I am an NHS Psychiatrist AMA

[ipredictariot5]

There has been so much in the news this week about the mental healthcare of the man who killed the three people in Nottingham. If anyone wants to
ask any questions about this or psychiatry in general fire away

Following on from the previous question what effect do you think technology like phones is having on our brains?

A lot
I think psychotherapy underpins everything and there’s not enough in quick enough time frames in most NHS services

Not something I know much about but I do think the highly processed foods also affect mental health as much as physical health. And I wonder how much poor MH in young people can be aggravated by poor diet

People will often take Quetiapine long term. I think ADHD can cause many symptoms that can be attributed to other mental health problems and emotional dysregulation is a common symptom

Thank you for explaining upthread what attracted you to psychiatry. With hindsight and considering the lack of resources etc would you still recommend it as a career to junior docs? (Asking as the mum of a couple of medics, one of whom is thinking about psychiatry)

Sorry to hear about your DD
Do not beat yourself up as a parent - it’s a normal reaction to have - seeing someone you love struggle with what seems completely irrational thoughts is challenging
ERP can take a long time to work in my experience
lots of therapy is delivered online now and with same degree of success - I was sceptical when it all went online but lots of therapists have continued and I see good results

Look up the stress vulnerability model - there is a theory that once you have had one bout of mental illness you are more vulnerable in periods of future stress
however lots of people are only ever unwell once - especially if there has been a clear precipitant for the illness

Adverse childhood experiences
Abusive relationships
poverty and homelessness
I don’t look after teenagers so can only comment as a parent. I think the evidence is mixed on this point and it certainly reduced isolation during the pandemic and was a life line for some young people

Yes definitely

I’m 57 and have ADHD (self diagnosed, but was seen by a psychologist at high school for the issues it throws up).

Is it worth getting a formal diagnosis/medication at my age?

I have worked my life around it and mostly work outdoors, which helps. I feel I’ve missed out on my potential throughout my life, and that makes me really sad.

I don’t have any expertise here beyond that of a parent and as a person who uses technology

I think assessment at any age is worthwhile. It is both a real condition and can be v disabling and medication can transform life

Thank you. I read through the assessment form you posted, and I’d say it’s pretty conclusive. Reading myself, in black and white, was upsetting.

I have been. under my community mental health team for four years. In this time I have received about 7 months of EMDR by three different therapists. I have CPTSD from bucket loads of childhood trauma and pure ocd. My issue at the moment is I have requested to see a psychiatrist to get a BPD diagnosis as I show all of the symptoms. My community mental health team are blocking this. I have put in a complaint to PALS as my care has been shocking for the last year. My question is, will this get me an appointment with a psychiatrist? I have not talked to one in the four years I’ve been with the service and my previous diagnosis were given when the community mental health team passed all my information over to the psychiatrist. I have tried most normal antidepressants (over twenty years), none of which work for me. I would like access to medication that may help, that only a psychiatrist can give. I am at my wits end at the moment as I just want to try to get better. Thank you for reading.

Thanks. This is my young adult DS who is v meds resistant and thinks all therapists ‘have their biases’. He’s at uni but struggles a lot esp as he had a big traumatic event last year. He was referred to psychosis early help team as he has exhibited some psychosis, but it only appears in v stressful situations. He’s got a meeting w someone from that team this week, but mainly he sees his issues as ocd and that’s also one of his diagnoses. He’s very clever & v possibly ASD (something I should’ve explored when he was younger but then he grew out of a lot of behaviours, but that grew into anxiety). Really is a bit of a complex (but lovely) young man and I get frustrated because he is just struggling to manage it himself and v much poo-poos intervention.

Thank you OP.. this is great thread. You sound like an amazing psychiatrist doing their very best in a difficult environment.

PALS should respond to this - it is something that Trusts generally have to respond to in a timely way and with a positive solution.
seeing a psychiatrist if you are already under a MH Team seems a reasonable request that in my Trust we would agree to if PALS requested it

anxiety/ OCD very often go alongside each autism
sometimes a diagnosis of ASD can help a person understand this. We also see people with ASD present with what looks like psychosis but is actually due to the ASD
NICE have guidance on OCD management and some advice on autism
https://www.autism.org.uk/advice-and-guidance/topics/mental-health/anxiety
https://www.nice.org.uk/guidance/cg31/resources/treating-obsessivecompulsive-disorder-ocd-and-body-dysmorphic-disorder-bdd-in-adults-children-and-young-people-pdf-194882077#:~:text=Information%20about%20NICE%20Clinical%20Guideline%2031,-16&text=Most%20psychological%20treatment%20for%20OCD,adapted%20for%20people%20with%20OCD.

young people are often v resistant to seeking help and support around their MH wanting to be seen as ‘normal’

universities can have v good student support services and helping anxious students is their bread and butter so perhaps he could look into this too

What do you think of the diagnosis of CPTSD. I know it is not a formal diagnosis but personally I really think it (or other trauma) is at the root of a significant amount of mental illness and gives rise to the symptoms that cluster together to form a lot of others.

I had significant CPTSD. I am absolutely blessed that I had incredible support to deal with it but had I stayed around the people who had caused my symptoms I never would have recovered. I was also at the edge of a cliff of developing other diagnosable conditions had I not had the right support or environment I probably would have ended up with a MH diagnosis.

The internal experience of going through what I went through was almost indescribably painful. I had significant physical symptoms that showed up medically in blood tests from the experience. I am as fully recovered as you can be now. It made me realise that people are going through truly unimaginable and unmanageable internal experiences from their environment all of the time.

My own view is trauma and ND are the most significant factors in mental health issues. I’d be interested to hear your view working in that field.

It definitely is a diagnosis - even on nhs website https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/
I definitely agree with all your other points. We don’t ask about trauma enough and don’t look for neurodiversity enough
would put both high on list but there are others such as family history and substance misuse amongst others that are also relevant .
lots of articles about trauma and later MH online

Do you ever come across mental health issues in older people which are only coming to light after a lifetime because families (which have previously always been able to cover up and deal with bouts of behaviour - except for one period of psychosis/manic & catatonic/in patient/received electrical therapy in 20's (now 80's) then no drugs or treatment of any kind since - as the individual is otherwise very highly functioning either the rest of the time or in all areas of their life, except their closest relationship for bouts at a time and very occasionally cutting a very few out if their life completely for bizarre non-reasons) are finally no longer able to cope? Not dimentia (very sharp otherwise), but a worsening jealousy, paranoia, silent treatment, suspicion, almost exclusively directed against their life partner (for increasingly unlikely reasons) whom they actually love deeply, with a few days at a time of mania / catatonic behaviour thrown in every now and again. I can tell by their eyes now, pinhole pupils, but that is the opposite of anything I've read online. Sorry, that's probably very specific. Any advice?

Thank you, this thread is fascinating.

Thanks for taking the time to make this AMA

What are the secrets to good mental health?
I think I've struggled because of menopause but I'm lucky, I'm ok.

What can people do to help themselves avoid life's ups and downs becoming bigger issues?

What can parents do to help their children have good mental health?

Especially teenagers.

Can 'prevention is better than cure' be applied to mental health?

Yes definitely - in fact some people get a lot worse as they get older - I am not sure why - to me it seems like the brain sort of gets less ‘flexible’ and able to adapt to situations
also anyone who has had one episode of psychosis is always at risk of another in their life time
and some presentations are much worse - older people with depression for example can be extremely low, suicidal and difficult to get better

If you go onto BBC and look for the Michael Moseley podcasts there is a brilliant one on happiness which has some of the best advice I have heard
There is also a good one on ageing well
it really is the boring stuff of eat well sleep well exercise find joy in life
we will all hit bumps in the road and that is normal and grief for example has to be seen through with no quick fixes
if there was one thing though I would stromgly advise is for women to watch their alcohol consumption.
It is easy to get into a habit of drinking most evenings to manage stress and sleep and your mental health slowly worsens

OP - you seem lovely, and you've helped a lot of people on this thread, which is wonderful. I have no doubt that you, personally, are an incredible person who has helped a lot of people. However, having just listened to Patient 11 over the weekend, it's clear that people like you are few and far between, and the regulations don't seem either tough, or indeed, well applied. Have you listened to it? Aside from the shocking injustices that occurred against Alexis Quinn, look at these general stats:

Key findings revealed in Patient 11 and the surrounding investigation:

• 19,889 sexual assault and harassment complaints recorded by more than 30 (out of more than 50) NHS England trusts from 2019 to November 2023. (Complaints made by both patients and staff)
• Fewer than a thousand incidents were reported to police in the same period.
• Just 14 NHS England trusts have told Sky News and The Independent that they have audited-in the 2019 government backed sexual safeguarding protections (The Sexual Safety Collaborative) - a set of protections brought about due to concerns over the then rising number of sexual abuse complaints in NHS England and NHS England supported mental health settings.
• Only six NHS England trusts provided evidence that they had completed audits of how they adhere to government-backed sexual safety standards.
• More than 800 sexual assault or rape allegations from 2019 to November 2023 across 21 NHS England Trusts - with just 95 of those allegations being reported to the police.
• 552 sexual assault allegations made on mixed sex wards/shared spaces across 21 NHS England Trusts.

How are already vulnerable patients expected to feel either safe or supported in these conditions? Having heard the podcast, and Alexis' story, I can categorically say that the last place I would self-refer in the event of a mental health crisis would be the NHS.

The article and link to the podcast can be found here, if you're interested:
https://www.skygroup.sky/en-gb/article/sky-news-and-the-independent-launch-new-podcast-series-patient-11-a-story-of-sexual-abuse-in-nhs-mental-health-trusts-