Don't understand how mental health referral works

[Lotterse]

This is probably a stupid question but I think I've got things wrong wrt referral to mental health services. I referred myself after I spoke to my GP. I said I had had suicidal thoughts. I then got a call from the service and spoke for a bit with a person. She said that she was concerned that the service wasn't right for me because of suicidal thoughts. So I made stuff up to make it seem like it wasn't an issue so that I could get help. I didn't want them to not give me help because of having the wrong kind of thoughts. But now I am thinking about it again I shouldn't have done that, I think. Like maybe she just meant there is another service for people who are suicidal. But that sounds crazy.

I’m prob not the best help as I got no further forward but I had similar when I spoke to someone. The service offered through the nhs, in our area, was cbt and they didn’t think it was suitable as my difficulties related to actual things in my life that were hard that the cbt wouldn’t change. They gave me details of councillors to contact privately as said that may help but I’ve not actually done anything yet

No, they're not big on explaining what's going on, are they, and tend to assume a prior knowledge of the system, which is just more unnecessary stress for the newly ill to deal with. I'm sorry you're experiencing this.

The self referral services are usually for people who are experiencing difficulties which are likely to be temporary and which in the long run aren't that debilitating. There's mental illness that your brain randomly gets upto and there's mental health difficulties caused by life. They're both very real and neither can be an easy fix, because sorting out a crap life can be hard if not impossible in some cases.

When the person said their service isn't the right place, it's because they're unlikely to be able to offer you the help and support you need right now. If you've got in there, go along and be honest, you'll probably be kicked out again but they can possibly refer you elsewhere or write to your GP who can if they can't. A lot of MH services in the community are very wishy washy IMO and aren't going to be of use to someone who needs clinical care. They can be of excellent use for those who aren't quite so ill or who are able to be more proactive with self-care/life and so can manage with less help.

GP surgery is primary care, other referrals for medical conditions are secondary care, for those who are too sick for the GP to treat whether that's eg cancer or MH.

Having suicidal thoughts doesn't necessarily put you into that category of needing secondary care (and sadly even if you do need it you may not get it). It would depend on things like how long this has been going on for, what self-help and medical care you've already tried, whether you have a previous psychiatric diagnosis of mental illness and now it's recurring etc.

It's relatively easy to get a diagnosis of depression/anxiety (they tend to get lumped together IME) by a GP, the criteria aren't high, so not everyone diagnosed this way needs referral to secondary MH services. It could be, for instance, that you need to wait for antidepressants to take effect and reduce your suicidal thoughts before re-referring yourself to the service you've already found.

I'm sorry if that sounds discouraging. I'm just trying to be factual. Well done for seeking help in the first place and I hope you can get some more help soon.

@Morph22010 CBT is about negative thought patterns. Sometimes those thought patterns can keep us stuck in a bad situation. So change the thought process, which then enables a person to change their behaviour and life can dramatically change. It's about learning to recognise and challenge negative thoughts (which essentially aren't real) to gain a more realistic perspective. It requires on-going effort on the part of the patient. It's not something they can do and then magically "be ok" forever more with zero efforts on their part. It's skills that are used going forward in life. CBT can be excellent when delivered by someone with in depth knowledge and training. A lot of CBT is given by less qualified and skilled people, on a short course.

On the other hand, your situation doesn't sound like that. You can't change a genuinely shite situation that's out of your control, into a good one, by thinking differently. CBT in those cases would be inappropriate.

It's also ineffective for severe mental illness. If someone's brain is doing random weird stuff, CBT may be able to help if they're well enough to undertake it and have never learned, or have forgotten, those skills, but it isn't going to fix the underlying problem.

Sometimes there are primary care counsellors or social workers attached to the GP surgery, the aim there is to catch people and fix them up, before they fall too far and possibly end up needing secondary MH services. So that's another avenue to try. (The SW's are adult MH SW's, to help the patient. Not children's services to look into your parenting, that's a separate thing.).There maybe a wait list and the service is likely to be a course of 6, weekly sessions. So not suitable for a deep dive into complex situations which would take a lot longer than that to unpick. But could help with improving a few certain aspects, even if you do have complex problems.

I hope anybody who needs it finds help soon.

Oh wow so I'm too far gone for mental health services?

Ok so that's what I thought initially which was why I lied to them. So there isn't any help then?

I'm not sure what area you are in but look at the website for your nearest Mental Health NHS Trust and get the number for their crisis line, phone them and explaih how you are feeling and they will be able to refer you to the right service and offer advice whilst you are waiting to be seen. Don't worry about how complex you think your issues are as they will know which service will be most appropriate for you.

No you misunderstood me. Maybe too far gone at the moment for the local self referral one. That could change if your suicidal feelings reduce, which they might. It's not that they don't want to help you, but that their help is likely to be woefully inadequate for you and basically a waste of time. Also potentially harmful, if you're somewhere that can't help and so you're getting worse and worse, when if you was somewhere that could help you'd be getting better.

Nobody is too far gone for secondary MH services that the GP referrs you too. They have the opposite habit of trying to get rid of people who they say aren't ill enough, which can leave some people with nowhere to go and is the reason why they're not supposed to do that.

Regardless of how unwell you are/aren't though, there isn't much help out there. So grab anything that's on offer and be as proactive with self help as you're able to, to give yourself the best chance of recovery.

I'm not sure physically where you are, OP.

In NHS Scotland there are Primary Care Mental Health Services (PCMHT), which see people with mild to moderate mental health concerns. These are self or GP or other professional referral. I believe in England the service is called IAPT.

They will typically decline people who are actively suicidal as they do not have an out of hours/"duty" team. This means that if you need them not between 9-5, they can't respond.

For people experiencing suicidal ideation or more severe mental ill health, there is the Community Mental Health Team (CMHT). This needs a referral from a professional eg GP. The referral must mention that you are suicidal and outline your mental health symptoms properly. These teams have out of hours /duty teams attached.

I would suggest you go back to the GP and ask for a referral to secondary mental health care/CMHT equivalent. Outline all your symptoms as honestly as you can (write them down and hand it to GP if that would be easier).

There will be a wait for services. If you have a secondary mental health referral you can usually contact them if you feel suicidal, even if you don't have a professional allocated yet. Id also recommend you have a "keeping safe" plan for yourself that includes numbers for charity services (breathing space, Samaritans etc) and for a trusted loved one you can speak to.

I'm not sure exactly what mental health symptoms you are struggling with outside suicidality, but it's also worth getting vitamin and thyroid levels checked; checking hormones (particularly if you are a woman towards peri or menopausal age), taking vitamin D and eating as well as you can (regular meals). This is because some vitamin deficiency, hormone problems and thyroid problems cause low mood and/or anxiety. Try to get outside every day if you can, even for 5 minutes. Schedule in some activities every week - ideally some social things and some physical activity. If sleep is a problem, work on sleep hygiene and free tools to improve it (for example sleepio app if you have insomnia).

These things are so hard when you are struggling with mental health but they are the building blocks of good mental health.

Wishing you all the best - your mental health matters, you matter.

Hi OP, i’m sorry to hear you’ve been having suicidal thoughts- that can be so distressing. I work in the sector (as I suspect PPs also do- they seem v knowledgeable), and part of my job is to run the kind of assessment it sounds like you had (for your local NHS talking therapies service? IAPT?) It sounds like the assessor felt your level of risk was too high - maybe it was your frequency or level of suicidal thoughts? Or perhaps you weren’t able to agree to a safety plan (services or people you’d call if you felt unsafe)? Those are some reasons the service might have been unsuitable, purely because these organisations aren’t crisis services, and once you’re on the waiting list they won’t be checking in on you, so need to be confident you can keep yourself safe.

However, in the situation you’ve described, I would refer you for assessment by secondary mental health care. In our area, we have a team called Single Point of Access that assesses and allocates to all the different teams, including the community mental health team, as a PP mentioned. There are crisis teams who will visit you at home, and/or call you at agreed intervals (once a day for example) to check you’re safe; in-patient wards if you need that; and other in-person crisis and treatment services. If you are actively suicidal, this could be the level of intervention that’s appropriate for you right now.

All this to say, they certainly shouldn’t leave you high and dry. There will be a service that can help you, and it is important that you get in at the right “level” so you get the support you need from the appropriate people. It IS confusing and opaque (I find that about the NHS in general, it’s a bug bear of mine) and that’s the last thing you need at this moment in your life. But if you did feel able to call them
back and chat about your safety, you’d be making a step in the right direction.

And in the meantime I hope you won’t mind if I just leave these here: Samaritans on 116 123 and the text helpline SHOUT 85258.

Sending very best wishes to you, I hope things start looking up for you very soon.