To think that I need a MH assessment *TW*

This really doesn't sound fair on you at all. I really think you'd benefit from seeing a psychiatrist. I don't see any reason why they shouldn't - I've been referred to a psychiatrist before and that was for 'only' depression and anxiety.

It might be that SSRIs aren't right for you. Will they not try another type? A tricyclic, maybe?

I'm sure you know, but taking street drugs is only going to exacerbate things. I don't know what you're taking but cannabis will make you paranoid, cocaine is going to destroy your dopamine levels, MDMA will drain your serotonin, and alcohol will make you depressed. There's absolutely no judgement from me about whatever it is you're taking, but the cost benefit analysis never works out. It'll always take more than you have to give.

Is it possible for you to start again with a different GP? Some GPs specialise in mental health, if there's one in your catchment area? It's worth a look at least.

OP the reason why you aren’t being referred is because technically you are under the care of Addictions, which includes a full MDT (Psychiatry and Psychology also). Therefore a Community Mental Health Team would reject your referral, because you are already open to Addictions. As you are now sober, you should be able to request a mental health assessment. Or you could ask to be discharged from Addictions, as it doesn’t sound like you are receiving any specialist input now you are sober? Are you prescribed any medication(s)? If you are not receiving any input and you are no longer struggling with addiction, it would make sense to me that you are discharged and re-referred to a Community Mental Health Team for psychological assessment and treatment.

Having worked in these services for years I know there are many gaps in the system and people end up getting bounced between services, which is massively unhelpful. There can be stigmatising attitudes around so-called personality disorders too which don’t help. I would advise speaking to your Addictions worker and requesting either a mental health assessment, or a referral to a CMHT if you no longer meet the criteria to be seen under Addictions. Sorry this is happening, this is a reflection on how dysfunctional the system is and all the levels of gatekeeping to access mental health support.

I’m a Mental Health nurse. Have you ever had therapy input, such as DBT or emotional coping skills? Many people with EUPD experience psychotic or paranoid type feelings when they’re stressed, but these are better managed through psychological skills based work to help manage the stress than necessarily medication. The other thing I would suggest is discussing a short low dose course of a medication like quetiapine or something similar with your GP or the psychiatric nurse is she’s a prescriber. Quetiapine would help take the edge off, balance your mood and improve your sleep. Of course, if you feel that you can’t keep yourself safe then you need to go to A&E.

Ask the worker to put their/your concerns in writing. And be open about risk. It’s much harder for a GP to ignore that.

If you are sober then that increases your chances of being accepted by secondary care. But as you are working with substance misuse services, you certainly should be seen by a general psychiatrist anyway.

Hmm I’m not sure either…. My dad has a diagnosis of bipolar, however I have a very dysfunctional relationship with him and had no relationship with him when I was a child so I’m not terribly well up on it.

I’m sorry you’re going through what you are, I know the other person I know who has episodes of things like thinking people are spying on her etc takes antipsychotic meds.

Where I live, a GP would refer you and you would have an initial assessment within 28d with a psychiatrist or nurse. It’s astonishing you have not been referred for a psych assessment. You very much fulfil criteria. Needing diagnostic review is absolutely a valid referral reason. Appalling.

When you say BPD is that borderline personality disorder?

Someone I know experiences similar episodes and she is diagnosed with bi-polar.

@Wantthistoend I’m in Scotland! And spent years working in addictions. Does this mean you are currently being seen by an addictions team? If you are then you won’t be referred to a community mental health team as you are already ‘open’ to a service, if you see what I mean. Psychology and psychiatry provision is limited in addictions which is a big problem. Has the nurse carried out a mental health assessment for you?

Push for assessment
even if u have to sit it out in A+E
look up EUPD - does that describe your experiences ?

Call your NHS crisis team re: Assessment

The fact you're not experiencing hallucinations doesn't actually matter, paranoia is also extremely common with psychosis and not everybody experiences hallucinations.

Hi, OP. The Mental Health Practitioner should absolutely be referring you to the Early Intervention in Psychosis Team for their assessment (providing you're under 35 years of age, or if over 35 the experiences have been happening for less than one year)

Your behaviour and response to your thoughts are concerning, ie moving house suggests in the moment you believe your thoughts with high levels of conviction. The fact they resolve without treatment within a week or two suggests either you're having blips (which may mean you can receive therapy from a different team, depending on your area), suggest substance misuse (I know you said these experiences continued when you stopped for two months, but the EIT works with people regardless of substance use) or indicate an acute stress response. How often do you have these experiences? EIT may not accept you depending on some factors (I'd need to ask more questions to know for sure) but the Practitioner can't make that decision and should refer you to the specialist team for their consideration.

If you send me your area via PM I'm happy to point you in the direction of services who maybe able to help. You can actually self-refer to the Early Intervention Team or I can help you find an assessment team for an overall assessment, again depening on area. X

I agree. I work with clients with mental health problems and it seems to get harder to get help with every year. Services are over-stretched and under-resourced, so only those most severely affected get help.

I feel like you may have to accentuate your negative feelings. I have experience of mental health issues with family members- it seems like there is such a shortage of help that only those who are gong to hurt themselves or others get much support.

This sounds atrocious, you really need to get some help. I know that in this area you are able to self refer online but evidently it’s different where you are. I think you may have to keep pushing and tell them you cannot live like this any longer. I don’t know what the escalation process will be where you are but there must be one and you are totally justified to advocate for yourself here. I am sorry you are having such a hard time.

Acting impulsively is another reason why they should refer you for assessment. I think you need to go back and push for it. Really lay on thick about the suicidal spells. It’s terrible so many people are falling through the cracks in the system.

It really shouldn’t be so hard, what a nightmare. I’ve never heard of GP practices having psychiatric nurses. Could you ask her for a referral, outlining what you’ve told us here? The system can be so disempowering but please gather your courage and say what you need. If the nurse still refuses, you could ask for a GP appointment on the grounds of not getting the care you need - someone needs to action this referral, it is better to be proactive than wait until crisis. Sometimes health professionals need to be pretty much told what to do unfortunately, as so much gate keeping goes on between primary care and secondary care. Please be assured that a mental health assessment is clinically indicated here (I’m a psychologist).

Yes when I’m psychotic it feels very real but it doesn’t end without intervention. So a change in medication has been what ends the episode. When I look back on it I find it all very confusing as the people I see (I get hallucinations) are very real. I also get feelings of bugs on my skin and I try to cut them out.

I am in multiple medications now. I tried to come off my anti psychotic at the end of last year and that was a disaster so I’m sticking with it!