3 February 2013 
No, this post isn’t about the Pulp song, good as it is….
…I’m referring to the first time somebody seeks support for a mental health problem. Be it by going to the GP, or their school/university counsellor, or a voluntary sector organisation.
In the comments thread to D Osborne’s guest post on work and mental health, a comment was left by Maureen, asking for advice.
I’m an 18 year old girl and want to see a therapist for my sleepwalking and symptoms of atypical depression. But I’m afraid that if I admit I occasionally self-harm they will slap a label of BPD or Bipolar disorder on me (I don’t have any symptoms of these disorders but I hear occasional self-harming is enough to get the label). I have read on this blog how horribly people with BPD are treated by the health industry. I hope to go to nursing school soon and I don’t think they would admit someone who had a bpd or bipolar diagnosis. For those of you who are knowledgeable about therapy, do you think it’s worth it for me to see a therapist or deal with it on my own? Thanks very much.
I’ve left what I hope is some useful advice in response.
The thought occurs to me that, working in a community team, regularly seeing children and famiies come to CAMHS for an assessment, It’s probably easy for me to forget how difficult and frightening it can be for people to make that first step. It also occurs to me that I probably haven’t thought so much about the unanswered questions that may be going through their heads while trying to decide whether to ask their GP for a referral.
I did once have a conversation about it, with a 17 year old boy who came to see us alone and without his parents’ knowledge. He said he’d thought long and hard about whether to come to see us. For him, the main worries were, “Will they put me on medication?” (We didn’t; we offered him therapy) and, “Will they tell my parents?” (Again, we didn’t; though we did tell him we’d prefer if he told his parents he was coming to us, and also warned him that if he became a risk to himself or others we would have to override confidentiality).
A couple of years ago I had a friend ring me in a panic, because her GP was referring her to the Community Mental Health Team, and she was terrified she was about to be hospitalised. In the end they sent her a routine appointment for an assessment. After this, they wrote her an advice letter and then referred her back to the GP.
I’d be interested to hear the experiences of others in this regard. Was it an easy or a difficult thing to make that decision to ask for support? What were your hopes and fears in doing so? Are there things that could be done to make it easier?
It was very difficult to seek support. Because of the nature of my trauma being paranormal and then followed by a psychotic break, I was convinced if I went to my GP they would put me in a straight jacket and transport me to the hospital psych ward. I also did not want to go on medication because of a pact I had made with myself 7 years earlier during my first depression to never be that numb again. Also I had a bad experience with a psychologist at that time and did not want to go to therapy. So I went the alternative therapy route and unfortunately worked mainly with a practitioner who had no experience with that I was going through nor did he have any compassion for it. He tried to help me though but ended up triggering me further. But I was convinced he would cure me. After a year of working with him to no avail, we stopped and I started seeing another alternative practitioner. It took him 6 months to have the conversation with me that he felt I was psychotic and that in his opinion, the only way to manage it was through allopathic meds or (because my psychosis was spiritual in nature) enter a monastery. I trusted him and was so defeated at this point that I started to seriously consider going back to an allopathic doc. I also seriously considered the monastery. My decision was to see a psychiatrist because of their expertise in mental health and meds which may sound easy but because of our medical coverage here in Canada, it is not. If I was to go through my GP, there would be a 12 month waiting list to see a psychiatrist and at this point, I was terrified of having a GP diagnosis me because I felt they do not have enough expertise. So I was very lucky to have a friend who was seeing a psychiatrist and the psychiatrist was willing to take me on. But I had to go to my GP to get a letter of referral. I was so terrified of that appointment I almost passed out in the GPs office. Needless to say, my GP thought I had OCD and willingly wrote me a referral letter because I had a psychiatrist who was willing to take me on. My first appointment with my psychiatrist I demanded a diagnosis and medication. It took her 6 appointments with me to come to a conclusion on either (I was mad as hell at her by that point, convinced she would never medicate me). I so wanted to be medicated at that point–I felt it would allow me to finally escape the terror–but as luck would have it, my psychiatrist recognized my sensitivities to meds and never put me on the lowest dosages possible. She was also very different from what I hear about most psychiatrists in our medical system where they give you a 10minute appointment to basically adjust your meds or refill prescriptions–they get paid by how may patients they see in a day. She saw me about every 3-5 weeks for an hour session up until she retired and then still helped me with all the paperwork for disability afterwards. Some help through talk therapy and my own determination and self-awareness, I stepped onto the road of PTSD recovery.
I think we need quicker access to psychiatrists who are enumerated by their quality of service and not how many patients they see. I think we should have access to someone who has had the same diagnosis and/or a similar experience to talk (say a mentor). I think we should be treated by an holistic approach to recovery including nutrition, self-education, self-care technique, somatic work, etc. I think every practitioner in this process should work together as a team… allopathic with alternative practitioners with therapists with mentors… with the client as part of the team of course. And above all, I think all health care practitioners–allopathic and alternative–should be trained in compassion.
I had had a number of issues with fitting in to the world around me or of otherwise not quite getting the joke that other people found the world but because I had talents in other areas I didn’t really let it distract me.
Whilst I lived with it, in my early 30s things came to something of a head and I found myself in the invidious position of making an attempt on my own life, during a long train journey from one London to Inverness.
When a friend of mine met me at the station I told him what I’d done and the circumstances behind it. He insisted we go to A&E and I got an appointment with the local (Inverness-ian) psych hospital.
Between the immediate issue and my first appointment as an outpatient, I tried again albeit via a different method. I would have been admitted there and then had it not been for my friend (an RMN) offering to care for me at his own home.
Since that time I’ve been delighted with the service I get from the NHS and private services that I’ve used independently.
I was petrified, not least because it could have meant the end of my career (due to my alcohol abuse rather than my depression)
The first time I reached out to medical folk was when I was at university, when I had been self harming a lot and was depressed. I remember being petrified, because I felt out of control, but had a high faith in doctors – expecting anti-depressants. Unfortunately I expected to be cured immediately, but there you go. I was sent to a psychiatrist, and was terrified of seeing him. I knew no one who admitted to seeing a psychiatrist and thought I would be sectioned! I was suspicious of him the whole time, partly because he wouldn’t tell me my diagnosis. I remember being scared.
I would have liked someone to explain that mental hospitals are not the ones of legend (as I found out when I actually was an inpatient) and that “crazy” is not an accurate description of me! Also that things can get better. Although I agree with mentalhealthtalk above that it would be nice to have been introduced to other people with mental health problems to gain some perspective. I felt very alone in my first illness.
They hospitalized you just because of self harmful behavior?! That is terrifying. Maybe I will simply leave that part out to be safe. I don’t want to be imprisoned and forced to take meds against my will. Hmm what’s funny is so many people my age smoke cigarettes (which cause cancer/heart disease) and binge drink, but that’s considered normal! I have made an appointment with a local therapist. If she can help me with sleepwalking I will be SO grateful. My sleep issues are ruining my life.
I don’t think Emma suggested that self-harm alone was why she had a hospital stay.
I can’t speak for what happens in New York State, but in the UK occasional acts of self-harm would not trigger a hospital admission unless the person was putting themselves in significant danger.
No, sorry! I was worried they would hospitalise me – in fact when I actually did go to hospital, some years later, it was not for self harm but because I was suicidal. And it wasn’t anywhere near as unpleasant as I thought it would be!
Ok thanks for clarifying. Glad everything worked out for you : )
Having thought about my first time, it’s suddenly quite scary to realise it was actually 15 years ago this month! One of my university lecturers had enquired as to how I was, (due to just failing all my exams) and eventually I told him how low and depressed I was feeling, and that I had suicidal thoughts. He convinced me to see my GP, who was fantastic. Yes, I was put on medication, but after long discussion with me about the pros and cons, And was referred to the uni counselling service. It was a huge relief to not be struggling along alone any longer. I was later referred on to the mental health services.
My fears were around being petrified of my parents finding out, but confidentiality was held. I also felt that I “should” be able to cope, and that I was the only one, but so found that wasn’t true [no blogs to read back then!!!]. I thought my friends wouldn’t want to know me – ok, so a couple didn’t, but most were fine and others that I only vaguely knew were so supportive and really helped.
My hopes did initially focus on there being “a solution”, and that someone somehow would take the pain away. Unsurprisingly this didn’t come true! But I’m still alive now, and certainly never thought I’d still be alive 15 years on.
Obviously this initial contact was a considerable time ago and systems and services have significantly changed over the years. But having suffered silently feeling very low and depressed for several years prior to seeking help, sharing those feelings and not being on my own with them made a huge difference.
Hope sharing this helps.
take care
I was 14 when I became depressed. I remember feeling very very ashamed. I first mentioned it very vaguely to my friends. They tried to pry more out of me, which was awful and never worked. But they were teenagers, too, they didn’t know what to do. When they asked the school guidance counselor, they didn’t mention my name, but he knew who they were worried about (I found that out later), and he gave them no advice, took no action.
Adults at church noticed I wasn’t quite right a few years later, I was vague, blah blah, one of them called my mom. I was terrified, in particular, of my parents knowing that I was depressed. I fully believed they would disown me (why I thought that was a bad thing, I don’t recall; they don’t treat me very well).
From there my mom called counselors in the area and got me in. I saw a psychologist doing his doctoral fellowship for about six months. It was awful. He was a nice enough man, but I was bad at therapy. He wanted me to talk and I was too afraid to. Like my friends he sometimes tried to pry over and over, trying to get an answer out of me, an answer I was too scared to give for an assortment of rational and irrational reasons.
I desperately wanted help and I knew that mental health care was the official help for my sort of problem, but I was too terrified to ask for that. It also didn’t much help. (Those first instances weren’t harmful, but most of my time in mental health care did me more harm than good.) I believed society’s message that these are the helping people and they will help you. I started out believing them when they said that this thing or that thing would help me. Then they didn’t. It was profoundly disappointing to go through all that terror of being in therapy and still feel so abysmally depressed. Sometimes it can be worth it, if it helps (it gets worse before it gets better and all), but it didn’t. It wasn’t until I was 25 that I finally got some mental health care that actually helped me.
My advice to people tends to be: try everything you can to try to get better before resorting to the professionals. They don’t have the magic powers that society led me to believe they had and I hate hate hate to see anyone go to professionals and leave worse off. It breaks my heart to see them increase the suffering of someone who already suffers.
I agree with you.
Hi Maureen
I hope you don’t mind, but I’ve sent you a private e-mail.
I’m slightly concerned that you may be getting conflicting advice on this topic, so let’s have a private chat about it.
Ooops, the e-mail bounced. However, my co-editor Pandora asked me to pass on this feedback to you:
+++++++++++++++++++++++++
Hi Maureen
Much as I respect Notpollyanna’s views – I can’t pretend we know each other well, but we did used to follow each other’s blogs – I have to offer an alternative view. I have no agenda here; I’m just another patient sharing my own experiences.
Mental health care is flawed. There is never a one-size-fits-all answer, and some psychiatrists, nurses and therapists are cocks who probably don’t ultimately care about patient welfare – whether that’s through long-term disillusionment or a sadistic form of self-interest, I don’t know. But this is certainly not true of all – or, I’d wager, most – of them.
I have a long, long story behind me that was detailed on my ex-blog, http://www.serialinsomniac.com. The site’s down at the minute for reasons I’ve yet to investigate, but I’ll try to move the archives somewhere and I’ll share the link when I do.
In short, I was in and out of the system for 12-ish years, only finally getting taken seriously in the last three or so. But I am now so, so grateful for the personnel involved in my care, and truly believe I’d be dead but for their intervention.
My psychiatrist takes me seriously, and forces nothing upon me; we discuss options and move forward together. I’ve had three CPNs, two of whom have been excellent (one was over an interim period, so I can’t really say much about her). My current one is one of the most warm, genuinely caring professionals I’ve ever met, and I feel I can totally rely on her if I need to. I always felt that I was a burden if I contacted services unannounced, but now feel entirely assured that I can do this as and when I need to.
Due to my borderline agoraphobia, my CPN is also arranging for me to see an occupational therapist for graded exposure therapy. I haven’t met the OT yet, but I feel a cautious optimism about our proposed work together. If nothing else, the fact that my CPN cared enough to suggest and arrange this makes me feel like my care team want the best for me and are willing to work tirelessly with me along the long road to stability.
I spent about a year in NHS therapy, and whilst it ultimately ended in what I felt was a deeply unsatisfactory way, I’m ultimately glad I went through it. It was at least a preparation for further therapy, in which I genuinely flourished. I saw a therapist in the voluntary sector, again for about a year, and that man helped my mental health immeasurably. In fact, I’m now just under half-way through a course of group therapy facilitated by the same man, and am really finding it useful too. I always thought as a cynical misanthrope (and proud of it) that group therapy would never be suitable for me, but I’m happy to admit that I was wrong (just as I turned out to be wrong in my belief that mental health services would always fail me). Meeting and talking to people who really ‘get’ my issues has actually been surprisingly comforting and cathartic.
I cannot make any claims that I’m cured – far, very far, from it. Anyway, I’m far too cynical to believe that most cures even exist for most mental illnesses. But I do believe that people can manage their conditions – sometimes on their own, which is self-evidently great…but sometimes, I feel, that only comes with help. Whether that’s through medication, psychotherapy, more modern practices such as mindfulness or CBT, or some combination of all of these of course depends on the individual. In my case, there is a very long way to go, but I’m moving forward, thanks in large part to that external help.
I hope I’m not coming across as either patronising or as some sort of Mary Poppins figure here. I’m not saying you can just access a service and your mental health can be sorted – I think everyone who’s tried would all but guarantee that doesn’t and can’t happen. But I suppose what I am saying is that engaging with professionals is not to be completely dismissed as hopeless pursuit. It doesn’t help everyone (and indeed can traumatise some), but it can and does help many.
In short – as if I’m capable of brevity! – my stance is one of “nothing ventured, nothing gained”. Do you have anything to actively lose by investigating seeing a shrink/therapist/whatever? I do understand that there are issues surrounding insurance and funding in the US, but as I understand it mental health conditions are often covered. If so, maybe you could give it a chance yet trust your instincts; if they’re crap, they’re crap. You can try another person if it doesn’t work out. If you try therapy or medication or whatever for a fair while and found it useless, by all means you could conclude that none of these options are for you, but on the off-chance that it could help you, it really might be worth considering.
Of course, the decision is yours, but I felt that this stuff might be worth sharing. If you ever feel like discussing any of this privately, please feel free to email me at pandora at theworldofmentalists dot com, and I’ll be happy to answer any questions or whatever.
Whatever happens, I wish you lots of luck and all the best for the future.
Take care
Pan
Pan, I could not agree more with what you say, similar for me, it feels it has only been the past three years in which I have been taken seriously, and I think that is partly because I have learned to ask for what I need / want and not let others force their choices and decision onto me. I finally feel in control of my own life, my mental health, and its ongoing recovery and that is partly because of the intense therapy I have received over a two-year period (just coming to the end of it!). Like you, I have an excellent CPN, and one I think I will miss when I am discharged from her care, but without her support, intervention and care I do not think I would be here now. She has encouraged me to follow my dreams and plans and is perhaps more excited than me that I am starting university in the next few weeks, she is someone who I hope I will be like when I qualify as a MH Nurse.
That is really great to hear, Anon! I wish you all the best on your continued path to mental health and with your degree
Take care
Pan
Hi again Maureen
I have temporarily put the archives of the blog up at http://formerlypandora.wordpress.com if you’re interested. The categories are down the left-hand side – ‘Psychotherapy’ (sub-categories ‘C’, and ‘Paul’), ‘Psychiatry’ (‘VCB’, ‘NewVCB’ and ‘Medication’) and ‘CPN’ (‘Christine’) are the ones that focus most on my treatment over the years.
Best wishes
Pan
Thanks for your response. It was discouraging, but very informative. You’ve spent 12 years in therapy, only recently saw improvement, are not cured and say you never will be. Many people seem to have similar experiences as you. Well I made an appointment with a psychotherapist recently (not a psychiatrist) and am going to see her on Monday. Hopefully she has some suggestions because my sleep-walking is ruining my life. I have health insurance but it doesn’t cover much so I hope to get this resolved within a few months. Thanks again.
Good luck for Monday. Let us know how you get on.
I can’t believe it but it was a hundred times worse than I could have imagined. I’m so disappointed and angry at myself for putting myself in that position to be demeaned and humiliated. I would rather sleep-walk off a cliff than go see another damned head-shrinker. Maybe nursing is not the right career for me if I have to become like these people! Sorry to be a Debbie Downer but this is just my experience.
My first experience I remember it well. I had moved out of my parents house six months earlier and was renting my first home, in that six months I ran up debts of £10,000 buying things for the house, and other people, you could say I was experiencing a ‘manic episode.’ Then I crashed and it was a friend (who is still my best friend) that suggested I saw my GP because she thought there was a chance I was depressed. It took four more weeks of feeling like crap, dragging myself into work daily before I finally made an appointment. The GP thought I was depressed, referred me to a counsellor (I never got that appointment!) and gave me Prozac plus 2 weeks off work. The Prozac lifted my mood instantly and within days I stopped the drug because I felt hyper and I was very agitated on it – I never went back to my GP about this, but looking back I think the Prozac clearly induced a manic mood. The weeks dragged on and I became more and more withdrawn especially in work, I was pulled up by a manager about my calls (I worked in a call centre!) and that was for me breaking point, I started to turn up to work late, take days off because I simply could not function (this was Christmas our busiest period!) eventually in the February I was sacked for sickness, I found another job months later, but the same circle of moods, depression and anxiety continued.
It took another year or two of constant mood changes, periods of depression, hyperactive moods, before a GP referred me to the Primary Mental Health Team in town and I was allocated a CPN. 12 years on I am under the care of the CMHT, have a regular CPN, a psych, a therapist and a whole other bunch of people involved in my care. For the first time in 12 years, I am well and there are plans to discharge me from their services in the coming months. I am also about to commence at university full time, role reverse to start my own MH Nurse training and I am so excited I might pee my pants! I am confident now that I am able to notice signs of becoming unwell and ask for help if and when I think I need it, I am not the person I was 12 years ago, it has however taken 4 hospital admissions (in three years) and two suicide attempts (in two years) to be where I am today. My diagnosis, Bipolar I, BPD, Anxiety and OCD.
Advising people to pursue mental health care is incredibly fraught for me, and I thank Pandora for her respectful and nuanced disagreement. I didn’t write it here (I usually do! I wish I had! I don’t know why I didn’t!), but I would suggest that when going into mental health care that you find someone who you trust deeply to be your advocate, informally. They don’t have to go into sessions or appointments with you, but someone who you can bounce things off of. “Hey, this thing happened at my appointment and I felt dismissed/verbally abused/whatever. Do you think I was mistreated? Can you help me pursue it if I was?” The therapy itself can be an echo chamber, so if something is going wrong, addressing it with the therapist won’t always solve the problem and the therapist won’t always be willing to even address it at all. (This should not be.) This isn’t foolproof, but it is better than nothing.
Mostly, if someone pursues mental health care, I advise extreme caution.