To be beyond frustrated my MH trust told me I’m too complex?

TW trauma and PTSD.

I was able to access EMDR through Talking Therapies. Honestly the assessment was like Fort Knox. I was going through a horrific time and had to explain in detail exactly what flashbacks I was having and what they were like.

The therapist once I had it was amazing. Genuinely has been life changing. I have cPTSD due to multiple traumas but am turning a corner. My life is genuinely getting better rather than living in fear. I've re-referred myself and am having it again but didn't have to go through such detail this time.

Sadly from experience I doubt you’ll get anything unless self harm and suicidal idealisation are involved.

Yes, I think you will have to get the GP to do the referral.

FWIW, I think its pretty shitty that the TT service did not refer you themselves- although a lot of CMHTs are quite prejudiced against referrals from TT services so being charitable it may be because of that.

Unfortunately, many TT services are now run by private companies that get NHS contracts, and they will avoid any extra work if they can because the money offered for these contracts is cut down to a ridiculous extent. When I worked in a directly run NHS TT service, we did referrals ourselves and would talk them through if there were any questions from the CMHTs, but I think that is dying out as more of these contracts are taken over by private companies.

From what you have said, I do think you would be better off with a service that can offer you a longer course of treatment. And possibly with someone whose training is not just from one modality of treatment, like a clinical psychologist or someone who specialises in trauma. A lot of TT staff (especially in the privately owned companies) are very inexperienced and wont be able to help you properly with the things you have been through.

Some local trusts have specialist trauma treatment services which would be good. The other option which may sometimes help is looking for charities which support specific types of abuse.

My local TT told me I was 'too complex' when I tried to get counselling when my mum was dying. I worked in a TT service at the time, and knew it was bullshit, but once they trotted that out, had no confidence in them, so did not complain. But you could ask them to explain themselves in more detail if you were so included.

I know its hard to reach out, so sorry this has happened, it can feel like quite a set back. I hope you find what you need.

What you are referring to is the typical offer from a Talking Therapies service. These can be conceptualised as tier 2 and 3 in the hierarchy (tier 1 is watchful waiting by the GP). Tier 4 is the local CMHT teams, psychologists, psychiatrists and CPNs. Tier 5 is specialist services, like inpatient psych.

Tiers 2 and 3 are supposed to be treating anxiety and depression. Any other problems should go elsewhere. The problem is that the whole system has been underfunded for years, so tier 4 and 5 is cut to the bone, commissioners continue to chip away at mental health budgets to fund shortfalls elsewhere, and people are left in misery.

But its not necessarily that TT services are crap- some are not good, for sure, but no service should be expected to do what they dont do. Its like going to the corner shop and complaining because they dont have the range on offer at the local supermarket. They do different things.

Agreed

Except there is NICE guidance on what type of complex trauma can be treated in primary v secondary care.

Not only does provision vary but also composition of clinicians and what can be accommodated.

Local thresholds agreements within stepped care model may also vary - this does across my locality

While it is not a very nice position to be in, Talking Therapies services are not the only access to therapy in any area and they are all designed as primary care level services - meaning they should be seeing mild to moderate problems. For trauma, that is a very narrow set of circumstances.

There is a lot of pressure on TT services to take people who have more complex problems, but that means you might be working with someone who is not qualified to treat you, who does not have access to other treatment professionals if you need more then therapy, who cannot support you fully if you decompensate and are at risk, and who may not be able to treat you for long enough so you get a proper dose of treatment.

Also, a lot of TT services are not directly run by the NHS, meaning that their ability to communicate with other forms of help for you might be compromised.

I am sorry because I know this can feel like a set back. But if you really have complex PTSD you need to be connected with the right services, which are likely to be to secondary care services through your local CMHT.

Some complex PTSD can be treated in primary care others needs to be treated in secondary care.

It’s not appropriate to offer therapy when it is known not be helpful or beyond the scope of the service/clinician.

If you were told you were complex they should be referring you on or notifying your GP to do so. Some services have different provision this depends on what has been commissioned.

Trauma focussed therapy is very challenging for clients and therapists sometimes and does require a commitment to work on it - what the NHS provide is not always helpful. You’ve also got to be at the right time for it to be helpful.

I worked in NHS talking therapies for years.

their remit is mild-moderate depression, GAD, panic disorder, health anxiety, OCD and PTSD (usually single event and fitting the treatment protocol closely)

for these presentations it’s really good and works well. For anything outside of these it’s not generally considered the right option as the assumption is people will need longer term therapy - which would be fine but it doesn’t exist in statutory services so those people end up getting passed to third sector services eg MINDA who also don’t have the training or capacity to offer that sort of therapy.

they really shouldn’t be using terms like ‘too complex’ as it’s probably more like the persons symptoms don’t fit well enough into the disorder specific protocols.

for example the PTSD treatment protocol is based around the client fitting a certain type of PTSD which a lot of people who have experienced trauma don’t present with. Lots of people with a complex trauma history don’t have dissociative flashbacks for example.

The NHS are notoriously shite at dealing with anything outside of anxiety and depression. If they can't address it with eight sessions of CBT, and some antidepressants, they won't help.

I found this out the hard way trying to get help for my CPTSD.

I waited 2 1/2 years for CBT only to be told I was too complex and would need to go to a different department, months later they eventually assessed me and said I could either admit myself as an in patient and basically commit myself (despite being a single mum at the time) or they couldn’t help.

So after nearly 3 years of asking and waiting for support I ended up healing myself of C PTSD!

I’m sorry to hear this. I hope you find some support from somewhere x

I got this too. I have complex PTSD with hallucinations and hear voices. I manage to work full time as a medical professional just fine but occasionally need to talk to someone to find perspective.
Talking therapies in my trust don't have the training to deal with this kind of thing so I go to the local psychiatric hospital for support when I need it or medication review.
It's a good service so its no big deal.

Yes I had this as well.

they assessed me and then said they didn’t offer anything suitable for me.