Saturday, 18 July 2020

"Square Peg....Round Hole"

(TRIGGER WARNING: Medication, including dosage and overdose, mentions of self harm, suicide, trauma, hallucinations, domestic abuse, and abortion)

For many months, I've been on Citalopram for my Depression. The past month or so, I've been on 40mg (the highest dose). At first, I seemed to be doing well but, especially since trying to contact some charities to help me with my trauma from the abusive relationship I was in, I relapsed badly.

My suicidal thoughts have returned, I am being more impulsive with drinking, self harm, and taking small overdoses to help me sleep. I have not been sleeping well recently, I have had very graphic nightmares and flashbacks, and my appetite has been all over the place. Getting out of bed has been very difficult, as I am either very distressed or extremely low. Everything seems pointless.

I finally decided to speak to my GP on the phone the other day. I was due to have my mental health medication reviewed anyway, and I guess I was just expecting her to put me onto something else and book another review in a few weeks' time.

When she rang, she asked me how I'd been getting on with the higher dose of Citalopram, and how I'd been feeling recently. I explained everything, and I think I sounded quite panicky. She was very concerned, especially about the suicidal thoughts. She told me to ring the Community Mental Health Team, to see if they would see me. She also said that I would need them to refer me to a psychiatrist to see what other medication I could be put on.

I guess I didn't realise how bad things had become. I suppose I've been so used to having suicidal thoughts, but no real help for them, that I'd given up fighting for support (especially immediate support from crisis team/access team etc). I told her about my previous experiences with CMHT and how the last time I went to A&E after an overdose, I spoke to the Psychiatry Liaison Team who said that I wasn't ill in the "right way" for CMHT. My GP still insisted I rang them though, and got back to her with what they'd decided.

I was very panicky by the time I rang access/crisis team (you ring them to be triaged and referred to CMHT) but I spoke to a very nice, compassionate person. They listened to what I had to say, asked about my mental health medication (40mg Citalopram, 10mg Aripiprazole), asked me how I'd been feeling, and went through the risk assessment with me (suicidal thoughts, plans, self harm history, hallucinations etc). I also mentioned the trauma I had experienced from a medical abortion at 19 and an abusive relationship soon after. I told them I'd spoken to some LGBTQ charities to try and get support for the trauma. I'm bisexual and agender. I didn't expect to come out as agender to this person, but it sort of slipped out when I was explaining why I'd decided to contact LGBTQ charities instead of Women's Aid (the place I was signposted to by my last therapist). I was quite worried that I'd come out so suddenly. In the past, I had come out as agender to a therapist/nurse who then proceeded to deliberately call me a "lady" multiple times. This set off my gender dysphoria, and I didn't feel mental health services would understand me being non binary.

The person on the phone acknowledged my gender (although I'm not sure if they understood or believed me). They then asked about my daily functioning, and whether my symptoms had affected that. I told them about the nightmares, flashbacks, lack of sleep due to feeling unsafe, distressed, and having a lot on my mind. My appetite has been quite bad recently too. I've eaten, but I haven't been very interested in it. Again, everything feels pointless. I'm extremely stressed about the future too. I'm on ESA and PIP (sickness and disability benefits) and at the age of 30, I really want to move on with my life and rent a place of my own. I would have to get a job if I am to afford it though. I really do want to get a job, but I'm not sure how I would manage it physically or mentally. If I can't move on with my life though, do I want a life at all?

The person asked a few more questions then told me they would speak to one of their colleagues and get back to me with their decision at lunchtime. They called soon after lunch and told me that they want me to have a telephone appointment with a CPN (mental health nurse). We booked the appointment, then they told me that I should ring anytime if I need them urgently. I thanked them for their time and for how kind they'd been.

Since then, I've been looking forward to the appointment, in a way. It's at least a crumb of support from mental health services, and for me to be referred for assessment at least means they feel my symptoms are complex and serious enough. My previous experiences of being assessed then discharged are making me pessimistic about it though. I remember the A&E Psychiatry Liaison Team trying to explain to me why I never seemed to be taken on by CMHT. They described me as a "square peg" and CMHT as a "round hole". I didn't fully understand why that was the case though.

What makes me so different as to not being right for CMHT? I have a history of self harm and suicidal thoughts (plans even, sometimes). I've suffered multiple trauma. I have experienced hypomania on rare occasions. Very very rarely I have had visual hallucinations (usually after an antidepressant overdose). I do not have psychosis, so I understand why I wouldn't fit the criteria for some of the CMHT pathways, but there's at least one pathway that I think I do fit the description for.

The one pathway that seems to fit me is the one called the "Community Intervention Pathway". It says it "provides assessment and evidence based time limited interventions for people who have complex mental health difficulties that are significantly impacting on daily life. This would include mood disorders, anxiety disorders, trauma related conditions, and other severe emotional difficulties"

I have Depression, Generalised Anxiety Disorder, Obsessive Compulsive Disorder, Borderline Personality Disorder, and Post Traumatic Stress Disorder. These fit into various categories mentioned above and at least some of these affect my daily life significantly. I socialise rarely (especially since Covid of course), I am currently unable to work (although I want to try), my sleep and appetite are affected. I think some of my relationships with others have been affected too. I've certainly lost some friends anyway. Sometimes I freeze and dissociate, which can affect me for hours; as I'll be staring at whatever is in front of me. I'll be sort of "stuck", unable to take in conversation, or focus on anything else. When I'm very depressed or anxious, I cannot process anything that isn't to do with whatever is making me anxious or how I'm feeling when depressed.

I think my problems are complex and severe enough for intervention from Community Mental Health Team, and I know I need psychiatric input in order to sort out my medication. Past experience is making me worry that I will simply be discharged with no support whatsoever. People are telling me to be positive and "cross that bridge when I come to it". I don't want to get my hopes up though.

Resources

Amy's Mystery Illness blog: I'm a Survivor -  https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

Symptoms of PTSD: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#:~:text=A%20flashback%20is%20a%20vivid,events%20from%20start%20to%20finish.

Rethink: What is a Community Mental Health Team? https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/community-mental-health-team-cmht/

Amy's Mystery Illness blog: A Mental Health Nightmare - https://www.amysmysteryillness.co.uk/2019/08/a-mental-health-nightmare.html

Amy's Mystery Illness blog: Am I Triggered? - https://www.amysmysteryillness.co.uk/2014/03/am-i-triggered.html

Mind Charity: About hypomania and mania - https://www.mind.org.uk/information-support/types-of-mental-health-problems/hypomania-and-mania/about-hypomania-and-mania/#:~:text=What%20are%20hypomania%20and%20mania,period%20(usually%20a%20few%20days)

Mind Charity: About Psychosis - https://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/about-psychosis/

Mental Health Community Services: https://www.mpft.nhs.uk/services/mental-health-community-services

Dissociative Disorders: https://www.nhs.uk/conditions/dissociative-disorders/#:~:text=Dissociation%20is%20a%20way%20the,longer%20(weeks%20or%20months).











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