Illustration by Clara Nicoll

Mindful life: Being locked out of NHS services hurt my mental health

An NHS admin error led me to reflect on how chronic physical illness is a tax on mental wellbeing 
May 23, 2024

One morning a few weeks ago, I woke up around 4am unable to breathe. Confused, I gasped for air as the room spun into view. I know what you’re thinking: “Mental health columnist—she must’ve been having a panic attack.” But while I am prone to dramatic hyperventilation, on this occasion my chest tightness had a biological cause: asthma.

I sat up and took puff after puff of my blue inhaler, trying not to panic, and when that didn’t work I took an antihistamine to deal with the pollen that triggers my asthma. When my breathing finally returned to normal, a familiar annual worry came back: the advent of pollen season means that asthma symptoms are soon to become my constant companion.

I didn’t know, however, on that particular morning, just how big an impact this year’s pollen season would have on my mental health. The cause of this outsized effect was a NHS admin error which meant that, just as I needed urgent healthcare, I was deregistered from my GP practice. I couldn’t access my prescription for inhalers and other medications, nor could I see a doctor. I was locked out of the system, a situation that took me hours to fully resolve over a timeframe of weeks.

The experience—one in which I behaved in an erratic and overwhelmed manner befitting of my various mental health diagnoses—led me to reflect on the relationship between chronic physical illness and the mental variety.

More than 15m people in England have one or more long-term physical conditions, and while this is most common in people over 60 (58 per cent are affected), 14 per cent of those of us under 40 also suffer from a chronic condition. I have several, including an unusual form of eczema which is exacerbated by sunlight, moderate asthma and a coterie of allergies, including to nuts. Together, these require a combination of medications to control them and many interactions with doctors and nurses to resolve flare-ups.

I felt almost manic with joy, confidence and wellbeing

The link between these kinds of conditions and common mental illnesses such as anxiety and depression are well documented—research from the Mental Health Foundation suggests that people with chronic physical conditions are twice as likely to develop mental ill health. The crossover is so marked that some scientists have hypothesised that common chronic physical and mental illnesses might have a shared biological cause: a malfunction in the immune system.

Anecdotally, this is a theory I can get behind. When I was prescribed an immunosuppressant steroid called prednisolone for my asthma, I felt almost manic with joy, confidence and wellbeing. During the week I took the drug, my usual negative thoughts about myself were replaced with positive ones about my appearance, my social skills and my creativity.

Sadly, you can’t take prednisolone full-time (I begged!). And even if there is not a biological link between the two, the stress alone of having to manage a long-term physical condition in a society geared towards the pathologically well, is enough to trigger mental ill health. It is not so much the pain, itching or breathing problems themselves that bug me, but the administrative and financial burden.

That NHS mix-up made me think about all the other admin headaches that come with the territory. For example: I have to import the only suncream that works for my eczema at significant personal expense. If I go abroad, I need to arrive at the airport early and armed with paperwork or I risk not being allowed to take my oversized eczema creams on the plane. I must keep applying for a prepayment certificate to make my repeat prescriptions even close to affordable.

Every morning, I have to remember to take all the right pills, and it is hard to relax when you have to be eternally vigilant about the whereabouts of your blue inhaler and EpiPen. In my 10 years of adult life, weeks have been spent on hold to NHS 111, to my GP or standing in pharmacy queues to find the right cream.

Each little administrative problem or niggling symptom may seem minor on its own. But collectively these issues create a continual low-level stress, such that chronic physical illness becomes a tax, not only on my finances but on my wellbeing. I guess the moral of the story is: pollen is the devil!