Any advice -DH at crisis point and CMHT won't help

[Scoutygirl]

First time poster although lurked for years... There's so much knowledge and support on these boards I was hoping some of you fabulous people could help. Sorry it's long but thought the info was important.

DH has been battling severe depression for almost 30 years. Caused by a catalogue of issues in childhood (including sexual and physical abuse) that have never been addressed. In fact he did get some counselling as a teen but the therapist told him he was making it up and "was as useless as your father" who was also being seen, the result of which has been that he has never really trusted therapist since.

Over the years he's had various episodes that have resulted in time off work and has been on a range of ADs for the best part of 15yrs.

So that's some background. In the last couple of months things have hit rock bottom. We have a DS who is there and DD is now 6mo - and two little ones who aren't great sleepers and a very energetic DS is hard work at the best of times. But something triggered DH into a really bad place - worse than he'd ever been before (was at real risk to himself not anyone else, but won't write more in case it triggers).

When he finally went to the GP he was fabulous and got an emergency Psych appt within hours resulting in being cared for by the crisis team. Which was mixed. He was offered a bed in the Unit which he declined. They sorted out his meds and as things seemed to be improving so was discharged to CMHT. He's still working ft and work are aware and supportive.

The weekly mtgs with his nurse/care coordinator started off ok but deteriorated and came to a head this week. The mtgs seem to be a trigger and he always drank heavily for 48hrs before and afterwards. He got an emergency appt with the Psych consultant who apparently told him that there would be no further help/support until he stopped drinking. So he has to see the alcohol dependency team before they can continue to sort out the much needed psychotherapy he needs.

Which now means that he has lost all faith in the system and just wants to "give up and go it alone". This is the first time he's asked for and accepted help and now he feels like he's been kicked when he's down.

I'm only just holding it all together. I'm lucky I've got good friends and family but there is only so much they can do - especially late at night when he's talking about ending it.

We're lucky that he's got private medical cover through work but he says he doesn't want to go that way either.

Do I try and call the crisis team? His nurse is now on leave until the end of the month so can't speak to her. So what do I do? What would you do?

Much as I feel for you and your DH I do think that the heavy drinking is a problem. I know a lot of people self medicate with alcohol and as someone who suffers from intermittent depression (severe at time) I can well understand the need to block things out. This is especially true in the case of your DH isn't it because of his traumatic past and the horrendous experience with the so-called therapist. The trouble is of course is that as I'm sure you know the person ends up with a double whammy of depression and dependency on alcohol, added to which alcohol is of course a depressant and so the person is caught in a viscous circle.

Has your DH been a heavy drinker through the past years, or is this something new, and do you know why the meeting with the CPN triggers a drinking bout. How does his drinking affect you and the children?

You are hinting that your DH has made a suicide attempt - and mention a trigger. Do you know what the trigger was - sorry I'm not asking you to say, just wondered if both of you knew.

It's a tricky situation now because if the consultant psych has said that your DH needs help with his alcohol dependency first, then the crisis team are highly unlikely to go against the consultant. I think the best thing you can do is to encourage your DH to get help from the alcohol dependency team, both because this would be a good thing for him (and the family?) and would enable him to get the help that he needs from the mental health service.

You mention your DH talks about "ending it" and I'm not sure if this is something he has talked about on and off over the years or whether this is something new. I have certainly had suicidal thoughts over the past 5 years, though suicide ideation, in the sense that I knew I wouldn't really be able to go through with it, but just wanted an end to the pain. I know that it's a very common symptom in depression and when we are rock bottom it's sometimes a "relief" to think there is a way out, not that we want to die, but we want an end to the pain. Posters often suggest going to A & E or calling the crisis team if someone is suicidal but I'm never sure this is the right course of action, though they will be able to assess the risk. Thing is your DH has refused IP care and so would be unlikely to agree to that even if it was offered, and he gets upset at seeing the CPN so not sure if he would welcome anyone from the crisis team either. Having said all that if you really feel he is at serious risk of suicide, then you should seek urgent help, and if he was deemed to be at a risk to himself then he could be sectioned under the Mental Health Act. It is though I think quite unusual for someone to be sectioned for depression.

Sorry I hope I don't sound unsympathetic, and haven't confused you more.

Thank you so much for your reply. You've touched on a number of points, many of which re-enforce my thoughts (which is helpful in itself).

In answer to a few questions:

Yes, he's always drunk more than average and does seem to use it as a form of medication / coping mechanism. In the time I've known him it's never been as "bad" as recently.

Before this "episode" he rarely got incoherently drunk. He'd usually have a couple of beers or glasses of wine in the evening (when the kids were in bed) but that's about it. Or a bit more if we were out (pre DC). So it has only been the last few months that it's got worse and so has started to impact me - mainly by making him very depressed and pretty incoherent as well as quiet and introverted.

I totally agree he needs help to overcome his dependency on alcohol. The first Psych Consultant he saw said that he was dependent on rather than addicted to alcohol and so to concentrate on getting it back down to normal for him levels. Which is part of the reason he's reacted so badly to the latest mtg with the different consultant.

The big challenge is now getting him to accept that he needs help and to find the right sort of help. And fast.

The triggers are new, in that he says he'd never experienced them before and so his response (suicidal thoughts) were/are also new. And they are wrapped up in the wish for all the pain to go away and so the "ending it" is the extreme way of getting rid of the pain - as you have described. And I am as confident as you can be that he doesn't really want to end his life. He did say to one of the crisis team that it was a cry for help. Which keeps me going on the long, hard nights.

It's the frustration that he's finally accepted that he needs help to overcome/manage the demons (rather than bury them again) and that he was in touching distance of getting the talking therapy he craves that he's feeling let down by the system. If they'd have told him from the start that he needed to stop drinking (in the same way they said they needed to sort out his meds so he was more stable) then I would understand. They just seem to have moved the goal posts and now he's having to battle his demons seemingly alone.

I think he finds the mtgs with the CPN hard as he has to go to a place in his head he doesn't like going but in 30mins doesn't have the time to deal with the stuff so walks away with it all raw again when all he wants to do is forget about it and make it all go away.

Hopefully with time the shock of what he was told will have subsided enough that we (he) can work out a plan to get him off the alcohol. And then finally we might be in a place to get the horrific childhood issues addressed.

Hi, am sorry things are so hard.
He can be re referred to the crisis team at any point no matter which "team" he is under. A gp can do this as well as a team. I am unsure if relatives or patients can - this varies from area to area. The point of a crisis team is to take over for a short time when need more intensive support than the usual weekly meetings offered by teams - whether CMHT or more specialised services such as alcohol teams. So if you think he needs this then do ask for it. Their options are to risk assess, offer inpatient if needed, see/phone daily and help with medication etc.

I know he feels let down but from your original post it sounds like in the works of NHS care he is getting the right treatment. He got put straight under a CMHT from crisis - not always happens. The cpn has realised that s/he cannot help right now due to it causing drinking so has referred to a specialist service - which is fantastic if he will use it. The NHS usually has long waiting lists for psychotherapy treatments and have to make sure when it is offered that the person can utilise it - if he is heavily drinking for 48hrs when seeing just a cpn the risk is that will deteriorate if see a therapist so they would want to wait until he is more stable until access therapy. As therapy is limited - unless go private - it will be such a shame to have the block of treatment and say later, but I drunk too much it was a waste of time and want more and not necessarily get it straight away or wait longer etc etc. an NHS therapy session is usually 50mins long so he would potentially have the same issues with therapy - bit he could learn coping skills before he started to help deal with that which may be useful.

I hope he will see the referral to the specialist team as a positive and address why he has drunk so much when seeing the cpn and get specialist help with that. Alcohol oh is said to bea depressant so if he is drinking more then that is an area to work on to help his recovery.

At any point you feel he needs help urgently do contact his team/a gp or an out of hours gp service who can refer to the crisis team. Use 111 to get an our of hours appointment or a walk on centre and they can refer directly.

Hi Scouty, sorry things are so hard for you and 2 little ones to look after...

I noticed you said you have private medical- I think you should use it to fast track therapy if that's what your husband needs and feels ready for. Drinking does not have to be a deal breaker if its not excessive and he can attend meetings and verbalise his thoughts and feelings. Mental health cover on private insurance contract is usually limited but could be just what he needs (to get over the first few hurdles at least)...

I've been depressed and drinking with anxiety and trauma background (tough admittedly not as bad as what you describe) and this approach helped me a lot recently- both my sadness and my alcohol intake have reduced enough for me to feel 'normal' again xx