GP suggested MH assessment at the hospital - I dont understand why

[Stressed91]

I have struggled with my MH for almost 20 years. Recently diagnosed with ADHD and autism.... so that explains it I think!

I have been to the GP in the past as I have felt so low and have had thoughts that I was better off not being here. To be honest I've always had these sort of thoughts, but I'm aware my emotions can get really high and I never ever act on anything and can usually just ignore the thoughts, but they are always lurking under the surface, I dont physically self harm myself ect.

I have always been extremely emotional whenever I have gone to the GP about this in the past and have received antidepressents and further support

I went through somthing really traumatic nearly a month ago, the GP is aware of that

When I went in today I was very calm, just explained that I was feeling like it was better off I wasnt here, usually I could ignore them but I'm finding it harder so I'd like to restart my antidepressents. I was not crying or emotional I was very calm.

The GP said she wasnt going to give me antidepressents as they didnt work for me she could see from my history that I'd been on and off different types for years and she thought it was best if I went to hospital for a MH assessment.

I explained the reason they didnt work is because I was not consistent in taking my medicine, I would frequently forget ect. And part of the reason I have frequently felt like this over the years is due to undiagnosed ADHD and autism.

I started crying at this point and said I know myself better than your screen and I know for a fact I do start feeling better off antidepressents, I'm having a chemical reaction in my brain and I'm asking you to help me fix that

She then said she would give me the antidepressents but if I felt like I was going to harm myself then I needed to go to hospital

So I know it's a safe guarding think, but I dont get why, now, of all the times I have been in feeling this way, why would now be the time hospital has been mentioned considering this is the calmest i have ever been when speaking about this.

I dont understand why hospital has never been mentioned in the past but was mentioned today when today is the calmest I've ever been when ive been in? It makes no sense to me

It sounds like you have a better doctor this time, it seems that you need more support than just the antidepressants and hopefully the hospital will be able to help you. Being calm can be a red flag that means you’re more likely to act upon your feelings.

She may also feel that antidepressants are not the right treatment for you if your feelings are a response to trauma and your past behaviour means that you’re unlikely to take them properly.

Really sorry you’re experiencing this, there are talking services available from Samaritans if needed. There is also a texting service option which may be worth looking into if you’re not aware.

If it’s the same gp, it may be due to the change in your affect with these thoughts so they might believe your risk is higher this time. The fact that you’ve had a recent traumatic experience may also increase the risk.
If it’s a different gp they may just be more prudent. I don’t want to second guess the gp as such these are just ideas and not medical advice or explanations.

Ultimately you need to be in the best place possible to keep you safe, ideally that will be at home. Have you got friends or family to support you? Try and keep to your routine as much as possible with extra self care.

I agree that you likely have a better GP. This time is different though as you had a traumatic experience two months ago so it would be unwise to think that anti-depressants that worked before then will work now after trauma. I think you should agree to a MH assessment as you may need trauma therapy in addition to medication.

Editing to add a MH assessment doesn’t need to be in a hospital. You can be referred and they will do it in an outpatient building as a scheduled appointment.

Agree with other posters, this was a very good GP. Lots palm you off with antidepressants, a good one will do exactly as yours has and refer you for a full assessment. If you have been on and off them for years as you say then it’s clear you need more support than just a tablet to take each day, the GP is trying to help you access that support.

She following the local MH pathway I would imagine…..you’ve expressed suicidal ideation….she has perceived you to present in a particular way….she sounds like a good GP ……hope things turn round for you OP

Did the GP say when the assessment would be?

it is so good that this GP is taking you so seriously that you are being referred for proper specialised help

remember a GP is just that - general, they cannot do everything, that's why there are specialists.

how soon can the GP refer you ?

GPs have been discouraged from prescribing antidepressants if they can treat differently (maybe they were over prescribed...or too costly?). She didn't want to not treat you as you were showing signs of depression and have a history of depression. If the hospital sends her a letter telling her to prescribe you X pill then it's their responsibility not her's, so you are getting effective treatment and she's not having to justify her treatment decisions.

Because you expressed suicidal ideation and the Go thought you weren't safe. It's not about being calm it's about her risk assessment. She felt you were at risk. Possibly she could have delved into your ideation and current risk further to assess that herself depending on her knowledge but obviously felt you needed further assessment.

You need to take any anti depressants consistently for at least a month to feel any changes - that should be a priority alongside the assessment

Why do you not want to go for an assessment, wouldn’t it be worth it? See if you can get better help?

Are you on ADHD meds? I take them and low dose citalopram. It took a while but low dose citalopram helps my RSD. I have to take it 100% consistently though. I was told the reason they haven't worked before is that I take them for six months then taper off as I think I am better. Then another life crisis happens. They said I should stay on them for a couple of years.

Can just present same day at a&e ….there mental health practitioners on duty 24/7

A good gp will o ow the limitations of their area of practice and refer on….also a gp appointment is for15 mins ….such an assessment will take far longer

OK thanks. OP this is good news I think. A GP referral/ letter is going to help you access services much more quickly.

Are you a narrator like me when it comes to how you're feeling? I'm also audhd and my mental health is so much better with the ADHD meds.

When I'm unwell, I also have the same emotions you do, but don't intend to act on them as I know it's because I'm unwell. I know when I need the antidepressants and when I'm ready to come off them.

You have a good GP who is looking out for you. She wants you to go to hospital if there's a chance you will act upon the thoughts to make sure you're okay. If you get the chance to stick with her, do it. My GP now trusts me to know when and what help I need, and he's been instrumental in keeping me well because I feel listened to and supported. This has really helped me through processing my mum dying and starting to heal.

This is great practice from the GP - you were able to express your feelings and be honest about what is going on for you. This has been taken seriously and you have been referred for extra help/ support. That may mean a community nurse supporting you, or short term crisis intervention. Your GP is wanting to keep you safe, but also perhaps get advice from the MH team on what else could be tried medication or therapy wise.

There’s more to good mental health than just taking tablets and it all getting better. It sounds like she recognised you need more support than her just waving you away with a prescription, especially if it’s one you aren’t likely to take consistently. It sounds like she’s trying to offer the fuller package of care and support you haven’t gotten in the past and might need more than ever now due to dealing with trauma and a new diagnosis.

Op if you’ ve been on and off meds for years it’s a great idea. It’s been 20 years and you said you’re finding it harder to ignore this time. Why not call back and say you will go? So you get the right support, ?

www.nhs.uk/mental-health/social-care-and-your-rights/mental-health-assessments/#:~:text=A%20mental%20health%20assessment%20is,mental%20health%20service%20for%20help.

GPs can't often prescribe much for MH, it's not usually their speciality. You've seen a good doctor who has actually bothered to check your notes, seen you're a complicated case (more than one MH problem) with long term issues and wanted to refer you to a specialist.

The MH assessment at the hospital would have involved a psychiatrist, who could prescribe other types of MH meds which might work better for you. Once those meds had been decided and you'd been settled onto them without issues, the psychiatrist would have written to the GP who could have then continued to prescribe them.

It's been suggested this time because although you feel better on ADs, they're not actually fixing your underlying problems. If they were you wouldn't have constant underlying depressive symptoms 24/7 your whole life. It's not normal to have to ignore these suicidal symptoms, most people just don't have them!

Maybe you do just need to stay on ADs forever, due to ADHD and ASD causing you to feel depressed. That's not really something a GP is qualified to decide though. Equally, perhaps a course of some other medication could mean these feelings go away completely, even after the course is finished and you stop taking them. Which may be better for your physical health than staying on ADs forever.

It's hard to get a referral to secondary MH care (psychiatrist/hospital/CMHT etc), so it would have benefited you to take the GP up on this offer. It sounds as though the GP has not made the referral to secondary care now, has given you ADs instead and told you to go to A&E if you feel like you might harm yourself. This is a lower standard of care for you, but was what you said you wanted.

I'd go back to the GP and ask for the referral. The reason they didn't want to give you ADs is because taking them would mean the psychiatrist couldn't see the natural unmedicated you. You also now possibly need weaning off the ADs before being put on something else, which delays you receiving the best help for you.

This sounds really unusual - referral to community mental health maybe but did the GP say any more? The state of mental health at the moment and the usefulness of a&e for mental health is clearly patchy unless she was saying a MHA assessment.

@one @OneFrenchEgg I believe different areas have different processes. A friend was once referred for a MH assessment at a hospital. Not a CMHT, that didn't appear to operate in that format in her area. She initially had no help until she saw a psychiatrist for a pre-arranged appointment, who kept her in for a few days observation (she was psychotic), diagnosed her, gave her meds and referred her back to GP. She also got a MH social worker and a psychiatric nurse for a while after that.

In my area it's referral to a CMHT who allocate a MH social worker initially, who then decides for themselves how ill they think you are and gatekeeps access to any further CMHT staff support, including diagnosis which often takes years.

Take the referral. Getting that assessment and seen by a psychiatrist was a game changer to me. They can prescribe things your GP can't, prescribe combinations of medication your GP can't.

If you have a history of not taking them and are calmly talking about suicide then you meet the threshold for referral so bite their hand off.

Thanks @Snowflake2 that's good to know

It’s very standard ….a&e referral for same day assessment if gp has concerns re the patient harming themselves or others ……there is always a mental health practitioner on duty ….often more than one