To be beyond frustrated my MH trust told me I’m too complex?

[Sillyquestion123]

I had my assessment call today, and the lady albeit very nice and understanding told me that they spontaneously be able to help as the talking therapies within my trust don’t deal with complex trauma.

As I’m also not currently depressed nor anxious, and only get symptoms when triggered I’m no way a priority.

Ive already contacted Mind which were nice, and NAPAC who were super helpful.

apparently the next step is my GP to ask to be referred to a psychiatrist.

I've only heard about his via the charities.

So AIBU for feeling so let down by my local trust?

Yes I had this as well.

they assessed me and then said they didn’t offer anything suitable for me.

I got this too. I have complex PTSD with hallucinations and hear voices. I manage to work full time as a medical professional just fine but occasionally need to talk to someone to find perspective.
Talking therapies in my trust don't have the training to deal with this kind of thing so I go to the local psychiatric hospital for support when I need it or medication review.
It's a good service so its no big deal.

I’m sorry to hear this. I hope you find some support from somewhere x

I waited 2 1/2 years for CBT only to be told I was too complex and would need to go to a different department, months later they eventually assessed me and said I could either admit myself as an in patient and basically commit myself (despite being a single mum at the time) or they couldn’t help.

So after nearly 3 years of asking and waiting for support I ended up healing myself of C PTSD!

The NHS are notoriously shite at dealing with anything outside of anxiety and depression. If they can't address it with eight sessions of CBT, and some antidepressants, they won't help.

I found this out the hard way trying to get help for my CPTSD.

I worked in NHS talking therapies for years.

their remit is mild-moderate depression, GAD, panic disorder, health anxiety, OCD and PTSD (usually single event and fitting the treatment protocol closely)

for these presentations it’s really good and works well. For anything outside of these it’s not generally considered the right option as the assumption is people will need longer term therapy - which would be fine but it doesn’t exist in statutory services so those people end up getting passed to third sector services eg MINDA who also don’t have the training or capacity to offer that sort of therapy.

they really shouldn’t be using terms like ‘too complex’ as it’s probably more like the persons symptoms don’t fit well enough into the disorder specific protocols.

for example the PTSD treatment protocol is based around the client fitting a certain type of PTSD which a lot of people who have experienced trauma don’t present with. Lots of people with a complex trauma history don’t have dissociative flashbacks for example.

Some complex PTSD can be treated in primary care others needs to be treated in secondary care.

It’s not appropriate to offer therapy when it is known not be helpful or beyond the scope of the service/clinician.

If you were told you were complex they should be referring you on or notifying your GP to do so. Some services have different provision this depends on what has been commissioned.

Trauma focussed therapy is very challenging for clients and therapists sometimes and does require a commitment to work on it - what the NHS provide is not always helpful. You’ve also got to be at the right time for it to be helpful.

While it is not a very nice position to be in, Talking Therapies services are not the only access to therapy in any area and they are all designed as primary care level services - meaning they should be seeing mild to moderate problems. For trauma, that is a very narrow set of circumstances.

There is a lot of pressure on TT services to take people who have more complex problems, but that means you might be working with someone who is not qualified to treat you, who does not have access to other treatment professionals if you need more then therapy, who cannot support you fully if you decompensate and are at risk, and who may not be able to treat you for long enough so you get a proper dose of treatment.

Also, a lot of TT services are not directly run by the NHS, meaning that their ability to communicate with other forms of help for you might be compromised.

I am sorry because I know this can feel like a set back. But if you really have complex PTSD you need to be connected with the right services, which are likely to be to secondary care services through your local CMHT.

Agreed

Except there is NICE guidance on what type of complex trauma can be treated in primary v secondary care.

Not only does provision vary but also composition of clinicians and what can be accommodated.

Local thresholds agreements within stepped care model may also vary - this does across my locality

What you are referring to is the typical offer from a Talking Therapies service. These can be conceptualised as tier 2 and 3 in the hierarchy (tier 1 is watchful waiting by the GP). Tier 4 is the local CMHT teams, psychologists, psychiatrists and CPNs. Tier 5 is specialist services, like inpatient psych.

Tiers 2 and 3 are supposed to be treating anxiety and depression. Any other problems should go elsewhere. The problem is that the whole system has been underfunded for years, so tier 4 and 5 is cut to the bone, commissioners continue to chip away at mental health budgets to fund shortfalls elsewhere, and people are left in misery.

But its not necessarily that TT services are crap- some are not good, for sure, but no service should be expected to do what they dont do. Its like going to the corner shop and complaining because they dont have the range on offer at the local supermarket. They do different things.

So do I contact my GP?

I mean there’s. LOT of abandonment , abuse, violence, suicide attempts (not by me!) and eventually my father being sent to jail for not very nice reasons.

im doing ok, and the clinicians I’ve seen have said it’s remarkable how well I’ve done through the years.

Yes, I think you will have to get the GP to do the referral.

FWIW, I think its pretty shitty that the TT service did not refer you themselves- although a lot of CMHTs are quite prejudiced against referrals from TT services so being charitable it may be because of that.

Unfortunately, many TT services are now run by private companies that get NHS contracts, and they will avoid any extra work if they can because the money offered for these contracts is cut down to a ridiculous extent. When I worked in a directly run NHS TT service, we did referrals ourselves and would talk them through if there were any questions from the CMHTs, but I think that is dying out as more of these contracts are taken over by private companies.

From what you have said, I do think you would be better off with a service that can offer you a longer course of treatment. And possibly with someone whose training is not just from one modality of treatment, like a clinical psychologist or someone who specialises in trauma. A lot of TT staff (especially in the privately owned companies) are very inexperienced and wont be able to help you properly with the things you have been through.

Some local trusts have specialist trauma treatment services which would be good. The other option which may sometimes help is looking for charities which support specific types of abuse.

My local TT told me I was 'too complex' when I tried to get counselling when my mum was dying. I worked in a TT service at the time, and knew it was bullshit, but once they trotted that out, had no confidence in them, so did not complain. But you could ask them to explain themselves in more detail if you were so included.

I know its hard to reach out, so sorry this has happened, it can feel like quite a set back. I hope you find what you need.

Sadly from experience I doubt you’ll get anything unless self harm and suicidal idealisation are involved.

It’s ok! I managed to contact NAPAC and they were absolutely lovely! So I’m just waiting to see if “Respond” which specialises in autistic pateiients will take my self referral.

at its simplest I want to know if what im doing is protecting my DC considering my parents were incapable of looking after me in that way.

TW trauma and PTSD.

I was able to access EMDR through Talking Therapies. Honestly the assessment was like Fort Knox. I was going through a horrific time and had to explain in detail exactly what flashbacks I was having and what they were like.

The therapist once I had it was amazing. Genuinely has been life changing. I have cPTSD due to multiple traumas but am turning a corner. My life is genuinely getting better rather than living in fear. I've re-referred myself and am having it again but didn't have to go through such detail this time.

There’s a middle ground between talking therapies and secondary mental health care that is a bit of a void in most trusts.

In some (the trust I used to work for) there is GPimhs, which stands for GP integrated mental health services. It fills that gap and takes patients who are “too unwell for talking therapies” but not unwell enough for being accepted by community mental health services (which the bar is very very very high to get accepted by them, you have to have a serious mental health illness). Can you see if your trust provides this service, or a similar service?

Having said that, let the GP do your referral to CMHS. They might accept you and you deserve to get the help you need, even if the system isn’t fit for purpose.

I hope you get the support you need.

They have assessed you and deemed that you need more specialist care than what they can provide for you.
They have done the right thing. YABU

They wouldn't even assess me, because I couldn't speak on the phone and they only do phone assessments.

I'd was acknowledged as in crisis at the time.

I don't actually know what the point of them is where I live.

That is great @Sillyquestion123 .

I am sorry that happened to you @RedToothBrush . Sounds like you needed the crisis team, not the Talking Therapy service. I hope its better now.

So they've assessed someone and said 'we are the mental health team, but you are too mentally ill for us so you aren't are fucking problem so we are going to dump you off our books and are going to make someone with very complex mental health needs try and navigate a complex system all by themselves".

They aren't fit for purpose.

The number of NHS departments who just go 'nope you don't tick our box, not our fucking problem' and then dump you from great height and then no one will take you on is appalling.

There was a case of a guy, highlighted by the BBC not so long ago, who was so fed up of being dumped by departments who won't take responsibility and falling between them that he's now refusing treatment which will lead to his death because the stress of dealing with this kaftasque system has become that much.

The stress of dealing with this fuckwittery itself damages mental health - and it's people who did this shit least who are getting fucked by this.

That was the crisis team.

Oh, thats really poor. I am so sorry. Could you get to A&E or call 999? Hope you are doing better now.

The stress of dealing with this fuckwittery itself damages mental health - and it's people who did this shit least who are getting fucked by this.

The people needing to answer for this are the commissioners who are constantly cutting money for MH services and the government ministers on both sides who are pushing for services to be outsourced. It might be cheaper in the short term, but it puts money first, and patient care last.

Unfortunately, because most people dont really understand what is happening and why, it is the burned out staff working to impossible criteria who get focused on. Not that there arent some terrible staff there. But there are a lot of great people working in impossible situations.

It was a while ago. Total car crash.

And no that didn't help. My trust is so unbelievably useless it's untrue.

There is literally no mental health support where I am as far as I am concerned. My GP has been staggered at what has happened to me and how no one would do anything because I don't fit their tick boxes. Long story I'm not prepared to go into on here.

I am doing ok now, thanks.

But yes, anyone who says they can't get access to services, I believe because I've had first hand experience of it. People don't understand just how terrible the situation is unless they've had to deal with it.

Its a lot of the reason I left working in general MH in the NHS. It was soul destroying to see people in need and know there was nothing you could do.

Having moved I can also see that Trusts are drastically different. Its not just about money either - see to be philosophical too. The ICBs have a lot to answer for.