Paul Ratner: My obsessive compulsive disorder story. The £100 billion plus cost of poor mental health. And what Ministers should do.

29 Jan

Paul Ratner was the Conservative Parliamentary Candidate for West Bromwich West in the 2015 General Election. He volunteers with OCD Action and is a recovering OCD sufferer.

Therapy offices whisper discretion. You’ll find them nestled in stuccoed terraces between hedge funds and law firms. Or hidden on uneven floors in townhouses in tree-lined streets. Or buried deep within blocks of new builds in complexes designed for rentals.

My therapist’s office had Florence Nightingale inscribed in black letters by the parapet (not that I noticed). It was the only distinguishing feature in an otherwise nondescript building that could have been any office in London.

And yet when I went into that office on that day for that meeting, I was expected to reveal more about myself to that kindly stranger than I had ever admitted to myself. Because for once I was going to talk about that gnawing, clawing, testing affliction that I was previously too bashful to discuss, my OCD.

OCD sounds like a cutesy nickname for a US senator, or a well-run exam board, but really it’s anything but.  It stands for Obsessive Compulsive Disorder. It stands for an impulse to do things in an irrational way to rid yourself of unwanted thoughts. It stands for being a hostage to caution.

Those with OCD, about 750,000 people in the UK, will give into this impulse when these thoughts arise to feel the sweet release from their anxiety, and yet sometimes, the thoughts won’t go away.

So they will keep on counting to ten or saying a prayer or washing their hands or doing whatever it is the OCD wants them to do until their fear subsides, even if those rituals take hours. Because OCD masquerades as the cure, even though it’s the disease.

There are two treatments for OCD that have a high success rate. Cognitive Behavioural Therapy (CBT) with Exposure Response Prevention (ERP), and a family of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). And, as with all conditions, there is a circus of charlatans out there who will promise all manner of therapeutics and crash courses, which have no evidence of working, but for which they will charge a hefty fee.

My CBT was five years ago. It was a success, and a relief. I was one of the lucky ones. But rather like a former smoker walking past a tobacconist, I have moments of relapse. OCD still has some purchase on me, but it’s weaker, and now I know how to deal with it.

So two years ago, I began volunteering every week on the helpline at OCD Action, the UK’s largest charity for people with the condition, and I’ve learnt two things that are worthy of sharing.

First, OCD is a pandemic. Every day our phone lines are lit up. The World Health Organisation believes that OCD is in the top ten most debilitating conditions for people across the globe.

Second, The Government recognises it as a disability and the Equality Act gives sufferers rights at work.

If you think you haven’t met someone with OCD, it’s only because the people who have it are normally like those buildings where the treatment is held, discreet to the point of distraction.

However, chronic mismanagement and lack of capacity hamstring the NHS in treating OCD.

In England, GPs are meant to refer low grade sufferers to Improving Access to Psychological Therapy (IAPT) centres and people with more severe symptoms to Community Mental Health Teams. If, after that, patients are still at sixes and sevens, clinicians can dial their treatment up to a ten by sending them to national Specialist Centres.

Yet most sufferers are swallowed up and stonewalled by the system. They stagnate on waiting lists. They are wrongly sent for softball treatment at IAPT centres when their condition warrants more acute care.

The treatment outcomes for children have deteriorated since 2006 – meaning that every night thousands of kids are trapped performing rituals before they can sleep. And a bitter shandy of stigma and low awareness mean that the average sufferer waits 12 years before seeking help.

Patients plagued with thoughts of violence are often misdiagnosed as a threat to society, even though they’re really only a threat to themselves. And people with co-morbidities (more than one mental health condition) find that their OCD is relegated in their therapy schedule, even when they beg for it to be the priority.

We talk about levelling up, although there is a still an alarming correlation between deprivation and restrictions to mental health services.

And getting into a national Specialist Centre is a Catch-22. You can be rejected if you’re not ‘clinically exceptional’, even though there’s nearly enough Brits with OCD to fill up every stadium in the Premier League. Hardly exceptional.

A miracle of modern science is that the treatment for OCD is clear. A tragedy of our society is that for so many, the pathway is barred.

So rather than get the help they need, OCD sufferers often turn to YouTube chancers or falsely believe that recovery is impossible, even when the science shows there is hope. OCD sufferers are all around us, in schools, offices, and factories, suffering in silence and not fulfilling their potential.

The human cost is immeasurable. The agony of emotional torment and lost time is severe. The despair is real. Patients with OCD are ten times more likely to commit suicide.

And the economic toll is measurable. On average, people with OCD lose three years of income over their lifetimes through work absence, which equates to £75,000. They are twice as likely to suffer from substance abuse and six times more likely to have serious financial problems. Taken in the round, poor mental health carries an economic and social cost of £105 billion every year in England alone.

So the question MPs should ask themselves about OCD is: are they spending public health funds wisely? NHS England has budgeted £12.2 billion a year on mental health treatment, but to what end if patients are misdiagnosed on the severity of their symptoms, misprescribed treatment and misdirected in their care?

There are four clear policy choices that the government should enact to change their approach to mental health provision in England.

  • They should streamline the triage system to ensure that patients’ default placements are to Community Mental Health Teams for robust CBT, not to IAPT Centres.
  • There should be a nationwide awareness campaign so that those with OCD symptoms learn that their condition is an illness, not a life sentence, and all clinicians become fully abreast of the latest information on the disease.
  • Three, there should be an increase in resources in poorer areas to sever the shameful link between poverty and inadequate access to mental health services.
  • There should be a root-and-branch overhaul of the Specialist Centre referral process to ensure that those deserving of a place are not overlooked on a technicality.

Lockdown has heightened OCD sufferers’ symptoms and hampered their treatment. There is a fierce urgency for innovation, if only to secure the results that came before.

And if, after all these measures are pursued, the government decides that there just aren’t enough trained CBT therapists to deal with the scourge of OCD, then they should write a cheque. The costs borne on the economy of the mind and the economy of the Exchequer are already too great. The vaccine is self-financing. Now we just need to inject the vision. Now.

Yes, therapy offices whisper discretion, but we should be loud about their power.

For more information and advice on OCD, please check out the OCD Action website.