No help from the psychiatry department

National Health Service no longer helps with bereavement

Joan came to see me last week.

She has been a patient of mine for twenty years but I do not see much of her. Two pregnancies, a fractured wrist after a skiing accident. That is about it. I saw her more often for minor problems with her two children.

Seven months ago, her sixteen year old daughter, Sally, was killed in a road traffic accident. Her son was in the car but was not hurt.

The loss of a child is the hardest bereavement of all. The death of a parent is in the natural course of things and usually by the time it happens we are to some extent prepared for it. But we are never prepared for the death of our children.

I saw Joan shortly after the accident and before the funeral. She wanted some medication to "see me through the funeral". She said, "I don't want to let Sally down." By which she meant that she did not want to cry at the funeral, she did not want to show any emotion.

The English are not very good at emotion. "Stiff upper lip, old chap, eh?" is often the approach. We could learn a lot from the Greeks and the Spanish where public grieving is an accepted part of bereavement.

I saw Joan a few times. She flatly refused counselling. She is an old cynic. She said, "God, no, not for me. One of the troubles with this bloody country is that you have to see a counsellor these days if you sneeze."

We laughed about that and talked some more.

I did not see her again until last week. She came in looking tired. I did not say anything. She sat down and looked me in the face and said, "I'm not coping."

Again we talked. A friend of hers had said she ought to go to the doctor and "get some Prozac".

When I started as a GP the world and his wife, usually the wife actually, was taking Valium. It took years to wean patients off it. Prozac has now taken over. There is a tendency for people to jump into a bottle of Prozac after the slightest upset. It is prescribed far too frequently, and often inappropriately. It has a role in the treatment of depression, maybe a valuable role. It is not a panacea for the problems of the world.

Joan is not clinically depressed. She is missing Sally. She still has not sorted out her bedroom and her clothes. Her husband deals with it by not dealing with it. He does not talk about it and he most certainly does not "do" doctors. I never see him.

Joan needs counselling. We used to have two counsellors in the health centre. But these were taken away from us because of financial cuts. The local psychiatric department is hopelessly unhelpful. Complaints to them about the lack of counselling services are met with, "This is not something the NHS should deal with. Send them to CRUSE."

CRUSE is an excellent organisation, but because the failings of the psychiatric services, they now have a waiting list themselves. And in any case, should the NHS be passing the buck to a charity?

So I shall jiggle around the time, and see Joan myself. She is not mad. She does not need tablets. She just needs to talk. The NHS I went into used to provide such a service. Sadly, it no longer does, or not in my area.