I don't feel able to return to work

[Geckos48]

I've had a tough few months, since february really, I have been struggling with depression, paranoia, social anxiety and fear.

Recently I have been off work because I am struggling to remain focussed and accountable. I am scared of harming people because of my health problems and I am scared of harming myself.

I really want to be moved away from my GP's care to a more specialised care and am going to request this today. I have uncontrollable sobbing, fear of leaving the house, paranoia, inability to motivate, insomnia. I feel like i need my medication checked, I am having longings to cut my arms and hurt myself, sometimes I feel like my head will explode with it all and social situations really make this all worse.

What can I do to get support with not returning to work immediately? I love my job and I'm not lazy or anything like that but I just feel life has been so utterly terrifying of late that I just can't face it all.

Any advice for me?

Get in touch with your local MIND or any other local charities that would help with MH/benefits issues. Ask for your GP to sign you off. I don't know the procedure for signing off sick but get in touch with your HR about it. I have not worked for years because my MH doesn't allow me to, but I manage on DLA and IS. It sounds like you could qualify for DLA, but it will be good for you to get a referral to more specialist support as it will carry more weight to have a consultant supporting your application than just a GP.

I have an urgent gp appointment today,, hopefully get a referral to a consultant. I am sici of speaking to different people each time I phone needing someone

They have referred me to the community mental health team

she said they might refuse to see me though(?) and that they might say it can be dealt with 'in surgery'

she also said that there is no one-to-one counselling on the NHS

does that include Psychotherapy?

I am so confused.

I dont know so am bumping this for you.

While you wait for the community mental health team, could you google your gp and see what services they do do? Not sure if that is a silly thing to post, as never googled my own GPs so not sure what each GP surgery puts on its website.

Thank you, They pretty much demand everyone go down the group therapy route :( Thats why I would really like to be with a psychiatric team rather than the GP, they dont seem to know what to do.

It must depend on where you live or how your GP practice spends their money because I am getting one-to-one counselling via NHS at the moment. I was also under the crisis team and home care team for a few weeks as they felt I needed extra support to stay safe. It is my GP who signs off the fit notes for work though not the mental health team.

Is your GP not agreeing to sign you off work.

I've been signed off for the last 3 weeks and am signed off for another week, I would like to feel able to go back to work and actually, i feel like only doing a few hours a week would be really good for me, but if they are going to mess my medication around and what not I would rather get that out the way before going back.

I have just spoken to the Mental Health Nurse, so nice of her to call me same day, shes made me an assessment appointment but that will probably take 2/3 weeks to come in.

I am going to go back to work as of next Friday, I think that just doing a bit of work will be really useful to me. Focus the mind. I dont know if i want to just be hanging around, not sure it will be best for my MH. If it doesn't work out, I can always take more time off but I have to try.

Hi. CMHT teams assess people and then decide which services best suit the person. CMHT teams do not provide themselves any talking therapy, they have a mix of psychiatrists who just do diagnosis and medication and see no more than 3-4 times a year, usually 15 min appointments. Then either a social worker, an OT or a nurse is the care co ordinator who does the risk assessments, sees you anywhere between once a month and once a week. They are not counsellors though, but chat and look at what adjustments one needs to make, what support is needed to cover risks, how to manage day to day activities or whatever is relevant to a patient. Once under a CMHT cannot access the counselling options from gp. Not until discharged from them. Some CMHT have a pathfinder ( or whatever called) service who see people for day up to 8 times to offer short term support and then discharge back to primary level services. Here people are only under CMHT if diagnosed with a psychotic illness, schizophrenia, bipolar or is risk rating is too high for no supervision. Often people are encouraged to use primary care resources such as telephone or group counselling first and then be referred upwards if deemed necessary. Some people start at CMHT level depending on diagnosis.

Great you got a call for an assessment. Oh and just to let you know under a CMHT not likely to get any counselling straight away and most of them offer group therapy, not all but many. So if you were hoping a CMHT was a quick way to be to one counselling I think you may find in most places that is not an option. Hope you are lucky. Often people in a CMHT get less access to counselling as it is provided by the SW/OT/nurse who are not counsellors. But if you tell them you wanted to be under a CMHT for one to one counselling as do not want the gp group counselling option they may at least tell you what is available. It also helps if you could tell them on assessment what reasons you have for thinking counselling would help, what type of counselling you want, how many sessions you want etc so they can match you up straight away with the best service provision there is. CMHT do not write sick/fit notes only a gp does that.

A fit note to work a few hours sounds a positive step. Hope a gentle return to work helps.

One of the biggest issues for me has been the medication, I am constantly under the whim of the various GP's that I manage to get an appointment with for the meds that I am on.

Because they don't know anything specific about the mind, its very difficult to know what to do.

The only way I could do group sessions is if i could know who was going to be there, the thought of going into a room and just not knowing if people I knew were going to rock up is bloody terrifying for me.

I need to find a way to access proper counselling, as well as having someone help me with my medication (which I am glad is what is available to me now) but I really don't think a 'stress management workshop' is what I need, unless they will allow me to travel to a different area to do it.

How would I go about seeing a psychotherapist? I know some work for the NHS so who gets to see them? It confuses me a lot.

Are you not happy with your medication? When I saw a psychiatrist she told me " so what do you want, tell me and I will say if it is suitable?" Grrrr. So might be worth researching anti depressants in advance and stating why the medications you have been on have and how long for and why they have not worked and what you need from a medication. Seeing a psychiatrist sounds a really good idea. So if you can tell the person assessing you that you are not happy with your gp service and why they may be able to get you a psychiatrist appointment. Tell them you are unhappy with gp service and think you would get a better service by being under a psychiatrist. Waiting times vary, on how busy they are but they have to see you within NHS guidelines by 18 weeks ( same as if you had problem with ears and had referral say to ENT etc!) Also you can ask the psychiatrist for a formal diagnosis which may help you gain access to treatments. To be honest where I live what treatment you get depends on how much risk one is perceived to be to family etc. I at last got short term counselling ( not psychotherapy) due to a high risk rating due to pnd. When a baby is involved they have to act I discovered but that is under the peri natal mental health services and only until child is 18 months old.

On NHS there is no long term psychotherapy as such, unless you are inpatient in a particular treatment option for 6 months. But there is short term options. Everything is time limited. What length or style of treatment do you want? If you get offered group you would be expected to try it and they would say it would be normal to be anxious and if that is what your CCG provides then that is it. You cannot travel out of area to get treatments other areas have sadly. For eg I suffered infertility; my area only funds one IVF cycle, next county funds 2 - I could not travel ( easy time wise!) to get the 2nd cycle.

Why not look up what options your CCG has? And then tell the assessor that you reject every option that the gp can provide (say not tried it and why or what you tried) Be prepared to demand psychotherapy and reject cbt in your assessment and say why. It may well be the assessor can refer you to the right treatment option for you. Just be aware that whatever you get will not be forever. The longer term options where I live are group therapy for people wi personality disorders. And that is a one year group therapy programme. Or people who are under the complex health banner have access to other treatments, to avoid sectioning and risk to the community or self. So might be worth researching what teams work in your area.

Have you tried accessing counselling through work or occupational health? Private insurance? ( I have neither but some do!)

Private counselling varies in cost. Psychotherapists can start from around £30 an hour ( similar cost to hairdresser, a massage etc). And go up in cost. My local university trains counsellors so they offer treatments from a small cost right up to a hefty £75 for the same person just assessed on income ( rules me out due to dh's income) but worth looking for charities or such options for reduced cost private perhaps.

I've just seen one of the 'seniors' from work in the shop. She totally blanked me and when I said 'hello' refused to make eye-contact with me and mumbled a 'hi' I said 'how are you' and she said 'fine' (still not making eye-contact with me) and walked away.

Am now way way more anxious about going back to work than i was, I just wanted to run out of that supermarket :( :(

I dont understand why psychotherapy is not an option when it says it is on the NHS choices website.

I would be able to go to group therapy but not unless I knew who was going to be in there.

I have a bit more time now as have left university but I dont have private health insurance or access to a counsellor any other way.

I might look into charities who can offer a reduced price. Its just so expensive :(

Hi, you may get offered what you want at the assessment. But I do urge you to go back to the gp and ask what the gp can refer you to as well, see a different gp at the practice. If you are taken on by the CMHT ( not everyone is at it is second tier mental health care used when first tier is not sufficient) you cannot do the counselling that a gp can refer to, until discharged by a CMHT.

Regarding a work colleague. Ignore it. You have no idea what is going on in their life and how they reacted or not to you will be totally down to what is going on in their life and nothing to with you. Unless you are so important to them to bother treating a certain way, which I doubt anyone is in reality!!! She may have had a row with her partner, got drunk the night before, be stressed about that day's events etc. I had a close family member die recently and I can tell you how behaved out of work was different as in work.

Try not to take everything personally. Try to focus on being kind to you, resting and doing more each day so can return to work.

Remember NHS choices website is idealistic. I will give you an eg from infertility. NHS choices and NICE guidelines say 3 funded IVF cycles. But some areas fund 1, some 2 and some none! Nothing can be done to challenge it.

The CMHT may want to know why you not tried talking therapies before being referred to them so I suggest you think very carefully about what you will and will not accept as they may say if you refuse treatment that medical people say is what you need they will not give you what you want. Sadly NHS is rationed. But counselling is about being prepared to make changes and challenge negative thinking patterns and it sounds like you are already working on that.

'Talking therapies'?

I was only offered group therapy.

That is all my GP offers, CBT in groups.

It's very much a postcode lottery so you should try to find out through word of mouth what other people have managed to get in your area. Perhaps a local organisation like MIND or other advice/advocacy service could help?

My own experience has certainly been in contradiction to HoopHope's. I'm under my CMHT and I've received therapy (CAT) from a clinical psychologist at the clinic, referred by my psychiatrist who is based at the CMHT. I see my psychiatrist about every three months, for a 40-min appointment, and my care co-ordinator about every four weeks for a 30 min appointment. I've also had sessions with an occupational therapist, these stopped as she went on maternity leave but I'm being referred to the replacement OT soon.

There are group therapy sessions offered at the CMHT but it was agreed that this wouldn't be suitable for me, I would find it terrifying too and I have real social interaction problems.

I've also had psychotherapy on the NHS (1:1 psychodynamic therapy, 3 appointments a week for 50 mins for 18 months). I live quite close to a training centre for psychotherapy but I know they take referrals from a range of areas, not just the locality. Personally however, I am a bit skeptical about how helpful the psychotherapy was for me...I felt that the therapist I was allocated didn't really take into account my various diagnoses and cultural background and made a lot of assumptions. One thing with the NHS is that there's very little choice, I could not ask for an initial session to decide whether I clicked with that therapist as you would if you were paying privately, and they refused to give me information about their qualifications/background which you'd get from a private practice. Also they could only offer me sessions at 8.30 am on weekdays - hardly ideal for a single parent having to do a school run! So although there definitely is the opportunity for longer term psychotherapy on the NHS, don't expect it to be the same service you'd get privately.

3 weeks to get meds sorted isn't that long, tho if you can get a phased return to work, that sounds fab. Remember if it isn't working, you can take more time off.

The senior may have had 101 other things on her mind, or something in the shopping basket you weren't supposed to see - I was really abrupt with someone when I had a pregnancy test in the basket. It might not have been against you personally.

Hope you find your feet soon