A couple of weeks ago, a meeting was set up to discuss concerns about my nan, and the needs that she has. Nan insisted on being present at that meeting.
Myself, my parents, and some of my uncles were also present. Luckily, we had time to cover one topic out of earshot of my nan. This topic was her mental health and capacity.
Over the past year or so, some family members and I have started to notice some changes in Nan's personality, memory, mood, and ability to process things. She seems very depressed as well as argumentative and verbally aggressive at times. She is finding it hard to follow conversations and often forgets things or mixes things up. She has trouble organising her medication. She does not cope well with bright lights or any kind of noise, and often complains of her head thumping. She doesn't seem to realise how much help she needs either. There's probably more that I can't think of right now, but these signs and symptoms are definitely worsening.
I explained all of this to the staff present (namely a doctor, an occupational therapist, a social worker, and a discharge nurse) and the doctor said he would arrange for Nan to have a cognitive assessment. I think the nurses involved in her care had noticed certain things themselves.
Straight after this, my nan came into the room. She basically lectured us on speaking about her behind her back. I wasn't sure what to say to this as I feel conflicted about it. I don't like to speak about people behind their back, but there are important things to be said that might not have been put across properly if Nan had been there. She tends to speak over people and doesn't allow them to finish what they say, especially if she disagrees with it. We needed to be able to voice some of our concerns in a way that would allow the hospital staff to understand.
Once Nan had (finally) sat down, other concerns were voiced by the present members of family. These included her struggles with sleeping in bed (she sleeps in her recliner chair as she cannot lift her legs to get into bed), as well as struggles organising medication, needing night visits from carers (but these not being available), problems with incontinence, problems controlling her type 2 diabetes, the help she needs to shower, and other help she may need since having a major operation (a full hip replacement).
Naturally, my nan disputed a lot of things and we had to explain to her why we had these concerns. The discharge nurse, occupational therapist, and social worker tried their best to explain too. The occupational therapist had a list of equipment she could order to make Nan's life a little easier. This included a shower chair with a back, a commode in her bedroom, a grabber (as she is not allowed to bend from the hip more than 90 degrees), a perching stool, a key safe, and equipment to help her lift her legs. Nan rejected a lot of this equipment, saying she didn't need it, but she did agree to the shower chair, perching stool for the kitchen, and key safe.
The next topic was help with care. The occupational therapist explained that Nan would have visits 4 times a day, for up to 6 weeks, from the Enablement Team. This is a team of carers who would observe and encourage Nan to do what she can for herself, and help her with things she cannot do. This help is free, and is designed to rehabilitate Nan so that she is able (with the help of carers) to look after herself in the community. Nan didn't see the point in this, as she believed the carers at her care home would do everything whenever she asked. This is not the case however, as the care home she lives in is vastly understaffed, and does not provide night visits. The Enablement Team unfortunately do not offer night care either, so would see my nan first in the morning.
Once everything had been agreed and clarified, the meeting came to an end. The family were left for a few minutes, to discuss things amongst ourselves, and this included explaining things to Nan again. She seemed to accept what was going to happen, if reluctantly.
--------------------------------
Yesterday, Nan was discharged from hospital, and brought home by hospital transport. We were told the transport would arrive at 12, and it'd be around 12.30 that she would be home. What actually happened was the transport arrived at 1, and dropped Nan home around 3! My dad was left waiting 3 hours to let the transport staff (and my nan) in the flat. Luckily, she'd had lunch before being discharged, so didn't complain about that. The Enablement Team arrived a couple of hours after that. I am waiting to hear how she is getting on with this team, so I will keep you posted!
Showing posts with label assessment. Show all posts
Showing posts with label assessment. Show all posts
Tuesday, 20 March 2018
The Big Meeting
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Thursday, 1 March 2018
Family, Social Services, and a Whole Load of Stress
I'm sorry for my silence recently! I've had a lot going on, mainly with family and illness. I will try to explain this in a somewhat coherent manner.
A couple of months ago, my Nan went into hospital for a total hip replacement operation. She has other issues, such as Arthritis all over (we're not sure which type), a worn out total replacement on her other hip, Type 2 Diabetes, double incontinence, memory problems and could potentially have the onset of Dementia. The nurse at the hospital originally said Nan would be in for 7 days, but this was before all the other issues were noted.
The operation went as planned, but due to these other issues, she is still in hospital. As well as all of this, she contracted Norovirus, so has had to stay in another 2 weeks regardless. Despite extra infection control measures, visiting members of the family (including myself and my parents) caught Norovirus too! Because of this, we've not been able to visit Nan for over a week, which is a worry as she does not cope well by herself. She doesn't mix well with other patients and will only "socialise" (to use the word very loosely) with family members.
Another issue is the care home she lives in. It does not have an adjustable bed, so Nan spends 24 hours a day in her adjustable chair (bought by herself years ago). She sleeps in that chair, badly, and due to such poor mobility, is almost completely sedentary.
She has carers in, but she has cut their hours down to the bone, as she thinks struggling on her own (even with her risk of falls) is acceptable. The care she does get is not adequate in the slightest. Before she went into hospital, she was getting care for 15-30 minutes in the morning; which mainly consisted of a very quick wash from her chair. She did have carers come to take her laundry now and again, but clothes etc often came back still dirty. It appears she is also paying for more care than she is actually receiving.
The care home itself is vastly understaffed. At night, you are lucky to get two care assistants and in the daytime there are often only two carers covering the whole home (which has quite a few flats as well as bungalows attached to the home). Nan needs two carers to help her to shower, but the home is unable to provide this, so Nan's hygiene is unfortunately quite poor.
Onto Social Services! Well, they have been involved to assess Nan's needs and whether the care home is suitable for her anymore. My family have agreed that it is now a nursing home that Nan needs because of the amount of personal help she requires. Dad has been speaking to a social worker, but despite all of our concerns, the social worker is under the impression that the care home will be able to provide the levels of care required. This is something we struggle to believe but it looks as if we'll have to trust the care home to do this, and if it is not done then we are going to have to find a nursing home for Nan.
In the meantime, next week there will be a meeting with the care home manager and an occupational therapist (as far as we're aware?) at Nan's flat, to see what other equipment she needs before being discharged. There will also be a bigger meeting with whichever relatives are available, at the hospital, to come to an agreement as to what Nan needs and whether she will be ready to be discharged soon.
One of my uncles does have the legal right to invoke Power of Attorney, so we need to discuss whether this is something that needs to be done yet.
We want her to be happy, but we also want her to be safe. It is very difficult and has caused arguments as Nan is not good with change and is very home sick. I will do another post once everything is finalised.
A couple of months ago, my Nan went into hospital for a total hip replacement operation. She has other issues, such as Arthritis all over (we're not sure which type), a worn out total replacement on her other hip, Type 2 Diabetes, double incontinence, memory problems and could potentially have the onset of Dementia. The nurse at the hospital originally said Nan would be in for 7 days, but this was before all the other issues were noted.
The operation went as planned, but due to these other issues, she is still in hospital. As well as all of this, she contracted Norovirus, so has had to stay in another 2 weeks regardless. Despite extra infection control measures, visiting members of the family (including myself and my parents) caught Norovirus too! Because of this, we've not been able to visit Nan for over a week, which is a worry as she does not cope well by herself. She doesn't mix well with other patients and will only "socialise" (to use the word very loosely) with family members.
Another issue is the care home she lives in. It does not have an adjustable bed, so Nan spends 24 hours a day in her adjustable chair (bought by herself years ago). She sleeps in that chair, badly, and due to such poor mobility, is almost completely sedentary.
She has carers in, but she has cut their hours down to the bone, as she thinks struggling on her own (even with her risk of falls) is acceptable. The care she does get is not adequate in the slightest. Before she went into hospital, she was getting care for 15-30 minutes in the morning; which mainly consisted of a very quick wash from her chair. She did have carers come to take her laundry now and again, but clothes etc often came back still dirty. It appears she is also paying for more care than she is actually receiving.
The care home itself is vastly understaffed. At night, you are lucky to get two care assistants and in the daytime there are often only two carers covering the whole home (which has quite a few flats as well as bungalows attached to the home). Nan needs two carers to help her to shower, but the home is unable to provide this, so Nan's hygiene is unfortunately quite poor.
Onto Social Services! Well, they have been involved to assess Nan's needs and whether the care home is suitable for her anymore. My family have agreed that it is now a nursing home that Nan needs because of the amount of personal help she requires. Dad has been speaking to a social worker, but despite all of our concerns, the social worker is under the impression that the care home will be able to provide the levels of care required. This is something we struggle to believe but it looks as if we'll have to trust the care home to do this, and if it is not done then we are going to have to find a nursing home for Nan.
In the meantime, next week there will be a meeting with the care home manager and an occupational therapist (as far as we're aware?) at Nan's flat, to see what other equipment she needs before being discharged. There will also be a bigger meeting with whichever relatives are available, at the hospital, to come to an agreement as to what Nan needs and whether she will be ready to be discharged soon.
One of my uncles does have the legal right to invoke Power of Attorney, so we need to discuss whether this is something that needs to be done yet.
We want her to be happy, but we also want her to be safe. It is very difficult and has caused arguments as Nan is not good with change and is very home sick. I will do another post once everything is finalised.
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Friday, 2 February 2018
CBT for Anxiety Session 2 - My Past
(TW: mentions of self harm, suicide, sexual abuse, psychological abuse, and diet)
I'd had a bad couple of weeks between session 1 and session 2 of CBT. I did, however, manage to do the homework my therapist set for me. This was to read and print off a booklet about Panic as well as doing an anxiety based thought record. I filled in quite a few entries for this record, so had a lot to talk about with the therapist. I also wanted to monitor my mood swings in order to help with filling in the questionnaires at the start of session 2 (as well as for my own benefit). One of my best friends suggested this and I found it a very helpful idea.
I used a mood diary template; where I recorded levels (from 1-10) of stress, mood, energy, and how many hours I'd slept. I also commented on my moods and things that had happened that day. I found that I had to add at least 2 or 3 entries for these topics throughout the day (except hours slept of course) as my moods changed. I found my moods changed rapidly and extremely in response to things that happened. I had a couple of days, for instance, where I had read too much into some things and got it into my head that some friends had got fed up of me. This resulted in me feeling very paranoid, angry, upset, and anxious to the point that friends noticed and reassured me. Reassurance helped my mood a bit, but did not completely alleviate those thoughts and feelings.
Moving on to my therapy session, I was a few minutes late but the therapist didn't seem to mind. Once we'd sat down, she gave me the usual questionnaires (see my previous post) as well as a Risk Assessment questionnaire. This yes/no questionnaire asked about suicidal and self harm thoughts, as well as plans and attempts. I did answer yes to some of these, so my therapist wanted to talk about this first. We moved on, once she was sure that I wasn't currently planning to end my life.
We next talked about the thoughts I have about myself, my family, strangers, and going outside. This brought us to various things that had happened in my past, and how they affected my thoughts, feelings, and behaviour nowadays.
Two particular things that were major factors in my mental illnesses were the bullying I experienced at school, and the psychologically and sexually abusive relationship I had when I was at university. These really affected how I saw, and still see myself. I don't see myself as a person of worth, I think of myself as "wrong" no matter what I do or say. I blame myself for everything and punish myself through regular self harm. Long story short, I don't like myself very much. My therapist commented that I speak about myself very negatively.
The next topic we went onto was lifestyle. What did I do throughout my day? What is stopping me from working? Do I go out much/socially? I mentioned that this past couple of weeks had been difficult and I'd barely been out of the house at all. Partly this was because I felt very demotivated and low, but it was also the Agoraphobia making me avoid situations that make me panicky and anxious. My therapist said that I needed to go out more, and try a short walk at first. I pretty much promised her that I would try to go out more. I also explained why I didn't work, but that I would like to if/when I am ready. I explained that this work would have to be very flexible and accommodating as I have energy "crashes" in the afternoon and need a 2 hour nap when I get too exhausted. Ideally, this job would be a work-from-home one (not easy to find!).
We then went onto general health. Did I exercise much? What is my diet like? Can I cook for myself? I told her that my Fibromyalgia and Hypermobility Syndrome do cause a lot of pain, fatigue etc so cooking is difficult and I need help when cooking from scratch. I spoke about the kinds of things I ate for each meal and that I was doing Slimming World online. Overall, my therapist decided my diet was relatively healthy. She also mentioned how certain inflammatory foods could make my Fibromyalgia flare. I had read up about that when initially diagnosed, but have forgotten now, so will look into it.
The session was coming to a close by this time, as we'd been talking about a lot for a while! My homework for this time is to find 3 things each day that are positive (it could be about my day, myself, something I'm looking forward to or that someone said to me etc). I need to work on being compassionate to myself. She also wants me to carry on with the mood diary and fill in the activities in the Panic booklet.
So far, I'm liking my therapist (apart from her questions about getting back to work soon) and the sessions are at least giving me time and space to vent. I did find this session very emotionally and physically exhausting, however, so had to nap for a while once I'd got home.
My next session is in 3 weeks time, so I hope to write a post on a separate topic before my session 3 post. I hope this post is helpful in the meantime!
I'd had a bad couple of weeks between session 1 and session 2 of CBT. I did, however, manage to do the homework my therapist set for me. This was to read and print off a booklet about Panic as well as doing an anxiety based thought record. I filled in quite a few entries for this record, so had a lot to talk about with the therapist. I also wanted to monitor my mood swings in order to help with filling in the questionnaires at the start of session 2 (as well as for my own benefit). One of my best friends suggested this and I found it a very helpful idea.
I used a mood diary template; where I recorded levels (from 1-10) of stress, mood, energy, and how many hours I'd slept. I also commented on my moods and things that had happened that day. I found that I had to add at least 2 or 3 entries for these topics throughout the day (except hours slept of course) as my moods changed. I found my moods changed rapidly and extremely in response to things that happened. I had a couple of days, for instance, where I had read too much into some things and got it into my head that some friends had got fed up of me. This resulted in me feeling very paranoid, angry, upset, and anxious to the point that friends noticed and reassured me. Reassurance helped my mood a bit, but did not completely alleviate those thoughts and feelings.
Moving on to my therapy session, I was a few minutes late but the therapist didn't seem to mind. Once we'd sat down, she gave me the usual questionnaires (see my previous post) as well as a Risk Assessment questionnaire. This yes/no questionnaire asked about suicidal and self harm thoughts, as well as plans and attempts. I did answer yes to some of these, so my therapist wanted to talk about this first. We moved on, once she was sure that I wasn't currently planning to end my life.
We next talked about the thoughts I have about myself, my family, strangers, and going outside. This brought us to various things that had happened in my past, and how they affected my thoughts, feelings, and behaviour nowadays.
Two particular things that were major factors in my mental illnesses were the bullying I experienced at school, and the psychologically and sexually abusive relationship I had when I was at university. These really affected how I saw, and still see myself. I don't see myself as a person of worth, I think of myself as "wrong" no matter what I do or say. I blame myself for everything and punish myself through regular self harm. Long story short, I don't like myself very much. My therapist commented that I speak about myself very negatively.
The next topic we went onto was lifestyle. What did I do throughout my day? What is stopping me from working? Do I go out much/socially? I mentioned that this past couple of weeks had been difficult and I'd barely been out of the house at all. Partly this was because I felt very demotivated and low, but it was also the Agoraphobia making me avoid situations that make me panicky and anxious. My therapist said that I needed to go out more, and try a short walk at first. I pretty much promised her that I would try to go out more. I also explained why I didn't work, but that I would like to if/when I am ready. I explained that this work would have to be very flexible and accommodating as I have energy "crashes" in the afternoon and need a 2 hour nap when I get too exhausted. Ideally, this job would be a work-from-home one (not easy to find!).
We then went onto general health. Did I exercise much? What is my diet like? Can I cook for myself? I told her that my Fibromyalgia and Hypermobility Syndrome do cause a lot of pain, fatigue etc so cooking is difficult and I need help when cooking from scratch. I spoke about the kinds of things I ate for each meal and that I was doing Slimming World online. Overall, my therapist decided my diet was relatively healthy. She also mentioned how certain inflammatory foods could make my Fibromyalgia flare. I had read up about that when initially diagnosed, but have forgotten now, so will look into it.
The session was coming to a close by this time, as we'd been talking about a lot for a while! My homework for this time is to find 3 things each day that are positive (it could be about my day, myself, something I'm looking forward to or that someone said to me etc). I need to work on being compassionate to myself. She also wants me to carry on with the mood diary and fill in the activities in the Panic booklet.
So far, I'm liking my therapist (apart from her questions about getting back to work soon) and the sessions are at least giving me time and space to vent. I did find this session very emotionally and physically exhausting, however, so had to nap for a while once I'd got home.
My next session is in 3 weeks time, so I hope to write a post on a separate topic before my session 3 post. I hope this post is helpful in the meantime!
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Thursday, 18 January 2018
CBT for Anxiety Session 1 - The Assessment
(TW Suicide and Mention of Sexual Assault)
I've decided to try Cognitive Behavioural Therapy again. This time, I want to focus on my anxiety issues with travelling alone. I've had CBT 3 times in the past, but without a specific goal so this is partly why I think it didn't work for me. I didn't know what exactly I wanted to achieve, apart from a lessening in symptoms. Previously, the focus was on my Depression and suicidal ideations. I found CBT unhelpful for this however, as I felt my issues were more complex than this type of therapy allowed for. At the time, I didn't know I had Borderline Personality Disorder however, and this is probably why CBT didn't work for me. Recently, however, I felt trying CBT with a focus on one of my anxiety disorders, with a specific goal/problem would probably be more effective.
After a self referral, a telephone assessment, and a few months on the waiting list, I had my first session earlier this week. As it was session 1, it was more of an assessment however. The therapist initially gave me the standard questionnaires to complete (PHQ-9, GAD-7, phobias and work and social adjustment scale (see page 5)) Once she had looked through my responses, she discussed my suicidal thoughts with me to find out whether I'd attempted in the past or made plans, and if I had plans to end my life right now. I reassured her that although I used to have quite strong suicidal thoughts, they are more passive now and would only be likely to become active if I were to suffer a sudden loss of support or someone from my support network (such as a close friend, parent, or my cat).
She then went through my diagnoses (both physical and mental) and asked how I felt about my BPD diagnosis. I said that the assessment for it was one I'd asked for, and although I did not like how stigmatised this disorder is, I'm relieved to put a name to my problems and to be believed. I mentioned to her that I had not been referred for Dialectical Behavioural Therapy when diagnosed (as this is the standard treatment recommended for BPD). She noted that I had been discharged from Secondary Care soon after my diagnosis, and she was very surprised about this. She told me that Primary Care mainly does CBT and it is Secondary Care that would carry out DBT.
We then went on to my anxiety problems; primarily anxiety with travelling alone. I explained how I felt when trying to travel alone, and problems I've had in the past that I think may have contributed. I used to be bullied and harassed on the coach to school for example. Because it happened for so many years, I expect it to happen on public transport (such as a bus). When I was 17, I was sexually assaulted at my local bus station. Although it has been 11 years, I still can't sit in a bus station by myself. Lastly, I had a panic attack a few years ago when changing trains, because I could not find the correct platform. It was so intense and scary that it put me off taking trains.
I also spoke about how often I have racing thoughts, and that it can get too much to cope with. The therapist asked how I would try to manage this, and I said through distraction (gaming mostly). She said that I was relying too much on distraction and mindfulness may help me to "sit with" my worries. Hopefully this will help me to face my fears and come up with solutions that could calm my anxiety down.
By this time, the session was running to a close. The therapist gave me some links to a worksheet for recording times I'm anxious and why. She also gave me a link to booklets online that described anxiety and panic. I'm to read these, fill in the worksheet and bring it to the next session (in a fortnight).
I hope this blog post has been helpful for anyone considering CBT for anxiety. My next post will be about Session 2.
I've decided to try Cognitive Behavioural Therapy again. This time, I want to focus on my anxiety issues with travelling alone. I've had CBT 3 times in the past, but without a specific goal so this is partly why I think it didn't work for me. I didn't know what exactly I wanted to achieve, apart from a lessening in symptoms. Previously, the focus was on my Depression and suicidal ideations. I found CBT unhelpful for this however, as I felt my issues were more complex than this type of therapy allowed for. At the time, I didn't know I had Borderline Personality Disorder however, and this is probably why CBT didn't work for me. Recently, however, I felt trying CBT with a focus on one of my anxiety disorders, with a specific goal/problem would probably be more effective.
After a self referral, a telephone assessment, and a few months on the waiting list, I had my first session earlier this week. As it was session 1, it was more of an assessment however. The therapist initially gave me the standard questionnaires to complete (PHQ-9, GAD-7, phobias and work and social adjustment scale (see page 5)) Once she had looked through my responses, she discussed my suicidal thoughts with me to find out whether I'd attempted in the past or made plans, and if I had plans to end my life right now. I reassured her that although I used to have quite strong suicidal thoughts, they are more passive now and would only be likely to become active if I were to suffer a sudden loss of support or someone from my support network (such as a close friend, parent, or my cat).
She then went through my diagnoses (both physical and mental) and asked how I felt about my BPD diagnosis. I said that the assessment for it was one I'd asked for, and although I did not like how stigmatised this disorder is, I'm relieved to put a name to my problems and to be believed. I mentioned to her that I had not been referred for Dialectical Behavioural Therapy when diagnosed (as this is the standard treatment recommended for BPD). She noted that I had been discharged from Secondary Care soon after my diagnosis, and she was very surprised about this. She told me that Primary Care mainly does CBT and it is Secondary Care that would carry out DBT.
We then went on to my anxiety problems; primarily anxiety with travelling alone. I explained how I felt when trying to travel alone, and problems I've had in the past that I think may have contributed. I used to be bullied and harassed on the coach to school for example. Because it happened for so many years, I expect it to happen on public transport (such as a bus). When I was 17, I was sexually assaulted at my local bus station. Although it has been 11 years, I still can't sit in a bus station by myself. Lastly, I had a panic attack a few years ago when changing trains, because I could not find the correct platform. It was so intense and scary that it put me off taking trains.
I also spoke about how often I have racing thoughts, and that it can get too much to cope with. The therapist asked how I would try to manage this, and I said through distraction (gaming mostly). She said that I was relying too much on distraction and mindfulness may help me to "sit with" my worries. Hopefully this will help me to face my fears and come up with solutions that could calm my anxiety down.
By this time, the session was running to a close. The therapist gave me some links to a worksheet for recording times I'm anxious and why. She also gave me a link to booklets online that described anxiety and panic. I'm to read these, fill in the worksheet and bring it to the next session (in a fortnight).
I hope this blog post has been helpful for anyone considering CBT for anxiety. My next post will be about Session 2.
RESOURCES
- PHQ-9 Depression questionnaire https://patient.info/doctor/patient-health-questionnaire-phq-9
- GAD-7 Generalised Anxiety Disorder questionnaire https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7
- IAPT Phobia Scale https://patient.info/doctor/iapt-phobia-scale
- Work and Social Adjustment Scale (page 5) http://www.practicalhappiness.co.uk/media/download_gallery/Assessment%20Measures.pdf
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Friday, 1 December 2017
Another CMHT Assessment
TRIGGER WARNING: mentions of overdose
To catch up on my experiences with mental health services, please watch my playlist on Youtube.
After another sharp decline in my mental health, and a small overdose, I decided to call the Community Mental Health team (secondary services). It'd been just over 3 months since I'd been discharged back to my GP. I was feeling confused, panicky, lost, and honestly unsafe.
Some things had contributed to my mental ill health; one of them being a PIP reassessment. I knew there was the possibility of having a face to face one, but being given just two days' notice was a real shock. I felt like I wasn't able to properly prepare, and I didn't have time to arrange a recording of my assessment. I vented about this, how I'd felt, and what I'd done, on Twitter, and some close friends persuaded me to contact mental health services.
Doing this wasn't easy. I doubted myself, and wondered if I really was ill enough for their help. I took a deep breath and called though. The person I spoke to was lovely. She said I'd done the right thing and booked me an appointment for an assessment with a CPN (community psychiatric nurse).
The assessment itself was thorough. It wasn't with my old CPN unfortunately, but this one was just as kind. We went through my problems right now, things in the past, things in the present, possible triggers, my meds, what therapy I've had before, whether I'd been with secondary services before etc. She wrote a lot of notes, and I hoped she could do something for me.
Her decision however, was to advise me to try mindfulness at home, and wait for the CBT (cognitive behavioural therapy) sessions with the Primary Care team. I did ask about DBT (Dialectical Behaviour Therapy), as I'd been diagnosed with BPD (Borderline Personality Disorder) but she said things had changed with the mental health team, and I may not fit the criteria for that type of therapy. I was emotionally and physically exhausted, so I just accepted this, and said goodbye.
I'm not sure how I feel about this assessment. I think I feel listened to, and I guess I wasn't expecting much in the way of help, but last time I was assessed, I felt pretty much the same and was offered some help from secondary services. In all honesty, I feel I've been abandoned since my BPD diagnosis, even though there are therapies suggested for it. Why am I not getting access to these, when they could help me a lot? Is the diagnosis just not enough anymore?
Resources
My Mental Health Vlogs: https://www.youtube.com/watch?v=0kX521jdPAU&list=PLLVKOK6LyfuspXXsZ0xdiKCW_Z6SYjTzO
CPN definition: https://en.wikipedia.org/wiki/Community_psychiatric_nurse
CBT definition: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
DBT definition: https://www.mind.org.uk/information-support/drugs-and-treatments/dialectical-behaviour-therapy-dbt/#.WiGLcUq6-M8
BPD definition: https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/#.WiGLtkq6-M8
To catch up on my experiences with mental health services, please watch my playlist on Youtube.
After another sharp decline in my mental health, and a small overdose, I decided to call the Community Mental Health team (secondary services). It'd been just over 3 months since I'd been discharged back to my GP. I was feeling confused, panicky, lost, and honestly unsafe.
Some things had contributed to my mental ill health; one of them being a PIP reassessment. I knew there was the possibility of having a face to face one, but being given just two days' notice was a real shock. I felt like I wasn't able to properly prepare, and I didn't have time to arrange a recording of my assessment. I vented about this, how I'd felt, and what I'd done, on Twitter, and some close friends persuaded me to contact mental health services.
Doing this wasn't easy. I doubted myself, and wondered if I really was ill enough for their help. I took a deep breath and called though. The person I spoke to was lovely. She said I'd done the right thing and booked me an appointment for an assessment with a CPN (community psychiatric nurse).
The assessment itself was thorough. It wasn't with my old CPN unfortunately, but this one was just as kind. We went through my problems right now, things in the past, things in the present, possible triggers, my meds, what therapy I've had before, whether I'd been with secondary services before etc. She wrote a lot of notes, and I hoped she could do something for me.
Her decision however, was to advise me to try mindfulness at home, and wait for the CBT (cognitive behavioural therapy) sessions with the Primary Care team. I did ask about DBT (Dialectical Behaviour Therapy), as I'd been diagnosed with BPD (Borderline Personality Disorder) but she said things had changed with the mental health team, and I may not fit the criteria for that type of therapy. I was emotionally and physically exhausted, so I just accepted this, and said goodbye.
I'm not sure how I feel about this assessment. I think I feel listened to, and I guess I wasn't expecting much in the way of help, but last time I was assessed, I felt pretty much the same and was offered some help from secondary services. In all honesty, I feel I've been abandoned since my BPD diagnosis, even though there are therapies suggested for it. Why am I not getting access to these, when they could help me a lot? Is the diagnosis just not enough anymore?
Resources
My Mental Health Vlogs: https://www.youtube.com/watch?v=0kX521jdPAU&list=PLLVKOK6LyfuspXXsZ0xdiKCW_Z6SYjTzO
CPN definition: https://en.wikipedia.org/wiki/Community_psychiatric_nurse
CBT definition: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
DBT definition: https://www.mind.org.uk/information-support/drugs-and-treatments/dialectical-behaviour-therapy-dbt/#.WiGLcUq6-M8
BPD definition: https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/#.WiGLtkq6-M8
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
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.
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.
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
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.
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.
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
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!
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!
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Friday, 18 November 2016
Flare ups, Frustration, and Fear
The Dreaded Envelope
The dreaded white envelope came through the post a couple of days ago. An ESA50 that I need to fill in and send back within a month. I had a feeling I'd be reassessed soon, but was hoping they would at least wait until my birthday and Christmas were out of the way first. Wishful thinking I guess! When I saw what it was, I became so panicky and tearful. I've been through it all before, and have horrible memories of the Work Capability Assessment and the Work Programme.
This is such a bad time for me to be reassessed. I don't know how I'm going to cope with it to be honest. If you've been following my vlogs, then you'll know that I'm having to talk about some very difficult things in the past, in therapy. This means that I'm struggling as it is. The pressure of being scrutinized and judged for daring to be too ill to work, and the possibility that I could either have my disabilities completely dismissed & found "fit for work" or I will be put in the work related activity group and possibly forced onto the work programme (or something similar), is likely to push me over the edge. I'm going to need a lot of support from my therapist and GP.
I hate the way the ESA letters are worded. They're covered in bold writing; telling you that you may be sanctioned/found fit for work if you don't do this or that. I struggle enough with letters like that, but I live with my parents, so they'd know if I was going into crisis. For a vulnerable person living on their own, the wording of those letters could have such a detrimental impact on their mental health. There is the focus on work being "good for your health" as well; implying that everyone should work, no matter how ill or disabled they are. So right from the start, you feel as if you will be found fit for work regardless.
I'm hoping I can get evidence from my physio, therapist/mental health nurse, and GP; to back up my claim. I know in some areas, GPs won't do supporting letters for ESA claims however. I've not been in this area very long, so have only been registered with this GP for less than a year. I do hope I can get some sort of evidence though.
Flare ups
I've been in more pain, much more exhausted, and more dizzy than usual this past week or so. I think the damper weather must be making me feel worse. I'm due to start my period soon as well, and find that I flare up more easily around this time. I've found it particularly frustrating this time round however. I'm finally having a type of therapy that might actually help, and physiotherapy with a physio who has one of my conditions. I had to cancel both of those appointments this week. I was getting motion sickness, bad dizziness, overheating and getting exhausted after simple things (such as brushing my teeth). I don't want to end up cancelling too many appointments, or I will be discharged. I need that extra support!
All I can do, I guess, is pace myself, rest when I need to (i.e. before I'm completely exhausted), and look after myself better. I wish I could control my illnesses, but I've tried and the best I can do is manage and work round them. Willpower does not cure chronic illnesses.
The dreaded white envelope came through the post a couple of days ago. An ESA50 that I need to fill in and send back within a month. I had a feeling I'd be reassessed soon, but was hoping they would at least wait until my birthday and Christmas were out of the way first. Wishful thinking I guess! When I saw what it was, I became so panicky and tearful. I've been through it all before, and have horrible memories of the Work Capability Assessment and the Work Programme.
This is such a bad time for me to be reassessed. I don't know how I'm going to cope with it to be honest. If you've been following my vlogs, then you'll know that I'm having to talk about some very difficult things in the past, in therapy. This means that I'm struggling as it is. The pressure of being scrutinized and judged for daring to be too ill to work, and the possibility that I could either have my disabilities completely dismissed & found "fit for work" or I will be put in the work related activity group and possibly forced onto the work programme (or something similar), is likely to push me over the edge. I'm going to need a lot of support from my therapist and GP.
I hate the way the ESA letters are worded. They're covered in bold writing; telling you that you may be sanctioned/found fit for work if you don't do this or that. I struggle enough with letters like that, but I live with my parents, so they'd know if I was going into crisis. For a vulnerable person living on their own, the wording of those letters could have such a detrimental impact on their mental health. There is the focus on work being "good for your health" as well; implying that everyone should work, no matter how ill or disabled they are. So right from the start, you feel as if you will be found fit for work regardless.
I'm hoping I can get evidence from my physio, therapist/mental health nurse, and GP; to back up my claim. I know in some areas, GPs won't do supporting letters for ESA claims however. I've not been in this area very long, so have only been registered with this GP for less than a year. I do hope I can get some sort of evidence though.
Flare ups
I've been in more pain, much more exhausted, and more dizzy than usual this past week or so. I think the damper weather must be making me feel worse. I'm due to start my period soon as well, and find that I flare up more easily around this time. I've found it particularly frustrating this time round however. I'm finally having a type of therapy that might actually help, and physiotherapy with a physio who has one of my conditions. I had to cancel both of those appointments this week. I was getting motion sickness, bad dizziness, overheating and getting exhausted after simple things (such as brushing my teeth). I don't want to end up cancelling too many appointments, or I will be discharged. I need that extra support!
All I can do, I guess, is pace myself, rest when I need to (i.e. before I'm completely exhausted), and look after myself better. I wish I could control my illnesses, but I've tried and the best I can do is manage and work round them. Willpower does not cure chronic illnesses.
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
Saturday, 1 October 2016
Let's try this again: Part two
(TW: Mentions of suicide, self-harm, and abortion)
On Wednesday, I had my phone assessment with the Primary Care Mental Health team. I was really nervous on the day, and was watching the clock. The more I waited, the more nervous I got, and the more shaky I was when the call finally came. In order to prepare for my assessment, I'd gathered together all my paperwork from previous assessments and appointments. I wanted to be as prepared as possible so that I wouldn't miss anything out during the assessment. I completely overwhelmed myself, however.
Although I was extremely anxious when answering the phone, I was very glad to have the opportunity to be assessed again and talk through the things I'd been struggling with. The therapist began the assessment by asking me what sort of problems had brought me to contact mental health services this time. I found it hard to know where to start. I had so much going on in my head that I don't think I made much sense at first. I tried to prioritise the main things that I needed help with; which included how easily overwhelmed I was getting, things from the past that needed addressing, how my anxiety seemed to be worse, and the recent breakdown I had. I told him that I'd been through CBT a few times in the past and found that it didn't help much. I said that it didn't seem to fit my problems, as I wasn't able to talk about certain things in the past that affected how I am now. The therapist said that there were different types of CBT, and some did consider the past when attempting to help with the problems that the person has right now. He told me not to completely shut myself off from the idea of CBT. I reluctantly said that I would keep an open mind, but that other therapies that have been suggested to me by my last therapist and my psychiatrist were EMDR and Psychodynamic therapy. This therapist said to me that there were other therapies we could consider if I found that CBT still wasn't working for me. One therapy he mentioned was a person-centred one. He gave a brief description of what that therapy entailed, and said that this would include going through things in the past and discussing how they affected how I see the world now. I said that this sounded like the type of therapy that may suit me a little more.
He wanted to know how long I'd had symptoms of Anxiety, Depression, and OCD. He also wanted to know the obsessions and compulsions I had now and in the past. Although I was diagnosed as an adult, I'd realised that I'd had symptoms pretty much since the start of primary school. He asked (sensitively of course) what I thought had led to this. Although I struggled a lot, and was in tears for most of it, I just about managed to tell him about the bullying, and the termination I had during my first year of university. He was very patient, understanding, and non-judgmental. He gave me time to talk about what I needed to, and was kind when my mind would go blank & it took me a while to remember what I wanted to say. After this, he gave me a brief analysis of what he thought were my main things that I needed help with.
Next came the necessary, but frustrating part of the assessment; the questionnaires. He admitted that he hated them too. I guess they have to quantify some things, to see how severely a client is affected by their mental health problems. It's just such a restrictive set of questionnaires/ I may meet the criteria for Anxiety and Depression, but if there are any other mental health problems, that could be identified by asking other questions, I don't have that access to those questions.
I may have described these questionnaires before, but the first one I had was the PHQ-9 . This is to test for Depression, and the severity of it. For each question, there is a score between 0 and 3. 0 means "not at all" and 3 means "nearly every day". When responding, you focus on how often you've been experiencing (the things stated in the question) in the last two weeks.
For this questionnaire, you have a score out of 27. My score was 24; which places me in the severe category. The therapist also had to assess my risk of attempting suicide. I told him that although I frequently had thoughts, and sometimes strong urges, I'm unlikely to actively plan or carry them out because of my cat and my parents. I forgot to mention about my regular self-harming, but I guess this is something I can talk about during therapy sessions.
The second questionnaire was the GAD-7 . This tests for Generalised Anxiety Disorder and the severity of it. Similarly to the PHQ-9, there is a score between 0 and 3 for each question. Again, 0 means "not at all" and 3 means "nearly every day", and you are asked to consider how you've felt in the last two weeks.
For this questionnaire, you have a score out of 21. My score was 18; which places me in the severe category.
The third questionnaire focused on phobias. For each types of phobias described, you give a score between 0 and 8 to state to what extent you would avoid various situations because of it. A lot of my fears involve loss of control; for example, losing control of my bladder in a public place, having a panic attack etc. 0 means you wouldn't avoid the situation, 8 means you would always avoid that situation based on the phobias mentioned.
Once these had been completed, the therapist discussed with me what the next steps would be. He said that he believed I should give CBT another go, at least to tackle my symptoms of OCD. He did say that I could have person-centred therapy instead, if I still find the CBT unhelpful. I reluctantly agreed to this. At least I can have access to other therapies, instead of it being CBT or nothing. He said the wait is likely to be around 10 weeks, as the waiting list is long. I knew to expect this anyway. Before we ended the call, he made sure that I knew who to contact if I do become actively suicidal. These were the Out of Hours team, and Samaritans.
I do feel a little more hopeful about this mental health team, but we'll have to see how therapy goes.
On Wednesday, I had my phone assessment with the Primary Care Mental Health team. I was really nervous on the day, and was watching the clock. The more I waited, the more nervous I got, and the more shaky I was when the call finally came. In order to prepare for my assessment, I'd gathered together all my paperwork from previous assessments and appointments. I wanted to be as prepared as possible so that I wouldn't miss anything out during the assessment. I completely overwhelmed myself, however.
Although I was extremely anxious when answering the phone, I was very glad to have the opportunity to be assessed again and talk through the things I'd been struggling with. The therapist began the assessment by asking me what sort of problems had brought me to contact mental health services this time. I found it hard to know where to start. I had so much going on in my head that I don't think I made much sense at first. I tried to prioritise the main things that I needed help with; which included how easily overwhelmed I was getting, things from the past that needed addressing, how my anxiety seemed to be worse, and the recent breakdown I had. I told him that I'd been through CBT a few times in the past and found that it didn't help much. I said that it didn't seem to fit my problems, as I wasn't able to talk about certain things in the past that affected how I am now. The therapist said that there were different types of CBT, and some did consider the past when attempting to help with the problems that the person has right now. He told me not to completely shut myself off from the idea of CBT. I reluctantly said that I would keep an open mind, but that other therapies that have been suggested to me by my last therapist and my psychiatrist were EMDR and Psychodynamic therapy. This therapist said to me that there were other therapies we could consider if I found that CBT still wasn't working for me. One therapy he mentioned was a person-centred one. He gave a brief description of what that therapy entailed, and said that this would include going through things in the past and discussing how they affected how I see the world now. I said that this sounded like the type of therapy that may suit me a little more.
He wanted to know how long I'd had symptoms of Anxiety, Depression, and OCD. He also wanted to know the obsessions and compulsions I had now and in the past. Although I was diagnosed as an adult, I'd realised that I'd had symptoms pretty much since the start of primary school. He asked (sensitively of course) what I thought had led to this. Although I struggled a lot, and was in tears for most of it, I just about managed to tell him about the bullying, and the termination I had during my first year of university. He was very patient, understanding, and non-judgmental. He gave me time to talk about what I needed to, and was kind when my mind would go blank & it took me a while to remember what I wanted to say. After this, he gave me a brief analysis of what he thought were my main things that I needed help with.
Next came the necessary, but frustrating part of the assessment; the questionnaires. He admitted that he hated them too. I guess they have to quantify some things, to see how severely a client is affected by their mental health problems. It's just such a restrictive set of questionnaires/ I may meet the criteria for Anxiety and Depression, but if there are any other mental health problems, that could be identified by asking other questions, I don't have that access to those questions.
I may have described these questionnaires before, but the first one I had was the PHQ-9 . This is to test for Depression, and the severity of it. For each question, there is a score between 0 and 3. 0 means "not at all" and 3 means "nearly every day". When responding, you focus on how often you've been experiencing (the things stated in the question) in the last two weeks.
For this questionnaire, you have a score out of 27. My score was 24; which places me in the severe category. The therapist also had to assess my risk of attempting suicide. I told him that although I frequently had thoughts, and sometimes strong urges, I'm unlikely to actively plan or carry them out because of my cat and my parents. I forgot to mention about my regular self-harming, but I guess this is something I can talk about during therapy sessions.
The second questionnaire was the GAD-7 . This tests for Generalised Anxiety Disorder and the severity of it. Similarly to the PHQ-9, there is a score between 0 and 3 for each question. Again, 0 means "not at all" and 3 means "nearly every day", and you are asked to consider how you've felt in the last two weeks.
For this questionnaire, you have a score out of 21. My score was 18; which places me in the severe category.
The third questionnaire focused on phobias. For each types of phobias described, you give a score between 0 and 8 to state to what extent you would avoid various situations because of it. A lot of my fears involve loss of control; for example, losing control of my bladder in a public place, having a panic attack etc. 0 means you wouldn't avoid the situation, 8 means you would always avoid that situation based on the phobias mentioned.
Once these had been completed, the therapist discussed with me what the next steps would be. He said that he believed I should give CBT another go, at least to tackle my symptoms of OCD. He did say that I could have person-centred therapy instead, if I still find the CBT unhelpful. I reluctantly agreed to this. At least I can have access to other therapies, instead of it being CBT or nothing. He said the wait is likely to be around 10 weeks, as the waiting list is long. I knew to expect this anyway. Before we ended the call, he made sure that I knew who to contact if I do become actively suicidal. These were the Out of Hours team, and Samaritans.
I do feel a little more hopeful about this mental health team, but we'll have to see how therapy goes.
I mainly blog about my journey with chronic physical and mental illness, as well as experiences with, & thoughts on, financial & employment support in the UK.
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