Is this discrimination?

[unicorncentaur]

Not really sure if this is the best place but i would be grateful for any advice...

I am currently doing a medicine course, during my second year i developed mental health problems and was subsequently diagnosed with bipolar disorder.

I struggled through the next 2 years and my university was fairly hands off, i knew i could access support if i needed it and i kept them informed of what was going on but as i was still passing exams and doing fairly well i was allowed to continue.

While i was taking mood stabilisers i had some fairly serious side effects and the physical illness it caused really wasn't helping my mental state. Therefore against medical advice i came off medication last October, continued counselling and was honest with my university and occupational health about what i was doing.

Since October i have managed to keep well, i've been really careful about looking after myself and it's taken a lot of effort but i have managed to stay happy and complete all my placements as required. Because i am percieved to be vulnerable, my university asked me to see occupational health for monitoring monthly and I've been going. All the report say exactly the same thing, that i'm doing well on the course and am well in myself but the only way to manage bipolar is with medication and its a case of when not if i relapse unless i go back on medication.

On the basis of the OH reports i was asked to appear in front of a panel of academics that deals with any issues with students academic performance today. They told me that there are definitely no concerns about my academic performance but they are concerned about the vulnerability described in the OH reports. I explained why i disagree with the OH Dr and they listened and said that i put my arguement very persuasively and they were worried i was lying and masking any difficulties, but as its not an academic progress issue i need to go to see the professional standards commitee in April.

I am finding all of this incredibly frustrating, that i was ill for so long and now as i'm finally feeling better they seem to be making me jump through hoops based on nothing more than a diagnosis. Are they actually allowed to do this? After the meeting my IBS flared up which it hasn't for months and i'm concerned that the stress i am being put under through this is actually going to cause me to relapse. I have tried to explain this to them, but was told that they are acting in my best interests.

The next meeting will be a much bigger deal, i have to wait for 2 months which isn't ideal and then it's right in the middle of my exams - so i could really do without it. I feel like i am being discriminated against because of my diagnosis, even though everyone is saying that i appear well.

Hi University,

Grim to be having all this extra rubbish to deal with... On a brief reading it may be that they are covering themselves...

You really can also do without it so close to exam season...

Are you involved with the university disability centre?theu have a role often acting as your advocate...
I think it needs to be pointed out unequivovally to the university that while you are well now... A whole load of additional, unnecessary stress will NOT help your mental health. The university has LEGAL duty of care to make reasonable adjustments for people w disabilities.

Unsure whether it would reach legal definition of discrimination but certainly badly thought out and kneejerk... It also strikes me you are being penalised quite punitively for being so open and candid with them

Would you be willing to try a different mood stabiliser? The difficulty with bipolar is that often when you are feeling most well, you can be at your most poorly.

Have a look at the following BMA link bma.org.uk/developing-your-career/medical-student/entry-to-medical-school/quick-questions/common-challenges.
The reason for these assessments may not be what you suspect. They are supposed to make reasonable adjustments so that students with disabilities and medical conditions can complete their courses.
Hope it works out for you.

I would suggest contacting the BMA too, am sure you're not alone in this situation. Very best wishes, I hope you get some good, supportive help.

Would you be willing to try a different mood stabiliser? The difficulty with bipolar is that often when you are feeling most well, you can be at your most poorly

Could it be this that they're worried about? You're training to go into a very tough profession, and one where everyone needs to be in the best position to make the best possible decisions & judgements, which can have huge impacts on patients. The effects of uncontrolled bipolar, regrettably, can be on judgement & decision-making.

And I expect they want to be absolutely sure that the demands of the course are not making you ill.

Just speaking generally: The difficulty can be, in educational situations, to balance the fundamental requirement for appropriate academic progress, with the legal requirement for reasonable accommodation. Sometimes (although it sounds as though this is not your situation) what the student thinks s/he needs in accommodation undercuts the academic progress aspect.

I wonder if they're making very sure that this isn't going to happen for you, and that your health is maintainable under the rigours of a med degree.

Good luck

I can't help you with advice but can I just say I know a recently retired GP who is bipolar and she was a very well respected medic.

Thank you for the replies

I understand that the are protecting themselves from any fallout if i were to kill myself, there have been student suicides during my time here. My problem is with it that they are doing it in a way that is very stressful and unhelpful for me.

The main problem i have is that i don't have any faith that it is/ will be a fair process. A friend of mine has repeatedly been flagged up by staff on placements as having serious issues, because she will repeatedly burst into tears at work amonst other things. There is lots of evidence, possibly that she isn't fit to practise but definitely that her mental health is poor. She met with the same committee and they didn't pursue it - i think mostly because she will not see MH professionals and doesn't have a formal diagnosis.

I can't really speak to the disability advice team, i used to keep in touch with them but then they disclosed to someone they shouldn't have about my condition and it caused problems. They have also given information to the commitee and so although they say they are there to advocate for me it doesn't feel like it and i find it very difficult to trust them.

I don't get any reasonable adjustments for my bipolar because i've never needed any and i suspect it would be difficult to balance with the need to make sure i was fit to practise. I was told in the meeting that the issue is professional standards and the fact that they are required to exercise a duty of case to me, so i know its not about resonable adjustments.

I am really starting to doubt myself, the meeting was quite intimidating because there were 8 people on the panel and i was on my own. I also have IBS which is triggered by stress and has now flared up. Mentally i think i'm ok - although i did have a bit of a cry earlier tonight. I have just been thinking about how hard i've worked to get to this point where i'm happy and enjoying things again and i'm not prepared to risk sliding backwards. I've thought about leaving if they do take it much further, but its 5 years of hard work and £50,000 of debt and it's a hard decision to make. Ultimately i think i'd rather be ok and not a doctor than the other way around. I've got back in touch with my therapist because clearly this is not going to be easy and he may be able to help. I'm not willing to try other mood stabilisers because they make me feel so awful

In haste, as I need to get to work, but I was thinking about this last night. You ask "Is this discrimination?"

I just wonder whether it might help to think more about, if it were discrimination, what would you like to happen? Is that the right question to ansl?

It may well be discrimination, if so, what is the next step for you? It may be that there are more productive questions for you to ask, that will get you somewhere ...

Chimney, i think i want them to understand the the way they are treating me, based on nothing more than a diagnosis is unfair.I want them to understand that all these meeting do cause me added stress, not because i have anything to hide but because they is obviously a very real possibility that they will ask me to leave. I want them to understand that their pastoral care system as a whole doesn't seem to have a set process or be consistent and they cause students with disabilities extra stress through this. I am obviously now more worried about what happens if i do become depressed again before i leave, if they are doing this when i am ok i don't even want to think about how it would go if i had a problem - i have always been honest with them but now i'm not sure that i could.

I want them to have to produce something to explain why they are treating me like this or leave me alone. I can't get any answer out of them except that they have to do this as they have a duty of care to me and they won't listen when i say that none of this is particularly caring.

I don't know who i can ask for help though

I think it could be a professional issue. To be a practicing doctor you have to be a member of the GMC and demonstrate you comply with Duties of a Doctor which include.

28. If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary. You must not rely on your own assessment of the risk to patients.

By your own admission you are going against medical advice and are relying on your own assessment of how to best manage your condition. You would not be able to revalidate if this continues to be the case and presumably you can't be added to the GMC register in the first place. I think you do need the BMA but your issues may be larger than the university if you plan to use your degree to practise medicine.

"I am obviously now more worried about what happens if i do become depressed again before i leave"

I think you need to think about the reality of bipolar disorder - not being depressed doesn't mean (the person) is stable and being stable doesn't stop (the person) having bipolar disorder - it is a chronic condition which can be stabilised but not cured.

That doesn't mean that you can't practice medicine or be a fine doctor. What it does mean is that non-compliance with treatment will put you in a high-risk category, even if you feel well, even if you appear well, even if you are stable.

It feels horrible and you feel victimised but the only way this close inspection of your affairs will reduce is if you comply with the treatment. If you honestly feel you can't do that, then the likelihood is that you won't be judged to be in a position to treat others (in the long term).

Right i understand. It's frustrating because medication has never worked for me even when i have been depressed or unstable, but it seems that the only way forward is to take it

I'll ask for a referral back to MH services, its always a bit of a lottery because i've seen 4 different psychiatrists and had 4 different diagnoses - major depression, BPD, clinical depression and bipolar. Bipolar is the latest one but i've never actually had a manic episode, BPD didn't really fit either because i don't have any abandonment issues or any of the risk taking behaviour. I was just really depressed for 2 years when a lot of stuff went wrong in my personal life. Before October i was just taking medication so everyone else was happy - i hadn't actually had any symptoms for over a year and with all the problems i was having it seemed stupid to carry on.

I just wish that i had known that this would happen when uni pushed me to get a diagnosis. The replies i've had here have shown me that people will always assume that i am mentally ill and trying to pretend not to be, rather than someone who just didn't cope well with a lot of change and is now ok

Perhaps the reality is somewhere in between? That you became mentally ill because of stressful episodes in your life, which you might otherwise have coped with if you didn't have an underlying condition.

The concern is possibly that if you became so ill when faced with stress, then that could happen on any day at work. Being a doctor is so stressful. Decisions that you make can save or cost a life. The responsibility of that can weigh so heavily. I'm 'only' a nurse, but I remember like yesterday many mistakes I have made over the years. Thankfully none that put a patient at risk. The university can't be seen to ignore your health and risk tipping you into crisis.

with all the problems i was having it seemed stupid to carry on.

What were the terrible side effects, did you stop taking meds under your doctor's supervision (even if without their blessing) or discuss alternative meds?

Maybe you are right Lougle, but either way clearly i was under a lot of stress once and i became mentally ill. So i realise that there's always the chance that it will happen again whether it was just 'simple' depression or something more complex and long-term.

I think that now i'm much more aware of my mental health, i took it for granted before and ignored things until they were really bad. Obviously i wouldn't do that ever again!

I am doing lots of things to manage my condition, i haven't had alcohol for 2 years, i eat as healthily as i can and i've started running - which has actually really helped. I make sure that i sleep and i've had a lot of counselling to get to the point where i feel like i can manage it by myself - my counsellor was happy with this too. As i said before medication has never really done much for me, so i have relied on counselling to help me get well again.

It is frustrating that the concern is that i'm not engaging with treatment, but i have engaged and have found the lifestyle changes and therapy helpful and medication not at all. I have explained this to psychiatrists, occupational health and Uni but because there's no medication its like i'm not doing anything.

The last thing i want to do is put any of my future patients at risk, i will admit if i'm not coping. Provided i do stay well i think this has actually made me a better doctor - i am now far less judgemental and more empathetic than i was at 21.

They were causing me to faint without very much warning and i hurt myself a couple of times, obviously i couldn't drive just in case i caused an accident.

They also caused me to pee blood all the time and i was getting proper cystitis around 2-4x a week, bad enough to just be peeing blood but every culture came back negative.

I tried a few different mood stabilizers and had one or both of these problems on all of them and they made me drowsy too. My psychiatrist suggested that i persevere with something that 'only' gave me cystitis because i do need to be able to drive. My compliance on medication was crap because i really struggled to take something that i knew was the reason i was in so much pain and the only way i could get it to stop was to come off it for a couple of days. I haven't had cystitis since i stopped taking the last one (valproate)

How long did you try the drugs.What did your doctors say about the side effects?Would they have disappeared as your body got used to them? wasn't it possible to take low dose antibiotic/ anything else to keep cystitis at bay?

What it does mean is that non-compliance with treatment will put you in a high-risk category, even if you feel well, even if you appear well, even if you are stable.

Lougie's post overall is an excellent summary of the probable point of view of academic/professional staff in this general situation. To be very frank, your "non-compliance" (I know you don't see it that way) with medication & other regimes would give me pause, even in a humanities context.

It could be that you need to get a further diagnosis?

What you are doing in terms of self-managing and maintaining your physical & mental health is exemplary -- I've spent most of the last 2 weeks giving much the same advice about "sleep hygiene," exercise, eating protein/diet, doing some sort of extra-curricular activity which is nurturing of the spirit (in an entirely secular way!) getting out of one's college room, doing things with others, no alcohol, and and so on etc etc etc

But given that you have a diagnosis of a pretty serious chronic illness, the symptoms of which can be lack of self-judgement, paranoia, extreme moods and mood swings, then your apparent "non-compliance" is cause for concern for those who don't know you personally, and intimately that is a domestic & non-professional context. I worked with someone on the edge of bipolar (their diagnosis veered between a pre-BPD and BP diagnosis) for several years and it is if you'll excuse me putting it like this tricky. One knows that there's a tendency to paranoia and extreme reactions these are symptoms of the illness, but day to day, they can be a challenge for those working closely with the person, especially under pressure. I'm sorry if this sounds tough, but I'm trying to be straight with you about hw it feels from a colleague/tutor's point of view, and the balancing act required to get the job done as a team, and not to discriminate.

Could you take someone with you from the Student Union or the STudent Guild (whichever it is)? They will be 'of the university' so appropriate to accompany you, and they can look out for you. They'll have experience of other cases which you don't so will be able to advise and keep an eye on consistency and reasonable accommodation.

I tried the drugs for 5 months and it got worse over time not better. Antibiotics won't help if there's no bacteria - the problem is that the drug (or its metabolites) irritate my bladder and no one knows of any way to stop it.

I have been diagnosed with both BPD and BP, having never been manic, paranoid, taken risks or had extreme reactions to things. I wanted to die for 3 years and on the odd days where I didn't I could very suddenly go into depression - which is mood swings. But all of the things that people infer I am based on my diagnosis just aren't right. I have asked other people just in case I am really so crazy that I have no insight and my parents, friends and dp all say that I scared them because I was so depressed and suicidal. Mum cried and said that she'd planned my funeral in her head No-one thinks I've ever been 'unstable' though. I know I need to go back to the psychiatrists and do whatever they say though. I just wonder if my diagnosis is accurate, I didn't care when I was actually ill because I was getting the help I needed but now it just seems to have so many consequences.

Can I ask how you ended up with a bipolar diagnosis if you've never had a manic episode? Have you had hypomania?
I have bipolar and tried several different mood stabilisers before finding the right one. This includes period where I denied being ill because I hated the effects of medication. I also say I don't needs meds during manic episodes. I'm not saying that this is your experience, just how you maybe perceived if you have a bipolar diagnosis.

Have you approached Bipolar UK for advice? It seems likely that they will have some knowledge of the experience of medics who are bipolar and might even be able to provide you with a mentor to help you through this? I support someone who is bipolar and understand whereupthechimmney is coming from, but also that it can be a long road to find the right medication. I am also surprised that you would be diagnosed if there is no history of mania as well as depression. However Bipolar UK (it used to be the Manic Depression Fellowship) will be a source of impartial advice, it is run by bipolar people for bipolar people, and I have been nothing but impressed with the support and advice they give. www.bipolaruk.org.uk/

I think your diagnosis needs looking at properly. Can you get a recommendation for a really good consultant?

I'm not sure the label for what's 'wrong' is helpful at all. They clearly don't really know or you wouldn't end up with 4 different diagnosis

What really matters is that you proceed with what works and you already know what works for you so far - healthy eating, running, seeing your therapist.

If you're not able or wanting to take medication then you may have to plan to see your therapist on a very long term basis - I know plenty of people who do this.

I think it sounds like you're doing really well. I'm sure you know that having a cry today does not mean anything.

I do think your uni sounds unhelpful and I think that there is a lot of judgement around about medicating. If you had a definite diagnosis I'm sure you could make a case yourself for trying out various medications until you found one that worked. But you don't have a definite diagnosis or a disease that's playing by the rules - you have a best guess by 4 different doctors.

The only thing that I wonder from your post is if you have people around you that you trust who can tell you if you're starting to get sick?

unicorn I would suggest you researching and requesting a second /third psychiatric opinion from your GP. When you see this psychiatrist, take a very good and reliable witness (not just somebody who tells you what you want to hear) of your period of illness. The critical issue is whether you have had a psychotic illness which by definition entails loss of insight and is at risk of recurring. If so compliance with the psychiatrist recommendations and medication is required. The second issue if you require medication is the psychiatrist in conjunction with you finding one with a low side effect profile. That step may take some more patience and persistence from you.

Thank you for the replies, they are really helping me to think through what I need to do.

I am incredibly fortunate to have people who did notice when things weren't right and told me so even when it wasn't really what I wanted to hear. Taking someone is a good idea, after all the times psychiatrists have done things that I disagreed with I get very stressed before appointments and visibly shake while I'm in there - maybe that is why they think I'm worse than I do?

Lately I've been frustrated because Mum and my close friends are all saying that I seem much better (I don't think they would lie and I know I'm not putting on an act or lying to them) and I want other people to see it.

I'm still really hopeful that I am at the end of what were temporary mh problems. I think I'm more realistic now about the fact that I won't know myself really until I've been ok for 5-10 years so I can't expect anyone else to believe me.

I am working on getting a second (or 5th!) opinion on my diagnosis and will go along with whatever treatment is recommended. It is incredibly frustrating that my only option may be to persevere with medication I feel has no benefits and significant side effects - but I'll cross that bridge as and when I need to. I'm not sure about the hypomanic episodes, before this started I was exhausted and running on adrenaline for 4 months and I have been told that this was probably my hypomanic episode... but once I could relax I did so I'm not sure.

Noone has ever suggested that I've ever had psychosis or lost insight... I always knew I was depressed and it wasn't normal. Noone has ever told me that my beliefs or actions have been strange either. So I guess thats a very good thing.

I was actually hoping to reduce seeing my therapist with a view to ending it, provided I could go back straight away if necessary. But I actually found the meeting really stressful and if its going to be an ongoing thing until graduation then I need to have somebody to talk to and make sure I cope with the stress, which can only get worse in the middle of finals

Fwiw I do believe that my uni are discriminating based on the fact that I have a diagnosis. Others who have had concerns raised about them have not been treated like I have based on no concerns and a diagnosis. Sadly students now know that the best way to deflect attention is to refuse to engage from the beginning and resist formal diagnosis. I think the system is counterproductive and wrong but I can't change it.