Saturday, 22 April 2017

Accompanying someone to a Work Capability Assessment

I've had a face to face Work Capability Assessment, as well as a face to face assessment for Personal Independence Payment in the past. I'm not sure I thoroughly described my experience of these assessments, but today I want to talk through a Work Capability Assessment my father had recently. I accompanied him and took notes throughout.

We arrived at the assessment centre, with the daunting thought that we'd probably have to park quite far away. From my experience, I know that there are a lot of cameras outside these centres and (also from my experience) there's a very high chance that the assessor is watching you to see how far you walk from your car/stop to the building, and they will write their "findings" in your report.

Luckily, we found a space just a few metres from the building. As we entered, we were greeted by a G4S security guard; who immediately asked to see our appointment letter. They also asked if my father could manage stairs or a lift. Now we were under the impression that the assessment would be held on the ground floor, and I made this fact very clear to the security guard. I also mentioned that, although my father could manage to use the lift, he wouldn't be able to use it in the event of a fire & would not be able to use the stairs. The security guard accepted this (reluctantly) and showed us to the ground floor waiting room.

The waiting room was empty, apart from one elderly woman who was noticeably struggling with pain and balance. Although the waiting room was small, there were two cameras strategically placed to film anyone waiting for their assessment. I asked the woman if she was ok, and if she needed a cup of water (there was a water cooler nearby). She declined, but told me she was very nervous about her assessment, and was fed up that she'd been waiting 45 minutes already. I told her I thought that was awful, and she replied that the couple before her had been waiting over an hour. Just before we were called in (after a receptionist came to check my father's ID and sort out travel expenses), the couple the woman had mentioned, came out of the assessment room. One of them (I assume was the claimant) was clearly in agony and could barely walk. People who are struggling this much, should not have to make their way to an assessment. They should either be assessed on paper, or in their own home. Unfortunately the rules (for an ESA claim at least) state that a doctor's note is required before a home assessment is considered. There's not much time to organise this, so this means that people are having to drag themselves to assessment centres that are not always suitable for their needs.

A rather snooty healthcare professional came to call my father in for his assessment. It was easy to tell he was watching my father's every move as we walked towards the room. I have no doubt that this will be (inaccurately) noted in the ESA report. We sat down, and I got out the folder of evidence we wanted to show, as well as a notepad and pen. The "healthcare professional" (I have no idea what his actual profession was, and his badge only said Healthcare Professional) noticed this, and commented that I was allowed to take notes as long as they were just for reference and not to be used in any investigations (hmm). I gave him my most patronising smile and said that these were just for reference. It was obvious to me that he wasn't happy about this, but there was nothing he could do. I know what's allowed. One thing I wasn't happy with, was that he didn't even introduce himself to us.

The assessment then began. The questions asked first were to do with the medical conditions my dad was claiming ESA for. The assessor went through each condition and asked how long he'd had it for, who diagnosed him, any investigations he'd had, what treatments he was on, operations he'd had, whether he'd noticed any improvements, and which specialist/s (if any) he saw for these conditions. What I found was that I had to reword some of the questions the assessor asked, in order for my dad to understand them. The assessor spoke quite quietly, mumbled a lot, and didn't word questions in a clear way. For example, when asking about my dad's total knee replacement surgery, he asked how he was rather than whether he felt there'd been any improvement since the operation. For some, it may seem easy to get what the assessor meant, but when you are put on the spot, it's much better to be asked questions in a clearer way.  

We next went onto the tablets my father is currently on. I'd brought them with me, so put them on the table so I could show each box to the assessor. He asked what my father took each medication for, how often, how many at a time, what strength, how long he'd been on them etc. As my dad answered, the assessor checked through each box (presumably to see if dad was telling the truth...).

After this, the assessor asked how we had travelled to the assessment centre, and how long it had taken us. He also asked who dad had travelled with (me!), my name, and age.

We discussed sleep problems next i.e., did dad have any, why he thought he struggled with sleep, how long he slept on average etc.

We then went onto the questions asked in the ESA50 (the limited capability for work questionnaire). The assessor started with personal care questions; such as washing and dressing. He asked how long it took to get out of bed, whether he needed help with dressing or used any aids (bed included). He also asked whether my dad was able to wash/dress his upper and lower body, have showers etc. My dad made sure to mention how much he struggles, and how pain and stiffness severely affect him.

Household tasks, cooking, shopping, and leisure activities were the next topics the assessor asked questions on. He asked what types of chores & cooking dad could manage, how often, whether he needed help, why he struggled and so on. I told the assessor that there's not much we can manage and I have to help my dad if his pain gets too much or he becomes confused.

As for shopping, we do nearly all of ours online (my mum and I take turns with this, as dad can't use a computer). We only go to the shops for a couple of bits (bread and milk, for e.g.) The assessor asked if we walked to the shops, and how far away they were. Dad said that the shops were only 5 or 10 minutes away, but we still had to drive there.

Dad was asked if he had any hobbies, but there wasn't much to discuss on this topic. His concentration is poor, and he doesn't have the energy spare for socialising so it's just light reading and watching a bit of television. The assessor then asked how long dad could stand/sit for. He tried to lead dad to agree with his suggestions for an answer (standing/sitting for 45 minutes, or 2 hours?). Dad was already exhausted and needed prompting, so I told him that it was more like standing for 5 minutes, and sitting for 30 minutes before having to sit back down or move around. This was due to stiffness in joints and pain. I'm hoping the assessor noticed that my dad had to get up a few times during the assessment, for these exact reasons.

The last question asked was how long my dad could walk for, before having to stop. I notice that assessors tend to ask how long (time taken) rather than how far (distance). This does not lead them to an accurate answer for how far a claimant can walk, however, and I think they do this on purpose. No two people will travel the same distance in the space of 5 minutes, for example. One may be able to walk 200 metres, whilst another could only manage 50 minutes. I believe the assessor predicts the furthest distance walked in the time specified; which of course makes the claimant appear more able than they are. I noticed that questions were repeated and reworded sometimes, in order to supposedly "catch us out". I think our answers were consistent though, and I'm glad I'd made my dad aware beforehand that this would happen.

The last part of the assessment was the clinical one; where dad had his blood pressure checked, then had to repeat some exercises (if possible). This consisted of bending/turning his head, moving his arms forward, backwards, to each side & over his head. He also had to make a fist with each hand, and push against the assessors hands. Lastly, he had to sit down and stretch and bend his legs, then push each one against the assessor's hands (both in front and behind).

At the end, the assessor explained what would happen next (writing up the report, sending it to the decision maker etc) and that we could ask for a mandatory reconsideration if unhappy with the decision. We were so glad to get out of the building soon after this!

So that was the face to face Work Capability Assessment! I hope my account of it may be helpful to anyone waiting for theirs. I'm no expert, just someone who has been through the process, but I am happy to read any comments or answer any questions you may have. If I'm not able to answer your question/s, then I will let you know where you may find the answers.

Sunday, 2 April 2017

Validation

A lot has happened since my last post about mental health . I've had two Community Psychiatric Nurse appointments; to discuss my main problems and where to start with treatment. I've also had a very thorough assessment with a Trainee Psychiatrist, and a Consultant Psychiatrist.

First CPN Appointment - 

My vlog below explains how my first CPN appointment went but to summarise; I was asked similar questions to those at my initial Community Mental Health Team assessment. I was also asked how I'd been since my assessment, and my main reasons for asking for help from the Secondary Care team. I explained how my last therapy session had gone (see My Mental Health Timeline and my vlog A Referral to CMHT for more details), the kind of help I felt I needed (beyond therapy) and the fact that I thought I might have Borderline Personality Disorder.

Once the CPN had asked all the questions she needed to, she gave me her impression of what support she believed would be best for me. At first she wondered whether Cognitive Behavioural Therapy, at Primary Care level, would be more suitable. After I explained more about my needs, however, she decided that some short term therapy for specific problems may be what I need at the moment. She also said that she would get a Consultant Psychiatrist appointment for me, to review diagnoses and medication.




Second CPN Appointment

My second CPN appointment was carried out at home. She asked how I'd been since the last appointment; to which I answered "a bit all over the place again". We went over my responses to questions about my main issues now, any relevant information from the past and any significant events in my life that may have led to my problems now. She asked me to explain my mood swings, how often I have them, how extreme they are, whether anything triggered them and how I coped with them. We went over the medication I took, and whether it helped me at all. Finally, she asked me some more specific BPD-based questions (relationships, mood swings, impulses, feelings of numbness etc). She concluded by suggesting I do some Self Compassion work with her and a support worker. She felt that this would be a stepping stone for me. I will be meeting the support worker (and CPN) on 11th April for this. I also have another CPN appointmen on 24th April, so will let you know how these went.


Psychiatrist Appointment

 A couple of days after my CPN appointment, I had a psychiatrist appointment. I saw a trainee psychiatrist for this, and was asked a lot of questions to cover a whole variety of mental health problems. As well as questions about depression, and various anxiety disorders, I was also asked about my experiences with paranoia, delusions, hallucinations, mania, impulses, and any instances of aggression. The amount of questions asked were exhausting and overwhelming, but I was glad that I was given an opportunity to talk about the kinds of symptoms I had that didn't just fit anxiety and depression. It helped me to remember the things I needed to talk about too, and I honestly don't think I forgot to mention anything! I have had a hallucination and some delusions before, although these aren't regular occurrences at all. I do get mild hypomania sometimes too, and have had impulsive behaviour (although these don't tend to go further than urges now).

The psychiatrist took lots of notes on what I'd mentioned (even things I weren't sure had happened often/severely enough to be relevant) and also asked about my request for a BPD assessment. After asking questions, more specific to the Borderline Personality Disorder diagnostic criteria, she discussed my responses with the consultant psychiatrist. He came into the room, and asked me more questions (to be absolutely sure, I guess) and then confirmed I had Emotionally Unstable Personality Disorder (aka Borderline Personality Disorder)

The consultant also discussed medication with me. He felt that I should stay on the Sertraline 200mg as it helped a bit, and suited me. In order to help balance my moods, he also prescribed the anti-psychotic Aripriprazole. I'm to take that at 5mg per day for a week, then 10mg per day.

Overall, I'm really pleased with the support I'm getting from the mental health team so far. I was so nervous about opening up about the diagnosis I thought I had, and what help I felt I needed. It was a bad start with the therapist, so I wasn't holding out much hope, but I'm glad I didn't give up! As well as support, as this blog post title says, I've felt validation.

Monday, 13 March 2017

Mental Health Questions Asked at Work Capability Assessments

(TW: Suicide)

Since my first Work Capability Assessment, my mental health has definitely declined. Throughout the process for claiming Employment and Support Allowance, claimants are treated as if they are faking/embellishing their disabilities. Letters from GPs, specialists, therapists etc are given little or no consideration in deciding whether someone is "fit for work", "fit for work related activity" or not fit for either.

There's a lot of pressure from filling in lengthy forms, gathering evidence (in the hope it will be considered), sending sick notes in on time, sending assessment forms in on time, being able to explain your disabilities to an assessor & hope they will not twist or completely disregard your words. This is all before a decision has been given, and already it is not surprising that someone's mental health will suffer.

A particular issue with Work Capability Assessments is how the assessor asks mental health-based questions; primarily suicide-based ones. Claimants are asked questions such as; "Have you ever tried to harm yourself or take your own life or needed to go to hospital?"¹, "do you have any intentions or plans to hurt yourself currently?"², and "what is it that stops you from acting on the thoughts that you have?"³ These questions are asked in a hostile environment; where the claimant is observed right from the moment they arrive in the car park of the assessment centre. To be asked such personal questions in that context is extremely distressing and has led to worsening of people's health conditions.

At my first Work Capability Assessment, I was asked if I have had thoughts of suicide, why I had those thoughts, whether I had attempted suicide, and what stopped me from attempting. It took a while for me to really open up about my suicidal thoughts to my own therapist, so being asked those questions so brazenly, by a stranger no less, was very distressing. I found it very hard to answer, and I burst into tears as I was made to think about my darkest times. The assessor was barely sympathetic, and was more interested in getting me to answer these questions.

Maximus has been criticised for the types of suicide-based questions they ask claimants, but their response has been that "Every healthcare professional we employ is trained to ask people with a mental health condition a series of clinical questions to assess how their condition affects their daily lives."

A spokesperson for the Department for Work and Pensions (DWP) said "If an individual has mental health issues or there is an indication of suicidal thoughts or intentions, this will be given careful and sensitive exploration to establish the circumstances"

According to a Freedom of Information request in 2014 (I haven't been able to find anything more recent unfortunately), WCA assessors get approximately 17 days' training if they are nurses or physiotherapists, and less than 17 days if they are doctors. I've looked through the PDFs released as part of the response to the request, & it appears that actual mental health training is only covered in just over 4 of those days for nurses, 7 days (including overviews of some mental health conditions) for physiotherapists, and just 2 days for doctors.

The British Association for Counselling and Psychotherapy (BACP) have ethical frameworks for working with suicidal clients. According to this, factors such as the following determine the best way of approaching the topic of suicide and what action to take:

  • The context in which therapy is taking place
  • The relationship with the client
  • The boundaries of confidentiality agreed
  • The confidence of the practitioner to explore the meaning of suicide

In the Risk Factors section of the BACP ethical framework document, it is stated that "Practitioners need to be aware of factors that might suggest their client is in a high-risk category" (for acting on suicidal thoughts). This doesn't mean that those in statistically non-high risk categories are unlikely to carry out any plans, but gives a guideline that can determine "the dialogue that then needs to take place with the client". Sources of information on high-risk category clients can also provide vital tools that support risk assessments. 

When exploring how to word questions based around suicidal thoughts & plans, the ethical framework document says "The wording of such questions is important and needs to be treated sensitively. Much will depend upon the setting in which the therapy takes place, the age, understanding, or emotional capacity of the client, and the individual approach of the practitioner" "It is important for practitioners to think about how they might ask a client about suicide. However, best practice suggests asking clearly, openly, and empathically"

This document goes on to explain that it is also important to explore protective factors with the client, and encourage them to use those support networks etc. If the client is at high risk of attempting suicide then specialist mental health services may need to be involved. 

And this is all within a therapeutic setting. A work capability assessment is by no means a therapeutic setting, & the vital resources for dealing with suicide risk are not there; which makes approaching the topic of suicide with the claimant potentially very risky. This could quite easily lead to the worsening of suicidal thoughts and even plans. As for the discussion of protective factors, this is only very briefly touched upon in Work Capability Assessments, so is very unlikely to counteract the impact of asking a claimant (for e.g.) if they have considered suicide, and what methods they would use/have used. If risk of suicide needs to be explored, as part of someone's assessment, surely the healthcare professionals involved in the monitoring/treatment of their mental health (therapists, psychiatrists, GPs even) should be contacted? This could also determine whether a face to face assessment would be necessary, or whether it would be likely to cause a significant deterioration in the claimant's mental health. 


Resources:

¹, ², ³ DNS Article - "Maximus 'admits' using brutal and dangerous suicide questions": http://www.disabilitynewsservice.com/maximus-admits-using-brutal-and-dangerous-suicide-questions/

Article in the Independent - "DWP's fit-to-work tests 'cause permanent damage to mental health' study finds": http://www.independent.co.uk/news/uk/politics/fit-to-work-wca-tests-mental-health-dwp-work-capability-assessment-benefits-esa-pip-a7623686.html

Freedom of Information Request: https://www.disabilityrightsuk.org/news/2014/september/wca-assessors-how-much-training

Nurses' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/nurses.pdf (see pages 6-7)

Physiotherapists' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/physiotherapists.pdf (see pages 7-9)

Doctors' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/doctors.pdf (see page 8)

BACP "Working with Suicidal Clients" - Introduction: http://www.bacp.co.uk/ethical_framework/documents/GPiA042.pdf (see page 6)

BACP "Working with Suicidal Clients" - Risk factors: http://www.bacp.co.uk/ethical_framework/documents/GPiA042.pdf (see page 8)


Tuesday, 28 February 2017

"Not really disabled"

The other day, George Freeman (Theresa May's Policy Chief) gave some very insulting and trivialising comments about anxiety disorders. You'll find the details in this article . It seems he believes that those with anxiety disorders are "not really disabled". Apparently all we do is sit at home; taking pills.

After a lot of (very much deserved!) criticism, he responded with a feeble non-apology; where he expressed "regret" that people were offended. Now I do understand that he has had an anxiety disorder in the past & I would never invalidate his experience of that. I do think, however, he needs to educate himself on various anxiety disorders. He may then learn that the symptoms can vary in severity, are complex, and can be very debilitating.

Disability is officially defined in the Equality Act 2010 as this:

"A person (P) has a disability if-

(a) P has a physical or mental impairment, and
(b) the impairment has a substantial and long-term adverse effect on P's ability to carry out normal day-to-day activities."

I cannot speak for everyone with an anxiety disorder/s, but here are the ones that I have and how they affect me.

Agoraphobia

I get very anxious about leaving the house; especially if there are people outside. To travel anywhere, I rely on my dad driving me. I get far too anxious to take public transport, and can't even take a taxi on my own. I can't manage group situations where I have to stay in the room/it'd be considered rude to leave suddenly (such as a class or meeting) and have to be near the toilet or exit if I'm in a restaurant/cafe etc.

Last time I managed to take a train by myself (years ago), I had panic attacks and had to wait for a later train than the one I'd planned to take. I felt very nauseous, dizzy, shaky and sweaty for the entire journey. Once I arrived at my destination, I was physically and emotionally exhausted. I found it very hard to focus, and when I had to change trains, I ended up lost for an hour and almost in tears at the train station. It's a good job the friend I was meeting was a patient one! In order to get home, I had to get my dad to pick me up (the journey takes over an hour by car).

Obsessive Compulsive Disorder

I've had OCD since childhood, and have tried hard to hide my compulsions. On a bad day, it stops me from leaving the house. It makes me irritable, snappy, and has caused arguments in the past. I take much longer to do things than I should, and am often late for appointments because I've had to complete compulsions, or repeat them until I am "reassured" enough to leave the house. This condition makes me feel trapped and, when I did work, it caused me to miss meetings and compromised my performance at work.


Generalised Anxiety Disorder

I don't react well to changes in plans. I need to know what to expect, Usually, my anxiety flares up in response to things, but I do find that I can randomly panic and not know what has set it off. I get panicky about hypothetical situations, and cannot just wait to deal with a certain situation when it occurs. I tend to think 10 steps ahead of myself, and think of the worst case scenario. I will dwell on potential problems; even more so if I cannot think of a solution.

I find I get very paranoid as well, and I worry a lot about people's opinions of me. I worry about losing friends and look for cues that they may be annoyed at me or drifting away. I also am constantly asking for reassurance.

Phone Phobia

Recently, my phobia of this has lessened and I can now cope with making some phone calls. I still find that I get very nervous when receiving phone calls though, and most of the time I will leave it to go to voicemail. I worry about not knowing the answers to questions I may be asked on the phone. I also worry about not having details like reference numbers ready when needed. I often mishear things and get very anxious (panicky even) if I have to keep asking the other person to repeat themselves. When I worked, I had customers react angrily over the phone because of this. I would avoid answering the phone in the workplace, and have been told off by my manager. I think this contributed to decisions not to carry on my temporary contract too.

I cannot think of a job where you are not expected to use a phone, leave the house, go to meetings, cope with changes, be punctual, have good attendance or be timely with tasks. Even without my other mental health and physical health problems, I highly doubt I could manage work of any kind.

So yes, George Freeman, I may sit at home and take pills but there's so much more to anxiety than that, and yes I am "really disabled".
    

Friday, 3 February 2017

My Mental Health Timeline

Childhood: When I think back to my childhood, I believe I had some mild mental health problems back then; which were probably brought on by the bullying I experienced. I have always had a low self-image, and been critical of myself. I've always had anxiety in some form or another as well. I'd feel anxious about eating in front of people, being in busy places, and catching the bus. I still managed to do all of these things, but I constantly worried about embarrassing myself, seeing one of my bullies, or having a panic attack. I self harmed fairly frequently as a way of releasing my emotions, and as a way of punishing myself for not dealing with things as well as I thought I should.

As I moved onto secondary school and the bullying continued, I became very self conscious & blamed myself for anything that went wrong. I started carrying out certain routines (praying 3 times, exactly at midnight) and carrying "lucky charms" in specific pockets. I truly believed that, if I did this, the bullying would lessen or I'd cope with it better. If I didn't carry out the routines, or forgot to bring certain "lucky charms" with me, I believed my day would be awful & that I wouldn't be able to cope with anything. If I did have a bad day, I believed it was because I hadn't done my routine properly or at the right time. I started to have violent intrusive thoughts, that led to violent dreams. I worried that I'd carry out those violent acts and that I was a terrible, evil person.


University: When I finished school, I decided to go to a university where it was unlikely I'd know anyone. I needed a fresh start, and felt I was a bit happier and confident enough to make new friends. I think this was one of the best decisions I made. I was independent, popular, enjoying life! I was also very impulsive and a bit of a risk taker when it came to certain impulses.

In my second year of university, the physical health problems started and I think this is what led to the anxiety relapse and depression. It certainly didn't help that I was in an abusive relationship at the time, and lost friends thanks to my fluctuating physical illness. I blamed myself for everything again and felt I had to explain why I was well enough to go out some days, and not others. I felt very trapped and isolated by my illness, as well as by my partner at the time. We broke up, but I still felt isolated & I struggled with making plans. As well as feeling too physically ill to attend most lectures, I became very anxious with being in busy lecture halls. I spent more time in my room & became fairly paranoid about friends. I wondered what they thought of me, whether they believed me, whether I was losing them.


Work: After university, I had my first full time job. I was in a relationship at the time, and was fairly happy. It was lovely to come home from work to my partner. He made me feel wanted, and encouraged me to be more sociable. Although not as good as university, I became a little more sociable; catching up with old friends. When it came to work, I often felt as if I wasn't good enough. I struggled with phone-calls, as I worried that the customer wouldn't think I was competent. I still had anxiety with busy situations, and found meetings made me panicky. Whenever I could, I would avoid meetings.  Eventually, my physical health had worsened so much that I had to give up working. My anxiety had worsened a lot too.


Breaking Up: The paranoia I had, the anxiety, and the fact that I wasn't well enough to go out much, I think led to my partner breaking up with me. I struggled with being single, and felt completely worthless and broken. Finding out that he'd met someone else just two days later didn't help either. Was I that easily replaceable? I'd moved back to my parents' flat and away from old friends. Most of my social interactions were online, and so I didn't go out much. I lost more friends, and ended up breaking ties with the rest of one friendship group, before they broke ties with me. It hurt a lot, and I still have times where I dwell on it now.



Unemployment: Once I'd moved back home, I had to decide whether to force myself to work again , or to try claiming Employment and Support Allowance. I was really worried that I'd be thought of as "faking it" or just not being ill enough to qualify. After a horrible assessment, I was accepted for ESA. Stories in the tabloids of "fakers", "scroungers" etc made me paranoid that maybe I'd be accused of this if I was seen outside, or walking one step further than I should be. If I saw a strange car or van outside, or if someone looked at me for longer than normal, I instantly thought they worked for the government.


Starting Therapy: I noticed my moods had been so low, and finally decided to open up to my GP about this. (You can find my blog post about this here). I was given the number to self refer for Cognitive Behavioural Therapy. My first lot of CBT was at a low intensity level, and I saw my therapist every fortnight. We talked about my home situation, physical health (and how that had an impact on my mental health) as well as things that'd happened recently and how to re-examine my thoughts. I liked the therapist, but wasn't finding therapy very beneficial. It seemed too simplistic, and I wasn't sure I really fit the boxes that come with mental health questionnaires etc. I didn't know how to explain it so thought that maybe I just wasn't trying hard enough. I started to have very strong suicidal urges, and was soon in crisis. My therapist at the time contacted crisis team, and I had assessments but nothing else could be offered for the diagnoses I had (Generalised Anxiety Disorder, & Depression). I got very panicky at my last low intensity therapy session, and was then referred on to high intensity CBT. I was also prescribed Amitriptyline by my GP, to see if this would help my moods.

I didn't seem to have such a good rapport with my second therapist. I felt she was repeating a lot of what I'd already learnt about CBT, and I wasn't given much opportunity to talk through how I felt. It seemed more about going through worksheets. If my suicidal thoughts were more frequent, my therapist would instantly go to contacting crisis team. In the end, I told her not to, and I began to hide my darkest feelings and just comply with the worksheets. I ended up finishing this lot of CBT early, partly because I couldn't get transport there any more (and was too anxious to use taxis/buses), partly because it just wasn't helping me.

My third lot of CBT (again at high intensity level) was carried out at home. I was far too anxious to travel, and had then been diagnosed with Agoraphobia, which helped a lot with getting a therapist to come to my house. I got on well with this therapist, and was opening up a bit more. I still didn't find much benefit from the worksheets, and found that I was just going through the motions with homework. It seemed I wanted the therapist to think they'd helped me a lot. I felt like I was failing otherwise. Apart from this, I found a bit of benefit from having the odd walk outside, with the therapist. She wanted me to get a bit more confident outside, and I liked how we didn't have to always be indoors for therapy. I knew I needed help for my agoraphobia, and having someone accompany me outside and build up to me being a bit more independent, would be a good idea. Unfortunately the sessions came to an end before I could make any noticeable progress.

As well as going through therapy, my latest crisis also led to some appointments with a psychiatrist. They changed my medication to Sertraline (with Diazepam as a short emergency prescription). They also suggested I have Psychodynamic therapy, as CBT didn't seem to be suiting me. Unfortunately, I was not given that therapy. I'm not sure any available therapists were trained to carry it out. My third CBT therapist did say, however, that due to the trauma I'd experienced in the past, she may be able to offer me EMDR, as she was training in it. She wanted me to have a break from therapy for a few months first though.

Moving: My parents and I moved house quite quickly, a couple of months after the third lot of therapy. Unfortunately the area we moved to was not under the same mental health team, so I was discharged and told to approach my GP and get referred to the team in my new area. I struggled to get up the courage for quite a while, and took longer to phone the self referral number. I wanted to avoid mental health services altogether, and be left alone. I felt that I wouldn't be reliable and would be discharged for cancelling so many appointments; due to (physical) ill health. When I did eventually call the number, and soon after got my telephone assessment, I found myself rambling a lot to the therapist on the phone. I wasn't sure where to start, and was already very nervous. It felt as if they listened though.

Interpersonal Therapy: I was very pleased to be offered a type of therapy that wasn't Cognitive Behavioural Therapy. I needed to talk about things in the past, and how I formed/maintained relationships, so Interpersonal Therapy seemed like a more suitable one for my issues. At my most recent session, however, I lost trust in my therapist after they dismissed my concerns about my self harming getting worse, as well as a diagnosis I thought I might have. This condition is Borderline Personality Disorder. I explained some of the reasons why I thought I had it, but I didn't feel listened to. The therapist just told me that BPD was something that psychiatrists diagnose you with, if they don't know what's wrong with you. This made me really angry, as I know this condition is real. I couldn't listen to what he said for the rest of the session, and spent most of it wondering whether to just walk out. It was a good job I stayed until the end though, as he suggested I get referred to Secondary Care services (CMHT). I went to my GP the next day, who contacted my therapist to confirm this referral was right for me. After a quick phonecall with the therapist, later that day, I was referred. I was contacted the following day by CMHT; who gave me an appointment for 3rd February.

Community Mental Health Team (Secondary Care): On Friday, 3rd February, I went to my appointment. In the room there was a Community Psychiatric Nurse (CPN). and psychology assistant observing. The CPN explained about my referral and gave me a Wellbeing questionnaire to fill in rather than the usual Depression (PHQ9) and Anxiety (GAD) ones. This questionnaire included questions about coping, making decisions, whether I've felt close to people etc. I've found this questionnaire, with similar questions. I was ticking rarely or none of the time for a lot of them; so I'm guessing my "wellbeing" isn't great!

The CPN then went on to asking why I think I've been referred to the Secondary Care Team, what my main struggles are, and what sort of help I think I need. I spoke about mood swings, the intensity of my moods, how I would be full of emotion (to the point where I feel I'll burst) or feeling nothing at all. I told him how I found it hard to cope with how quickly/extremely my moods can change. I mentioned the numerous crises I've had, suicidal thoughts (which became plans at one point) and frequent self harming that's getting worse. I said I was feeling less in control when it came to my moods and self harming. I can get very irritable and angry, but tend to turn this anger on myself. I also mentioned the times where I've been hypomanic, quite impulsive, agitated etc and how I find that strange; given my diagnosis.

I spoke about the many years of psychological bullying I experienced, as well as an abortion I had at 19, and a controlling, abusive relationship I had, not long after.

Finally, I spoke about my last therapy session, where I felt I could now open up about how, for over a year, I've wondered if I have Borderline Personality Disorder.  I can relate to pretty much all the criteria, although some were more prominent when I was a teenager/ very early 20s. The CPN didn't confirm or deny a BPD diagnosis, but did say that (looking over what I'd told him) he believed I had a long-standing trauma related disorder. He wasn't entirely sure if secondary or primary care would be more suitable for me, but he would have a word with my therapist and give me a call next week.

So this is where I'm at now. I'm not entirely sure what to think about the CMHT appointment. It was a shorter appointment than I expected, and not quite as thorough either. The CPN did ask some specific questions, but it was mainly left to me to explain how I'd been feeling. There were things I forgot to mention to him (and he has given me contact numbers to ring if I do need to talk about them) but I think he got a fairly good picture of my problems. I guess I'll just have to wait and see!

Thursday, 12 January 2017

Hypomania symptoms?

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Tuesday, 27 December 2016

Spinning Plates

I was trying to think of a half-decent title for this blog post, and "Spinning Plates" was all that really came to mind. I needed a title that described how I felt when it came to dealing with physical health problems, as well as mental health problems. I've mentioned my diagnoses before, but I'll state them here and hopefully I can explain how managing these conditions feels a lot like "spinning plates".

Fibromyalgia: I've had this since 2010 and sometimes I feel I've accepted it, sometimes I get extremely frustrated, upset, and angry at how much it limits what I can do/how often I can do it. I'm so used to pushing myself that I find it very hard to stop and pace before I cause my symptoms to flare up. Sometimes I deliberately go too far, because I find physical pain a little easier to cope with than mental pain. When I do pace, the internalised ableism kicks in, and I feel as if I'm being lazy, not making the most of the day etc. I know that pacing myself is a good thing to do, and resting is still productive as it means I am looking after myself. I just wish I could feel less guilty about it!

Hypermobility Syndrome: I'm not entirely sure when it became Joint Hypermobility Syndrome, but I know I've been hypermobile all my life. As I learn more about it, I realise how mindful I have to be when it comes to using my joints. I have multiple subluxations every day, and sometimes I have dislocations too. Having doctors finally believe me (after a physio actually seeing and hearing a joint dislocate!) has helped a little, but doesn't take away the frustration with working around limitations and not getting much support for it.

Depression: Looking after yourself is so so important anyway, let alone when you are dealing with multiple illnesses & disabilities! I really do try, but Depression zaps my energy (what's left of it, thanks to Fibro and JHS anyway!). I struggle with motivation as well. Emotionally, the most basic sounding tasks can feel like trying to climb a mountain. On my bad depression days, I barely do a thing, and then I hate myself for being "lazy". If it isn't too bad on particular days, but my physical health problems are, I then get frustrated with myself for physically not being able to do things that might help my mood a little (e.g. making a nice snack, doing some cross stitch, meeting a friend).

Generalized Anxiety Disorder: When anxiety gets severe, it can limit you so much. I could be having a day with slightly less physical pain, or even less fatigue. On this day, I may want to make the most of this by maybe having a walk, or at least getting out of the house (even if just into the garden). Anxiety can have a real hold on me however, and often it becomes a panic attack (which then makes the physical pain, fatigue etc worse!). As much as I want to be able to do stuff, I just can't. It's as if invisible arms are squeezing me tightly, the room has become unbearably hot, my head is pounding, the room is spinning, and I can't focus on anything else. I know these things are down to anxiety and panic, and that they will lessen in time, but it does not stop me from feeling them so intensely.

Agoraphobia: The symptoms I get with Agoraphobia are very much the same as with GAD, but they are of course more about situations (such as being out of the house, being in a busy place, not being able to get out of somewhere quickly or easily). If it is quiet, having a short walk can help lessen my depressive symptoms temporarily. I want to be able to do this as much as my health allows, but the agoraphobia holds me back. Even if I manage to force myself outside, if it is bad enough, I will not feel better. I will spend the whole time on the edge of a panic attack and that will be my energy gone for the day.

Obsessive Compulsive Disorder: This can affect my ability to get out of the house and cope with daily things. The meds I'm on do help calm down my OCD related anxiety a little, but on a bad day I could struggle just as much as I did before I was on the meds. Again, this holds me back and stops me from being able to make the most of low pain/fatigue days.

I hope this makes sense. There's a lot of similarities with each condition, and of course I know that mental health and physical health often overlap. For me, it feels as if they clash too! I'm trying to manage my struggles with things like anxiety with going outside and guilt from not going outside, when it occurs on a day my physical symptoms aren't too bad. On the less anxious days, I want to do more to help myself, but physical symptoms limit how much I can help myself on bad physical health days!

I guess it's about moderation and, yes, Pacing. If anyone has any tips on getting that balance right, or even if you don't and you need to vent to someone who understands, leave a comment below!

Thank you for reading.