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What can the NHS actually do to help if you're suicidal?

15 replies

Appletini · 26/04/2014 21:06

I'm in therapy which is helping but means I feel worse some of the time as there's painful stuff to deal with and old feelings that need to come out. Sometimes it gets overwhelming and I get very low and feel hopeless.

I'm not on ADs. I tried them in the past (including a long time on Prozac) and just felt like a zombie. The old bad feelings were all still there when I came off them, I still have to grieve and work through them. I find it hard to tolerate my feelings and I'm not sure medicating them away is the answer.

So I don't think I want a prescription and I don't want to be sectioned. Is there any point going to my doctor for help, is there anything else they can actually do? Or should I stick to seeing my (private) therapist, leaning on supportive DH and phoning Samaritans at times?

It's just I've been assuming the NHS won't be able to help me and now I'm wondering if I'm missing out on help I don't know is there to be asked for? My therapist hasn't told me not to take ADs I should add, I just don't feel I want to - plus they would react badly with medication I take for a chronic illness.

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LEMmingaround · 26/04/2014 21:10

I am sorry you are feeling bad. There are other anti-depressants, sometimes it takes a while to find one that doesn't give you unwanted side effects. I take citalopram which works well for me.

How long have you been having the therapy? what sort of therapy is it? if you find you are going round in circles then maybe a different kind? again, there are lots - but CBT works really well for some people. It is a bit of a post-code lottery as to what is available locally with the NHS, but if you can afford to pay then your doctor could well refer you to a therapist. Could you discuss alternative therapies with your current counsellor.

It is good that you have a supportive Dh, it can be very hard for partners - my partner gets so exasperated with me at times.

NurseyWursey · 26/04/2014 21:18

The NHS can help you but from experience I can say sometimes it's hard to get the help you really need.

I had breakdowns and had to go to my GP, this was only 2 months ago. Gave me new antidepressants and a referral for CBT. That's it. I was sat at home every single day just begging for someone to help me.

I got slightly better but 5 days ago I self harmed, ended up with DP having to pin me down on the floor to stop me headbutting the wall and he rang an ambulance. Only then did I get the help I need. I'm now with a mental health consultant, and have daily visits from the mental health team. And FABULOUS meds which worked straight away and these past 3 days have been a dream.

You sound different to me though because you seem to have issues in your past that you need to work through - I have nothing to get me down except stress, my brain is just funny. so I really would try to keep on with the therapy and try and work through it. How long have you been going can I ask?

I know you say you don't want anti-depressants, but there are so many you could try and a very low dose of certain ones can stop the zombie feeling. It really is worth trying. If not, there are other drugs that aren't anti-depressants can can take the edge off, so do go to your GP and talk through everything and see if you can come up with an action plan.

Their hands are tied really because apart from therapy, drugs and support there's not much they can do. It's a long and horrible road for us isn't it, but it just takes time and there is light at the end of the tunnel.

I wish you lived in my area because I have the golden notebook of mental health service numbers! Might be worth you having a quick google of mental health services in your area to see if theres anything you don't know about.

I really hope you feel better soon Flowers

Appletini · 26/04/2014 21:55

Thanks so much for your replies. I'm seeing an integrative relational therapist and it's not going round in circles I'm pleased to say - there's just SO much to work through and I have a lot of trust issues due to childhood abuse. I think my current counsellor is really helping, it's just it's still hard. I've been going for just over a year and am surprised how much I've been able to trust him and open up.

He says to remember these are thoughts with big feelings attached and I won't always feel like this. It's just so hard. I hate the fact that my only options are to deal with the crap or have un-dealt-with crap. That I can't just not have the crap.

When you say therapy, drugs and support, what kind of support is it - I don't really know what it is they can do? I think I just need to plough on with therapy, the person I see is also trained in CBT - he is working hard to help me find things more bearable and says none of this is insurmountable but it's so hard to believe it.

Thank you v much for your replies it's appreciated hugely

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Appletini · 26/04/2014 21:57

Also may look into meds. Thanks again - am sorry anyone is in a position to relate.

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Appletini · 26/04/2014 22:01

Also can I ask what sort of drugs there are that aren't ADs if you're able to just give general info?

My GP has just left so I would have to see someone I haven't met before which isn't helpful

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NurseyWursey · 26/04/2014 22:08

Keep at the therapy, you're working so hard appletiniand you will work through it. And I'm really glad you can trust him, that's one wall broken down right away.

I think you should look into meds, I'm not pushing them btw but they made a world of difference to me and worked hand in hand with CBT and the support I was receiving.

The support I have is I've got a few numbers I can ring that put me straight through to mental health support, a team of people who if I'm in what I call 'crisis mode' they'll talk to me, or come to my home and help me get through that particular moment in time when it all gets too much.

I was on a tablet called Buspirone that helped with anxiety, but I'm currently on quetiapine and that has been an actual godsend. It's a really low dose, 25mg, it makes me a bit sleepy but when I wake up in the morning I'm actually ready to face the world - which is a massive thing after struggling to even get out of bed for so long.

A new GP might be a good thing y'know, maybe a fresh face to have a fresh start. Outline everything, have a good chat about what you've done, what you're doing and where you hope to be. Ask if there's anything they can help you with, anything they'd suggest to get you there.

joanofarchitrave · 26/04/2014 22:15

The right meds really can make a difference. DH has found amitriptyline to be the AD that has finally worked for him. He HATED citalopram due to feeling dead inside. He slept for a week on a tiny dose of Mirtazapine. Venlafaxine was OK I think but seemed to get less effective, though I have talked to people for whom it was a miracle.

I don't want to suggest that you CAN'T get there without meds - can be quite problematic. But they really are different.

Appletini · 26/04/2014 22:17

Thank you for your replies, lots to think about, sorry not to write more - really greatful.

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NurseyWursey · 26/04/2014 22:27

Dont worry about it, concentrate on yourself and have a think about what you want to do. We'll be here if you feel like updating in the future Flowers

NurseyWursey · 26/04/2014 22:29

Joan i've had all 3 of those, amitriptyline at the same time as citalopram but those stopped working. Started on Venlafaxine couple of months ago along size the quietiapine. Hoping this works now

SilverStars · 26/04/2014 23:31

Hi, you sound like you have a good therapist there.

NHS help can vary - at one end you have the talking therapies referred to by the gp, usually limited to 6-8 sessions, sometimes individual othertimes in a group. I would not think this was going to add to anything you already have. Longer term decent talking therapy like you are already receiving tends to me hard to get and it can be confusing to do two different therapies with two different people at the same time, NHS and private. Also you do not get to choose who you see on the NHS and it is usually limited sessions.

Medication is one good avenue to explore with the gp - they often suggest counselling first but you have that. Sleeping tablets, diazepam type medications for short term crisis or specific problems. A whole range of antidepressants depending on the presenting issues. Also anti anxiety medications. Things like sleeping medication and diazepam type drugs are usually given short term as: they are addictive and do not work if keep taking them in longer term. Antidepressants come in many different types and have different uses. However if someone does not have depression, then not sure they would be useful.

Othe rsupport from NHS tends to be linked to your risk rating. Some people with severe mental health issues are referred to a community mental health team for: diagnosis, assessment and they may get regular meetings ( once every 3 months for eg to review medications if on several), or have a community worker - a nurse, a social worker or an occupational health worker. Some people get additional support, such as a family worker or support assistant to help with getting out of the house, caring for themselves practically or for their children ( though this usually comes as a result of a social care assessment and funding). Risk rating will be assessed every six months, to see if extra intervention required ( and to consider safeguarding issues - with children, are you a vulnerable adult that requires additional support etc...).

If under a CMHT they can refer to crisis teams although this depends on where you live as to provision ( a few people get 24 access but not usual). This means when at risk of hurting self or others a crisis team worker can phone to visit daily - nb it is rarely the same person each time and can be at random times depending on how busy they are). It is not therapy, not long term and has no continuity for a patient as that is not its purpose.

Other support could be a referral to a psychiatrist for an official mental health diagnosis if the gp cannot diagnose. For conditions such as bipolar, schizophrenia, personality disorders etc. they can then liaise with your ooupatibal health for risk assessment and making adjustments in work if needed.

You can get support of a crisis team other ways though: by presenting at hospital for mental health assessment, by police or ambulance or social services being called by others, or by going to a gp or out of hours service and they thinking you need a mental health assessment doing or short term intervention.

With medication, they cannot get rid of crap, sadly. Nor can they change how we think or react - that is work you are already tackling with your therapist. They cannot take away life events. For some people they help numb them a bit as feelings can be overwhelming. For some people they are depressed and they help with moods etc.

Other things that can help are more natural:
Fresh air/daylight/exercise helps with low moods for many people
Healthy diet, fluids
Routines - good sleep hygiene, enough rest but not spending too long in bed either
Work - for many people, having positive distractions can really help, so not totally in a " mental health bubble" if that makes sense. Or for people not working, hobbies, volunteering, activities and routine.

Sorry I wrote lots. Feel free to ignore!!

metaljunk · 27/04/2014 02:23

I have been severely depressed for about 17 years, with attempts on and off over the years. In the NHS I've had psychotherapy, CMHT care coordinator, monthly meetings with my psychiatrist, benefits advisor sessions and sessions with an OT. My psych oversees my meds and put me on escitalopram which is not that frequently prescribed by GPs, as it's a bit more expensive and more potent than the cheaper version. So that is something that's worth bearing in mind, psychs have much more experience with different meds than GPs.

One thing I think is most valuable is having the documentation of my needs on NHS files, so I can use my medical records to secure DLA and ESA. This means I can use the funds towards self-care and routines that are most effective for me. These have included courses, travelling, hobbies and sports. You wouldn't get these offered through the NHS or SS but I'm able to pay for them through my disability allowances (and also get extra funding with my education as well). They are probably more helpful than any actual service offered through the NHS tbh, and if I tried to deal with all my MH issues on my own or privately outside the system, then I would have no real evidence of my needs for benefits purposes.

Appletini · 27/04/2014 10:21

Thank you all so much. Lots to think about - again sorry not to write more right now but v grateful for your replies.

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madeuplovesong44 · 27/04/2014 20:50

When i have been in therapy i too have found it tough going. My cpn would often schedule an appt afterwards to help me deal with the emotions evoked during the therapy session which made me feel like i didn't have to cope with them alone or burden my husband. Might this be something the nhs could offer that would be useful to you? Sorry if it has been mentioned, i haven't read through the replies x

Appletini · 28/04/2014 09:26

Thanks so much everyone for all your replies. As I read them I felt increasingly resistant to the idea of asking for medication. On reflection I think my current anxiety is actually useful in a way because it flares up when I'm struggling and not being kind to myself, kind of like a warning klaxon. If I medicate it, I suspect the same underlying issues will just manifest in some other way.

As to the really desperate feelings, they seem to come in waves. I feel really reluctant to tell my doctor as I've had such bad experiences in the past. I claimed ESA while signed off work and the many many many letters increased my stress. DH and I have had a long chat and decided the first thing to do is take a break from work and see if it helps to have some time out. I'm self-employed so can do this though will lose income - but we will manage and both agree the 'brown envelope syndrome' was not worth the stress for the very small amount I could claim (if you are self-employed you only get taxable contributory ESA, we are not particularly well off but above the cutoff for help for couples).

Hopefully a bit of breathing space will help. If not, doctor I guess

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