They’ve been in the news, mostly focusing on in patient care. Whilst this does need highlighting I’d like to have a rant about out patient services, or the complete and utter lack of them.

I’ve never been in in patient care, I was threatened with it once as a teenager but I can barely remember those years and ironically I wasn’t really crazy then (they saw my M.E/CFS as psychological, so I was sent to the psychiatrist from hell), they just thought I was and now I am actually going crazy everyone seems much less keen to actually treat my craziness.

My experience of outpatient care can be mostly described in one word :


min·i·mal

–adjective

1.

constituting a minimum: a minimal mode of transportation.
2.

barely adequate or the least possible: minimal care.
No 2 specifically.

I was formally diagnosed with depression (as opposed to the false it’s not M.E it’s depression mess from my teens) about 5 or 6 years ago. In those 5 or 6 years I’ve been on about 3 different anti-depressants, none of which have really worked and some of which have sent me crazier, or just not worked at all. My doubts and queries about my medication have rarely been given an answer beyond the monosyllabic, I have felt for the last year or so that my latest medication, venlafaxine (which has had the dosage raised again and again, like all the others) is leaving me emotionally dulled and deadened to the extent that it is starting to add to my depression symptoms. All I’ve been told is I am not well enough to consider lowering the dose as I am still ‘very depressed’. I need to be ‘more stable’. It’s like talking to a brick wall.

I have been referred to psychotherapy twice. The first time was useless. I had 16 sessions of CBT which I didn’t find very helpful and when I came to the end of my allotted 16 sessions I was told that was it regardless of the fact I was still as depressed as ever. It took me about 2 years to get referred for a second time; with one memorable false start of referred for counselling at my GP’s surgery only to be told a few weeks later I wasn’t eligible as I was seeing a psychiatrist and was thus too ill. That counselling wasn’t for ‘people as depressed as me’. After asking the psychiatrist and GP about 20000000 times again the psychiatrist (not my regular guy, interesting)  referred me to some ‘improving access to talking therapies’ thing. About 6 months or more after I got that referral I had my first appointment. It seems like it’s CBT again, which I have told everyone I didn’t find helpful. Though on the plus side the guy seems nicer than the other one and said there were other options available should I need them.

My appointments with the psychiatrist last about 5 minutes on average, I say I’m still depressed, go over my feelings, say when I was hurt myself or felt suicidal it all gets noted down and nothing happens. I raise the odd question it gets ignored or I just get told to go away.  I had one good one hour or so session about 5 years ago where I went over things in depth, but no more since as it was an introductory type thingy-ma-bob.

I am just given pills and sent away. I am not getting better, if anything I am getting worse. No one seems to care.

Beyond mostly ineffectual pills or short courses of CBT it seems there is nothing anyone can offer me.

The treatment I found most helpful, when I thought I might be getting somewhere was when I saw a clinical psychologist, I had more than one long session where I could talk in depth (one hour is woefully inadequate for a long history of ‘shitty stuff that fucked you up’) but that was arranged through university and I graduated last year.

I feel pretty much left to get on with it on my own.

It’d be nice to have someone who listens to me and my concerns, to not be fobbed off with more pills that don’t seem to bloody work; it’s the same pattern over and over. I get a bit better, it fades, the dose gets raised with little or no improvement till I plateau or even get worse, I can’t go any higher on the dosage so my medication gets changed and it starts all over again, or I just get stuck asking questions and being ignored. Not to mention the good few months of the horror that is withdrawal and changing over of anti-depressants , which I why I won’t just stop taking them as I am often tempted too, it’s too fucking hard to come off them without doing it properly, If I miss even a day or two I go ‘cold turkey’ (or more accurately hot, sweaty, dizzy, nauseous, headachy and roller coaster emotion turkey).

I spend more time starting at the fish in the waiting room than getting anything that can be described as ‘care’.

Share

During my long history of being ill (can you be a professional ill person?) I have undergone many ‘treatments’ and being the lucky girl I am I have managed to develop not one but two illnesses with no definitive cure and piss poor access to treatment on the NHS.

I am also lucky enough to have the wonder cure all CBT do fuck-all for me twice, for both my M.E and depression.

Though what really, REALLY annoys me is how I have been made to feel like the world’s most awkward patient and that the failure of certain treatments and therapies has been my fault for not ‘engaging’ with the therapy enough or ‘not trying hard enough’ or another assortment of excuses. What did I do that was so awkward? Well I asked questions,  I had doubts and I expressed them; something which I assumed was supposed to be a good thing during something billed as ‘therapy’.

During my latest bout of CBT for depression (which seeing as I’m still depressed as ever has been an amazing success) I made the mistake of uttering the word ‘existential’. I got threatened with having my treatment stopped as I wasn’t ‘engaging’ as I kept trying to get across that for the most part my depressive moods don’t tend to have any obvious external triggers, that they come on suddenly and for no reason. This was apparently not good enough. I couldn’t just come in and say I was depressed and I didn’t know why (I’d also like to point out I was given no help in trying to figure out any ‘hidden’ deeper reasons for my moods). I was patronisingly told ‘well obviously you’re intelligent’ (I think I mused about Descarte’s ‘cogit ergo sum’ on one of the forms, I may depressed but I can still be a pretentious arsehole), which seemed to be code for “stop questioning things now ! don’t reveal the holes in the treatment we didn’t ahve the time/money to think about! Shut up an fill in a sheet!  and no you can’t have ‘musing on my existence’ as an acitvity!”.  My depression didn’t fit into the narrow categories that the CBT seemed designed to cope with and I felt like I was made the scapegoat for this. I tried I really did, I racked my brains trying to think of things to put in the stupid little forms and make sure my mood-swings fitted into the little ‘thought pattern’ sheets. I went through the thought excercises and tried to make them work, sometimes they did but when they didn’t I was yet again made to feel bad that my ‘mood score’ hadn’t improved after doing the excercises, so by the end I was inflating my scores so I didn’t get ‘dismissed’. I tried and admittedly it did help with some  minor, more peripheral problems like being anxious about uni work etc. But the big looming problem which was my main problem? The mood-swings that come on so suddenly and without any obvious logic behind them, the problems that have been haunting me for as long as I can remember? Those were left untouched. Unless my moods had a ‘trigger’ or a ‘negative thought’ I could counteract I was left helpless. I tried to explain that the whole illogical, unknown  and unpredictable nature of my depression is what scares me the most; how those moods that seemingly come out of nowhere are the worst and most terrifying. Yet those were the problems that were ignored, I was told (not in so many words) that by drawing the focus on this I was being ‘unhelpful’. I started out being as honest as possible about my moods and by the end I was effectively lying. I was lying so I wouldn’t be chastised for not having a ‘trigger’ or some identifiable thought pattern.  In short I was trying to change my illness to fit in with their definition of what my illness should be as opposed to reflecting honestly on what actually was.

I’ll admit I wasn’t perfect, but as I was doing this treatment due to chronic mental health problems I think that can give me a bit of leeway in the whole ‘may not actually be thinking like a logical human being’ department. Why should someone with serious depression who obviously isn’t ‘thinking straight’, be under so much pressure to make a treatment ‘work’ even if it means their concerns are ignored? Is it really that much of a shock to a mental health professional that severly depressed people are sometimes really rather apathetic about things, that it’s not deliberate ‘awkwardness’ but a symptom of our illness? When you’re on the edge of despair and you just wish it would all go away, even if that means suicide, it’s safe to say that logically appraising things is not really something you’re finding easy and that filling in a form and rating things on a scale from 1-10 can often slip your mind.

Why should people be made to feel they cannot speak up about what is truly worrying them as they will be chastised for being ‘awkward’?

I am not saying my therapist was a bad guy: I feel the problems with this lie primarily in a lack of NHS funding. Even with the best therapist in the world 16 hours is nowhere near enough to treat someone with serious depression, but that was all I got.  I worry that if I apply for more benefits (atm I can’t work I’m far too unstable, unless anyone wants to employ a moody, unreliable, tired person with fuck all experience who will take a lot of sick days; in which case I can send a C.V) I will be penalised again for not ‘doing my best to access treatment’. If the treatment isn’t there and what is there has failed me, what the hell can I do? I’m even considering going private but as I have about 2p to my name this isn’t an option I can seriosuly consider beyond a short daydream about recalling my childhood on a Le Corbusier lounger.

Share

I got my referral for ‘talking therapies’ through so hopefully the NHS will provide me with more than 16 sessions of largely ineffectual CBT. Though the NHS being the NHS I have to wait a few weeks before they will phone up up for a phone consultation to decide what therapy will be best and then put me on another waiting list.

I want to get my medication sorted, the venlafaxine is just making me feel so numb, flat and beige (not black, black has something about it, beige is just ‘meh’)  and it’s not doing much for the depression seeing as I’m currently having one of the worst episodes in years; but trying to get anyone even vaugely interested in this is a chore, especially those people in charge of my medication. I am also worried as I had a new psychiatrist last time and he bore a spooky resemblance to Moss from the IT Crowd, but middle aged and with a bow-tie. It is worrying when your psychiatrist looks like he’s crazier than you are.  I am all for eccentric dress sense but I’m just not sure if it gives the right image for a mental health professional.

I have also started to notice that the fish in the waiting room have changed, the little glowy ones have gone. I liked them. I fear the worst, it perhaps reflects my morbid moods that I wonder how often the fish die in that place. I hope they at least flush them with dignity.

As I am at a pretty low ebb and am rather incapable of full time work my Mum has decided I should tackle the hell of the DLA form. My Mum is far more optimistic about these things, coming at it from the logical position that as far as the DWP’s own defintions of ‘disabled’ go I am disabled so I should get it; I however have had too many experiences of DWP doctors to know that I could actually be dead and still deemed capable of work (‘has not decomposed yet, so can still work’) . My friend calls the people who do the benefit medicals ‘Davros’ and it’s a definition I agree with.

 

Share
%d bloggers like this: