Category Archives: Mental Health Team

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.

Being young with a mental illness

This piece includes personal stories. For this reason please be trigger aware when reading.

Just recently there has been a lot of talk in the press about the number of young people being diagnosed with a mental illness, as well as a lot of talk about the state of the services they have at their disposal. Below I’ve included some facts from http://www.youngminds.org.uk/training_services/policy/mental_health_statistics and I also intend to discuss my own personal experience of being a young person who has a mental illness.

“1 in 10 children and young people aged 5 – 16 suffer from a diagnosable mental health disorder – that is around three children in every class.
Between 1 in every 12 and 1 in 15 children and young people deliberately self-harm.
There has been a big increase in the number of young people being admitted to hospital because of self harm. Over the last ten years this figure has increased by 68%.
More than half of all adults with mental health problems were diagnosed in childhood. Less than half were treated appropriately at the time.
Nearly 80,000 children and young people suffer from severe depression.
Over 8,000 children aged under 10 years old suffer from severe depression.
72% of children in care have behavioural or emotional problems – these are some of the most vulnerable people in our society.
95% of imprisoned young offenders have a mental health disorder. Many of them are struggling with more than one disorder.
The number of young people aged 15-16 with depression nearly doubled between the 1980s and the 2000s.
The proportion of young people aged 15-16 with a conduct disorder more than doubled between 1974 and 1999.”

It’s hard for me to pinpoint when I first became ill. I normally base it on when I first self harmed which was when I was thirteen nearly fourteen, although I did not receive any professional help until I reached the age of nineteen, after a suicide attempt.

When I look back though there were missed opportunities with teachers from school and doctors that I visited, who did not seem to take what I was saying, or what they were told by others, seriously until it got to a point where I was attempting to take my own life. This is something that has been pointed out as a failure in children and adolescent mental health services.

Now a quick note before I mention two of the missed opportunities that I have identified. At one of these times I was unwell to the point that I didn’t realise I was unwell and was very reluctant to be helped with something that was, to me, not really a problem. However looking back I can see how ill I really was and actually how obvious, when certain parts of my behaviour were made public, it was that I was actually quite unwell. Therefore, to an extent, I can understand why some things were missed.

The first opportunity that I identified as possibly being missed was when I was fourteen and involved a teacher at my secondary school who was told by a couple of friends of mine about my self harm. By this point I had been self harming for nearly a year. The conversation my friends had with this teacher led to me being called out of my tutor group to speak with her about the situation I was currently in. I was asked to roll my sleeves up and therefore to show the self harm to her. I was reluctant as I knew it wasn’t usual and something to be kept hidden. After I had shown the teacher my self harm she said that she would have to let my parents know, something which I was desperate to avoid due to my home situation at the time.

The next day I went to see the teacher in question and begged her not to discuss this with my parents. I have since learnt that this should have been a warning in itself and obvious indicator that more help was required, however I did manage to persuade her not to talk with my parents on the condition that I saw one of the mentors at school. However this never happened and I was left to my self harming ways which continued to deteriorate.

The reason I identified this as a possible missed opportunity is that someone in a position of authority and with a duty of care did nothing in response to a child who was obviously physically harming themselves when in fact this was a safeguarding issue. My training in safeguarding matters, which I realise may have changed in the 6 years between the incident and the time of my training, shows that this is an issue that should have been reported no matter what protests I made at the time, and in fact more so due to those protests. This opportunity could of led to me getting help five years earlier than was the case and may of prevented some of the events that followed.

The second opportunity I have identified was a doctors appointment I made when I was seventeen. I had decided that actually, maybe, I needed help. I had by this point been self harming nearly four years and had in fact had increasing thoughts and actions surrounding suicide. My parents were still unaware of the state of my mental health. I made the doctors appointment secretly in a bid to still conceal from my parents what was going on.

The appointment started off well enough with her assessing me for depression and coming to the conclusion that, that was indeed the cause of the issues I was having. The doctor was even considering me for counselling to help me. And then came the line that made this appointment unsuccessful for me. The doctor asked whether my parents were aware of my issues and when I declared that they weren’t she told me “well doesn’t it suggest that you do not love your parents, if you don’t tell them.” At that point I shut off from everything the doctor said and decided that if this was going to be the reaction of professionals I would deal with my issues on my own. I never attended any counselling and as far as I can remember it was never actually set up.

The reason I looked at this as a missed opportunity is that the actions that were discussed were never set up for me and because of the doctors reaction I did not follow it up. Some of the reasons behind it being a missed opportunity were down to me as I was unwell and felt that this option wasn’t going to help me. I understand that now, but also if the doctor had responded differently maybe I would not have become disillusioned with the NHS so quickly and may have accepted and followed up on the help that I needed. As it happened the next time I really came to the attention of the professionals was during a suicide attempt.

These situations were just a couple of examples of possible missed opportunities. I understand that over time some things have changed but reading the news and reports of other young people and children being let down it still seems that these changes have not been enough yet. More changes to avoid these situations need to be put in place. Hopefully with the campaigning of charities, such as Young Minds and Rethink, we will start to see an improvement. I also hope that the changes that are made will improve the transfer of young people from CAMHs to Adult mental health services as well. This happens at a much younger age than when it happened to me at age twenty. I keep my fingers crossed for all the young people who have to go through this in the future.