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

A year ago - I went through a mental health crisis which involved me calling 101 - and seeing a mental health professional; they did in a week, what my gp hasn't been able to do in the 20 odd years. I saw a psychiatrist - and you can imagine what the waiting list for that is, I got a medicine review, I wasn't admitted but I was seen by people who know what they're doing.

Also if you have asd and adhd - I also have both - we found this could be related to the peri-meniopause and there is a study - when my autism broke, which outlined why, this is such a critical time for us and our mental health.

I was worried speaking to the proper doctors would mean I'd be sectioned but in fact it has opened up some avenues.

You're confusing a MH assessment with a MHA assessment. The former is about diagnosis and treatment, the latter is about whether you need to be hospitalised for safety reasons. You're talking about the latter. OPs GP may be talking about the former.

Going to A&E because you're unsafe isn't how to get MH meds prescribed, so there'd be no point in the GP refusing ADs if that was where she was sending OP. I believe the GP was wanting to refer OP to secondary care services.

OP I am a mental health nurse and I work in an assessment service.

Experienced and/ or well trained MH professionals will be rightly more concerned

about a person expressing suicidal ideation but who seems calm. This because people often seem calm once they have decided to end their life- this is what the research tells us. In addition you have recently had what sounds like a trauma which for some people might increase risk.

It can be hard for GP’s to make decisions on risk with such a short consultation time and only getting a snapshot and so its often helpful to suggest or refer onto specialist MH services for a fuller assessment.

I would also say she wasn’t wrong not to jump to prescribe, antidepressants have to be taken consistently over many months sometimes years to be filly beneficial and if someone struggles a lot with concordance there may be little point in just repeating a cycle of prescribing again.

I hope you do access some additional support and it does sound like a more in depth assessment would be helpful. I hope you feel better soon.

The A&E assessment would be by a mental health clinician and longer than the 10 min GP appointment. It would look at the risk you pose to yourself and might lead to a short term mental health team working with you. Alternatively for the gp it gives them an other professional's perspective in case they are missing something.

How can it make no sense though?

It doesn’t matter how calmly you say it… you’re still vocalising suicidal ideation (or saying you’d be better off not here etc)

GP is safeguarding, this is a good GP.