I’m a mental health nurse- AMA

[Tethersend01]

I’ve been a mental hear nurse for 27 years, I’ve worked in inpatient and community, all in adult care but I’ve never worked with Children’s services. I know work in a service thats a bit like a general triage service for everything. Happy to answer questions about my role or any general type of mental health queries!

Thank you, you really helped me to understand this condition a little more. That was a question I have wanted to know for a while now and I couldn’t get any answers anywhere x

@MoscowMules yes it can be a struggle in my experience. People shouldn’t be declined MH treatment on the basis of substance misuse but sadly it does make engaging in psychotherapy much harder and less successful if someone is actively using ( for a variety of factors). However its a bit chicken and egg as often times people are using to manage overwhelming emotions so theres an argument that you need to address that first or at least alongside substance misuse services.

Do you treat children with autism who also suffer with their mental health ?

@Choccolatte honestly it really is largely down to resources. Inpatient services have been pared down to the bone and are iften running at 110% capacity. Staffing is always an issue so only essential stuff tends to get done. The environments could be better imo but are heavily influenced by laws, policies around maximising safety ( so eg places look stark as the more stuff thats contained on the ward the more potential for risk.
unfortunately the alarms do have to be pretty loud as its to elicit an urgent (sometimes lifesaving) response but I have great empathy about the noise! I’m so sorry you have needed inpatient care and i hope it was helpful in some way. Xx

@lollipoprainbow no I only care for people 18+ xx

Have you read the book "Sexy But Psycho" & if so, what are your thoughts on some of the subjects raised within- especially regarding the systemic pathologisation of women's trauma?

I have emmetophobia which rules and ruins my life
Have you ever come across or known of anything to help

Hiya , thank you so much for taking the time to post and help people . I suffer with depression and mental health issues and I’m currently taking Sertraline which I have took for around a year now I don’t feel it is helping me but each time I relay this to my doctor he says to preservers and give it a little longer so I feel like I’m stuck in a rut . I have also in the past been prescribed citolipram which didn’t work for me so you have any advice as to which route I should take from here thank you so much xxxx

Also thank you so so much for all your hard work you really do save lives it’s greatly appreciated xx

@Fluffluff I'm obviously not the OP but am also a MH nurse and have emetophobia. I had EMDR and it was hugely helpful. I still have emetophobia but it is now entirely manageable. It ruled my life for many years.

Can ANYTHING be done to help a period of derealization go away quicker in your experience? I've had it twice for three weeks at a time and live in terror of it coming back one day. It completely debilitating and terrifying but most Gaps dont seem to know what it is.

Does it make you feel uncomfortable talking about suicide? I personally find it comforting to have an exit strategy in place but when I try to talk about it I’m aware that I’m making people uncomfortable. Surely I’m not the only person to feel this way? I think about it almost on a daily basis.

@Tethersend01 thanks for taking the time to reply - feels a bit less daunting now! Thank you

@CrackerIsland no I’m completely comfortable talking about suicide and self harm, that may seem odd but its a discussion I have multiple times every day.
Many of the people I assess do feel uncomfortable, ashamed, overwhelmed etc etc and can struggle to verbalise thoughts of this nature and so we try hard to find a way to support people to open up.

@HangingOver yes de realisation and depersonalisation can be successfully treated. It would usually be a two pronged approach to try to identify the root cause (eg past trauma, untreated or under-treated anxiety for example) then helping the individual to develop tools and techniques which can reduce the likelihood of an episode or shorten/ reduce intensity. Many techniques focus on uses body or environmental stimuli- these can be really effective, but are best learnt with the support of a therapist who understands the condition- usually trauma focussed therapists or therapists who specialise in anxiety disorders. This is quite a specialist area however and I wouldn’t expect a GP to really know enough to advise- if you haven’t had a mental health referral yet it would be helpful to request one!

@staciea31 We would usually recommend someone to give their antidepressants 2-3 months at a good therapeutic dose before thinking about switching- for sertraline in most healthy adults the max dose is 200mg per day.
Obviously there may be situations where someone can’t tolerate a medication so we look to alternatives sooner.
You have had antidepressants from the two ‘main classes’ GP’s are generally comfortable prescribing from, but it might be worth trying an alternative in one of those classes (there are quite a few!).
Alternatively your GP could refer you to the local MH assessment team for some medication guidance.
Its important to also address what may be causing or contributing to your low mood however as medications will only do ‘so much’- have you had any talking therapy at all to support you with this?

@Fluffluff yes emetophobia can definitely be treated! As a PP said if you’ve had a specific trauma around vomiting then something like EMDR can be really helpful, also CBT therapy which should be available via self referral in England (looks google ‘IAPT’ and your local area. Name eg ‘Bristol IAPT’ and the local service to you should come up. Alternatively all GP’should know how local services can be accessed.

Hi there. I was wondering if there are any instances where MH patients are commonly treated badly or ignored? For example, if they were considered to be a malingerer or perhaps if they were thought to have a condition that wasn't treatable, or there was a stigma? I'm thinking narcissistic personality disorder, borderline personality disorder, antisocial personality disorder or similar? My late-middle aged aunt has been seriously struggling for about 5 years, unable to work and yet doesn't seem to get any help. She's a bit antisocial but more fearful and isolated, not unkind. We have tried the NHS many times, supporting her to go to the GP, assessments with the local mental health department and even IAPT said she's not suitable for that service. So naturally we're thinking there must be an underlying reason and we're resorting to Google. A GP receptionist friend told me that they have a 'frequent patient' designation for the more hypochondriac patients so maybe there is something like that which could explain? Hopefully you can shed some light.

I spent three months last year in a secure unit under section 2 following a serious suicide attempt. I was wondering why one particular member of staff is allowed to keep her job. She was vile to 95% of the patients and 50% of the staff. She was honestly one of the most horrible people I have ever met. She was also unfortunately also one of the cleverest, I did complain about her while I was in but was told I was wrong and she had a heart of gold( not at all true) she did however do me good in that I made sure she had nothing to genuinely shout at me for so for example made sure I was up washed and dresses and sitting at the table waiting for breakfast before she had a chance to come in my room to shout at me. Why do they keep these people on? The only thing I can think of is that I'm sure her paperwork was spotless compared to most of the other compassionate staff. She had a terrible attitude and basically if she didn't think you were properly ill( depression was malingering being bipolar was okay) she spoke to you like shit. Why does the NHS keep these types of people working with people at their most vulnerable?

Thanks so much @Tethersend01

Iv found a lot of stigma surrounding bpd among medical and mental health professionals is this something you've noticed

Great AMA!

I have a primary diagnosis of EUPD/BPD. I have been treated awfully when inpatient... basically "let her cry it off" like I was a baby. I am in my 40s.

Do you think people, especially women, get a rough deal when inpatient due to a EUPD/BPD label?

I'm currently a ld student but I would really love to work in mental health. I did try and switch to mh in first year but was told I couldn't. Do you think it would be possible for me to work in mh still or would I need to do the add on once I complete my degree?

Are most MH problems situational? I.e a consequence of trauma?

@PeppermintChoc Im my particular role we look at predisposing, precipitating and perpetuating factors. We also look at goid or protective factors. So the predisposing would cover things like early trauma, genetic vulnerability and things like neurodiversity (not an exhaustive list!). For many people with predisposing factors they may still remain fairly well with regards their mental health, if they have adequate protective factors, for example good supportive family or social networks, stable housing, employment or occupation and their lifestyle promotes mental wellbeing. However for some, another factor, the precipitating factor may come along such as relationship breakdown, a traumatic event, debt, housing issues etc and that tips them over into a state of mental illness and not coping. Then the perpetuating factors are things like substance misuse, lack of support, unstable social situation (job, money, housing etc). This is a simplified version but hopefully you get the idea! I will say that for some mental illnesses the predisposing factors eg genetics do play a much stronger role eg Schizophrenia, some of the more serious forms of bipolar etc.