Crisis and no help

[Titianshe]

Week 7 of dh being in bed, distressed, hugely anxious and incredibly low. 4 weeks of duloxetine didn’t suit him and now over 3 weeks on fluoxetine. Rang crisis team repeatedly and don’t get any help. It’s beyond the GPs skills. He wants to end it all. 3 kids, one with a disability at home full time. I don’t know what to do. I thought crisis were there to help prevent hospital admissions. They’ve been no use at all

They prevent hospital admissions by gatekeeping. While he has you looking after him he's not a priority. They'll do nothing if you phone them, IME. In my area you're not even allowed to phone them unless you've been put on a list of people who can phone them that week. Mostly all they'll do is come round and ensure someone takes their meds and assess whether they need further help at that moment. They don't prevent hospital admissions by actually doing anything to cure the patient.

The procedure for being suicidal and unable to keep yourself safe is to go to A&E and ask to see the duty psychiatrist. So if that's him, then either someone watches the kid while you take him, someone takes him while you stay home with the kid or you call an ambulance (if he's unable to get himself there in a taxi). If he's genuinely in danger of ending his life then now is the time to call in favours from whoever you can, don't be proud about it.

Has he only tried two antidepressants? That's not beyond GP capabilities yet, you're only at the start of the journey, there's more to try and if the problem is primarily anxiety then there's anxiolytics he can be prescribed by GP too.

Is he having panic attacks on repeat all day? If so, return to GP ask for something to combat that, at least until the the ADs have kicked in, antihistamines and beta blockers aren't addictive if the GP has concerns about that.

Ask at your GP practice if there's one with a special interest in MH and book in to see that one. If he's tried lots of ADs (not just of one type either, there's several types, Google to see what types he's had. All psychiatrists do is experiment with the meds, a GP can do the same. Psychiatrists can prescribe more than the basic ADs that's all) and if nothing is working then ask for a referral to secondary MH services.

Now apologies if this sounds harsh but if he is, in fact, just feeling shit and being a bit of a baby about it then dish out some tough love. He won't feel better wallowing in bed. Curtains and windows open. Up and in the shower at some point daily. Outside for some fresh air even if that's just the garden, but preferably some form of exercise (a walk round suburbia where it's quiet during the day if he doesn't want to be around people). Proper food. It's all a situation where he doesn't have to like it, he just has to do it, because it's good for him.

Reading calms the mind, so get him some books or magazines if he's upto doing a bit of reading, get him to come to the shop/library with you if you can, just to get him out of the house, even if you end up choosing the reading material for him.

Hopefully it goes without saying but just in case - no alcohol at all, it causes depressed feelings and anxiety next day and stops ADs working properly, it also interrupts sleep. And obviously no drugs! That includes excessive amounts of tea or coffee, or cola, because of the caffeine which won't be helping anxiety symptoms.

Sleep is massively important so no staying up all night playing computer games etc. Sleep stories on YouTube or an app if he can't sleep, he can lay there listening to those and focus on keeping his breathing steady and resting his body.

If he needs someone to talk to call Samaritans or a charity MH helpline. Daily if necessary.

What he can do doesn't matter, the point is he must do what he can. It's that constant trying whenever he's able to which will lead to him overcoming this and finding a way through with various coping strategies etc. There'll be times he can do nothing except survive minute by minute, but there'll be other times he can do a little more. Nobody else can cure his depression, it has to come from him. All anyone else can do is help him along, with meds, therapy, support etc.

I’m so sorry. I hope you’re doing ok. It’s been so stressful for you.

What help do you want from the crisis team? What have you asked for? It sounds as though they’re trying medication options. It does take time to work so it won’t be quick if the first medication they try isn’t right.

When I was hospitalised it was a case of observing me to accurately diagnose (hypomania for me) and keep me safe while the medication kicked in. Staff were around but I spent about 5 mins a day interacting with them and the rest of the time in my room or speaking to other patients on the ward. As your DH had already been diagnosed, the only reason to be in hospital would be if he isn’t safe at home.

My Mum has schizophrenia and used to sometimes want to be in hospital. When they said no, she’d call an ambulance for herself instead and sit in A&E until they gave in.

the crisis team will be assessing on something similar to the follow questions I would think:

• do we know what the illness is? Are they on appropriate treatment?
• does the patient recognise they are ill?
• are they a danger to others?
• arecthey a danger themselves?
• Are they vulnerable?
• do they have a safe place to live with food etc?

Does your DH have a consultant psychiatrist? When I was acutely ill in hospital, the protocol was a weekly meeting (via zoom type set up) which lasted about 10 mins.

Do you need help, especially with the children while he is so unwell? Do you have a support network who can step up and help you?

They only get involved when people report they can't keep the self safe unfortunately. He sounds like a medication review is required , keep pestering the gp. I work in the talking therapies team he will likely be referred to your local service but we operate in waiting h lists so be prepared to wait but he sounds like his medication isn't quite right to start therapy at the min anyway

Could he start an at-home mediation course? When I was in an extremely anxious period, I did the 8 week mindfulness course (can find it for free on Youtube) called “Mindfulness; finding peace in a frantic world”.
I stuck to it religiously and by the end I felt so much better. It became an anchor for me when I was feeling overwhelmed.
it might be something your husband can try and stick to - give him something to do that’s easy and he can do from his bed.

Hi OP. The threshold for being seen or helped by the crisis team is very high. At least in my area things have to be absolutely catastrophic. I am a lifelong sufferer of mental illness and have only been helped by them when I’ve actually reached the point of undertaking dangerous actions, not ‘just’ talking about it. I am now properly medicated and monitored, I’m very lucky.

If you can get him in front of a psychiatrist, preferably a consultant, that may help. Whether you can scrape together for private or brace yourself for A&E. I‘m sorry your family is going through this.

What do you want them to do? They will be monitoring if the medication works. There’s no quick fix or solution sadly. I do feel for you though as it’s such a tough situation. I hope you’re able to look after yourself.

It's a tough situation but he is home, medicated and safe - not in crisis. As a family we have experienced severe mental health crisis with our son which took us to A&E (transported by the police). What I have learnt is..that it can happen at anytime (he has specific SN) but we work to reduce the likelihood with exercise, good diet, fresh air, talking...we also get his medication right and monitored. Your DH needs his medication adjusting or give it time to work. The rest he has to do himself. Dare I ask - is he just massively fed up with his life - looking after a young person with SN relentless. Once he improves you need to address what is really at the bottom of the problem.

What area do you live in OP?

Very good advice on here op. I would say antidepressants can take a while to work, 8 weeks or more possibly so give one time to work before switching. Also CBT can help but not until he feels well enough to engage.

Thank you so much to all of you for all of your great advice. I keep trying to reassure him that he needs to give it time. @Alstromeria Definitely not alcohol drugs or just feeling a bit shit but no offence taken. He’s a self employed, insomniac workaholic and it’s all got too much for him. This is his second episode of crisis in two years. He’d just gone back to old ways and stopped taking his medication. I feel absolutely run ragged

@dontwannadothis High Peak, Derbyshire

Then the answer, once he's regained equilibrium, is ideally to alter his life and start taking proper care of himself.

He needs to find a way to deal with the insomnia, stop ducking out of family life/running away from his feelings by throwing himself into excessively working all hours and understand he can't continue to live the way he is and then expect you to pick up the pieces when it all goes wrong. You've got enough on your plate already.

Workaholics are the socially acceptable face of addiction in a capitalist society. He's making money while he escapes something, so it's all good. Except it isn't, is it. Like all addictions, eventually the wheels of life start to come loose and fall off, whatever form that may take. In this case a MH decline to the point of not functioning.

I suspect he essentially has two choices: drastically altering his life so that it actually works and he's in good health, or continuing on as he is propped up by various forms of medication and his workaholism forever. Comes down to personal preference, change can be very hard even for those who want it. If he'd previously changed nothing then he was feeling ok because of the meds, not because he was actually ok. Removed the meds and fell apart. Same will happen again unless he commits to meaningful and permanent change.

I'm glad he's not into drugs or alcohol. You'd be surprised how many are, then wonder why their prescriptions aren't working. Energy drinks are popular to counteract the sedative effects of some meds, the patients missing the point entirely that in many of their cases sedation is exactly what is needed to control their unruly minds and bring some balance back to their lives.

@Alstromeria thanks for your insightful words. You’ve given me the bit of strength I needed for this afternoon

Totally agree with all of this. It is hard when the person who is ill doesn’t seem able to do what is best for them.

Op, I’m not surprised your feeling on the edge yourself. I hope you’ve got some good support around you. Remember you don’t have to set yourself on fire to keep someone else warm. Take care.

Everyone quietly marvelled why my Dad stayed with my Mum but she’s a wonderful clever woman with an illness and once she was well enough to understand what she needed to do to stay as well as possible, she did it with bells on.