Depression and hospitalization

[amber1979]

I'm just wondering, how ill do you have to be for this too happen?

The reason I am asking is because my Partner has been recent diagnosed with severe depression. He is on AD's (Sertraline, changed from Citalopram) and is getting weekly counselling sessions.

The thing is, nothing is getting any better. In fact he has become far worse over the past week, irritable, bad-tempered.... I got shouted at the other night because he spilled a glass of wine while I was in another room. Apparently it was my fault as I left the lamp on and he moved to turn it off and spilled the wine... Totally bizarre things like this are happening all the time now.

He'll go days without washing, seeming to actually prefer his clothes and himself to stink. He spends money he doesn't have on meals out and concert tickets, and then can't pay his bills. He lies about money - even to the point of blatently denying it even when I have the evidence in front of me. He owes money to so many people. He refuses to let me help sort any of this out.

I am seriously starting to wonder if he would be better off in hospital.

Please help!

Is he under any local Community Mental Health Team? or just a GP?

He may benefit from input from a CPN, although he sounds fairly unbearable to live with- IME he doesnt sound like someone who would warrant an Inpatient bed.

He may also be responding to the change in medication (why was it changed?)

I suspect he may be able to choose to admit himself

I doubt he would be admitted as an inpateint unless he requested it or unless he were committed for being a danger to himself or others?

Just a GP. The medication was changed a few weeks ago, as the Citalopram didn't seem to be doing anything other than make him feel ill.

What is a CPN? Community Psychiatrict Nurse? I've heard of those, don't know what they do though.

You should pressure his GP into referring him to the local CMHT.

He would only go into hospital if agreed to go as an 'informal' (volunatry) patient, the only other route would be to have him sectioned under the mental health act, but his actions- although frustrating are not enough to warrant this. Beds are in short supply and only really reserved for those deemed an extreme danger to themselves or others.

even when admitted,its usually not long term....my ex was/is bad...very,trie to kill himself regularly,every 6 months or so....he's never been kept in more than 3 nights.

I'd do that, but I didn't think that his GP would be allowed to discuss his case with me? Believe you me, if I thought it was allowed I'd be in there bashing heads together. This has been going on for six months with things steadily getting worse. All the NHS seems to want to do, is drug him and pat him on the hand and go "there, there".

His family aren't interested in helping either.

I may actually suggest the voluntary patient idea. I think he might actually appreciate the idea of going somewhere safe to be looked after.

Does he actually feel that he is a danger to himself at the moment?

You have two options- you either go to the GP (together) and ask to be referred to CMHT or (and this is a piss poor approach and quite extreme)- he presents at A&E stating he is a danger to himself- this will then action a visit from a crisis team who can assess his appropriateness for Hospitalisation.

But remember, the beds go to the very, very unwell- and generally people who agree to go to hospital go to the bottom of the list.

Its a shit system but thats how it is. I would really push for him to see his GP and demand a referral.

He has talked about killing himself before. I seemed to be able to talk him down - mainly through emotionally blackmailing him about what it would do to the people who loved him.

I may suggest the referral idea. At least if I go with him he can't pretend that he's done it and lie about it. That's what usually happens.

amber...how long would he be in for? a day or two at most,seriously,i have been there

the only time my ex was away for a while was when he got sent to Headley Court,army re hab place...he was there two weeks and the therapy made him worse...so bad we split.

i was with a 'depressed' man for ten years.....psychiatrisr assessed him a while ago.....no depression,never had been....personality disorder was what he has

take some time for yourself...its a long road and the suicide attempts/threats is emotional abuse.

hmmm ThreeBloneBoys, you say your ex was assessed by a psychiatrist?

How was that achieved? So far, my DP has only been seen by a GP and a "counsellor". I would like him to see a properly qualified psychiatrist.

amber- if your DP is referred to CMHT by the GP then he is likely to have an assessment initially by a mental health nurse. The MHnurse may, depending on the outcome of the assessment ask the Psychiatrist to also do an assessment.

what was he like before?
has something specific triggered this?
do you have dcs?

if you have DCS then you need to consider the impact on them.

if you dont have DCS then is your choice how much ongoing support to give him - but you do also need support yourself and a break.

who is caring for you and asking how you are feeling?

do ask for CMHT.

there are day units but they might not be suitable - does he/did he have a job?

it is worth going to GP with him - and also asking if you can speak to his counsellor; they might be amenable to you going to a session wiht him together.

but also go to the GP yourself about the impact on you (and any DCS)

they do have to be v bad to get hospitalised - even when my nowexP ASKED to go to hospital they said no - that it would be "too distressing" for him; till he comepletely exploded (got violent) and then i refused to let him back home....

you can talk to GP about the impact on you and how it is getting worse - it is very difficult to live with.

are you working, do you have a job, do you get out? rl support for you from friends/family?

is there some place he can also go for few days to get other support and give you a break?

his assesment was court ordered as he's a danger to dc.

hug for you, and sorry your DP feels so low. Doesn't sound like a case for hospitalisation though. When I was very depressed it was only after ODing and a massive amount of self harm that they thought I would benefit from treatment (not that I'm bitter or anything )

IME bog-standard counselling is pointless. Generally just listening and, in your words, just saying 'there there' does nobody any good. It was only once I had CBT (Cognitive Behavioural Therapy) - which was nothing to do with the hospital - that I started getting better. It helps you really change your thought processes and behaviour, if you're willing to work at it.

IME getting admitted to hospital is a very last resort. They don't like to do this as it is very expensive and also they are not the best places in the world to get better i.e. no privacy, people with psychosis crying out at all hours of the night, people nicking your stuff, boredom etc. My friend went in as a non-smoker and came out as a smoker because it was so engrained in the culture and the boredom was so intense it gave her some relief.

I was in a mother and baby unit for 3 months which was part of the larger mental health unit. The mother and baby unit was better as you had your own room, there was a lounge and a separate kitchen to make baby's bottles and another kitchen to make tea and toast etc.

Another lady in there got transferred to one of the other "regular" wards after her baby turned 1 year old (the "cut off" point for PND ) and she said it was absolutely awful. A terrible experience.

As others have said it's only really appropriate where there is significant risk of harm to self or others. Hard as it may seem. I don't think it's the best place for your DH. Yes it's safe, but it's a very stressful place to be. The ward rounds are awful - just you sat in a room of about 10 professionals, all scrutinising you.

I do recommend the CMHT though - a CPN will come out to your home and make regular checks and report back to the psychiatrist who can adjust medication etc. My CPN is really good and i'm glad she's there, knowing there's someone I can call if I go downhill...

Thank you Ladies, there is lots of useful stuff here. As you can probably guess I know sod all about the Mental Health system.

I am probably being a bit over-dramatic about the hospital idea - but I get to the end of my tether sometimes. Also, the description of a mental hospital above sounds horrendous. I thought they'd improved since the days of victorian asylums? Doesn't sound so!

Next week, I am going to look into the CBT/CMHT/CPN ideas.

I say next week as there are some horrendous finacial problems which must be sorted out this week. That will be enough for both of us to deal with! Just going to have to bulldoze my way through and do my best screechy, geordie fishwife impression if he tries to put any obstacles in my way lol.

ThreeBlondeBoys I'm very sorry to hear it came to that. I truly hope all is better for you and yours now.

CBT requires him to want to address issues that he realises he has.

CBT made my exP worse. he was made to confront issues he didnt want to. eg they might ask someone to look at positives and negatives in their lives, as a way of seeing things are not so bad ...etc.

thing is, he is an adult and there is only so much that you can do for him. (until and unless he is danger to himself or others). he has to want to get well...has to somehow see the implications of his actions (eg washing, spending money etc) and be prepared to take the steps...

you can find out about CBT/CMHT/CPN - certainly if you go with him to GP you can make sure these are requested. GP can refer to CBT (depends what is readily available in your area as to wait list etc; also would be up to his current counsellor to also suggest refering on to diff type counselling/psychotherapy as well) .

but it will be down to the GP and him.

tho it is useful for you (as a carer) to have the number for the CMHT (eg the crisis team) to call.

just remember tho that you are entitled to call 999 if you concerned for your or his wellbeing.

That is a worry Cestlavie. I don't really know what my man's issues are.

We we're coasting along nicely when he had a nervous breakdown and has been off sick with depression ever since.

He does want to get better. He feels incrediably guilty about his behavior - which just makes him more depressed...which makes his behavior worse... ad infinitum.

hi amber, didn't mean to scare you, mental health units have moved on a lot from the victorian institutions, but they are just not very nice places to be IYSWIM. And I don't think they are environments condusive to getting better really..

If only we could all afford The Priory!!!

You have to be very ill to be admitted.
It depends on the psychiatrist seeing you, you can be shouting about how you're going to kill yourself and saying you need to be looked after and they will can still easily say no go home etc.
I know 3 severly depressed people who wanted to be admitted, while overdosing, self harming etc, and they were not admitted despite requesting it. Including a friend who recently was taken my her parent to the doctor and tols she's planned to kill herself on this date and keeps watching we can't cope, etc.
They hear it all the time and seem to rarely take it very seriously.
Psychiatirc hospitals are for seriously ill people, as a last resort, or people with a history of being an inpatient.
Whether they need admitted is for the professionals to decide not you or the patient.

As for mentally ill people making YOUR life hell, do not put up with it at all.
I've seen people suffer too much people their loved ones have the excuse that they're just ill.
If a partner is EVER abusive, bullying or threatening towards you, don't put up with it regardless of their excuses.
They're grown adults and can deal with themselves, mentally ill or not.
Don't make yourself a victim of it.