Posts Tagged ‘PCMHT’

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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Q: Why Do Buses Come In Threes?

With very little to take me out of the house, my days have been melding into each other, each one with its own small challenges to surmount – food, washing, keeping the electric meter fed with credit.

And now suddenly everything else has come up at once.

I have…

  • Tonight until the weekend – time with my grandma and parents
  • 6th September – appointment with my old psychiatrist to see if she would be willing to back my application for ESA, despite having told me I should look for work last time she saw me.
  • 10th September – appointment to have two tenacious baby teeth removed, as some sort of “gentle introduction” into having dental work done.
  • 13th September – appointment with a “mental health practitioner” from the PCMHT for an initial assessment (same as in May 2008), as a response to my psychology referral.
  • 16th September – appointment for my ESA medical

Since I don’t seem to have the option of just sleeping through the next fortnight (doubly true while I’m being more insomniac than usual), I fear the next two weeks are going to be lurching from one raw wound to another. I shouldn’t cancel the dental appointment – delaying it is only going to make me more nervous about it, but I don’t think I can cope with worrying about it on top of everything else. Also, physical pain tends to make me forget everything mental related for a while – which is perhaps not what I want directly before two assessments where, in some wierd sense, I need to be as mental as possible in order to get a positive outcome.

Sheesh, I sound like I’m faking it just for the money. Since I started applying for benefit I’ve become a lot warier of things like that – it’s hard not to be, in the current climate, with news articles like this and this (by the way, my grandma reads the Torygraph).

Especially since I’m much better and should be applying for work, right?

Also, how do I explain to my (generally disbelieving) parents that my psychiatrist discharged me and told me I’m much better but I’m seeing her again because I’m applying for sickness benefit?

If only real life worked the same way that we all think the systems should work.

A: Because travelling alone is dangerous

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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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(I hope you can see what I did there. Do not adjust your monitor. Anyone who tries to should go and sit in the corner…)

I had a rather heavy conversation with my worker at the young people’s place today. I clued her in on some of my history, and showed her my copy of the feedback from the PCMHT team’s initial assessment, back in May, which she asked very nicely if I would let her photocopy for her own future reference if necessary (translation: for extra ammo if she was ever concerned enough about my safety to be considering tattling on me to my GP).

It also solved some confusion on her part over who I’m seeing in the NHS, though she then seemed confused about the fact that I was refered to the chocolate teapot and not to a psychologist for that mythical CBT I was promised and never got. When looking through a leaflet about the PCMHT that I’d been given at the assessment (and was now also showing her), she paused at the page which details who they do and don’t provide a service to, and queried why I’d been refered to them – “Ermm… which of these do you think you fall under?”. I refrained from saying something along the lines of “Uh, durrr… ‘Depression and anxiety’?”, and gave the more honest answer of “To be honest, I’m still not entirely sure…”.

It’s not easy to put a finger on the point where I stopped feeling ambivalent about working with her, but I guess it was at the point where I pitched up unannounced in an utter (Prozac-induced) state, and she dropped what she was doing to see me virtually there-and-then, and provide me with some practical support and advice on how to cope until I managed to get some help from my GP. Since then I’ve been increasingly confiding in her, about things that I’ve never mentioned to anyone else. I think she may be the person who gets to see the most of me, the bits I’d prefer to hide as well as the more socially acceptable bits. It helps that I’ve known her since July, rather than just in this context – and she’s seen the changes in me as I’ve moved through the various moods and med side effects that have plagued me over that period.

I suppose what I’m trying (very badly) to get across is that I feel she sees me as a person, not a “case” or a collection of psychiatric symptoms. She’s not there to “fix” or to “counsel” me, nor for one particular purpose, she’s more able to be whatever I need her to be at that particular time.

Now that ambivalence has been transferred to the chocolate teapot, and I’m still thinking about discharging myself from him…

Er… hang on… on second thoughts, was I ever unambivalent about him???

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Considering Self-Discharge

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

A combination of Kate’s latest post and a long conversation with my worker at the young people’s place has gotten me thinking.

I just don’t think I’m in the right place or at the right time in my life to be benefiting from the PCMHT’s services.

Who are the PCMHT, anyway?

As part of BigCity PCT, the Central and South BigCity PCMHTs provide a service for people experiencing a range of common mental health problems, such as depression and anxiety disorders. They provide a confidential, non-crisis service for adults and offer short-term interventions. Referral into the teams is made by GPs and the team supports GPs to develop a range of options for their patients.

..and what do they offer?

We [The PCMHT] do not provide a service to people:

  • who need an urgent or crisis response
  • who need a psychiatric assessment or diagnosis
  • with significant problems relating to alcohol or drug use
  • with eating disorders
  • who present a serious risk to themselves or others
  • who need long term therapy or support

What do we provide?
A range of brief, evidence-based forms of help and support including:

  • Advice and information
  • Signposting and referral on to other services
  • Guided self-help
  • Cognitive Behavioural programmes
  • Counselling
  • Problem solving

…and what was I promised?

  • That they would monitor my mood swings, to pick up on if these were a problem or not
  • That they would give me CBT
  • That they would help me prevent further episodes of low mood from occuring

Sitting here, I cannot think of a single thing the PCMHT has done for me. I haven’t even noticed much CBT going on! And I can count the number of times the chocolate teapot has asked me about suicidality on, er… one finger.

My GP thinks the PCMHT is keeping an eye on my mental health and my meds, the PCMHT thinks my GP is doing it. My notes are spread across primary care and secondary care, and as far as I can tell, there’s little communication between the two.

The chocolate teapot wants to recommend lifestyle changes that will enable me to ditch the antidepressants. I feel, and my worker seems to agree with me, that this isn’t such a great idea while I’m still struggling so much with the basics: finding medication that I’m stable on, and actually coping with my work and my life as-is.

He also thinks I’ve made depression too big a part of my life, that I get depressed because I let it in and give it the power over me. I feel this is unhelpful – I didn’t ask the depression in, it barged through the door and gatecrashed the party. For me, admitting that I have depressions, that I need help, support and medication is somewhat of an improvement over 6 years or so of complete denial. One step at a time, please, m’kay?

The PCMHT can see me at most every two weeks, and it is often much less often. This is more than enough time for me to deteriorate from “bit ill but coping” into acute illness. The PCMHT’s job is to keep me “out of mainstream services”, which I don’t feel is helpful when I may occasionally need to access those services and the more intensive/specialist support they can provide.

Frankly, I think I can do a far better job on my own and with the support of afore-mentioned young people’s place.

I’m not going to make any split decisions; I’m planning to take along the relevant bits of paper and talk it out with my worker next week before I decide anything for good.

But at the moment I feel quite optimistic that this would be the best way forward.

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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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As above.

Appointment with “Mental Health Practioner” at the end of July (NHS).

Appointment next Tuesday at the young-people place.


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