in some way, in a healthy way, and share with someone that you know is going to listen to you. 

There is people that will listen to you always; you might not know it but there are. And just please remember that you're worth so much more than whatever it is you're going through, and you can…you're strong enough to beat it.
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