@Flowersinthehood · Today 06:56
I work in MH services, it is difficult to get through the door, you have to be a risk to yourself or others really. What I find interesting is that what people expect from MH services isn’t what they get. People expect to sit on a sofa, chat about their inner most feelings and trauma for years, and be spoonfed support. That’s not what we offer. We try to put it back on them, what are you going to do about this? What solutions can you find to solve this?
What exactly do you mean by "spoonfed support"? People who are utterly broken expecting some empathy, guidance, or therapy? (And these are the people deemed enough of a risk for services to actually see them! They must be severely affected.)
If people know they have been through trauma that is affecting them - that's good. So many people won't even acknowledge their past has affected them/is causing issues in the present. It's a good starting point for beginning to unpick the effect of the past and begin healing and living better.
... And what you do is ask them what are they going to do about it?! You don't think perhaps they figured facing up to things and unpicking their problems in therapy was their way of doing something about it?
What we don’t want is someone attending appointments for years and not being accountable. Yes we will ask you to turn up, yes you can chat about things that have gone wrong this week but for the first ten minutes only and then we change the subject.
What sort of appointments? If the person is awaiting therapy, you can't actually expect them to get better until it's happening, can you? A chat with a nurse or similar, whilst it could be vaguely supportive, is hardly going to do much if the person needs to dig deep in therapy.
Or are you talking about therapy sessions? In which case "changing the subject" seems inappropriate. Wouldn't you start to dig deeper, link their recent difficult week/feelings to earlier experiences, unhealthy internalised attitudes, and so on? Not just shut them down.
People have been lied to by American sitcoms that therapy is all about them opening up, it’s not, therapy is work and self reflection.
Therapy is about both these things. Work and self-reflection in a safe environment where they can open up and access deep feelings without judgement or feeling like a burden. Whilst American sitcoms may have it wrong in terms of lying on a couch, the basic idea is far more in line with the sort of reflection that leads to insight and lasting change, than your idea of how patients/clients should be treated.
So as much as people fight to get in, a lot of people aren’t in the place to do this work and discharge themselves.
It sounds like an awful lot of people aren't being offered appropriate therapy to do this work. I certainly wouldn't feel comfortable opening up to someone with the attitudes you have described, and you imply you wouldn't want me to anyway! So perhaps they just leave realising they can't get appropriate therapy. (Or even find the dismissal from services makes things worse.)
So overdiagnosis? I’m not sure. Misdiagnosis I can imagine. I think there are a lot more people with emotional intensity rather than ASD/ ADHD (not clients but people I know socially). But no one is paying privately to get a ‘personality disorder’ diagnosis, because of the stigma, despite the fact that it is still a condition which you had no control over, and usually the result of trauma which also wasn’t your fault.
People don't need to pay to get a personality disorder diagnosis, because the NHS hands them out with ease. Perhaps because they can then dismiss traumatised people as "not mentally ill" and thus no service needs to be provided. More charitably, perhaps services are still way behind in terms of recognising neurodiversity, especially in women, as well as generally having a really narrow and medicalised view of how people "should" think, feel, and function. Whatever the reason, it is extremely common for women to be misdiagnosed as BPD whilst autism is ignored, not the other way around.
In terms of PIP it is near impossible to get PIP for anything that isn’t significant mental health. I know people in psychiatric hospitals for stays of over six months who have been declined. The proposed changes will make it impossible almost.
Agreed. Especially bad as people need it to pay for therapy that isn't available from the NHS.
Rather than carry on as we are, we need more trauma informed, psychologically minded work coaches. We have one in our trust, one!! Because work is generally beneficial for our mental health, but building up tolerance is difficult.
Surely they need appropriate therapy, to get to a stage where they can go back to work? Not just be encouraged to take step ten without addressing step one.
Agree that once they have had a chance to recover to a sufficient extent they should have access to specialist support to help get back into the workplace. But that shouldn't be from MH services - it risks people being pushed into work before they're ready, or as sounds like the case, pushed towards work rather than actually getting treatment. It shouldn't be an NHS outcome/aim to get people to work - doesn't seem fair on staff either. It also creates a perverse incentive to take on only the most work-ready patients so that a "successful outcome" can be met quickly, whilst those needing more help will be denied treatment as they cost a lot and appear as an "unsuccessful outcome" on paper.
I used to be a mouthy angry young woman and I would quit jobs if someone told me I took too long on my lunch break. I needed someone to validate my rage but let me think through my options. Think about the cycle of quitting and then regret and self loathing, think about self harm and how this was a bit like that too. I needed someone to show me why I thought and acted the way I did in the context of the work place and how to rewrite my brain and change that behaviour/ cycle through understanding why I did it.
Not everyone is the same as you. What about those who aren't "mouthy and angry" but are breaking down, in emotional pain, sent home by managers, actually unable to do their job, not just walking out?
And how, exactly, is someone supposed to explore why this is happening for them, why they are struggling so much, if you don't think they should have in-depth therapy? You seem to be promoting a CBT style approach, which isn't suitable for those who cannot even get through the day due to complex trauma.
This is what happened to me. I actually went to the NHS to get therapy as I knew the awful feelings I had related to my past. At the time I had no idea how much had affected me, how long it would take to unpick. I know, however, that if I'd been able to access therapy, rather than a punitive blaming approach from services, it would have been a lot quicker.
The thing that helped me wasn't someone banging on about changing thought processess, with only a cursory nod at the past (I already tried to do that myself). What helped was actually being able to explore the feelings, the past, have insight, more memories surfacing, and being treated with empathy and like I mattered. That way I could have real insight, and somehow, feeling empathy from another whilst in tears recounting past experiences made the nightmares go away, and the memories stopped having an overwhelming emotional impact.
A diagnosis such as ‘adhd’ does not mean someone has done that critical thought analysis/ reflection work. So in some ways it does do them a disservice.
Yes, but they need the diagnosis to be able to accurately understand themselves in context. Finding out I'm autistic was life-changing, it helped my healing process so much. Not to mention understanding the present and future better too. And this is without any specific support after being diagnosed.
Yes, people should be able to go through the work of reflection and analysis. This is important. I don't know about ADHD, but people with autism are often excluded from MH services, as if everything is "explained" by the diagnosis but no method of accessing appropriate therapy for the mental health side.
However, you don't appear to want them to have appropriate therapy, from your other comments.