Does the NHS offers anything other than CBT and if so what criteria do you have to meet in order to be referred?

[ShoopShoopBaDoop]

Because after decades of trying various CBT with different therapists I feel it has done sod all to help me (and I honestly tried so hard).

I currently feel worse than I have ever felt, both physically and mentally and one feeds off the other and vice versa and I have lost the ability to stop the vicious cycle.

Maybe I just don't articulate myself well enough at GP consults but I genuinely don't find CBT helps me at all and yet despite my records clearly showing I have tried it time and time again, this is all I am ever offered.

I have trialled so many different medications which all gave me side effects so bad and that in itself exacerbated the anxiety so I haven't been able to continue with them for more than a few months at a time (Citalopram, Escitalopram, Sertaline, Fluoxetine etc)

I was diagnosed with adhd last year by a private company (via the NHS right to choose). I am loathe to bring this up in conversation with my GP because whenever I mention it she always seems to gloss over this as though she isn't interested (or doesn't agree with the diagnosis?) and I know that it's a controversial subject so I tend to keep the diagnosis close to my chest and tbh I haven't done much with the information since I was diagnosed (the meds made me unwell so I had to stop) and not sure if treatment for inattentive adhd is much different to that for severe anxiety/depression/ocd?

I am not sure what more I can do to help myself.

I suppose if I had money to throw at this I would go see someone private but that's out of the question.

Has anyone else found CBT just hasn't helped them and did you find any alternatives to help?

FWIW:- I don't drink, smoke, do drugs etc. I exercise, I meditate and do yoga every night, listen to the Clam app at bedtime and have to watch what I eat as I have digestive issues. I can't see what more within my control I can add into my life to make it easier and enjoyable.

The CBT techniques are useful for some people, and I’d used them for years to successfully manage my mental health. That’s partly why I was so angry at being sent on another CBT course when circumstances beyond my control sent me into depression.

The point is effective triage to find out where people are, what is going on and what they’ve already done. Rather than just putting everyone into CBT.

And more joined up thinking. If there was more support with housing, employment and other social issues then that would go a long way to resolving problems that can’t be dealt with using CBT.

There is a gap in provision with the people who are deemed too risky for IAPT and not risky enough for Secondary Care CMHTs.

Some areas have secondary care psychotherapy departments that are not CBT - they are not open ended, but longer term, 20 sessions to say, 90 sessions. I think the NHS could use funds more effectively to employ therapists, perhaps at level 7 and above, from all the voluntary organisations - BACP, UKCP etc. Psychodynamic, Integrative, Trauma etc.

Some people that end up being admitted to psychiatric hospitals for example, at extraordinary cost incidentally, would have probably not needed an admission were they to have been seen on a longer term basis.

And then also those who carry on and don't have a crisis, but are miserable, perhaps suicidal, therefore screened out of IAPT, also I think could do with this kind of provision.

Band 7 is a very expensive staff member. I doubt that IAPT therapists are on more than a band 5. To employ a whole army of extra expensive staff at primary care level something else would have to be defunded and what would that be? There is zero additional investment all MH Trusts are in the red. I absolutely agree there is a gap that ideally would be filled but it will not happen any time soon unless the country someone gets rich and decides to spend on MH which is so unlikely.

Ir wouldn’t save on admissions either. Everyone always argues that new innovations will save admissions but it’s not credible. No one is getting admitted anyway these days. The vast majority of people admitted to an acute ward have psychotic illnesses for which the mainstay of treatment is medication. Very few people with the kinds of conditions that can be helped by therapy will be admitted precisely because it’s unlikely to help them as there will be no therapy available as an inpatient.

When I said level 7 I was talking about training level of the therapist, sorry it wasn't clear. And then yes band 7/8 employment level.

I think it would be preventative of all sorts of things tbh but I can understand the funding issue you raise. Difficult one!

In my area we have a tier of provision to plug that gap between IAPT and CMHT. It’s a large city-wide service. I am a Band 7 clinician working in it, and there are scores of other Band 7 or Band 8’s in it.

We comprise senior mental health nurses, specialist occupational therapists, senior psychotherapists, associate psychologists, specialist MH pharmacists, wellbeing practitioners, employment coaches, social prescribers, medics etc. It’s a great service.

Very nice. Not the case in most places sadly and certainly not in places with the most need (inverse care law)

”Very nice”. Did you mean that to sound snarky? Are you misplacing your frustration at the system to me - a lone parent frontline NHS worker who works day in day out with the most severely unwell in society? I have a severe mental illness (disability) myself, as stated up-thread, which means I have to take 7 medications per day and nearly cost me my life last year.

So it’s worth remembering there’s a real life human at the end of snarky off-hand texts.

ps: you’re wrong that it’s not in places with the most need. The patch I cover is the most deprived council estate in the UK. I work every day to improve the mental health of those with 3 generations of unemployment, intergenerational trauma, sexual abuse, war torture, and endless suicide attempts / drug addiction / alcoholism. Last week I assessed a woman who experiences psychosis rooted in the trauma of having been gang-raped whilst watching militia soldiers decapitate her patents. And then went straight into an session with a woman who the night before tried to throw herself from a motorway bridge (this also being the method by which my partner ended his life, so quite challenging for me).

But thanks for the lesson on where help is “needed most”.

You misread me. It wasn’t in the slightest bit snarky. I meant that it IS really nice that some places do have those services. I am sincerely glad that they do. I did not know it was possible. We have nothing like that where I am. I am also a frontline worker who has lived experience and tries their best to help people in tough situations every day. The inverse care law is a recognised thing. In most cases the best services are not in the places with most need but I am very glad if that is not so where you are.

Roughly 3 year wait to see a psychiatrist in Essex then assessment for psychotherapy then if you get
accepted 2 year wait for it