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Siobhan

Brief Outline: Siobhan went to see the GP because of problems with eating, low mood and self-harm, but found it hard to talk about her feelings to someone she hardly knew. She advised GPs not to ‘just give young people leaflets and put them on tablets’ if they had depression but to offer other options too. She was having online CBT as well as taking medication, and had started feeling better.
Background: Siobhan is doing her A Levels, and voluntary work in her free time. She lives with her parents. Ethnic background / nationality: White British.

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Siobhan went to see the GP because of problems with eating, low mood and self-harm. She found it hard to talk to a stranger about ‘making herself ill’ after eating, and felt that doctors were ‘quite official’ and ‘don’t really show any empathy’. She sometimes found appointments daunting because she felt that GPs were formal – they often wore suits and ties, used medical jargon and seemed ‘a bit like teachers’. Siobhan had seen a few different GPs and had become ‘bored of repeating’ herself and ‘filling out questionnaires’. 

Siobhan’s brother, who she is close to, went with her to the first appointment and helped her ‘find the words’ to talk to the GP. The doctor told her that she was depressed and that depression was treatable. He prescribed her tablets, which Siobhan said helped after several weeks of taking them. During that time, she went back and forth to the surgery and the dose was increased. 

The GP told Siobhan about local counselling services and she chose online CBT (Cognitive Behavioural Therapy). Siobhan also talked to one of her teachers about her feelings, who told her that she could leave a lesson if she needed to answer phone calls related to her counselling or if they were studying depression. Siobhan hadn’t talked to her parents as her mum was quite ill and her dad was under a lot of stress. She talked to close friends instead and found them helpful. She also contacted the Samaritans, and preferred texting to talking over the phone. Volunteering at a local charity also helped. 

At the time of interview, Siobhan was feeling better than before. She advised young people to be patient and continue taking medication even if it seemed to make little difference at first. She advised GPs to read patients’ notes before they come in, and not to ‘overcomplicate things’ or give young people too much information. In terms of mental health she said, ‘Don’t just give young people leaflets and put them on tablets. Offer them other things too.’
 

Siobhan’s brother found out that she’d been making herself sick. He told her that a doctor could help. Seeing the GP with him was easier than going on her own.

Siobhan’s brother found out that she’d been making herself sick. He told her that a doctor could help. Seeing the GP with him was easier than going on her own.

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About two years ago, I went cos like I was really struggling with my eating and my weight. So I went about like cos I was, after I’d eaten a meal, I was like making myself throw up. So I went about getting help with that. But I hadn’t lost enough weight for him to put me in the system yet. And then a few weeks ago I went with low mood and were diagnosed with depression and anxiety.

And when you went to see him that first time, did you go by yourself or did you go with your mum?

My brother took me.

Your brother took you?

Yeah.

Did you want your brother to come with you?

Yeah, my brother’s like the person I’d go to with anything.

So you felt more comfortable, a bit more reassured going with him?

Yeah.

Is he an older brother or younger?

Yeah, he’s older.

So did you feel comfortable talking to your brother, “I think I need to go to the doctors”? Or did other people say, “Oh I think you need to go”? How did that all happen?

My brother had found out like what I were doing. And he were like, “I think you need to go and do, like just get sorted out and see what they can do for you. Cos there are things that can help to make you better.” So he sort of pushed me to it. But he didn’t like force me. It were more my decision to go.

So he was the only one who knew at the time?

Yeah.

And he came with you?

[mhm]

So that made you feel a bit better, not a huge -

Yeah, not shitting it.
 

The antidepressants took 6 or 7 weeks to start working. It’s important to be patient and not miss a dose.

The antidepressants took 6 or 7 weeks to start working. It’s important to be patient and not miss a dose.

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For the first four weeks it was one 50 milligram every day. And then a few weeks ago it went to 100 milligram every day.

Did you feel that they were helping at all?

I do now, but not at the beginning. Like when I first went on them I couldn’t notice a difference at all like. But those particular tablets in some people can cause like worse self-harm thoughts or suicide thoughts at first until they kick in properly.

And did you feel that’s what was happening? Or did you feel like --

Yeah, like --

-- changes or?

Before I went on the tablets I was self-harming but it wasn’t really bad. It was sort of capable, copable. Is that a word? Copable, yeah.

Yeah, manageable.

Yeah, manageable. After that like, when I were on tablets for a few weeks, like it started getting worse. But I’d wake up in the morning thinking, “I need to self-harm today.”

And when you were thinking about self-harm, was it like being sick and.... 

Some of it was being sick, some of it was like cutting.

And could you, when you were at home, did you talk much to your brother? Or did you feel you just didn’t wanna talk to other people?

I didn’t wanna talk about it. I just wanted to stay in bed and, not really with anyone, just be left alone to stay in bed and sit and just think.

And if someone else was in that very same situation that you were in, is there any, now, any advice that you would give them?

Just stick it out cos the tablets do kick in eventually. But they do take a while. So you’ve just got to stick with it as long as you can.

And how long did it take in your case?

Six or seven weeks for them to properly kick in. Like they’ve only just started working properly.

So it could be as much as six or seven weeks?

[mhm]

Just be patient with it.

Yeah. Don’t forget a dose either. Cos I have to set reminders on my phone to make me take them, cos I’m crap with remembering stuff. 
 

Siobhan would like it if her local surgery offered implants. The sexual health clinic does but is only open at certain times and is further away.

Siobhan would like it if her local surgery offered implants. The sexual health clinic does but is only open at certain times and is further away.

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Would it help if they had like a clinic just for young people?

I think that would be really good cos like the doctors would be used to working with young people more often. And it wouldn’t be so varied in what age they’re looking at. So they’d be able to use young person-friendly terms and work with them in a better way.

And how about if there was a drop-in clinic for young people? Like on say Tuesdays, 5 to 8pm is a clinic for young people. Do you think that would help?

Yeah, that would be really good cos obviously you can get there. Like when I were getting my contraceptive pills, like I couldn’t get the implant in because of the times the drop-in sessions were open at the sexual health clinic. Cos they were open at such difficult hours, like it was Tuesday, 12 till 3.

The

Sexual health clinic in [place name]. Like obviously I can’t get there at that time. So I can’t have the implant in my arm, so I have to stay on the pills.

So would you ever go to the GP for that?

I went to the GP first about it cos they put me on the Pill. But they said, “We don’t do the implant here. You’ll need to go to this place.” And it’s like, “Have you seen what times it’s open, you poo? I can’t go there, can I?”

Every day the same time?

Every day the same time, 12 till 3. And then I think it’s 8 till 10. But cos it’s in the middle of town and my school’s in [place name], it’s like, “Well, no.”

Would it be better if your GP’s surgery did that then?

Yeah, it would be a lot better. Cos then I could just go, have it in, and then I can, without having to prat about going into town and things like that. Or having to get a repeat prescription for the Pill as well as my like Serchiline.

So if you went to the GP for the, like the Pill, would you prefer to see the GP or one of the nurses?

I think I’d like to see like probably a female doctor first. Cos I specifically asked for a female doctor when I had that appointment.

Did you get a female doctor?

Yeah, I did that time. And then after that maybe like the nurse to administer the implant or whatever.

So that’s a bit inconvenient, isn’t it? So you really have to plan ahead in a way?

Yeah, I was gonna go and have the implant in my arm. But I have to book it for like holiday time, cos they don’t open on a weekend either.
 

Siobhan needs an appointment before she goes on holiday but getting one when she’s free is hard. If the surgery was open longer, she could see the GP and get all her jobs done.

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Siobhan needs an appointment before she goes on holiday but getting one when she’s free is hard. If the surgery was open longer, she could see the GP and get all her jobs done.

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Most of the time if you needed to see your GP, even if you have to wait a bit --

[mhm]

-- you could go and see the GP?

Yeah, most of the time.

What’s the longest time you’ve ever had to wait to get an appointment?

I’m still waiting for one [laughs]. After the woman on the online CBT said probably four weeks ago I need to get one, I’ve just not been able to get one. Cos I’ve not been off school, and I’ve been here on work experience or volunteering.

So four, it’s taking four weeks or more than four weeks?

Yeah, just to find an appointment that I can make. Cos I go on holiday in a few weeks, so I need an appointment before that to make sure I’ve got a stock of tablets for two weeks.

So actually finding it open --

Yeah.

-- at a time that you’re not at school?

Yeah, or like working or whatever. Cos I’m looking for a job as well at the minute. So obviously I’ve got, I’ve like put time in my afternoon or my evenings to look for that.

So really it would be really handy if your surgery was open till 8 in the evenings or something?

Yeah.

Or even 9?

Yeah.

That would make quite a big difference, wouldn’t it?

Yeah, cos like I can still do everything I need to do that day, but then I can make sure that I’m looking after myself as well. Not just going a hundred mile an hour like I normally do.
 

It’s hard to talk about mental health to a stranger when you’re 14. Siobhan hardly knew the GP. Doctors can come across as ‘official’ rather than empathetic.

It’s hard to talk about mental health to a stranger when you’re 14. Siobhan hardly knew the GP. Doctors can come across as ‘official’ rather than empathetic.

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When you went the first time with your brother, did he come in the room with you as well?

Yeah, he were in there with me. Cos like I were a bit nervous. It were the first time I’d been with like a mental health issue.

So did you find it easier, easy to talk to the doctor? Or did you feel it hard to actually say everything that you wanted to say or…?

Yeah, I find it difficult to like talk just openly for the first time to like a stranger. Like that’s getting easier. But just to like go, “Well, I can’t eat a meal without wanting to, you know, make myself ill.” So that were difficult cos I was maybe like 14 at the time. So that was --

That’s pretty hard, isn’t it --

Yeah.

-- to talk openly to a complete stranger?

Yeah, cos that, that was really quite official, like they don’t really show any empathy. Cos they’re like focused on the job and that.

And your brother was there. Did he say anything as well? Or he sat quietly and listened?

Like when I were struggling for words and that, he helped. Cos I’ve, like struggle with my words. Like it’s almost dyslexia, but it’s not. So he helps me with like what word I’m looking for sometimes.

So that was a help?

Yeah. Or if I don’t wanna say a certain word cos I don’t like it and things like that, he’d like butt in for me. Or if I’ve not said summat that he thought was important, he’d say it.
 

The GP that Siobhan liked was smiley, happy and empathetic. It can be daunting seeing a doctor on your own and talking about mental health.

The GP that Siobhan liked was smiley, happy and empathetic. It can be daunting seeing a doctor on your own and talking about mental health.

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Were you seeing the same one [GP]?

Yeah, the first time round. But the more recent time I’ve been, it’s been a different doctor every time. So the time before I had the same doctor, but she went on maternity and never came back.

Oh right. And that’s the one you liked?

Yeah.

What was nice about her?

She were just always, like, if I were having like a crap day, she’d just be dead smiley and happy. And like she’ll just do, like the doctor, the male doctor I’ve seen in there, he just sort of looks at his keyboard when I say summat rather than looking at me. So she like always kept her eyes on me and made notes after I’d left.

So you feel that she listened more --

Yeah.

-- and gave you the attention that she’s listening and, you know, all of that?

Yeah.

What would you say make, are the qualities that make a good doctor? So a few things you’ve mentioned....

I think like empathy with people, like especially with like mental health difficulties. Cos it’s difficult to talk about that kind of stuff for the first time, especially as a young person. And if you’re all on your own as well, be like, realise that that’s probably really scary for you to go on your own and talk about everything that’s going on. And just to be happy and not grumpy.
 

Siobhan’s uncomfortable with talking about her feelings. The online CBT sessions are 40 minutes each and all she needs is internet access.

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Siobhan’s uncomfortable with talking about her feelings. The online CBT sessions are 40 minutes each and all she needs is internet access.

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And you mentioned that, was it through the doctor that a counsellor got in touch with you and said, “Do you want to do the online CBT (Cognitive Behavioural Therapy)?”

Yeah, the doctor said that there’s an onsite counsellor who they were gonna send me to. But that took a few weeks to get the appointment cos she only works Tuesdays till like 4 o’clock and I have school. So I had to book it for holiday times. And I went to see her and she like gave me the leaflet about IAPTs [Improving Access to Psychological Therapies] and what options there are and stuff like that, about what I can do. And just told me about different types of CBT, like face to face, online, like workshops that you can do in town and things like that.

Did you only see her the once then?

Yeah, I’ve not seen her since.

So she just told you about all the different options?

Yeah, then she just called me to ask me what I wanted to do.

And you felt that the online would be best for you?

 [mhm] Yeah.

Would you like to try any of the others? Or do you think, “No, this is the one that’s best for me”?

I think the online one’s one of the better ones for me. Cos I’m not very good at just like when people go, “And how did that make you feel?” I’m like, “Well, I don’t know.” So, and like with the workshops, it’s a big group and having to just blurt it out. It would be like, “No, I’m not going to a support group. I’m not going to bloody ‘self-harmers anonymous’.”

And the online, can you do that any time or..?

Yeah, as long as I’ve got an Internet connection I can do it. But you’ve got to have headphones cos it talks. But it takes like about 40 minutes, so obviously I’ve got to have that chunk of time free.
 

The counsellor told Sophie about the Samaritans. She prefers texting to phoning so she can think about and get her words right. She got a reply 10 minutes later.

The counsellor told Sophie about the Samaritans. She prefers texting to phoning so she can think about and get her words right. She got a reply 10 minutes later.

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The counsellor person who I saw, she gave me the texting number for Samaritans, which has been helpful.

Oh that’s good. A few people have mentioned that actually. So with the Samaritans, did you phone them or..?

I text them for that. Cos again it’s talking. I don’t like doing it. So I’d rather send a text so I can get my words right. Cos Autocorrect tells me what word I want.

That’s a really good point.

Yeah.

So you just text them. And did someone text you back straight away?

It were about a 10 minute delay but they did text back. But they said to me like the phone calls get priority over the text number, but they will get back to you.

And so you could text what you were thinking and --

[mhm] Yeah.

-- then someone would, would --

Yeah, they’d say like, “How can I help you? It’s completely confidential etc.” Like you then explain and they say like, “Oh, that’s really shit” or whatever. “What’s been going on to make you feel that way?” And things like that.

And would they actually give advice or suggestions or anything?

I think they’re more just someone to talk to over a text like. Rather than going, “Well, you could do this, you could do that.” Just like, “That’s shit.” And then they’d go. Just someone to like let your problems out to and who were just confidential. And they’re like volunteering to do it, so you know that they want to listen.
 

It would have been helpful if the school nurse had more mental health training. She gave Siobhan coping strategies for when she felt like self-harming.

It would have been helpful if the school nurse had more mental health training. She gave Siobhan coping strategies for when she felt like self-harming.

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How was the school nurse?

She was okay. But I think her job role, like the training she’s had, it’s more around sexual health, especially in a school environment, rather than like being in the mental health sort of area, which is quite common in schools because of exam stress and that. But she was good, she was really nice. But like she did all she could, but like, she was setting homework and stuff like that for me to do, like the CBT stuff does. It’s like, “Have you done your projects?” I’m like, “No, of course I haven’t. I’ve got more stuff to do than bake a bloody cake.”

So how could she have been better? Like knowing more about mental health issues?

I think she just needs training in how to deliver mental health therapy. Cos obviously she can’t diagnose things. She was having to say, “You need to go to your GP. You could do with going to your GP” like every week. But I was really scared to go about my depression and anxiety. She was the first person I went to.

Oh, before you even went to the GP?

Yeah, she was the one who like said, “You need to go to the GP now.” But she was like good at giving me like temporary coping strategies and things like that. But she wasn’t specifically trained in general practice. It was like how to deal with young people and sexual health in young people I think mainly.

When she like gave you some techniques --

Yeah.

-- did you use them? Did they help in any way?

I tried them. Like she said, “If you feel like you need to self-harm, just leave it 5 minutes, then leave it another 5 minutes.” But ob-, I found that difficult cos when I’m gonna self-harm it’s obvi-, it’s normally at a point where I’m doing nothing and I’m just like in my own head. So often leaving it 5 minutes can feel like leaving it 3 hours.
 

Siobhan usually books appointments online when she’s at school. Extended opening would allow her to finish her homework after school and then see the GP.

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Siobhan usually books appointments online when she’s at school. Extended opening would allow her to finish her homework after school and then see the GP.

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It opens at 8 o’clock and appointments are released at half 8. I have to be in school for 9. And then the appointments in the afternoon are released at 3 o’clock. And I don’t get home till 4.

So what could be done to improve that? How would it be better hours- wise?

Yeah.

Open later?

Yeah, I think if like, staying open a bit later or having weekend appointments. But they’ve got like an online booking thing. But there’s only like a few appointments released on that at any time. So I think maybe having more appointments available on the online bit. Cos that’s what I’ve been using to book my appointments rather than going in. Cos I can book them in school then.

Oh right.

Get --

So you can just get on the computer?

Yeah, and book it. So that’s a lot easier to book it. So I think there needs to be like more appointments available through that system.

More choice, more choice of times?

Yeah. Like when I’ve looked, it’s always been 10 o’clock on a Wednesday. I can’t do that obviously.

And does it say which doctor you will see? Or just the appointment and then you would see which doctor’s there?

Sometimes it says which doctor. But often it’s just one particular doctor that has online appointments. Like you don’t always have the same one every time. And if you want a certain doctor, it can take ages to get it on the online appointments thing.

So really it would, if they were open say till 8 o’clock or something like that, would that --

Yeah.

-- be much better? Because you’re not missing any sixth form --

Yeah.

-- lessons and --

If like, cos I sometimes revise or do my homework as soon as I get home so I can relax for the rest of the evening. That gives me time to finish off whatever I need to do. Go there, and then I can just go and sit in bed and watch TV.
 

The worst part about having a mental health problem was the reactions of some friends. It would help if GPs and counsellors told people that this could happen.

The worst part about having a mental health problem was the reactions of some friends. It would help if GPs and counsellors told people that this could happen.

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I think the worst part for me about having a mental health problem is, like when I’ve told people and I’ve seen their faces. And like some of my friends who I thought I was close to were accusing me of attention seeking. So obviously like the stigma was really difficult to cope with. Cos it was that stigma of attention seeking, not being really ill.

So that’s really hard, isn’t it?

I think that were the hardest thing for me to have to cope with at the time. And as well like cos I was like making myself throw up, it’s like my teeth aren’t very good. Like they’ve got a bit of yellow in, which just doesn’t go, because like they’ve got a bit of like stomach acid and things like that. So people would say like, “Oh, you don’t brush your teeth, you scrut.” I’m like, “I do, but it doesn’t go.” So that’s like cos the eating disorder was because of like body image problems, it’s been difficult to cope with things like stigma, attention seeking or whatever.

So they didn’t really know much about it?

I think they know about it. They just don’t really cover it during like sessions sort of thing. 

So what would be, do you think, what could be helpful, a good way of like raising awareness, telling people more about these kinds of things?

I think like just saying, “Look, you might experience stigma from people who don’t understand or haven’t gone through a mental health problem.” But 1 in 4 people will experience a mental health problem, whether directly or indirectly. So at some point in their lives they’re gonna have to learn to understand mental health. So you’re just gonna have to learn to stick it out and cope with it and find someone who you can really open up about how the stigma is affecting you.
 

Young people sometimes find it easier to talk online than in person. Talking to a GP can feel daunting. Siobhan liked the idea of an online chat room.

Young people sometimes find it easier to talk online than in person. Talking to a GP can feel daunting. Siobhan liked the idea of an online chat room.

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I found out like the other day that there’s this, it’s like a chat room but with doctors. And you can like, they’re all certified. I think it’s in Sweden or summat like that. But you can talk to a doctor like 24 hours a day and get advice with that. Cos like sometimes young people in particular find it easier to talk over a computer cos there’s a barrier. So . . .

So that would be good? Like a chat room where you can ask a question 

[mhm]

-- but the person is qualified to answer the question?

Yeah.

You would find that helpful?

Yeah.

And say that service had been around then, when you were 14, do you think you would have used it if you’d known about it?

Yeah, that would probably be the first thing I’d do. Like cos sometimes like I find it, cos I find it difficult to talk face-to-face situations. And doctors are always in a suit and tie. And that’s quite daunting I think. It’s, I feel like it’s going to a teacher sometimes.

So it’s sort of feeling like an authority figure there?

Yeah.

So say there was an option like that at that time when you could have emailed the doctor before the appointment to say everything that was on your mind.

Yeah.

Would that have been easier rather than having to talk about it?

To an extent, yeah. Cos like if you go in after, they are gonna ask you questions about it. And sometimes like I feel like they’re being nosy even though I know they’re just doing their job. But I do think it would be good to be able to just put a summary of what you’re coming about, rather than just going, “What’s up with you?”
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