Should I pay for a private psychiatric assessment for PTSD?

[Babbiees]

For my PIP claim?

I was awarded PIP 2 years ago based on my mental health issues, eating disorder and autoimmune diseases.

When I had my assessment my only paper 'diagnosis' were anxiety and depression (I bet you are rolling your eyes already) but I am seriously unwell mentally as well as ND and in the last few years I have had a lot of input from my GP and therapists after a seriously traumatic family even about 4 years ago brought everything to a head.

Because I have been engaging with my Doctor and trying to keep a record of my thoughts I have since been diagnosed with OCD.

I previously had several rounds of CBT therapy for 'genral anxiety ' that I can now see was actually OCD going back 2 decades :(

Over the last few months I have had Tier 3 talking therapy (which was originally going to be for the OCD but the therapist decided to do intense talking therapy first because of disclosures I made about childhood and the traumatic event from 4yrs ago, then another course focusing on the OCD afterwards)

So I have been talking a lot about my abusive childhood and how debilitating my issues are in my day to day life.

I mentioned to my GP a while ago about PTSD and he said the NHS is moving away from making those diagnosises now and wouldn't refer me, he said he cannot diagnose PTSD. But everything I read online says to go to your GP for a referal and nothing about them not doing that anymore

Anyways since starting the talking therapy I feel like it has worsened, to the point where a song from my childhood caused me to go back to a memory and I totally spaced out into that bad place as a kid and I urinated myself in the kitchen. Its happened twice in the last few weeks.

I said all this to my therapist who agrees I have severe signs of PTSD but she also said she cannot diagnose me.

Because of my OCD my brain latches on to any negative connotations and of course there has been a lot about PIP in the news lately.

I can't help but feel like my 'diagnosis' of 'anxiety and depression' do not represent what is going on in my life and those things are a symptom of a more serious mental halth struggle, rather than stand alone issues.

And I keep reading that people with anxiety need to get a grip and get a job etc... and they're going to cut down benefits for people who claim for anxiety etc...
I just can't stop thinking about it at all and the NHS doesn't seem to have an interest in me seeing someone who could look at my life as a whole and give me a diagnosis rather than a GP just telling me I am anxious (when I have been suffering from OCD for almost 20 years without them ever putting 2 + 2 together)

I don't feel 'safe' right now at all and my head is spiralling with the worry of losing my PIP. With the shame and embarrassment of reading what a waste of space I am, over and over and with the frustration of knowing that I am not just a bit anxious, there is something bigger going on and I want help.

And the fear that I am going to be forced intondoing something I can't deal with right now just because I don't have the right words on paper.

I feel like treatment for PTSD is very different and it could actually help me if i got the proper diagnosis and therapy.

But the assessment will probably cost in the 4 figures and its a lot of money.

I have therapy tomorrow, does anyone know if NHS therapists can help refer to other services for diagnosis?

Its 3.30am and I just can't sleep thinking about it all :(

Right OP. I have looked into this.

I do think it would be a good idea for you to get the diagnosis. While you should be able to get it on the NHS and I would push for a referral, the reality is that your mental health would be best served by your going privately for this. But I would find a psychiatrist with a special interest in cPTSD and check how many consultations would be necessary for him to be able to make a diagnosis of cPTSD, if he believes it fits. A lot of consultants working privately will respond if you email them directly, surprisingly. And receptionists are sometimes very nice people too when you're looking for this kind of information. They might inquire and get back to you.

Tier 3 doesn't refer to a specific treatment but it does indicate you are recognised as having quite severe mental health problems.

The fact that they can see this yet are still denying you access to a psychiatrist is ridiculous. Some of what you're going through could probably be alleviated by a more aggressive and experienced approach with medication and you need an NHS psychiatrist for that. Don't try to go private for ongoing treatment because you need to have access to a networks of support if things go wrong as they can do.

EMDR is offered at Tier 3 on the NHS in some areas and it is a good treatment for what you feel you have. Tier 3, like all NHS treatment, is keen on CBT approaches. There is good news and bad news here. The good news is that it's effective for treating cPTSD. The bad news is that it needs to be adapted in order to be effective. I can completely understand why you're overwhelmed unless it's adapted. You're going to need time to work on returning to a safe space, you're going to need support in reframing difficult memories - you can't just jump in to CBT when your cognitive function has been deeply affected by trauma.

I don't care what they like or don't like doing. It's not even your problem. They should be following NICE guidelines and offering patient centered care.

I'm hugely in favour of getting the correct diagnosis and therapy and know someone who has virtually made a full recovery from PTSD after EMDR. In terms of PIP it may or may not help. As you already receive PIP I think you're in a better position than someone who doesn't but I would do it for other reasons.

I keep hearing good things about EMDR.

With the CBT I have read that it doesn't work as well on people who are Autistic. I was diagnosed about 2 years ago but again I keep reading that people who have CPTSD have almost identical presentation to autism and are often misdiagnosed as autistic.

I don't necessarily think my autism diagnosis is wrong but Infind that very interesting that they overlap so much.

The person I referred to is also autistic. I do think sadly autistic children and adults are more vulnerable to abuse than the general population which may explain the correlation with PTSD/CPTSD.

@Stopthattractor Thankyou so much for that thoughtful and insightful post.
Hopefully my therapist will be able to help me with the referal but if not I am going to go back to the GP and argue my case

I wonder what we did 50
years ago?

We called it shell shock and sent people to asylums. We didn't believe children and over prescribed Valium.

Try and find out if they're an accredited counsellor, clinical psychologist when you're talking to them. It could be that they're a social worker without very much training in what you need and no awareness of NICE guidelines. You might like to ask them what the recommended treatment would be if you were diagnosed with cPTSD. If they say they'd do the same thing as they're doing now, I wouldn't be very impressed. There are lots of opportunities for
professional advancement in best practice as it relates to developing trauma informed responses. I would like to think they have taken advantage of those or maybe someone else on the team has taken that on. You have the right to know what therapeutic approach they are using and how it has been tailored to reflect your circumstances and suit you. They should also be aware if EMDR is offered and what the criteria is for accessing it.

Please don't lose heart. There are better things ahead. I truly believe that you are very far from having exhausted the therapy and medication that should be available to you. There are so many roads left.

If you find things unbearable, and you don't sound far from it to be honest, push hard for a hospital admission. Don't let them leave it all up to your partner to keep you safe. GPs take you a lot more seriously if you've been in hospital, a consultant will be able to try more things in that setting and you'd remain linked into more support. CPTSD is a difficult diagnosis to make in a hospital setting because they're unable to observe the avoidance aspect but there's no reason why you shouldn't push for the screening.

“If you find things unbearable, and you don't sound far from it to be honest, push hard for a hospital admission. Don't let them leave it all up to your partner to keep you safe. GPs take you a lot more seriously if you've been in hospital, a consultant will be able to try more things in that setting and you'd remain linked into more support”

Assuming you are talking about the NHS, this advice seems wildly unrealistic. given the shortage of MH beds. What is your experience in this area?

OP I think they're are two separate things here. Full disclosure, once upon a time I was a PIP assessor.

What everyone says is true; it's the impact of the condition, NOT the diagnosis. I cannot stress this enough. If the impact is significant, the assessor will look at that. They won't be rifling through the bits for a psych letter (they will check consistency with other details, but you will not be penalised for not having the documentation).

Do you want the diagnosis to unlock access to EMDR? Or for something else? Is entirely reasonable to request an assessment for the diagnosis or for EMDR (a psychiatrist may not be necessary).

Be kind to yourself and maybe consider asking your MH professional to look at this thread with you?

All the best.

@Indenialagain what would be the benefit of an admission?

I don’t think there would be any benefit to an NHS admission for the OP and she wouldn’t meet the criteria anyway as the threshold is so high.

Well my Mother didn't adress her issues 50 years ago and so took them out on me throughout my childhood so personally I'm glad things have moved on from ignorance around MH issues.

Me too, Mine was drugged up on Valium most of the time and took great pleasure in bullying, criticising and belittling me for my entire childhood, resulting in a lifetime of psychiatric issues for me.

The benefits of an admission for the OP are:

1. She will have fast access to a consultant psychiatrist who will review her medication.
2. A consultant psychiatrist will have a deeper understanding of the medications available to and will be able to try these to see if they help in a safe environment, meaning that the process can happen more quickly and there are nurses around in the event that side effects are difficult or dangerous.
3. Depending on where the OP is, there are clinical psychologists who can see the OP in the hospital without a wait. We don't actually know if the OP has been able to access this. A clinical psychologist can assess the OP and make recommendations and referrals that will inform her care after discharge.
4. The OP would have access to skilled support from a team of nurses who are trained in helping her see new perspectives and manage distress. Rather than strangers on the Internet.
5. Those nurses can advocate on her behalf to her psychiatrist and give the doctor a more complete picture of how she is doing in herself and with the medication.
6. Following discharge the OP would not be in the position she's in now, trying to persuade a GP that her distress and suicidal ideation is not being managed. The GP will be acting on instructions from her consultant.
7. If a diagnosis of cPTSD is made while the OP is an inpatient (and that's the part that I'm unsure about because that might not happen), the OP can clearly set out an expectation that future NHS therapeutic interventions are informed by her diagnosis.

I don't think it would be helpful to argue about whether the OP would be given a bed. Sometimes doctors are surprised by who is given a bed and who isn't. The knowledge that I have in this situation is this: the OP is not thinking or acting particularly rationally at all times and is unable to control this. She foresees a situation in which she would take her life very quickly, suggesting that she has considered how this can be done. She's suffering from high levels of distress. She's concerned about the PIP for now. My worry would be what happens if her next concern is centered around something that is likely to happen. I think she's in a precarious position because she's already so distressed and acting in ways that she can't rationally justify. I struggle to see how she could guarantee her safety.

Admission to mental health ward ?
have you any idea what admission criteria are ?
this notion of accessing an admission is bonkers and unhelpful

the OP is already under NHS mental health services at tier 3
she needs to focus on working with her current health care team and discuss if they can step her up / refer on when she is completes her treatment with them

OP -
my two pennies worth -
as many PP have said the PIP assessment is about the incapacity you have, not the label
you could ask your current therapist to write a letter that summarises your current difficulties
getting the diagnosis you want through private assessment won’t access you treatment for it under NHS
and don’t pin all your hopes on EMDR -
it can be highly effective but it requires careful assessment to ensure it is the right treatment for the right problem for the right person

there is an ocean of people self diagnosing with CPTSD and PTSD and seeking EMDR
often people watching TikTok -
I absolutely don’t wish to minimise your suffering but listen to the professionals you are currently under
and clarify with your GP. Is he saying he does not diagnose PTSD if so seek another GP in the practice
or
is he saying he does not diagnose PTSD in your presentation??

I also think that portraying an admission as a chance to access various professionals is unrealistic.

You see your psychiatrist once a week.

Clinical psychology access? Not once in multiple admissions.

The nurses are largely there to dole out medications. I've never seen one do anything else.

Great advice.
I went to the GP for years about agonising pain around my periods for 3 weeks every month.
After 16 years my late dad (bless him) paid me for to have a laparoscopy. He wasn’t rich by the way he used savings. It was everywhere.
Now practically it didn’t make much difference. I was still in agony and was only ever given pain relief. But it helped me to know I wasn’t going bloody bonkers!!!!!

That's interesting that this is your personal experience. I can assure you this is not always the case.

Admission to NHS mental health inpatient ward
will be generally after crisis team have said their daily visits are insufficient,
for those under mental health act -
sectioned
very psychotic episodes presenting significant risk
those recalled undef community treatment orders

admission will be about managing a
risk that cannot be managed in a home
setting or crisis house

and discharge as fast as can be achieved

I'm glad to hear it.

Eleven sections in, private and NHS, all over the south of England and that's my experience.

And I'd choose NHS over private care every time.

And back in the real world….. there are not even beds for people who have been sectioned because they are a serious risk to themselves or others. There is little to no therapeutic support in NHS psychiatric wards either. It is a case of patch the patient up with meds and ship
them back out with little or no support.

What is your experience @Stopthattractor? Are you a patient or a clinician?

Agree