Category Archives: Mental Health Team

They’re Not All Bad

I realise I’m quite often pretty scathing about mental health professionals but some of them are OK. Some do an amazing job and are let down by their colleagues. Quite often our bad experiences overshadow the good and we get into a negative view of all professionals, which is understandable.

I’ve had a few good experiences with different professionals. The negatives with these professionals only come when they are let down by the system they work within, otherwise they are amazing and make all the difference. When someone is caring and takes time with you it makes you feel valued and has a positive effect.

The first professional I found that was great was my art therapist. This was the first major mental health professional I worked with. At the time she was part of the young person’s service which was part of CAMHS (Child and Adolescent Mental Health Services) and worked with those aged 16-25. I was 20 when I started working with her. She treated me on a level with her. I was training to be a teacher and she treated me like a professional as well as a patient. She didn’t patronise me and went at my pace. Her main work was to get me to communicate and she did well with this but at my pace. She made herself available between sessions if I needed to leave a message or write a letter to help with the next session. She’d talk me through situations. She tried to teach me it wasn’t all my fault and at times I almost believed her. The main thing that sticks with me though is that the young person’s service was disbanded so all over 18 were to be taken on by adult services meaning I’d lose my therapy. However she fought for me and told them it ws totally the wrong time to take it away from me and that she needed to continue her work with me. This led to me having a further 18 months with her. Leaving her was hard and I miss her a lot. I still have the card she gave me at the end of therapy.

Another mental health professional that gave a good impression was a psychiatrist I had in adult services. She is the one that diagnosed me with BPD (Borderline Personality Disorder). She always valued my opinion and explained things when asked. She wasn’t perfect in that she didn’t discuss my diagnosis with me before it appeared on my notes but she was happy to go through it after. She was also a consistent presence for nearly a year before she moved on. This makes a difference.

The next professional who I had a good relationship was a care coordinator of mine, L. L was very proactive in my care and worked hard to get things sorted for me, not only with my mental health but my physical health too, even spending ages on the phone to a hospital trying to sort an appointment for me. She didn’t make me feel like our time was limited, it was always as long as I needed to talk. She took an active role. It was sad when she moved on.

My current care coordinator is also great. She’s not been involved in my care for long but has already shown me how great she is in that she gave me direct contact details for her and allows me to text rather than talk on the phone. She doesn’t mind me messaging between sessions and is quick to reply even if it is to tell me she’ll get back to me properly later. She’s also always on time or early for appointments which makes all the difference. I’ve kind of thrown her in at the deep end with my crisis but she hasn’t made me feel bad about it. I hope we can work together for a while.

Unfortunately these professionals are the exception rather than the rule. It shows as these are four out of many professionals that I have encountered. Hopefully things will improve and we will get more professionals that want to help rather than make us feel like an inconvenience or stigmatise us more. If we can be part of the education of professionals I think it would help them to be more empathetic and understand us more.

Have you had any good experiences? Feel free to share in the comments or on Twitter, Facebook or Instagram.

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Self Harm Etiquette For The Medical Profession

This is a blog post for anyone working in the medical profession. This includes Doctors, GPs, Nurses, Healthcare Assistants, Paramedics, Support Workers, Psychiatrists, Care Coordinators, Psychologists, Pharmacists, Admin staff and Receptionists. Basically anyone who comes into contact with a person who may have self harmed (therefore could also be useful for police officers too).

It has come to my attention that some of the people we want to help us deal with self harm can be some of the least useful with their comments and actions regarding dealing with self harm. Therefore I thought I’d put some tips together specifically for them and any professional that needs to help with self harm.

1. Don’t comment on it in front of other patients

This may sound really obvious. Patient confidentiality is key. Bringing it up in front of other patients without permission is wrong and can cause harm to the person who is self harming, the relationship between patient and professional and possibly even the other patient/s who could hear about it. You never know where this information will go. Unfortunately I know it happens. I’ve seen it happen.

2. Don’t guilt trip us

I’ve had this happen with a former GP. I was told I obviously didn’t love my parents over my self harm. It was awful. I didn’t return for treatment until two years later after a suicide attempt. This isn’t the only impact it can have. Self harm is not a selfish act. It’s a way of trying to keep going. It’s a way of coping. Most people who self harm probably already think about the perceived damage they do to others. To be guilt tripped by a professional is more likely to make the situation worse and even cause the patient to withdraw from seeking help, maybe until it is too late.

3. Don’t mimick self harm behaviour

Again this is something I have encountered and not just with one professional but many. It seems some can’t bear to say the words “self harm” and so use actions like using their hand to mimick cutting across an arm. Not only is this not clear communication, it can be triggering. It is a difficult topic but it is one that needs to be dealt with sensitively and professionally. Yes you do need to ask, but please use words rather than miming actions.

4. Be careful with what you say

Most professionals are careful with what they say. They think before they speak and take into account the individuals situation. That’s great if they know the patient. However without continuity of care, which is heavily missing in places, you may not know details or you may just be someone that only encounters someone briefly so has no background information to draw on. This means being careful with what you say. I’ve heard things that concern me. They may be useful for some but I can also see them as potentially inflammatory to the wrong person. I’ve heard “you’re scars look cool”, “just use your faith” and “what would your family think?” as common phrases among others. Let’s work backwards, the last comment can easily be seen as a possible guilt trip but it can also cause some negative emotions to surface, particularly if there is friction within the family. The middle comment is also dangerous as some people don’t have a faith and this may be because of trauma or abuse. It can also suggest unless you have a relationship with a god, you can’t be helped. The first statement may be the most troubling though. You’re reinforcing the behaviour. Yes self harm shouldn’t be something people feel ashamed of, but it shouldn’t be highly celebrated either.

5. Don’t judge or use stereotypes

Some professionals have a preexisting picture of what a person who self harms is. They may see them as frustrating and a drain on resources. They may see it as attention seeking. These stereotypes tend to grow over time within a staff member. I can see how hard it must be to treat someone who seems to be causing their own suffering. But it is a symptom of an illness. It is like an addiction. It is hard once you have started to stop. It can feel like all you have in the world at that time. It is a sign of distress. Being compassionate, non judgemental and just kind to the patient goes a long way. It can help the person to keep accessing help. Doing the opposite could push people away and leave them in dangerous situations.

6. Don’t compare us to other patients who have self harmed

Every person is going through their own unique experience with mental illness and self harm. Self harm is self harm. So it may not be as deep or as “bad” as someone else you have treated, but to that person the pain they feel inside is probably just as intense and unbearable. Hearing that we aren’t as serious as someone else because it doesn’t reach a certain level is heartbreaking and can have a negative impact. It can cause us to try and do more damage. It makes us think we aren’t good enough or that we don’t deserve help. Everyone, whatever level of self harm they present with, deserves support and compassion.

7. Don’t use the terms “superficial” or “attention seeking”

I hate the term superficial when it’s used to describe my self harm. It makes me feel like a rubbish self harmer and that I need to harm worse or more. It can encourage the behaviour and make things worse. The same can be said about the term attention seeking as it can drive the behaviour underground and prevent people getting help.

Those are just a few helpful hints for medical professionals. It might not be a regular thing you encounter but it is always useful to know how to help someone who self harms.

If you have any tips you wish professionals knew then feel free to use the comments or Twitter, Facebook or Instagram.

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CMHT Fail

This was not the post I planned on sharing today but I needed to get this out.

Today I had a psychiatrist appointment. It was with a new psychiatrist and my latest care coordinator. Except it wasn’t. While in the waiting area I received a phone call telling me my care coordinator had left on Friday and trying to arrange an appointment with my interim care coordinator. When I told her I was waiting for my appointment that was already running ten minutes late they rushed down. Remember they don’t even know me.

In the appointment the psychiatrist had no access to my notes as he had been blocked from the system. Thanks to the interim care coordinator he was able to access the last letter but couldnt read in detail.

He asked me how I was and when I mentioned my mood was low a lot and unstable, he asked more questions about my concentration, appetite, memory and sleep. He asked me to rate my mood which I put at two at best. I mentioned I was having suicidal thoughts and that the voice I hear is worse. He said I didn’t have plans to end my life, he actually didn’t ask.

The psychiatrist then wanted to refer me to a service that has refused to take me on. When I explained this he said he understood and offered no alternative. He did not want to change my medication despite my obvious deterioration. I managed to persuade him to up my mood stabiliser but he did it by the smallest margin possible.

I tried to bring up some other concerns but by that point he was already wrapping up the consultation and urging me out the door with the words “I’ll see you in two months”.

Everything felt like it was too much effort for them. This is from a trust that is rated as outstanding. A trust that can’t seem to retain staff or offer support. It is currently a postcode lottery within this Trust as to what treatment you can access (I am aware that this is actually down to the CCG).

When did continuity of care in mental health services become unimportant? Especially with people with BPD where fear of abandonment is a major symptom. When did it become acceptable not to fully risk assess people?

Unfortunately this seems to be the way it goes for many service users of mental health services. It isn’t often I cry in an appointment and straight after in the street but today’s fiasco made me feel awful and worthless. (Thanks to the psychiatrist who actually sked if I felt worthless).

To keep up to date with my mental health experience, follow me on Twitter, Facebook or Instagram or use these and the comments to share your experiences.

Losing A Mental Health Professional

This piece contains my personal opinions and some of the content may be triggering.

Sometimes in life we can’t control what is happening around us. People come and go in our lives whether we want them to or not. This can be hard to deal with. One big change can be when we lose a mental health professional who has been involved in our care for a long time. We may have come to rely on their help and support. We may have built up a good relationship with them. And then it ends.

As someone with Borderline Personality Disorder (BPD) endings can be particularly tough. Having a fear of abandonment means that when someone does actually leave our lives it is like a self fulfilling prophecy. Our worst fears are happening. This may lead to us getting involved in risky behaviours or rejecting the person before they are out of our lives in a way we believe will protect us.

Recently I was given the news that my care coordinator was moving on and I was going to have to say goodbye. It was difficult news to take as we had a good relationship and she was a great and supportive care coordinator. Getting the news made me feel like I was being abandoned as at the time there was no replacement on the horizon and no idea when one would be recruited. I was close to tears. Many thoughts went through my head including “was this my fault?”.

As I came to accept that this was going to happen I started to pull away from my care coordinator. This is what often happens with people who have a BPD diagnosis. It’s a way of protecting ourselves from a perceived abandonment even when it is not a true abandonment.

What helped though was the way my care coordinator rounded up our sessions together. She made sure my care plan was updated before everything ended so the next person would know what I needed help with and what I was working on already. Also in the end a new locum care coordinator was appointed so my old care coordinator could introduce me to the new one. This allowed her to inform the new person as to how often we met, what my major issues are and what needs to be brought up at my next psychiatrist appointment. It also helped to make a plan with the new care coordinator as to how our meetings would work.

What should a mental health professional remember to do when leaving a therapeutic relationship?

  1. Let the person know your leaving face to face
  2. Answer any questions about the change that the service user/patient has about the change
  3. If possible introduce your replacement to the service user/patient
  4. If unable to introduce your replacement, leave notes for your successor
  5. Tie up all loose ends

What can I do if I’m losing a mental health professional?

  1. Talk about any issues you feel need to be taken into account with a member of your mental health team
  2. Make sure you have numbers of people you can contact if you need help
  3. Create a support network (if possible) away from the mental health team
  4. Be open to a new mental health professional, remember just because they are new doesn’t mean they’ll be awful

Those are a few pieces of advice that I have but if you have more then feel free to use the comments or Twitter, Facebook or Instagram.

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Mental Health Professionals

This is a post about the different professionals involved in my mental health care. I aim to discuss a bit about what each of them do and my relationships and experiences with them. There are many different professions in mental health care and it can be confusing to know what they do.

1. My GP – I thought I would cover this role first as its normally the first port of call for anyone struggling with their mental health. They can offer advice and medication, as well as referring you on to get help from other professionals. My GPs have on the whole been great. I see two who deal with everything and have been really supportive in getting me the right care. Sometimes it takes a while to find a good GP in the practice; the ones I see now were not the first I approached about my mental health, but keep trying as there are great GPs out there who can act as your advocate.

2. Psychiatrist – This is a doctor of the mind. Mine is involved in prescribing medication and referring me for other treatments and services, such as therapy. I have seen many different psychiatrists over the years, some great, some appalling. Getting one who listens to you and respects your opinion is amazing and can make all the difference. I currently see a different one each time I go which makes continuity of care hard.

3. Care coordinator – A care coordinator can be any mental health professional and is usually the main point of contact for support. They also sort out your care plan under the care plan approach (CPA). I’m on my second care coordinator after my first left. Neither of mine has actually really made the time to sit down with me yet and discuss my care plan. I hope this changes as I feel I need their support.

4. Support worker – These are people who support you in different ways, from being a point of contact with services to getting you involved in activities. Me and my support worker don’t always see eye to eye but she has been my regular contact with the mental health team and sees me on a weekly basis (usually, she is currently off sick) to check in with how I am doing and to trouble shoot any problems.

5. Psychologist – A psychologist is different to a psychiatrist. A psychologist offers talking therapies in order to treat mental illnesses. They have nothing to do with medication. I am currently going through the process of getting an assessment and hopefully starting therapy, and it will be my psychologist who facilitates this all. In the past when I had art therapy I had a great psychologist who really understood me and respected the way I work. I hope this will be the case again.

6. Crisis team – A crisis team is there to support you when you are particularly unwell and treat you outside of hospital. They will often see you every day for a short period of time. Although they are not currently involved in my care I thought it was important to include them as they do play an important role in keeping people safe in crisis times. I have seen them a number of times with varying responses, unfortunately not all good. Some people find them frustrating.

So there you have the professionals that are, or have been, involved in my mental health care. There are other professionals that work in mental health but I haven’t had contact with them. Please feel free to share your experiences of different professionals in the comments. It may also be different if you live outside the UK. For more information on mental health professionals check out the Mind website.

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Crisis Team Come Down

This is a personal piece. Please be trigger aware when reading.

Yesterday, after a psychiatrist appointment, I was referred to the crisis team for the second time in a month. This led to some very mixed feelings following my interactions with them. This is something I thought I’d explore in writing.

When I saw the crisis team a month ago I was desperate for their help and support. I was on the edge and finding the voice I hear very distressing, but I wasn’t self harming at the time. My experience with the crisis team was not a positive one. I was told I was not ill enough at the time; that my main problem was that I lacked confidence and was shy. Nothing to do with the voice in my head telling me all number of distressing things. I felt completely disheartened and it actually made things worse for me. I began self harming again as I felt this was all I had to help me cope.

So yesterday when I was told I was being referred back to the crisis team I was sceptical. I even decided I didn’t really want their help. I was over ruled and they made an appointment to come to my house. When they arrived I told them how uncomfortable I felt having them there. The two people were great. They told me they understood and that they could rearrange the appointment at their base the next day. They did their risk assessment and left. I was glad as it gave me time to think.

Today I had that appointment and it went OK. I had to talk a lot about what is going on for me and I was finding it quite hard. But the doctor was great and very gentle in her questioning. This was something that had been missing from last months appointment. It was decided they weren’t the right service to support me as I felt, myself, that it was too overwhelming. But I was OK with this. Or so I thought…

This afternoon has been extremely difficult. The come down from feeling quite positive about the outcome has been difficult. I feel completely uncomfortable in my own skin and everything is irritating me. I now feel quite negative and the thoughts that were troubling me are back. I just can’t understand this sudden change in mood that has come on or the speed that the elation, of not having to see the crisis team, turned to absolute misery.

This post has little use other than to document this feeling and try and make sense of these feelings in my own head. I am lucky to have friends to help me make sense of this sudden shift. Maybe we will never know why this come down took place.

The next step for me is to have my care coordinator allocated. This is something the crisis team are chasing. I hope to keep you updated on my continuing encounters with mental health services.

Continuity of Care: What it means to me

Continuity of care is important in all areas of health care but in mental health care it, to me at least, is more important. However it is something that I have found to be lacking. Here I talk about my experiences and what I think is important about continuity of care.

For the first time in years I will be seeing the same psychiatrist for more than one appointment. For the past three years each time I have attended an appointment it has been a different psychiatrist resulting in a lack of continuity of care. This, I believe, has led to missed opportunities and my life being a mess for longer than necessary. Now I know a lot of people will think this is an exaggeration but to me it feels as if I have lost out. This includes losing out on referrals for therapy as each time someone has said they will refer me they have left the service before doing my referral, leading to a gap in my care. Also changes to medication have been slower at being implemented as generally each new psychiatrist has wanted to wait until the next appointment before changing my dosage and/or medication. This leads to months and years of not having the correct treatment all because of a lack of continuity.

Another impact that a lack of continuity of care has is that I do not get to build a relationship with a professional and therefore each time I find myself starting over with a new person wondering if they will be around for the next appointment. This means I have to explain my history over and over again to new doctors who have not had a chance to read my notes. This includes traumatic events that I do not wish to relive constantly. I also have to remember which medications I have tried (which is a growing list) and how they have or have not worked for me.

Continuity of care would hopefully eliminate a lot of the reliving of traumatic events and the endless list of medicines. It would hopefully lead to a more concise and helpful treatment plan that could be reviewed at each appointment by the same doctor. It would also mean I could build up a relationship and trust the professional I am seeing. To me continuity of care is important.

I hope that most of you do not have to relate to this post as that would mean you are receiving continuity of care which is a good thing. I know continuity of care can have a negative side if you do not get on with your health professional but on the whole I believe it to be a positive thing. Please feel free to share your experiences in the comments below.