Moving from Seattle to London, Bipolar

[artsyseattle]

I am very stable on Lithium and the antidepressant Celexa (citalproam). My DH has received an offer to move to London and we are excited to take it. We will have NHS and private insurance.

I am very unaware of how the mental health system works in the UK. I know I need continued counciling (psychotherapy) as well as to continue my medication. Can anyone tell me more about how your health system works, and what I need to do to ensure I can continue my meds?

First of all get a detailed letter from your current prescriber not just with the names of your meds but with the underlying diagnosis and treatment history. Then ask if you can be given a 3 month supply for when you move.

Are you British? If you are American you will not automatically have access to the NHS but it sounds like you've looked into it. The first thing to do is register with a GP (family doctor) practice, usually the one nearest to you. They will ask you to fill in a form and attend a new patient medical check-up. As soon as that is done you probably need to book an appointment with your new GP to discuss your medication and decide whether you need to be referred to a consultant psychiatrist or community mental health team (NHS = waiting lists, be aware of that)

If you are receiving psychotherapy that is working well for you and you want it to continue be prepared to find someone privately and pay for it. Alternatively your private insurance may be willing to step in here depending on their policy about pre-existing conditions. Therapy on the NHS is sketcy and often limited to Cognitive Behavioural Therapy with waiting lists of between 4 months and 1 year+

If you need to know anything else please ask.

Thank you so much. We are waiting for our exact "offer" from my husbands company, but we were told we would have NHS plus private insurance. It is an american company, but the office in LondonWe are US citizens, so I am sure there will be some hoops to jump through, I just need to be aware of the hoops!

There are waiting lists here in our medical system for just about everything. It usually takes 1-2 months to get into see a mental health care professional, and sometimes there are no openings, we don't do wait lists. I've learned how to be persistent. It took me four years to get a bipolar diagnosis, and it took me almost killing myself for them to look at me seriously.

Some questions:

What do I do if I need urgent help, if I am suddenly suicidal and/or spiraling downward when I first move?

Can I find a doctor in the area I am moving, or do I need to rent a place and get an address first?

How do I determine the closest hospital to my residence? Mileage?

Hi,
It is very unlikely you will get psychotherapy on the NHS and certainly not without many months/even years of waiting. There are long waiting lists in the NHS for appointments, then you need assessing and then more waiting lists. Many NHS consultants just treat with medication - there is a shortage of NHS psychotherapy for all people in the UK. I am not sure you would qualify immediatedly for NHS treatment, as a non-citizen so you would have to look into that - just as a UK citizen can't go to the USA and get free treatment. You can see a Gp as a non-citizen, or any dr if you pay in the UK. However, if you have private insurance I would definitely follow that line and see what you can get privately. There is quite a difference in quality of care in mental health between private and NHS.

If you need help urgently when you are in London, the only way to get access to help (and I use the word help in a very loose sense) is to either see a Gp, who you need to be registered with or go to an A+E department and ask to speak to a duty psychiatrist (with generally about 4 hours of waiting). This will not mean you are admitted to hospital, that is quite rare, and you certainly will not jump up waiting lists and will not get any talking therapy in a crisis. You may get short term medication and then told to see your Gp. You will need an address to register for a Gp, although can see one as a temporary resident (say of a hotel) for a certain number of weeks, but then you will need to move GP practice when you rent somewhere.

If you have enduring mental health issues you will need to register with a Gp and then ask to be referred to a psychiatrist, who manages your care in the NHS. I see mine 3-4 times a year, for 15-30 minutes a time. Again you may qualify for this privately. You may then be placed under a CMHT - a community mental health team where you will be allocated a care co-ordinator, either an Occupational therapist, a Social Worker, or a community psychiatric nurse. Then if you spiral down you phone them first - only contactable between 9-5 Mon-Fri and if they think you need it you can get access to a Crisis team. The Crisis Team can support you day or night, but they will only see you generally once a day and it will be a different person each day generally as that is how they work. There will be no continuity, no talking therapy and all staff you see are at nurse level, unless you need a Dr for medical treatment. They can advise you are sectioned and action that, place you in hospital and help you get access to short term medication to help. After that you are referred back to your cmht.

PS - there is no such thing as continuing NHS therapy - it is all restricted by time, usually at nurse/counsellor level and often 6 sessions long, or possibly up to 6 months. If you get private health care with your husbands job that may give you another avenue to persue. Depending on what level of therapy you want a general counsellor can be anything from £40-50 an hour, though London tends to be more expensive. For a psychologist privately it is upwards of £100 an hour, a friend pays £250 an hour.

If you are here on a work permit there is not waiting period to register with the NHS. Once you are registered with them there is no difference in how you are treated.

Your private insurance will be a sort of top up to NHS. You need to make sure your husbands policy will cover your pre-existing condition. Large companies negotiate there own terms. A lot of large companies self fund private health insurance, and merely use the insurance companies as administrators of their fund. The larger the company, and the more senior the position, the more likely you will be able to get individual terms and condition s set out. This is something your husband needs to get onto HR pronto. My DH negotiated coverage of my prexisting condition as part of his contract negotiations.

Leziah I'm in the Midlands and pay £60 for an extremely well qualified and experienced psychologist.

Thanks everyone! I'm a little bummed to hear its so chaotic, but I am happy I am quite stable and able to monitor myself. I will look into the private insurance as well.

I saw online about the MDF organization. It looks like they have some form of peer support. Does anyone know about this organization?

Chaotic is the word, but you will very quickly become a master at negotiating a path through it all.

A good Gp is the key to getting to grips with the system. They mightn't do much in the way of treatment but they will be your first port of call.

Mdf are good as is mind. They are helpful and knowledgable - good to hear you've found medications that suit you

Oh and the length of waiting for talking therapy and how long you can get it often depends on you local nhs trust - I had 3 courses of talking therapy, 1 yr , 12 weeks and 6 months with only a couple of weeks wait. My area does seem well organised and reading others experiences I realise ive been v lucky.