Into the system…

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Posts Tagged ‘referral

NHS Psychiatrist…

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Bloody hell, the CMHT is in a weird and slightly scary location. The building is a dilapidated old school on a council estate, with rusty railings and dodgy damp portacabins. It was in one of these cabins that I had my appointment. My social worker met me and took me in. The ceiling was falling down from damp. It really shows how much priority mental health care gets within our social services and NHS. Most of the other council buildings are shiny and swish.

It turns out that the NHS psychiatrist I saw today has seen me before, although I wouldn’t have known if he hadn’t have told me. Dr D assessed me in February after my massive overdose and arranged for my admission to the NHS ward back in February. I don’t remember the assessment at all, but vaguely remember his face.

The appointment was fairly routine. He asked me about discharge from the ward, what happened at The Priory, what has happened since. He asked about current mood. He asked about history, self harm, suicide, family history, childhood, education etc. All the usual things. It was a chore going over it all again. The more often I do this history thing, the less I manage to cover and recall. I just skip over things because I have said them so many times I forget what I’ve told who. I think he got the main points though.

He didn’t change my medication at all, as my social worker had warned me. He seemed to think that my current meds were doing some good and that we should persevere. I didn’t know if to ask about Dr G’s planned increases up to 300mg. I think I should have, but I couldn’t find my tongue. He said my meds would be reviewed when I next return to the CMHT.

One positive outcome was a referral to therapy. My social worker needs to get this done, so I’m not holding my breath considering her previous record, but we shall see. He said the waiting list is extremely long, but the sooner the referral is done the better. As I have covered most of the shorter therapies at The Priory, especially CBT, he said they probably won’t bother with these, but he was keen for me to have psychodynamic therapy. He thinks I will need to be in intense psychodynamic therapy for years. I had expected to do some psychodynamic stuff as Dr G had mentioned it in the past, but I thought it would be for a few months. I didn’t think I would need years. I guess I never really saw the whole psychoanalytical, lie on a couch and talk about your childhood thing as for me.

I wonder what issues he thinks I will need so long to deal with. I started on some psychodynamic stuff at The Priory when I did “Life Maps” and I grappled around for some reasons for all of this, but my childhood was uneventful and I don’t know what problems there are to find. I know there are some relationship issues with my mother and I was bullied in primary school, but aside from that I am unsure. I don’t think these are deep enough and I see my condition as largely chemical.

The plan is for me to continue on these meds, wait for a referral to therapy and see him (or someone else on the team) again in around 8 weeks. This wait is better than I’d feared but it still seems a long way away. I find the future so hard to comprehend I don’t know how I will get through to then. I was told to continue to see my social worker and to use the ALERT service, the CMHT in hours, the crisis team or A&E if things get worse, but I don’t know how easy that will be. I tend to suffer in silence and hide how bad things are getting, even now after everything.

I’m glad the appointment is over. I was so nervous and didn’t really know what to expect. The next step is to contact Dr G and tell her what happened. I think she will be glad about the therapy as she had wanted to find me something before. I am scared about letting go of her support, but know I will have to eventually. Dr D seemed a little concerned that I had still been seeing a different psychiatrist and I think he wanted that to stop. I understand it would be complicated. I guess I’ve always got the option of going back to Dr G if I felt I needed it. Dr D asked me to contact Dr G and get her to send a summary of my care at The Priory and a date for which I will be discharged by her as well as a list of the therapy I’ve had at The Priory. It all seems quite final.

p.s. I updated the My Story page today.

Appointment Letter…

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It came! It came! Would you believe it? I am finally going to see an NHS psychiatrist, only 6 months after I was referred to her. The appointment isn’t until 22nd September, which seems like ages away, but at least I have a date now. The letter has the ominous line “or a member of the team”, so I don’t expect to actually see Dr B, but we shall see.

Anyway.. proper post coming soon.

Written by intothesystem

Monday, 10th August 2009 at 2:44 pm

Typical NHS…

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I got through yesterday, although it was a long day. My partner didn’t seem to understand why I was so anxious beforehand, nor did he understand how drained I felt afterwards, but I guess he hasn’t experienced these sorts of appointments. I find the strain of having to try and articulate yourself when your head is spinning and you have relentless negative and suicidal thoughts just too much at times. It’s so hard when you have to explain exactly what is wrong and why you need more support, when you don’t really know the answers to those questions.

Before the two scary meetings, I had a one to one with my therapist. This would usually be something that would make me nervous, but I had much bigger fish to fry yesterday, so it wasn’t a problem. The session went a similar way to most of them recently and I’m not sure how helpful they are being, but it went a lot quicker than usual, for which I was grateful.

Lunch was difficult as I felt sick with anxiety. I tried to eat but struggled. Then it was time for the session with my partner and Dr G. My partner arrived at 1pm, but she was running late, so I was sat in reception feeling very nervous. I didn’t know what to expect or what they were going to say.

The meeting went okay, but I’m not sure how much use it really was. Dr G had received my last letter and she said it was helpful, although she already had an idea that I was really struggling without me having to tell her. I guess that’s positive.

We tackled the question of medication first and I have got my wish and am coming off the Depakote. This is being replaced by Lamotrigine. I just hope it doesn’t give me a rash like the Depakote did. If we fail with the Lamotrigine then it’s onto Lithium, although Dr G is reluctant for me to do that.

Following that was some discussion about how me and my partner can improve our communication and work together to ensure he is not suffocating me. I think at the moment a lot of that was going in one ear and out the other as I just can’t process it. I just feel crap about it all, even if the reality might not be like that. I don’t know what reality is like. My head just feels like fuzz. I can’t really remember anything else from the session, which shows how much use it was to me.

The meeting with the CMHT was frustrating and has left me feeling strange and disappointed. I had hoped that the session would ensure I would have some NHS support within a few days, but that is looking extremely unlikely. The assessment itself was uncomfortable to say the least. I felt like they were trying to catch me out. It was almost as if they didn’t want to take me on and they just wanted to find an excuse not to. I had no confidence in any of what I said and felt like I was always saying the wrong thing and I just couldn’t concentrate a lot of the time. I didn’t know what to say, couldn’t remember anything and generally found myself struggling to articulate everything. I wonder if all assessments are like that.

The most frustrating thing was they were completely unprepared for The Priory and NHS liason thing. They hadn’t a clue how it was likely to work and seemed to want to get me to agree to being transferred completely over to the NHS. I don’t want that as I want to make the most of my day care before my insurance runs out. I don’t want that as I want to stay under the care of Dr G now that I have got used to her. I don’t want that as I just have no faith in the NHS for mental health services. The whole point of my referral back in April was that the NHS would have time to work out how they would manage me and my care within The Priory before assessing me. The fact none of that has happened is annoying. I found myself getting more and more annoyed as I realised that nothing has happened and nothing is going to happen until someone cuts through some red tape.

So I am left waiting. Waiting for some support. Waiting for someone to do something. Waiting for an answer. I’m left in this strange state, not knowing what comes next. I can’t think and I just feel awful. I wish it was over.

September/October: Meet the Shrink…

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Late September: Referral to Psychiatrist

I returned to Dr N shortly after my trip to A&E. I was embarrassed about my previous visit to him and quite apprehensive, but it was okay. He was lovely as ever and showed his concern. He apologised for sending me to A&E, but pointed out he had to. He was concerned that I could have taken something else and not be telling him, so needed to get things checked out. I explained what had happened in A&E and following, with the crisis team. He was pretty shocked and disappointed that they hadn’t offered me more support or a proper assessment.

I questioned him on the borderline thing and he kinda avoided the question, horrified that the A&E department had been stupid enough to show me the letter, but did suggest that he wasn’t attempting to make a psychiatric diagnosis, more trying to assure I got the right attention in A&E. I wasn’t really happy with his response, but nevermind. He’s since redeemed himself.

Anyway, I asked him what other options there were and reminded him of my health insurance. In the end we agreed that a referral to a private psychiatrist was probably the best option and he arranged to do this.

When I saw him again, he explained he was referring me to Dr G and had written the letter. When I got to see the referral letter I was a little horrified. It was hard to see everything in black and white, honest and accurate as it was.

The referral process was quick and I managed to get a cancellation. An appointment was booked for October 2nd.

October 2nd: See Consultant Psychiatrist, Dr G.

I was absolutely terrified before my appointment. So terrified, I managed to miss the turning on my drive there and took a while to realise I was going in the wrong direction. I was not really in the right frame of mind to be driving. I got there safely though and was pointed in the direction of a waiting area. She was running quite late, although no one thought to tell me, so I sat there nervously looking at the clock, worrying I’d been forgotten or was in the wrong place. Eventually she came down to find me and led me up to her consulting room.

I was relieved to see there wasn’t a couch. I was terrified I’d have to sit on the cliché psychiatrist’s couch. No one prepares you for what it is going to be like, so I was relying on Hollywood’s interpretation of the psychiatrist for clues. I sat in a small, blue armchair and she began. She explained that the session would take around an hour and that she wanted to go over some of the things discussed in the referral letter and gather an overall history. Then she left it to me to talk.

I am not good at talking. I find it very difficult to open up, but I knew I had to if I wanted to make the most of her expertise. So I went through things. I probably forgot stuff. I was very nervous and didn’t know what to say, but we got there. Afterwards, she wanted to lay out the options for how to proceed. We discussed medication and Quetiapine (Seroquel) was brought up as a possibility. Then she dropped the bombshell. She thought I should come in as an inpatient. I was completely shocked by this and did not know how to react. I had not expected it. She did say if staying as an inpatient wasn’t an option, day care would be the second best thing, but she really wanted me to stay. I couldn’t really think straight after this. I was worried about what my other half would think and terrified at the prospect of being admitted.

At the end of the appointment, she showed me down to the ward and the woman in admissions showed me around. I think they wanted me to see that it was more like a Travelodge than a hospital and were trying to put me at ease. There were no beds available so they explained I would be put on a waiting list and it was up to me if I accepted and came in.

A million thoughts were racing through my head after this. I was worried about what my partner would think. I was anxious about the argument that was likely to follow when I told him. I was worried it was all an overreaction. I worried that maybe I’d been exaggerating things to make them seem worse than they were, yet at the same time I was glad to be taken seriously for the first time. I was cynical and thought that she probably just wanted to make the most money she could from me. Mostly I was just plain scared. I didn’t know what to expect and also knew that if I was to be admitted I would need to tell my parents.

An argument did follow and it took a while for my partner to come around to the idea. He didn’t want me to go in at all. I’m not sure he had realistic visions of what it might be like and seemed to worry it would make me worse. I also suspect he didn’t want me to go because he’d miss me and he was probably worried about not having me around to look after the house too! He did say that he wouldn’t want to visit me there and considered going away for a few days, but in the end he didn’t.

I also went and saw Dr N to get his advice. He agreed that I should be admitted and was glad that I was finally getting some support. He told me he’d have wanted me admitted to the local NHS unit if he thought it would do me any good, but said that it was so terrible it would probably do more harm. I think that’s a sad reflection on NHS mental health services. He also told me he’d been a ward doctor at a Priory hospital for a while, so knew what it was like and thought it would be beneficial. We talked about the benefits of staying over day care, such as not having to drive to and from the hospital after a challenging day of therapy. He really helped me to make up my mind and I made the decision to be admitted.

entering the system…

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Thursday 12th June was what I guess you could describe as a life-changing day. After many, many years of burying my head in the sand, pretending I was okay and avoiding getting help, I saw my GP. A strange string of events led up to this point. It was like a big snowball that was out of control, but in the end I reached the point of no return and had to go see her.

I booked the appointment the Monday before, following an afternoon of nagging from my line manager. I hate doctors. I have to be practically dying in order to make an appointment. I find it difficult enough going for a physical problem, but the idea of going for a mental issue seemed almost impossible. Unfortunately, it got to the stage where I had little choice.

The appointment rolled around. I’d had little sleep and felt physically sick. Thankfully it was an early morning appointment, so it would be over quickly. At the doctors, I presented my doctor with a piece of paper. This paper contained some typed words describing how I’d been feeling, what had been happening lately and what had happened in the past. I knew I would be unable to find the words to talk to her directly and I’d been encouraged to write by others. She read my script intently and then looked at me and just said “what you’re describing here is obviously some form of depressive illness”. So that was that. I obviously knew before, but it was strange to finally have a doctor telling me and more importantly writing it in my medical notes. She immediately suggested that she referred me to the local community mental health team for assessment and the possibility of counselling or therapy and began to fill in the form. As she did so, she asked me further questions. Questions about self-harm and suicide mainly. Difficult questions when you’re ashamed of your thoughts and don’t want to admit that they’re still bothering you, but somehow I felt I had to be honest. I almost thought she’d be able to tell if I was lying.

She then went on to ask me my thoughts on medication. She was keen to prescribe an antidepressant and I told her I’d already feared she would but wasn’t sure if I wanted to. She quickly tried to convince me of the benefits and asked me to think about it. I’m still reluctant, and as such remain unmedicated, but I wonder how long I can keep it that way.

Finally, she signed me off work. Now the sign-off was the thing I was dreading most. It was only a note for a week, with the instructions to “take a break” and return to see her a week later. I was disappointed though. I love my job and I’ve been using it as a distraction for so long, I was unsure how I’d be able to handle an enforced absence.

It’s weird. The whole appointment only lasted a few minutes, yet it felt like so much had changed. I’d never seen my GP about any of this before, despite suffering from similar episodes on and off for years. I was now being classed as a mental health patient – someone suffering from depressive illness. It scared me, the implications of this. It still scares me. I may have been someone suffering depression, long before I was told I was, but it still seems different to have it in your medical notes. There in black and white. It takes some getting used to.

The appointment also presented some more immediate issues. The most prominent of these was telling my partner. If I was to take the time off work, as dictated my GP, he needed to know that something was up. He would obviously question why I was not in work, so I quickly realised I had no choice but to tell him or to keep working. I had been keeping from him everything that had been happening and all that I felt. We’ve been together years, but he had no idea of my thoughts. No idea I’d been desperate, hysterical and suicidal. No idea I had a history of self harm that dated back before he even knew me. No idea that I’d been to my doctor. No idea that work had forced me to see occupational health. No idea I’d been seeing a counsellor. No idea at all.

Written by intothesystem

Friday, 20th June 2008 at 5:11 pm