Can I ask GP for specialist referral.

[Darthwazette]

I’ve had poor mental health for at least 20 years. It’s been considerably worse since Covid and lockdowns. I have anxiety and depression and, undiagnosed PTSD from childhood abuse

I can just about manage the 5 minute walk to my kids school alone. Some days this is too much and I ask friends/ family for help. I can’t manage to go anywhere else by myself. I struggle with general anxiety about leaving the house and flashbacks from the abuse I suffered.

My DH prepares all my meals and has to encourage/ prompt me to eat them. He has to supervise me taking my medication to ensure I take it and encourage/ prompt me with basic hygiene tasks.

I have little motivation for life, I frequently have thoughts of suicide and self harm (albeit in a safe way - I use ice cubes on my skin so I feel the pain sensation without the danger/ visible damage)

I struggle to sleep at night and when I do sleep I wake up in a panic with my heart pounding and feeling breathless.

I am prescribed 40mg citalopram, 20mg amitriptyline and 3x 40mg propranolol.

I have weekly counselling sessions and have been for the past year. Before that I’ve tried CBT and further counselling.

I’ve tried various other medications including sertraline, fluoxetine, mirtrazapine - none of these have been any more effective.

I feel like there’s no point in me anymore, I’m waiting until my kids reach adulthood so I can end it all.

I have an appointment with my GP tomorrow to discuss a referral for an ASD assessment on the suggestion of my counsellor. I wonder if I can ask for a referral to a more specialist mental health service because I feel so lost.

I'm a GP and in my area I think that referral would be rejected unfortunately, our local mental health team can only see the most complex cases due to capacity.
Not saying that's right and it's very frustrating as a GP.

The ASD assessment is totally separate and requires a different pathway, it's quite good in our area but I know some areas struggling with finding for ASD or ADHD diagnoses in adults.

As an aside, many patients who have tried the usual SSRIs and mirtazapine already often respond well to Venlafaxine, I'd consider that if you've not tried it already.

Thank you for your honest reply. It’s made me cry realising that there is no more help available but it’s probably better to be realistic.

Can you afford to go private, OP? I just paid to get a private diagnosis from a psychiatrist as I couldn't bear waiting years on the NHS merry-go-round. I used https://psychiatry-uk.com/. It was £360 inc. diagnosis and a care plan. I had a good idea of my condition, but you might need a different approach, i.e. a few sessions to figure things out.

It's not a cure, but it's given me hope and some relief to have some proper advice and direction.

Thank you but no, I don’t think I could afford to go private and the NHS page says that even most private psychiatrists need a GP referral.

Are you claiming PIP? From what you say I would imagine you would be eligible. I receive it and use it to pay for private therapy - for me it is enough to cover twice weekly sessions which the NHS could never provide. I’m so sorry you are struggling so much, it sounds completely exhausting and debilitating. You deserve support

My PIP claim was rejected due to a lack of evidence which is another reason for wanting a specialist referral, so I could have the necessary evidence.
The reason I tried to claim in the first place was so I could pay for more extensive private therapy but I didn’t get anywhere. It would be so helpful for me as my weekly counselling is now coming to an end. It was supposed to be a six week course from the NHS and my therapist kept applying to extend it for me but now we’ve reached the end of the line. I can’t complain, I’ve had a year rather than six weeks, it means joining the queue again though and the. Hoping I get placed with a therapist who seems like a good match.

Understood. Just to share, I did not need a GP referral for my private psychiatrist. I wrote a two page personal history which gave him my background and he was able to diagnosis based on that and some additional questions during the session.

Sending you strength. xx 💐

If you're feelings of hopelessness and thoughts of suicide are overwhelming, like you're describing, you can go to A&E and they will offer you an assessment? That might open doors to specialist services. But it's so rubbish as mental health services are overrun; still doesn't mean you shouldn't pursue it though