Getting professional help for a diagnosed SMI (Serious Mental Illness) like bipolar should not be hard. I know my GP has a flag on my computer record to alert anyone accessing it that I am “special”. Not that special. This post relates recent experience of me being proactive in keeping myself well, trying to access mental health services after eleven years of successful self-management. It is in no way a criticism of individuals in the NHS and CMHT where I live, who have been professional, knowledgeable and caring, rather shows (to my mind) :
- fragmented and ill-thought through funding
- underdeveloped integration of digital and face to face systems
- siloed services – or simply staff shortages and vacancies
It confirms to me, now that I am actively engaged in the NHS, after a decade of good mental health, that it is no longer able to provide the holistic care for mentally ill patients, I once had.
Caring for someone else when mentally ill
A while before the pandemic, a friend of mine became unexpectedly and severely ill and, because they have no close family, I stepped up with other friends to help and support them, I became their next of kin – none of us knowing what lay in store globally or for my friend’s recovery. Supporting someone remotely and via email is intense and stressful for everyone involved whether family members or health and care staff. Who had even heard of, let alone used, zoom before March 2020?
Initially, my friend was not able to speak very clearly and soon lost confidence that healthcare staff understood, preferring to email friends instead. During lockdowns these messages were prompted by anxiety and panic, so staccato cries for help most days. Receiving such an email does not always give the recipient (often me) the full picture and there were plenty of false alarms. I was in almost constant alert over the unread emails in my inbox.
Early in the pandemic I started to experience new physical symptoms including the well-known lithium bad tase in the mouth. Along with the rest of the population, I enjoyed several telephone conversations with a quartet of locum doctors. A year later, none of the symptoms had subsided, so I asked for a referral to the psychiatrist at my local mental health centre. The most notable thing about me, medically speaking, being that I have taken Lithium for decades, so I wanted to rule this out as a possible cause.
Time waster?
Seeing a psychiatrist for the first time in over a decade means the inevitable retelling of my history – most of the first consultation over. I am older so there is a lot to say and I talk a lot anyway. A second consultation three months later and a different doctor, so rewind to the inevitable retelling of my history, which resulted in agreement to reduce my Lithium dosage from 800mg to 700mg.
Simple.
When it came to the prescription and for decades only having taken 2 x 400mg and now needing 1x 400mg , 1x 200mg, 1 x 100mg. Only there is no 100mg and I wasn’t sure if 200mg could be scored. Neither was the locum GP. This is when I learnt I know nothing of the mysteries of the NHS, nor who to ask once the locum GP was no longer on the phone and didn’t call back as they said they would. This took a while to resolve with a Google search finally providing the answer. In the meantime, I got wound up in a heightened state of anxiety trying to establish how to get my prescription updated so that I wasn’t running out of 200mg tablets (FYI they can be scored) before the 400mg so I
- posted a message on the NHS app
- took photos of boxes of Priadel and emailed anyone and everyone I’d had contact with
- phoned the crisis team where the lovely person I spoke to could not advise on medication
- spoke to a duty officer who said they would pass the message on
- spoke to a duty psychiatrist, who had never met me, ” It’s driving me mad”
Continuity of care?
Perhaps not the best phrase, but it worked and I got an emergency prescription for the missing 200mg. On to the third consultation and a third doctor, with a new approach. We get to the meat of the matter and a medication change to sodium valproate is proposed. After a short discussion, it is left for me to mull over pending our next meeting, which thankfully is with psychiatrist three again. We also agree a further reduction to 600mg as tests show blood serum is still in the therapeutic range with no harmful impact on mood.
At the consultation with psychiatrist two I had also explained the stress of supporting my friend, which had become all-consuming and they told me to ask my GP, who in turn sent a text with the web address for self referral to IAPT. How modern, I thought.
Counselling and bipolar
A few weeks later I received a letter telling me my IAPT application had been turned down and inviting feedback on a third party website. I am not backwards in coming forwards so took up this invitation immediately.
I didn’t pull my punches, I felt abandoned. Is it because I manage my mental health well, that when I ask for help, I am not deserving enough? Lithium, which works well for me, costs pennies a day – a hospital stay? Well, you tell me. It’d be blocking a bed for someone, who needs it more than me.
A manager phoned me to explain that because I was already under the care of a psychiatrist at the mental health centre there was no funding to access IAPT separately and needed to go via the psychiatrist. I explained
- I had been to the psychiatrist , who
- referred me to my GP , who
- who sent a link, where
- I completed their web form
I also was seeing the psychiatrist for physical symptoms and a meds change, not talking therapies.
The manager sent me a list of charities providing low cost counselling. I contacted one and promptly booked a telephone assessment. This was promptly followed by an email telling me I was too complex for their trainee counsellors. The only complexity I know of is my diagnosis, so this was dispiriting. I just wanted help/strategies to reduce my stress levels and avoid unnecessary hospitalisation. I found a counsellor in spite of it all.
In March I should be seeing psychiatrist four.
Background to this post
This post was prompted by a thread on Twitter about a children’s mental health services being in turmoil. This is very important, today’s children being tomorrow’s young people and adults and I have mentioned it in an earlier post.
However, services for people with existing mental illness should not be forgotten.