Can the psychiatrist do this?

[Crawling]

He told me if I stop taking my meds again he will discharge me. Can he do this? He also shouted at me is there anyway I can change doctors?

I really don't like him he makes judgements regarding my hypersexuality and my choice of male friends. He also told me off for going to crisis when my appointment was only a week away. He told me off for drinking and smoking and all this when he knew I was feeling suicidal.

[Crawling]

He is my third psychiatrist I liked both the others btw.

[bebopanddoowop]

Any medical professional that shouts at or tells you off is not being professional. Definitely ask to see someone else.

[RandomMess]

I think you have the right to have a 2nd opinion.

However it does sound as though they haven't got the balance of your meds correct yet and if you don't take the same ones continually for long enough they can't assess whether they are helping or not.

It sounds as though you are self-sabotaging?

[bookishandblondish]

Make a complaint.

You have the right to choose which consultant you see although not for urgent care ( A&E) - it will mean a new referral so there may be a gap in treatment.
www.nhs.uk/choiceintheNHS/Yourchoices/consultant-choice/Pages/choosing-a-consultant.aspx

[Crawling]

I stopped my meds because most of my hair fell out and his exact words were" if I stop taking my meds again he will discharge me and I can cry to my gp instead"

[WaitingForMe]

If OP is self-sabotaging I think that is quite possibly due to the reason she has a psychiatrist in the first place!

No matter what, the health professionals are the ones who should be calm and patient.

[RandomMess]

Indeed WaitingForMe absolutely true.

I crossed posts btw and now know that you have been happy with 2 previous psychiatrists so perhaps the current one is just a bullying arse...

[working9while5]

I agree.

I had a similar issue. I didn't want to increase dose as breastfeeding. Was shouted at.

Ended up discharged when pregnant again despite strong history of perinatal mh issues.

I have actually had a much better service from my gp and am doing well!

[HoopHopes]

A psychiatrist generally only does a diagnosis and supervises medication. They are not counsellors or involved with day to day care. Therefore if you are not taking medication then they do not have to offer you an appointment to see you I would guess. That is your choice, as is your choice to request a different psychiatrist, but you would have to wait and would not be a priority to be seen as already being assessed etc.

[working9while5]

That doesn't really fit with what http://www.rcpsych.ac.uk/expertadvice/treatments/psychiatrists.aspx Royal College of Psychiatrists describe as psychiatrists' role though.

I was signed off by psychiatry because I didn't want meds in pregnancy even though NICE guidelines recommend other treatment. Friends in the medical profession in my home country were horrified, saying it's like forcing consent.

[belis86]

The way mental health services are commissioned at the moment in many areas is that in order to qualify to be seen by psychiatrist in secondary care you need to be on psychotropic medication. If you are not on medication that needs to be supervised by psychiatrist you get discharged back to the care of GP. That may be the case where you live.

However the way your psychiatrist put that to you was not very professional.

[HoopHopes]

The way it was done may not be ideal but sadly there are so few NHS resources in some area that if there are no medication issues to oversee the psychiatrist does not see a patient. If a psychiatrist prescribes medication and a patient chooses not to take it then it can be perceived as a patient not choosing to be compliant or to need the services of a psychiatrist. A dr prescribes medication, a patient chooses to not take it. Then there is not much else a dr can do and as not on medication then not under secondary care as belis86 says so not under consultant care.

Patients have choice, to take medication or not. Many people on medication are also not supervised by a psychiatrist. Same with therapy, a gp etc may suggest counselling, up to a patient to turn up. If a patient says no do not agree with it or want it then that weekly slot will not be wasted and someone else will get to use that service.

Regarding you going to crisis many areas do not allow direct access to crisis as it such a limited service. Where I live only a dr or mental health worker can refer a patient to crisis service. The psych may have had feedback about patients not using crisis services appropriately as well.

What other mental health services do you have access to? Do you want to see a psychiatrist? What benefit do they give you? I found once they diagnosed and done medication, they leave it to other gp's or nurses to monitor. Sme psychiatrists do not see people with personality disorders at all, as there is debate about whether it is even a psychiatrist illness so some areas have different teams for people with PD's.

I guess drinking is not advisable as it acts as a depressant and can react with medication,so it is good he was giving you advice, whether it was delivered in a gentle way varies. Many dr's are not how one may expect to find them. But that does not mean what they say is not helpful at times? If suicidal and low maybe the dr was saying drinking at that time is not helpful?

Why not go to your gp? Say you want a better psychiatrist, one that will give you an approach that suits you?

[working9while5]

I know all that. I work in the NHS myself in a different field. The elephant in the room in most cases is that it is poor and sometimes dangerous practice that costs lives. I honestly think people have come to accept a very low standard of service in the NHS. I have seen it just disintegrate over the last ten years in my own area of work. I just disagree vehemently with 'what happens' being described as though it were anywhere near approaching good practice.

Not getting at any one's response btw but it's never okay to behave like this psychiatrist did and it's extremely inadequate, even if it's becoming more common.

[HoopHopes]

Sorry working9while5 I meant that reply for crawling.

[HoopHopes]

Not disagreeing with you I should add.

I know it is not ideal, but same happens in other areas of NHS. When. Get an appointment for a physical health issue I get a letter that says I need to ring to confirm apt, if no I lose the slot. And in letter it warns that failure to turn up to appointments could result in loss of referral and need to go back to gp for another referral and another 18 week wait. But I guess one difference is that with physical health issues we are often prescribed medication and perhaps less likely to not comply? Well true for me anyway.

No idea what it is like in private treatments though.

Crawling, hope your gp is useful for you .

[working9while5]

Failure to attend in NHS terms is v different to denying someone a service because you only want to offer one limited aspect of what your profession can provide. It's like a midwife can't refuse to attend a woman who wants an epidural she doesn't feel is necessary. In fact in midwifery you have to provide a service frequently where a woman goes against advice.

If I 'prescribe' therapy exercises to someone and they don't do them, I can't discharge them from my care. A service user not following advice is not equivalent to failing to attend, especially where the condition may cause noncompliance or the treatment has adverse effects.

Again, just because services get away with it doesn't make it right.

[working9while5]

Also in my case, say, NICE guidance recommends reduction of medication in pregnancy. Removing expert review at that time is just poor practice and a bit negligent really.

[HoopHopes]

Sadly much of NICE guidelines do not get followed in many areas of health.

[Crawling]

Thanks for all the replíes just to clarify I'm on 4 different medications atm. 3 of them I am happy with its just I stopped the fourth as it had unbearable side effects for me and I asked to switch.

Now my psychiatrist has prescribed a medicine that is almost a sister medication with similar compounds and is very similar side effects. He said if I stop taking this med I'll be discharged but I've never stopped my other three meds.

[working9while5]

It's not just sad though, it's wrong and potentially seriously harmful. I find the prevailing attitude here is 'oh well, it's the NHS' with very little will to fight for improvement. Also the fact few seem particularly concerned by very poor and sometimes dangerous practices is mindblowing.

Mh service users are far less likely to make a complaint when faced with poor practice, rudeness and even abuse.

This psych is not behaving appropriately EVEN if crawling is self-sabotaging.

[almondblue]

You don't have to tell him you're not taking the meds though? I stopped taking meds for good reasons but didn't want the conflict of my psych disagreeing with me, so I just continued getting them without taking them.

[Brittapie]

Almond, that is really dangerous advice.

I'm a serial medication refuser, but I find that if I explain it slowly and calmly, with evidence to back it up (and keep taking my other medications so they know I've not just gone randomly non compliant) they are mostly ok.

I reckon ask for a new doctor. You clearly need one, so they should not be discharging you.

I've had the moralising about hypersexuality too. They can bog off, quite frankly. As long as you stay safe, what you do with your own vagina (if you are female) is your own business. Just smile and nod.

[HoopHopes]

Is it an antipsychotic, if so although other ones may appear the same on paper they can be very different and it might be worth trying it to see?

[Crawling]

Lara you are right it is the depakote/epilim similarity the fact that they are both sodium based and it's the sodium which has caused me to be nearly bald.