# Dealing with a substandard mental health care system



## cosmo (Apr 27, 2009)

I walked into an out of hours medical unit last night (in the UK) and told them that I was having suicidal thoughts that were overwhelming. 

I was discharged to my husband's care (I have two small children under 4) with instructions to take a sleeping tablet and see how I felt in the morning. They would send the crisis team out in the morning. 

Come this morning they didn;t call - when we rang them, they said they had lost the referral. Eventually we persuaded them to see me, I had an assessment with the psychiatrist. He suggested that I had bipolar and wanted to talk to my husband. 

Having spoken to my husband, who has not known me long, he decided it was unipolar depression (despite my manic and mixed episodes that I clearly described!). He discharged me to my GP and told me to ask the GP for antidepressants. I told him they made me worse (as one would expect with bipolar) but he seemed fine with that. Last time I had antidepressants I had a severe mixed state and tried to kill myself. 

I really don't know what to do. I am under so much stress quite apart from this (big problems with my son and schools). I am just feeling so hopeless and in so much pain.


----------



## Jazzey (Apr 27, 2009)

*Re: Dealing with substandard Mental health care system*

Hi Cosmo,

Have you discussed this with your GP?  When do you have an appointment with the GP?

I'm so sorry that you're struggling right now.  For the time being, just remember that they are just thoughts.

Also, I'm posting the suicide hotlines.  I'm wondering if even just talking to them may not ease some of your pain for right now. 

http://forum.psychlinks.ca/suicide/4972-suicide-resources.html

Stress can be a real trigger at times - it is for me too.  Just remember that there is an ebb and flow to stress as well as these thoughts.

Here are some of my favorite threads here at Psychlinks, they've helped me through some of my darkest moments:

http://forum.psychlinks.ca/suicide/1921-when-you-feel-you-cant-go-on.html
http://forum.psychlinks.ca/suicide/15020-suicide-a-reactive-action.html
http://forum.psychlinks.ca/suicide/12706-if-you-are-thinking-about-suicide.html
http://forum.psychlinks.ca/suicide/...e-dont-let-despair-obscure-other-options.html
http://forum.psychlinks.ca/suicide/13886-hope.html#post101171


----------



## Retired (Apr 27, 2009)

*Re: Dealing with substandard Mental health care system*

Cosmo,

I am not familiar with the medical system in the U.K. so I cannot suggest ways to get the services you need.

However, it seems you have a referral to your GP who is in a position to be your best resource, given your experiences.  

When is your appointment with the GP and does this doctor have your medical history to know your past experience with anti depressants?  If not, you need to explain all this.

Is there a possibility to request the crisis team be sent out again?

Do you have local access to a crisis line?

Were any of the resource numbers suggested by Jazzey helpful?

Is your husband available to you for support and to help keep you safe throughout the day and night?


----------



## Jazzey (Apr 27, 2009)

*Re: Dealing with substandard Mental health care system*

I'm adding the additional link Cosmo.  You can also reach Samaritans via email if you're not up to talking....

Samaritans Home Page-->


----------



## cosmo (Apr 28, 2009)

Thank you. 

Well that was a waste of time. I did get to see a psychiatrist (eventually). He is suspicious that it is a Bipolar disorder and that currently I am having a mixed episode, but he is not convinced enough to put me on lithium so wants to try antidepressants first. Surely that is dangerous?

I was then referred back to my GP with an instruction to start me on Sertraline (Zoloft). They put me on 50mg, which has knocked me over like a ten ton truck. Apparently that is the therapeutic dose, aren't they meant to ramp it up to that slowly? I had to call my husband back from work as I couldn't even stand up. I am meant to look after my kids tomorrow on my own, I have no idea how I will manage - suicidal thoughts vs ten ton truck PLUS suicidal thoughts, tough choice. I know it takes a while to kick in, but I have no support whilst it does. And despite feeling like I have been hit by a truck, my brain is racing like a train. Are these standard side effects?

The problem is that I can intellectually see that suicide is not an option, but the compulsive suicidal thoughts are so overwhelming I have had to make sure my husband is with me at all times or that I am with my kids and/or another adult. It is as if part of me is trying to persuade me. Not voices - man, I'd be right back in the ER if that happened - but something similar.


----------



## Retired (Apr 28, 2009)

Cosmo,



> knocked me over like a ten ton truck


 
Do you mean feeling drowsy, dizzy or are experiencing headaches?

Can you get in contact with the prescribing doctor to report that you are experiencing uncomfortable side effects.  

Ask your doctor if you might start with a lower dose such as 25 mg per day initially then increase to 50 mg as prescribed.  

When discontinuing sertraline (Zoloft) it is recommended to taper the dosage over a week or two in order to avoid discontinuation symptoms.

I would suggest speaking to the doctor or pharmacist (chemist) if in the U.K. the pharmacist can help with dosage modifications.  It would not be advisable to modify dosage on your own, as your doctor has a treatment plan based on your medical history.



			
				Cosmo said:
			
		

> I can intellectually see that suicide is not an option


 
An you are correct, suicide is not a solution, but distorted thinking caused by your illness at this time.  You are doing the right thing in keeping your husband and trusted adults in your company during this difficult time.

Your husband a family are your reasons to live, Cosmo.

Please keep us posted on your progress and the outcome of your conversation with your doctor.


----------



## cosmo (Apr 28, 2009)

TSOW said:


> Do you mean feeling drowsy, dizzy or are experiencing headaches?



Dizzy - I've had to lie down for the last few hours. I have a splitting headache too. And then it feels like my head is all over the place. 




> Ask your doctor if you might start with a lower dose such as 25 mg per day initially then increase to 50 mg as prescribed.



I have spoken to the GP, thank you for suggesting that. I am back down to 25mg tomorrow, and if that is still awful, down to 12.5 the next day and then come slowly up again to 50. The problem is that I am so severely depressed, normally they would admit me but as it would have such a traumatic effect on my children, they want me to stay at home but take as much as I can tolerate as fast as possible. A fine balancing act if I can;t look after my kids when severely depressed - but can't look after them because of the side effects. 



> An you are correct, suicide is not a solution, but distorted thinking caused by your illness at this time.  You are doing the right thing in keeping your husband and trusted adults in your company during this difficult time.




I know it is distorted thinking. But I am in so much pain and have been for so many years. I don;t know how I can tolerate it for the rest of my life.


----------



## David Baxter PhD (Apr 28, 2009)

cosmo said:


> He is suspicious that it is a Bipolar disorder and that currently I am having a mixed episode, but he is not convinced enough to put me on lithium so wants to try antidepressants first. Surely that is dangerous?



No, not dangerous. It may help to clarify the diagnosis, in fact. There is a possibility that on an SSRI you might become more hypomanic but if so that wiould confirm the diagnosis of bipolar disorder and would indicate the need for some sort of mood stabilizer, probably in addition to an antidepressant.



cosmo said:


> I was then referred back to my GP with an instruction to start me on Sertraline (Zoloft). They put me on 50mg, which has knocked me over like a ten ton truck. Apparently that is the therapeutic dose, aren't they meant to ramp it up to that slowly?



No. The does range is typically 50-200 mg per day so that's a low dose. Sometimes, patients are started on 25 mg but likely the doctor felt that would be too low to do anything at all.

The grogginess may just be an adaptation effect as you get used to having the medication in your system. If it doesn't go away or diminish within the next few days, call your doctor and let him know. In the meantime, take it at bedtime.

*Added: Dizziness or light-headedness is fairly common for a day or two when starting an SSRI. That should go away within a few days.*



cosmo said:


> And despite feeling like I have been hit by a truck, my brain is racing like a train. Are these standard side effects?



The racing thoughts, no. That might confirm the psychiatrist's suspicions about bipolar but it's probably premature to conclude that until you've been on an SSRI for a while.


----------



## cosmo (Apr 29, 2009)

The problem I have with all of this medication is that I know that my depression is highly reactive, probably related to an adult attachment disorder. But I get so depressed and suicidal at the point that something triggers it, that I spiral very fast into a state that I am unable to cope. 

In the past I have avoided the need for medication because I have not had any dependents, and therefore have been able to 'hide' the depression. Last time I was this depressed, my son was a baby - he ended up with an attachment disorder as a result. This time - I have two under 4, so I have not been able to hide out at home (avoiding the anxiety that comes with the depression), and have not been able to distract myself from the intrusive thoughts, and the additional demands of my kids have reduced my ability to cope. 

What I wonder is - is it a chicken and egg situation? Is it a biochemical thing (bipolar), as I think it is, which precipitates certain situations and then with the adult attachment disorder on top, leaves me unable to cope with them? Or is it just the attachment disorder with a hefty dose of unipolar depression thrown in? Or is it what my previous therapist suggested as a possibility, which is a bit of borderline thrown in for good measure? 

Because of the fragmented state of the british Mental Health system, there is absolutely no continuity between any of the professionals I have seen, and certainly Monday was the first time I have ever seen a psychiatrist despite 30+ years of periods of severe depression. As the system cannot cross-refer, I have seen three different specialists in the last 12 months, none of whom have talked to each other or even made notes for the other or have known that the other has assessed me, before I brought it up. So the psychiatrist doesn't know what the psychotherapist decided over the course of the year's treatment (the psychotherapist was also a trained psychiatrist, just not acting in that capacity). And they in turn don't know what the clinical neuropsychologist decided, other than what I have told them. It just seems insane, even to me! Particularly as two of those individuals KNOW that it is due to PTSD / childhood events / attachment, but the psychiatrist won't take my word for it as I am considered at a crisis point and therefore unable to decide for myself what is the problem.  

I know you can't answer these questions, but I am just coming to terms with the fact that I will not be able to 'get rid' of this or hide from it any longer, whatever the reason for my recurring depression. I KNOW that I need further psychotherapy but I can't seem to get this into their heads. Whether or not I need medication right now is beside the point - I probably do just to cope - but I don't want to get into a situation where they are controlling this with drugs alone as it is easier and cheaper for the NHS to do so.  And that is certainly the direction that this is heading.

---------- Post added later and automatically merged ---------- 

ps. 
you will probably look at the above post as insane ramblings of someone in a crisis situation - and I will probably look back and agree in time! but i did want to put my feelings out there in case someone has had a similar situation OR can advise in any way.


----------



## Jackie (Apr 29, 2009)

Cosmo,

I can relate about the NHS mental health system, it is a big mess and the support and help people need isn't there, people are left to struggle alone often with dire consquences. I wish I could point you in the direction for some help but I can't you are just like me and many others here. The only organisations I can think of that might help are Re-think or Mind but I know their resources are way over stretched with the situation here in the UK.

http://www.rethink.org/

http://www.mind.org.uk/


----------



## cosmo (Apr 30, 2009)

Well I had a visit from a CPN (community psychiatric nurse), and that was pretty useless. She can't refer me for anything, and isn't even sure if she can see me for my next scheduled appointment - and won't be able to tell me til that morning. And they are meant to be the Crisis Support Team!

She agrees that psychotherapy will be the best plan but can't do anything about getting it for me. 

Am feeling pretty hopeless right now. If the people who are paid to help you can't help you, what else can you do?


----------



## Retired (Apr 30, 2009)

> If the people who are paid to help you can't help you, what else can you do?


 
Cosmo,

I said earlier I have no experience with the medical system in the U.K. so I cannot provide specific suggestions.  However we are dealing with an overburdened socialized system in Canada, and I can appreciate your frustration.

In Canada, in order to get the services we need, we as individuals need to be pro active, and even imaginative in locating access to required services.

By learning and understanding the workings of our system locally, we need to seek out individuals and services we require and personally make arrangements, and not necessarily count on the system to make those arrangements for us.

Sometimes it seems that we need to be a little more than partners in our own health care, and take on the role of administrators of our own health care.

If you can locate the institution or individual who can provide the service you need, such as psychotherapy, can you take steps to make your own arrangements to get an appointment?


----------



## Jackie (Apr 30, 2009)

TSOW said:


> Cosmo,
> 
> If you can locate the institution or individual who can provide the service you need, such as psychotherapy, can you take steps to make your own arrangements to get an appointment?



That is easier said than done, very often in this country you have to be referred by another person like your CPN or GP or psych social worker. You cannot just walk into a place and ask for an appointment on your own, unless your paying privately of course! Which is why its hard to get help here!

Sometimes the Crisis Team takes a week to come and see you. for me a Crisis team should be out to see you within 24 hours if not straight away. I understand fully how Cosmo feels, when I was really ill there was no where to go for help so I had to rely on my friends and family. I eventually got therapy, 10 weeks of it for which I had to wait 6 months.


----------



## cosmo (Apr 30, 2009)

The situation here is atrocious. I have managed to circumvent the 'system' with regular hospital visits by ringing up directly, but the mental health system has been devolved and split into very separate areas here, which means the psychiatrists don't talk to the psychologists/psychotherapists in any way at all other than via the GP. So, when I saw the psychiatrist I had to provide my own copies of my discharge letters from the other service, as they don't even have copies of my notes. Ludicrous. And my GP has already requested a fast-track of my evaluation by the psychology service - but their psychiatrist will not see me for another 6 months even by her referral (at the earliest - she can't even refer me for 6 months, so goodness knows when the actual appointment will be). And my crisis psychiatrist is just that - a temporary one and not one who will follow through my care, he has devolved the prescribing to my GP but can advise by phone re dosage, but I have to make that call via the Community Psychiatric Nurse (CPN) who will only see me every 10 days or so for 3 visits. And THAT is the 'crisis' service. The standard service is even more ludicrous, and is often devolved to charities where you part-pay for service, instead of the standard NHS 'free' care. Even the CPN feels sorry for me which has got to say it all. If we can afford private counselling (which I can't), they are entirely separate from the NHS so don't get any of your previous notes or any diagnosis details, so are often working 'blind'. If my one visit to a psychiatrist in 34 years is anything to go by, I won't be getting a 'proper' diagnosis any time soon, as his visit was inconclusive (his words).

---------- Post added later and automatically merged ---------- 

ps I did investigate the possibility of paying my psychotherapist to see my privately but there are also laws that they have to follow re seeing patients privately having seen them on the NHS, and they are very tricky to navigate. I wasn't able to do it in this case. So even if I did want to continue therapy privately, I would have to do it with someone completely new rather than someone I have spent a year building up a relationship of trust with.


----------

