Mental health... am I being unreasonable about this?

[NovemberRose90]

I'm sorry to post this here, but I just need to know if I am having unreasonable expectations here or if I have a reason to feel hard done by... and if so, what can I do about it?

I've been having mental health difficulties since September... I was experiencing bad anxiety before that, but I was assaulted by two strangers in the late summer and it really sent me into a bit of a spiral. It took me weeks to tell my GP about it and by then things had got quite bad. She referred me for counselling on IAPT (it's not self-refer in my area) but they rejected it, as it was outside their remit. I was then referred on to secondary services, but when they phoned me they said it would involve having a social worker, being put on a vulnerable adults list and going to workshops about employment and integration into the community. I have a job I love, a stable family life and I think I'm pretty integrated into the community - so it seemed to me like a bit of a waste of their resources and I went back to my GP and asked if there were other options. She said she could refer me for psych evaluation at the hospital and made another referral. This was back in September, and it was supposed to be on some kind of urgent pathway.

Since then I've not heard anything, despite chasing! A few weeks ago I went to A and E because I felt so bad and I was having such scary thoughts (I won't go into it, but you can imagine what I mean). The psych liaison woman there was lovely and said that she would write to my GP to tell them to speed things up.

This week I've been feeling worse... and my GP told me that I'd get a call at the start of the week, but still nothing. I ended up going to A&E again because I felt so utterly desperate, but there were much more serious things going on and they sent me away. Today I called the SPA number and they said they have received my referral but it has been reviewed and the case has been closed because I have "not engaged" - but I never heard from anyone, despite chasing up many times, so I am not sure what I was supposed to do?

I just feel like I can't carry on like this... I'm so scared all the time and I sometimes have such bad thoughts. I feel like it must be my fault... Yet at the same time, the little part of me that still feels some self-worth thinks it's not right that this has happened.

So... basically, am I being unreasonable to think that this is not okay? I don't trust my judgements any more and I just can't keep asking and getting knocked back... I don't know how I can make this better.

What you experienced is called dissociation and it is an unconscious survival mechanism that happens only in life or death situations. As a survival strategy it is designed to get you to live through that crisis, but the downside is what you are now experiencing, the later trauma of feeling what if....I could have done more...etc. You couldn't, your bodies reaction to this life or death situation is as unconscious as breathing. And also it doesn't matter if now you can think it wasn't really life or death, to get that dissociation response at that time your unconscious brain thought it was.
My advice is to Google five fear response as it will explain much better than me. I will also later find a good ted talk link but please forgive yourself this is an unconscious response to life or death situations and nobody knows which one of the five types of response your unconscious will force your body to do, not even a saint. In my area rape crisis provide counseling and you don't need a sarc referral, please try contacting them. You are not alone lots of women experience similar feelings if what if and guilt and they can help you make sense of stuff.

I get dissociative episodes all of the time. They are not just a life or death response. They can be very scary and distressing but it's your minds way of coping. The mental health system is useless. You have to keep bombarding them until they listen.

sertraline - if doubling the dose has made things worse, have you considered dropping back to original dose?

I was taking it recently, had problems on increased dose so did exactly that and updated GP by email.
Pescribing ADs is not an exact science - the increased dose was v much Gp saying "let's see if this helps..." Her response when I decreased what I was taking was "yes, absolutely, that was the best thing to do."
(I found side effects were unbearable, rather than efficacy of medication reduced).

Don't stop taking them altogether; or have a conversation with GP first about reducing if you feel more comfortable with that.
With my GP, telephone appointments often faster to arrange, or emailing with no appointment gets a speedy-ish response.

OP it was absolutely not your fault, I am so sorry you've been feeling that way . It seems to be a bit all or nothing with mental health care, it's very hard to get referred until you reach the point you require sectioning, and then once you are back in the community you get a worker etc; very reactive rather than proactive. Does your GP know to what extent you are struggling?

People always forget about the freeze response to danger. It's just as natural a response as fight or flight, and is just as likely to save your life depending on the situation. You definitely need some support, I really hope you get it. As well as pals you could try writing to your gp practice manager to push for this to be sorted.

Thank you for all the suggestions, you've all been so kind and I don't deserve it!

I looked up on Rape Crisis their options just now, but unfortunately...

West London Rape Crisis Centre

For women who have experienced any kind of sexual violence, recent or historic.

Current open for referrals in: Sorry, all of our waiting lists are currently closed.

Currently closed in: Brent, Harrow, Hounslow, Ealing, Hillingdon and Hammersmith & Fulham.

So I think that means I can't even refer?

I will consider dropping down the sertraline because it doesn't feel like it is working well. I have spoken to the GP practice manager, but they have chased the referral multiple times already and she says now it is down to me to do it.

I just can't fight anymore and I just can't help but feel that it's my fault and I deserve to feel like this, because I am weak...

It might be that sertraline doesn't suit you. There are lots of other antidepressants to try. Can you book another appointment with your GP on Monday morning?

I sympathise. I was abused as a child then lurched into a disastrous first marriage at 18 to a man twice my age who got me hooked on heroin. I was sectioned at 20 but told that due to my addiction they couldn't diagnose me correctly. To cut a long story short, I eventually got clean but my mental health got worse. Second marriage to a guy who abused me physically, sexually and emotionally led to me becoming suicidal and I set off in my car to drive off the motorway bridge. I had an image of my son pop into my head, swerved and slammed into a wall instead. My mum, herself crippled and living on disability benefits, paid for me to see a private psychiatrist who diagnosed emotionally unstable personality disorder also known as borderline, and the relief I felt was amazing at finally being heard. I left the second husband, moved counties and because the private psych had written to my gp with his diagnosis, my care was taken over by the nhs. Take it from me, it is so easy to end up pushed from pillar to post with nobody taking ownership of your problem. It sounds as though you are coming to the end of your tether, the thoughts of overdosing (I've done that a few times along with self harming) is no less than suicidal ideation and my advice to you is to see your doctor and spell it out to him or her that you are considering ending your life. They should listen. Don't get to the state I was in, it was a living nightmare and it's only thanks to being on mood stabilising medication through a psychiatrist that I can now get on with my life. It is worth paying for one single consultation with a psychiatrist to get the ball rolling in terms of your care, don't leave it til it's too late. I wish you all the best and hope you get the care you need xx

Awful about the rape crisis centers
Have you thought about trying Victim Support, or looking for other local charities that may be able to help?

OP, you are 100% not being unreasonable now and not when you were a teenage girl questioning that Sainthood either.

Mental health services are not only inadequate in many areas, they are actually dangerous for someone like yourself who seems to easily blame themself for things that go wrong. There is large capacity in mental health services (IAPT) to offer help to people who are mildly unwell and very small capacity to help people who need more. Yet no one in mental health policy wants to own up to this and they'd rather lie about how wonderfully they are doing. It's proving incredibly hard to get the truth out about this. There was a report on File on 4 and Radio 5 live in November about staff pressurised to get people off waitlists and falsify recovery rates in IAPT services but it's so rare for the truth to be spoken about. It's outrageous that NHS mental health services shy away from working with rape and sexual assault and the charities have had to close their lists due to demand. Our local IAPT will happily see you for a phobia that is not much affecting your life but will refer people away to a charity staffed by unpaid volunteers where what you describe is presented with.
This need to get people off waitlists leads to really hurting someone like yourself who might end up thinking, I'm not worth it.

Please believe that you are worth it and you deserve treatment. The services shy away from giving you a proper assessment because then they have to provide treatment. If IAPT have said that they think your difficulties are too complex for them to treat, you should still be able to have a full assessment meeting with a clinician who can recommend the best therapy for your difficulties. Do you have a letter from anyone so far suggesting what diagnosis your symptoms are consistent with and what the recommended treatment is?

If you are looking for someone privately,it is a minefield and you are not wrong to be careful because there are a lot of therapies and those that ask you to talk about details of what happened to you can cause you to get worse unless it is done as part of structured programme. If you do approach people privately don't be embarrassed to ask what their experience is in working with clients who have been assualted and what approach they work with, if you feel pressurised by any of them to make an appointment when you don't feel right with them then trust your instinct and don't.

Sometimes work places have mental health services you can access

Samaritans can be helpful too

@Waveysnail - OP has already been turned down by her work sponsored service for this she wrote earlier upthread, presumably because her service offers general person centred counselling and this is not recommended for the difficulties she is describing.
You would need a higher level of private insurance for this in order to get a psychiatric assessment and the recommended type of therapy

Samaritans can be helpful but you have to be careful not to slip into talking about the details of what happened if you are suffering from PTSD because it can cause flashbacks, so it's imporant to use the call to talk about how you are feeling now and to bring you back into the present. Also if you are suffering from self criticism and spend the call talking about your perceived negatives this can reinfornce your negative beliefs about yourself, so again, the calls need to be used wisely.

@NovemberRose90

East London Rape crisis doesn’t say anything about referrals being closed. So could be worth trying them.
www.niaendingviolence.org.uk/

Or South London
www.rasasc.org.uk/

Do you have a local rape and sexual abuse centre?

You won't get the right counselling from GP. You need specialist counselling.

I was referred through the police but you can contact these centres anonymously if you wish and get on to a list which hopefully wouldnt be too long.

I was able to access specialist counselling a couple of weeks after I went to the police. I was even able to have a second bout of counselling 2 years later when I had a mental breakdown over it.

It was the most beneficial thing I'd ever had.

See if that's an avenue for you?

Oh gosh sorry, didnt see your last post.

If you are going into work everyday crying, then you need some time out. Can you take some time off and see Occupational Health.

That's what happened to me. I went into work and couldn't stop crying - not good in a teaching job!

This wasn't your fault, I promise you. Not everyone fights, not everyone kicks and screams. I froze. Which is a less well known body response. Your reptilian brain takes over and tries to survive at all costs - sometimes it decides it's best to freeze and play dead.

I'm so sorry you have such massive waiting lists in your area. That's really not what you need.

I went on anti depressants to help until I got through the counselling. The anti depressants will help a bit until you find something.

If you're anything like me it just feels like a massive, swirling, melting pot of different emotions, trying to piece together some sort of timeline, feeling like utter rock bottom.

You can always talk on here and those of us who have been through similar can maybe help you feel like you're not alone and that sometimes your current way of thinking is a little skewiff albeit normal (I.e. blaming yourself. Very common way of thinkinf but absolutely not true).

@romeoonthebalcony thank you for the very helpful practical advice - what you mention about it being difficult to know what's the right help to look for privately is what I've been worried about. And also about Samaritans - I did call once and I genuinely felt worse afterwards, which was just because talking about what I was already thinking made me feel worse.

My GP wrote on my fit note (which I didn't use) "severe anxiety, ?PTSD, stress" - not sure if that counts as a diagnosis though!

you are very welcome @NovemberRose90. You sound lovely and kind.

Diagnosis in mental health is a contraversial thing but if you do have PTSD then there are NICE guidelines for treatment which helps to get treatment even if one is against diagnosis (There's a whole movement called "Drop the Disorder" which says people are getting too medicalised in mental health, they make some good points but diagnosis and guidelines can help you at least to fight for the right help). The guidelines recommend CBT or EMDR for PTSD. These are not the only therapies that can help but they are at least ones that should not make you worse so if someone suggests another one it may be safe and OK but you have every right to ask about it. If you were looking privately for these it is safest to find someone who is properly trained in these, there are unfortunately counsellors and even psychologists out there who say they offer CBT and/or EMDR but do not have full training and ongoing supervision specific to it.

Did you get a letter after your triage with your IAPT service? If they think you do not have PTSD they should have said and if they think you might they need to explain why they cannot treat it in their service and who they would recommend.

I understand it is horribly hard to work through this mire when you feel so unwell and your brain is telling you that you deserve no better. Another thing to perhaps Google is "mental health advocacy" in your area in case you can find someone to support you to get to the right place.

I think there is an element of things getting worse when you discuss this sometimes. Just something to bear in mind.

This is going to be a painful process whatever therapy you decide to go with. You will experience a whole range of emotions as you go through it and will most likely feel pretty awful at the end of certain sessions.

At least that's how I felt. It wasn't until much later in the sessions that I felt like I had pieced things together and gotten some sort of sense out of it. Then I started to feel better. It started to feel good to talk it out.

Just because it feels worse in the beginning, does not mean it won't work though.

tavistockandportman.nhs.uk/care-and-treatment/our-clinical-services/trauma-service/

So sorry you're going through this.

I had my first breakdown almost 15 years ago and I haven't really been well since largely because it's impossible to access all the treatments which are supposed to be put in place to happen concurrently.

At the moment I'm approaching 2 years housebound, I've been without ANY mh team involvement in over 6 months, the involvement I had immediately prior to that frankly did more harm than good, I was supposed to have an appointment recently that's been postponed for another 3 weeks which was yet another blow.

I'm on mh meds' that are not meant to be taken lightly and which can have long term effects on certain organs, so I'm supposed to be monitored and have blood tests but that hasn't been happening. I can't just stop them as it's dangerous to do so in several ways.

I'm existing I'm not living, that's 2 years of my life I'll never get back.

I'm not an old woman being only 47 but I'm scared this will be my life forever now.

I hope your experience ends up being better than mine. I know it's hard to fight when you're ill like this, if you have anyone that can advocate for you let them or as pps have said certain organisations can provide this service.

I'm out of luck on that score as I'm in semi rural Scotland and my family aren't very good at that stuff.

I'm trying to get the help I need but it's damn hard!

@Thecurtainsofdestiny thank you for this! I'm not sure how to make contact though and I have a feeling I'd be out of area since I'm a different borough / NHS trust. But it is worth following up so I will ask!

@Graphista So sorry to hear what you've been through, it is terrible that you haven't received the help you need and deserve.

@romeoonthebalcony I didn't get a diagnosis from IAPT - they just said I was unsuitable because of their waiting times (a couple of months, which seems not too bad to me) and my need for quicker support.

But I have finally some better news, I hope. I got a call from the SPA triage this afternoon and they finally had my referral. The lady I spoke to was nice and seemed to understand what I was saying about community team/home visits being difficult and maybe not suitable (apart from anything else, I work slightly unpredictable hours, so it would be hard to be home for a home visit). She said that she would refer me back to the IAPTS and recommend that they fast-track me.

So maybe there is yet hope! I hope so, anyway.

The mental health services are the most underfunded section of the NHS and many people wait up to a year for just an assessment. I've been in the system for four years now as I have bipolar disorder. If you're desperate to be seen I would do the following:

Go to A&E, make it clear you are not coping and demand to see the on-duty psychiatrist.

When you see them, make sure you completely act up to show them how bad it is (I'm not saying threatening to kill yourself) but don't be afraid to cry or say how you really feel.

Ask to be admitted to the home Crisis team, don't worry, from the sounds of it you won't go into hospital or anything, there's very few beds and you have to be a serious danger to yourself to be admitted. But make it clear you need some form of intervention.

When you're admitted to the Crisis team, who will likely see you a few times for a week at your house, explain everything that has gone on. They will go back and have their weekly meeting with your community mental health services and they can fast track you for appointments.

It's not easy, but it is worth it.

Good luck!

I'd agree with the poster above. In other areas they are called the Home Treatment Team and they can get a pysciatrist, psychologist, Occupational therapist etc out to your home to see you.

I would advise saying your suicidal if you are as the threshold for the services is high and you have to be very explicit to get what you need.