To think that I need a MH assessment *TW*

[Wantthistoend]

I've suffered with self harm, suicidal tendencies, depression, chaotic behaviour essentially my whole life. I also have an eating disorder and what seems like OCD.

I get these spells where I believe thing slike people are building cases against me, I've committed fraud, people are recording me, I've quit my job and moved house because of this, empty my bank accounts, delete all my social media etc.

When I'm not in this frame of mind it's easy to shrug it off even though the thoughts are always there, but when I'm in it it feels so real.

I've asked for a mental health assessment but been told because I'm 'ok' just now I won't be referred. I've been offered SSRIs but to be honest I'd like to speak to a psychiatric professional before I start taking meds.

I was diagnosed with bpd in the past but I didn't feel that they spent very long with me to form that diagnosis.

I'm really suffering and I use drugs and alcohol to cope. I hate being in my own head. I got clean for two months because I thought they would then take me seriously but they just gave me a list of websites.

I'm in a toxic relationship and my job is suffering too - I hate it and it causes me a great deal of anxiety but I live on my own so I can't quit. There's a good chance I'll be fired because of all the time I've had off 😔

I feel like ending it all at times and I don't really know what to do.

Hmm I’m not sure either…. My dad has a diagnosis of bipolar, however I have a very dysfunctional relationship with him and had no relationship with him when I was a child so I’m not terribly well up on it.

I’m sorry you’re going through what you are, I know the other person I know who has episodes of things like thinking people are spying on her etc takes antipsychotic meds.

Ask the worker to put their/your concerns in writing. And be open about risk. It’s much harder for a GP to ignore that.

If you are sober then that increases your chances of being accepted by secondary care. But as you are working with substance misuse services, you certainly should be seen by a general psychiatrist anyway.

I’m a Mental Health nurse. Have you ever had therapy input, such as DBT or emotional coping skills? Many people with EUPD experience psychotic or paranoid type feelings when they’re stressed, but these are better managed through psychological skills based work to help manage the stress than necessarily medication. The other thing I would suggest is discussing a short low dose course of a medication like quetiapine or something similar with your GP or the psychiatric nurse is she’s a prescriber. Quetiapine would help take the edge off, balance your mood and improve your sleep. Of course, if you feel that you can’t keep yourself safe then you need to go to A&E.

OP the reason why you aren’t being referred is because technically you are under the care of Addictions, which includes a full MDT (Psychiatry and Psychology also). Therefore a Community Mental Health Team would reject your referral, because you are already open to Addictions. As you are now sober, you should be able to request a mental health assessment. Or you could ask to be discharged from Addictions, as it doesn’t sound like you are receiving any specialist input now you are sober? Are you prescribed any medication(s)? If you are not receiving any input and you are no longer struggling with addiction, it would make sense to me that you are discharged and re-referred to a Community Mental Health Team for psychological assessment and treatment.

Having worked in these services for years I know there are many gaps in the system and people end up getting bounced between services, which is massively unhelpful. There can be stigmatising attitudes around so-called personality disorders too which don’t help. I would advise speaking to your Addictions worker and requesting either a mental health assessment, or a referral to a CMHT if you no longer meet the criteria to be seen under Addictions. Sorry this is happening, this is a reflection on how dysfunctional the system is and all the levels of gatekeeping to access mental health support.

This really doesn't sound fair on you at all. I really think you'd benefit from seeing a psychiatrist. I don't see any reason why they shouldn't - I've been referred to a psychiatrist before and that was for 'only' depression and anxiety.

It might be that SSRIs aren't right for you. Will they not try another type? A tricyclic, maybe?

I'm sure you know, but taking street drugs is only going to exacerbate things. I don't know what you're taking but cannabis will make you paranoid, cocaine is going to destroy your dopamine levels, MDMA will drain your serotonin, and alcohol will make you depressed. There's absolutely no judgement from me about whatever it is you're taking, but the cost benefit analysis never works out. It'll always take more than you have to give.

Is it possible for you to start again with a different GP? Some GPs specialise in mental health, if there's one in your catchment area? It's worth a look at least.