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Posts Tagged ‘GP’

Testing Times

My psychiatrist appointment is going to be rearranged – my care-co couldn’t make it, and I declined to go alone.

I had my “initial assessment” with the PCMHT today. I wish I could say it all went swimmingly and will be referred onto psychology as planned.

It didn’t start well when she revealed that she knew next to nothing about me. Past notes are archived after two years, and the only thing she had about me was a letter from my old psych – written in June. Not a trace of my GP’s referral, which was the one my care-co said he’d been told they were acting on. So, this was referral #3. With #1 never having gotten off the starting blocks, and #2 seemingly MIA, I was left wanting to throw something very messy at mental health services.

The truth is, it seems, there may be some issue about who funds this therapy that everyone seems to agree I need. It’s apparently “very unusual” (sounds kinda familiar) for the PCMHT to see someone who is also seeing the CMHT. I showed her my care plan, in an attempt to clear things up, but it backfired spectacularly – after she’d read it, she told me that what she’d read in it made her think I should be seen by secondary care psychology. She almost looked intimidated – I could practically see her mentalist alerts flashing, which was rather disconcerting, and gave me a lot of guff about “knowing how annoying it can be when different services keep saying no to you”. She did then try to ring my care-co, but he wasn’t in the office (he never is), and that was very nearly an end to the appointment – but I did manage to convince her that going ahead with the assessment would save time just in case, especially since my care-co is only planning to stay involved “until the psychology referral is sorted” (having been the person who first uncovered what a mess the professionals have made of this, I think he’s trying to make sure I don’t slip through the cracks again).

It then took her an hour to do the flipping risk assessment. I was surprised at how affronted I felt over being asked to “give my assurance that I wouldn’t try to hurt myself”. I tried to explain that not even my worker at YP-place has ever asked me for that, and there was no way I’d give that to some random lady, however well meaning, that I’d only just met. The only person I can recall who ever asked me that was a psych nurse in the hospital, who was trying to work out if I was OK to discharge (having spent the whole weekend in a 12 hour assessment unit, while other patients came in and were sent home around me…). Even when I’m suicidal, asking me questions like that only makes me lie – how is that a productive question to have on a risk assessment if it turns your clients against you?

In the end I offered up an alternative question that I was happy to answer (and luckily, in the negative), stolen from previous risk assessments “How likely is that you might try to harm yourself?”, but I don’t think I managed to get across to her just what my objection was. Apparently they “always ask everybody that question”.

By the time we finished the risk assessment, we were already 90 minutes through a 60 minute appointment, and she was struggling to fit everything into the small boxes on the form. She suggested we break it there, and meet again to finish the assessment, which we were, to quote “nowhere near finishing”.

Then she started in on the page headed in big bold letters “Evidence of serious mental illness”, trying to cram more of her very small writing into too-small boxes. I reminded her that she’d already proposed to stop – she countered that this bit was important as it could be “the sticking-point”.

All I can say is that I’m glad I finally convinced her that I was getting really fed up of it and wanted to stop there before we did any more “just the next page”s. She never did get to finish quizzing me on hallucinations, illusions and delusions, which was a good thing, as by that point I was downplaying everything, trying to convince her that I was mental enough to need a psychology referral but not so mental that it was inappropriate.

I did, however, have to wait for yet more time, while she photocopied that oh-so-damning care plan.

Outcome: I have to wait to hear whether I’m deemed too severe to be seen by primary care, and booted up to secondary care (who, of course, as we all know, only see people with Severe and Enduring Mental Illness, which of course I’ve repeatedly been deemed not to have).

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So, the mood has deflated somewhat, leaving me feeling…

… disappointed,
… betrayed,
… slightly dirty,
… bewildered.

I’m sure I should simply rejoice in the fact that I can enjoy moods like that, but the rollercoaster is getting tiring. I want real gold, not fake gold that flakes and tarnishes as soon as it is exposed to the light of reality. I’m embarrassed by some of the (minor) things I said and views I expressed, and worried by the fact that I stopped taking my dulox at one point.

Luckilly the euphoria started disappearing before I (finally!) saw the psychiatrist, as a week previously I’d been fully intending to give him the benefit of my theories and ask to be discharged… as it was, the session went ok. It was a fairly standard assessment, with all the usual questions asked, and the conclusion was that I should continue on the dulox as I seemed to be “stable” on it, and come back in three months (with the normal get-out-clause of “see your GP or make an earlier appointment if you feel you need to”). I was vibrating like a struck string all the way through the appointment, but I think he must have mistaken my agitation for anxiety/desperately needing the loo, and even commented that it “wasn’t long to go now” so I didn’t feel I wanted to enlighten him.

My sleep is still a problem, but he had no words of wisdom on that front, only noting that “insommnia can be a side effect of duloxetine” but that he “wasn’t sure about ‘nightmares'”. Great…

I did, however, manage to convince the receptionist at my GP’s to give me an appointment (whole ‘nother story there), so maybe I might get some advice tomorrow. It’s slowly driving me insane, as I’m still waking up in the night, having weird dreams, and am tired ALL THE FLIPPING TIME. It even drove me to embarrassed pleading with one of my collegues to take some of my work off my shoulders… not ideal, as he’s in the middle of failing a bunch of exams, and pretty stressed out himself.

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So, after seeing my second psychiatrist in two days (with, luckily, the same conclusion: don’t need hospital, do need crisis team), Crisis finally came round and assessed me today.

Unsurprisingly, they were reluctant to take me on, and said that they’d be doing me a disservice by doing so (they also complained about “budgetary constraints”). However, we’ve compromised that they’ll have me for a week just to help me get some longer-term support in place, as I’m too deeply mired to be able to do it alone. It’s the exact outcome I wanted, so I don’t know why it’s not making me feel happy, why I feel like I’ve been punched in the face and then kicked some more for good measure.

I mentioned CMHT, but, again, unsurprisingly, it appears I’m still not “severe and enduring”. Instead, they’re going to ring up the PCMHT and ask if I can see someone other than the chocolate teapot, and liase with the young people’s place to see if they can offer me more support as well. And I think they’ll be bringing my psych appointment forward as well.

All well and good, and I’m sure the young people’s place will step up to the plate, though less sure about the PCMHT, who were the first people to ever point me in the direction of CMHT.

My worker (with the young people’s place) is unavoidably away this week, so I can’t see her tomorrow and tell her she was wrong. Wrong to tell me that if I made up my mind to ask for help then it didn’t matter who I asked, that they’d help me and shelter me and give me a hand. Wrong to say that there was support out there through the NHS for people with “severe mental illnesses”, to suggest that the NHS would be able to “support” me, to try and “stabilise” me, to take away some of the burden of my own care, to “make sure I’m in hospital when I need to be”.

Because I asked my GP, and she referred me to A&E. A&E referred me to the Crisis Team. Crisis very nearly discharged me straight back to my GP.

I don’t fit any of their little boxes.

I’m just Chou, and I seem to be falling through the gaps.

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What to do when the PCMHT don’t want you because you’re too severe but not severe enough for the CMHT?

Blue Skies and Green Grass

I think I may have found this out, at long last.

Dropping down to crisis point seems to have mobilised referrals and people in a way that would never have happened otherwise. The crisis team are on the verge of discharging me, but I now hold promises of a referral to both the Primary Care Clinical Psychology service and to a psychiatrist for regular follow-up over my meds – so I suspect I shall be seeing that blue-green waiting room a few more times. Unlike last time, they are insisting on creating a crisis plan with me before discharge.

Both my worker at the young people’s place and the crisis team have independently expressed the idea that they should talk to the other side. Whether that phone call has actually been made, I don’t know, but I know that my worker was very keen on putting her head together with them/my GP before I’m discharged, and working out a way that she and my GP can keep me from “falling through the net”… like I very nearly did this month.

Frankly, if they do talk to each other, I will be A) amazed, but also B) relieved. I’ve gotten fed up of playing the chinese whispers game, and of forever being the one to relay information between services. Yes, I realise that there is an issue of confidentiality here, but there is some automatic liason between NHS services that simply doesn’t happen between my worker and those same services. When I was discharged from the hospital, one of the nurses there gave (after asking my permission) my worker a phonecall to explain what had happened, and followed it up by faxing a letter that she could keep in my records. Sure, it was a simple thing, but it made the world of difference to me at a very vulnerable time – I did not need to explain the details yet again, or even work out how to broach the subject… instead the time of our session together was freed up for deeper conversation. I did not need to say anything, because she knew, and she understood.

So, this seems to be where I stand now: freed of the PCMHT, and with a potential pic n’mix from both primary and secondary care (as, to be fair, I expect most people have).

I hope it doesn’t all go back-end-up again, but I really do fear that it may.


NB: I’m drafting a post to try and explain what was going on in my mind and in my life prior to this post, which might help make more sense of my posts since, but I haven’t really wrapped my head round it yet myself, so it will be a while in the coming.

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Goodbye Meds, Goodbye Chocolate Teapot

So, I’ve just got off the phone with the PCMHT, and it’s sorted – no more choc teapot (hurrah!), and no more PCMHT for Chouette.

I also saw my GP this afternoon, who’s happy for me to go off my meds, though she did emphasise that “her door was always open”, presumably in case I change my mind. She was a bit more surprised that I wanted to stop seeing the choc teapot, but was happy with that after I explained why (that I’d simply finally given up hope of ever actually getting along with the chap).

Incidentally (and somewhat amusingly), I don’t think anyone will be surprised to hear that he failed to follow through on his promise to contact my GP to pass on the venlafaxine recommendation.

I can’t quite believe that this has been so easy – the only person who’s concerned about this change of direction is my worker at the young people’s place, who managed to talk me into carrying on seeing her.

Personally, I’m happy, and at peace with my decisions. I’m doing something I was supposed to do a long time ago – I disobeyed then, but I’m determined to bloody well get it right this time.

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Change is in the Air

(Side note: This is my 100th post)

…well, a change of med may be coming my way.

I duely delivered my “I hate citalopram” speech to my GP, who seemed to listen, and then commented that I’d been on so many antidepressants (er… three?) that we were running out of first-line options, and maybe it was time I tried “one of the newer ones, like venlaflaxine” – but that that would likely require seeing a psychiatrist first.

Instead, she’s going to speak to the chocolate teapot before she decides what to do, so that they can “form a coherent plan”, and then she’ll let me know.

So, I’ve really no idea what’s coming next, I just hope something does!

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Goodbye Mirtazapine… Hello Prozac

So, go on, hit me with the stereotypes. I’m sitting here with a piece of green paper that tomorrow I shall exchange for a nice new shiny pack of fluoxetine hydrochloride.

I went off Mirtazzy over the weekend, it just wasn’t proving compatible with university studies and early-morning lectures. The snag now is that I’m going off a med that had a really short time of effect, onto one that takes a long time to kick into gear. I do have somewhat slightly mixed feelings about this, especially as Mirtazzy worked quite well for me – I was quite happy, just happy and asleep. However, at least people won’t be recoiling in shock/surprise when I tell them what med I’m on anymore. And I’m in good company.

I had an appointment with my GP this afternoon. Technically she’s not my GP at all, however she did want me to see her again the next time, so I guess practically speaking that makes her “mine”.

She turned out to be very nice, except for the fact that she started hitting me with what felt like half the diagnostic criteria for depression… “Do you have difficulty concentrating? Are you thinking more slowly than usual?”.

Perhaps I should nick Seaneen’s idea and use emoticons for consultations like this. “:(” would indicate I’m depressed, “:'(” would be PMS, “:s” could be anxiety or hallucinations, and “:|” would be “about to kill myself”. As it was she gave me a PHQ-9 “to think about”. The irony is I don’t feel very motivated about filling it out. Looking it over casually, I think I’d get “moderate” depression, but that’s quite a good score for me, so I’m not too concerned.

I was nervous as hell before the appointment, but chatting to a friend I happened to meet in the waiting room helped. It didn’t really go to plan, to be honest – I wanted more just to get the med change and ask her advice about my uni problems, but she seemed more interested in whether or not I was depressed. It started to feel more like seeing a therapist than a GP at one point, as she kept insisting there was someing “blocking me”, and wanted to know what it was. By then so did I, just so that she’d move on, but I had no real idea what she was talking about!

One positive thing that came out of is that she’s going to chase up the PCMHT. She rang up her secretary in the middle of the consultation to query what had been written on my rather cryptic notes and ask her to do that, plus “expediate” the notes from my previous GP, which it appears they still don’t have on the system. She enthusiastically promised me that her secretary would definately ring me back tomorrow to let me know “because she’s good with things like that”.

She wanted to see me next week, but she was away, so I’m seeing her in two weeks time.

Her parting shot was quite amusing, so I thought I’d share it with you…

If you get into crisis before then, don’t crisis alone. Let us all share the enjoyment!

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