CBT referrals.

[firsttimedad79]

I wonder if someone can help with something.

I won't go into detail but earlier this year my partner was diagnosed as having complex ptsd from multiple traumas.

She was getting cbt for this.

We've moved areas so she can be closer to her family but the new area nhs keep rejecting her referrals for cbt, despite her diagnosis!

How can 2 different areas allow different things? I'd we'd stayed where we were they were going to continue her cbt as it was felt it was working, albeit very slowly, and she was allowed more sessions (they were limited to x number of sessions each time).

Is there anything she can do?

@firsttimedad79 Not been in this situation but my first thought was: do you have anything in writing that has some details of the service your partner was receiving before you moved? Even better would be a letter or email that says she was due to continue receiving CBT there. If not, her new GP ought to have transferred her records over from her previous GP and you could ask new GP to write a brief letter outlining her previous course of treatment, eg. start and end date, old treatment plan, any final comments from the CBT provider (if there's any record of that). Then look on the website for your current local primary care trust and get details of their complaints channel (PALS or similar) and contact them with your concerns and any evidence of the previous treatment. Explain that your partner was due to continue treatment and ask them to specify how their policy on suitability for treatment differs from that of your partner's previous provider. Given that it's all NHS, surely they can't be that different.

Hope your partner gets something helpful soon. Just wondering though: you say her diagnosis was CPTSD, was that the term they used or does she prefer that term to BPD/EUPD? I only ask because some psychiatrists might be biased towards the BPD label and think that calling it CPTSD weakens the diagnosis, even if it was given by another psychiatrist. (Although personally I feel the CPTSD diagnosis is more enlightened.)

CPTSD and EUPD / BPD are completely different diagnoses and any psychiatrist will know that. There are some overlap in symptoms but huge differences as well, particularly when it comes to treatment.

OP different areas have different ways to treat CPSTD - your partner needs a referral for trauma focused treatment and CBT is often not one of the preferred treatments (unless it's Trauma Focused CBT).

Ask for a referral to the local trauma service rather than a CBT provider and that may help. Good luck.

@Orlios my understanding is that CPTSD is under-recognised by many in the psychiatry profession because it was originally termed as a more humane way of describing people with so-called personality disorders. CPTSD is not listed in the DSM-V and isn't recognised by the American Psychiatric Association. That's why I made the point in my previous post.

[quote baroqueandblue]@Orlios my understanding is that CPTSD is under-recognised by many in the psychiatry profession because it was originally termed as a more humane way of describing people with so-called personality disorders. CPTSD is not listed in the DSM-V and isn't recognised by the American Psychiatric Association. That's why I made the point in my previous post.[/quote]
Your understanding is wrong.

Many people with BPD are pushing for a change in diagnosis and self diagnosing with CPTSD as they believe it comes with less stigma / more access to services (both of which I'm sure anyone with a primary diagnosis with CPTSD will tell you are untrue).

Both diagnoses are rubbish, there's overlap but they are not the same thing.

I work with both groups, and indeed many patients who have BPD who also have a CPTSD diagnosis. The vast majority of patients with CPTSD do not have a BPD diagnosis.

We use descriptions that are the same in both conditions but they present with the patients very differently for the most part.

You work with these groups but believe the diagnoses are rubbish? Why is that? I also work in mental health and have not met any clients who thought challenging their EUPD diagnosis by preferring it to be conceptualised as CPTSD would result in them having more access to treatment. The opposite, in fact - some feel they were denied treatment, or treatment was discontinued, because they disagreed with their diagnosis and felt CPTSD more accurately reflected their difficulties.

I'm curious about the primary diagnosis of CPTSD you mentioned, because the Royal College of Psychiatrists doesn't recognise the term.

I didn't bring up diagnoses...

Nor did I bring up a totally separate and very stigmatising diagnosis when it was unnecessary

Regardless of what anyone thinks about diagnoses there are times they are necessary.

I only ask because some psychiatrists might be biased towards the BPD label and think that calling it CPTSD weakens the diagnosis, even if it was given by another psychiatrist. (Although personally I feel the CPTSD diagnosis is more enlightened.)

I brought it up because I was trying to be helpful about the difficulty OP's partner is having accessing treatment. I'm well aware that many people with EUPD diagnoses feel stigmatised by them, but have discovered the concept of C-PTSD and feel it describes their mental health experiences better. But it is not recognised as a diagnosis by the medical profession, so OP's partner might have problems getting her treatment if she's referring to herself as C-PTSD and her new psychiatrist or health authority don't take that seriously. You work in the field, you've said, so you'll know very well the bias I'm referring to among psychiatrists and some other mental health professionals where recognising C-PTSD as a legitimate term is concerned.

You told me I was wrong and didn't understand, that both diagnoses were rubbish but completely different. I said nothing about diagnosis being unnecessary, please don't twist my words. I was only pointing out that C-PTSD isn't a recognised formal diagnosis, unlike BPD.

The diagnosis came from the CBT team that she was under with the last authority, she also had it in writing on nhs letterhead that she is suffering this.

That's great OP, the letter will be great evidence for her to fight for treatment. As PP said, if there's a trauma team in your Care Trust you could try pushing your GP for a referral to them. It might also be worth contacting her previous therapist/team for a brief statement that they had intended to extend her therapy before you moved.

We already have all this written down from the previous team, but the mental health team down here just keep rejecting the referrals.

Can you DM where you are and I'll try and get you the correct service.

Provision is different for each area- and so is referral acceptance (ie some services for trauma won't take people until their stable from self harm).

It's very hard for patients and professionals to navigate.

OP it might be worth writing a personal statement as her partner, detailing your concerns and frustration. When you find the right service, your statement might have some impact. But as @Orlios says, provision and referral varies by area. My local mental health services don't have a trauma team as such, for example, and while they offer CBT and counselling for PTSD, they don't list CPTSD as a condition they offer therapies for. Years ago I was diagnosed with EUPD as a result of psychiatric assessment and 12 months of psychotherapy, but someone like me now would struggle to access that level of support. It's because of all sorts of cuts to services in the last 10 years, resulting in a massive overhaul of how community mental health services operate and what they provide.

If you haven't seen this page, you can use it to try and get an idea of what your borough/LHA offers. But it can be very limited. In many areas now, provision stops at IAPT, which has been criticised for its agenda - a very narrow remit that effectively abandons people with serious mental health problems.

www.nhs.uk/nhs-services/mental-health-services/how-to-find-local-mental-health-services/

Has your current GP referred you to psychiatry, or just CBT or IAPT? It might be that going through a local psychiatric assessment is the only way for your partner to properly access the service now.