Doctor refusing to treat me what are my rights

[MysteryMoose]

Hi I'm not really sure what info to put here but I need help with my legal rights.

Basically my mental health collapsed in September. I was very depressed. GP referred to Mental health. Mental health bounced me back to GP. Went to GP. They put me on Citalopram and referred back to MH. Within 2 weeks I was having a manic episode and have been struggling with mixed mania (feeling like life is pointless but all the energy of mania) ever since. Community MH refused to treat. Left me in that state for 6 weeks. They bounced me to perinatal who bounced me back to MH as my daughter was approaching age 1.
Now SS are involved. MH still refusing to give me the "proper" amount of antipsychotics, they have me on a joke dose (5mg olanzapine) that isn't controlling the issue, and they are refusing to give me my ADHD medication because I'm breastfeeding.

I have a letter from the perinatal psychiatrist saying that the "benefit outweighs the risk" and recommending that I start ADHD meds back in October but MH said "that's just a recommendation".

I have never been a self harmer but I've been suicidally manic since October and have now attempted to end it 7 times. Crisis team bounced back to CMH, CMH still refusing to take responsibility or actually do anything.

I have racked up £12,000 worth of debt from the mania, had arguments in the street with my husband (I have never had an argument in my life before, I'm usually very quiet), and harmed myself.

Legally, if they are refusing to treat, surely they have to refer me to someone who will, right? Article 3 of the human rights act says I can't be subject to inhuman or degrading treatment including witholding medication and other neglect, but how does that translate to actually getting someone to do something about this? I am trying to stop breastfeeding but as the perinatal psychiatrist noted, without that ADHD medication I just can't organise feeding times.

Additionally, they have said that if I do come back to them and say I've stopped breastfeeding, they want a signed letter from my husband saying I really have, and they have also said they will want to test my prolactin levels (despite the fact these are unlikely to go back to normal for at least 6 months to 1 year even if I wasn't on olanzapine). I have capacity. I asked if a man had ADHD and bipolar would they ask a man's wife to sign a letter like this and they just blustered. It was humiliating and infantilizing as all fuck.

I'd like to add that according to Lactmed, the medication itself isn't contraindicated for breastfeeding and serum levels are undetectable: www.ncbi.nlm.nih.gov/books/NBK501310/
www.ncbi.nlm.nih.gov/books/NBK501056/

Doctors and social workers have a duty of care to the health and welfare of your daughter. They will not prescribe medication to you, that can harm her via breastmilk.

If your condition threatens the safe nutrition of your baby, its very likely you will be separated so that she can be safely fed formula.

That's appalling. Make sure you bring someone to every meeting and make notes of everything. That they would need a signed letter from your dh is shocking. That they won't take the experts advice re the medication is shocking. The whole thing is a disaster.

When you say the CMH are refusing to treat you have the offered non medical treatment? I’m confused if you meant the are not offering you medication or if they refuse to engage with your treatment.
You are entitled to a second opinion so you could ask for a different psychiatrist to review your case if you are known to CMH

I just wanted to say that your post is brave and eye opening. I deal with many people in my professional life who are suffering with the negative affects of mania, mental health issues and suicidal tendencies and to read your informed, intellectual standpoint has really opened my eyes and has educated me on seeing the person behind the situation. Sorry I'm no help whatsoever with your actual question x

Hi.

I don't have an answer but there is a great Facebook page called Breastfeeding Older Babies and Beyond. It's international so if you post you need to make it clear what country you're in. I have seen posts of similar complexity to yours on there and it's possible someone there may be able to give advice?

Sorry you are going through this.
I agree with those encouraging you to stop breastfeeding. I sympathise that it's difficult but it is the obvious way forward. No need for formula or sterilising as your little one can drink cows milk.
It should be fairly straightforward for you and your partner to make a timetable of what DD needs and at what time.
Is the low dose of olanzapine also due to breastfeeding? All the more reason to stop.
Are you finding it emotionally difficult to give up breastfeeding? I found that too and it made me really sad, but there is a higher aim here of getting your condition under control so you can be the best mum you can for your growing DD.
Regarding the mental health team, are they refusing to treat or do they just disagree with your opinion? It might be worth approaching PALS. Otherwise you may need to find a private psychiatrist who will help you.

Your nearly 1 year old will be fine on cows milk now, and no need to sterilise anymore as a pp said. Your husband could double check the dates on the milk if needs be and help out with the washing of bottles?

If you have already been advised by a professional the risks of being without your ADHD medication outweigh the bf'ing risks just tell the GP you aren't anymore. They won't know.

I am not if advising someone who in the OPs situation to deliberately deceive medical professionals is wise. It's is the OP to be seen to be open and cooperative.

You have the right to a second opinion. Have you formally requested one? When you do they need to refer you, either to another psychiatrist in the trust or one in another area. If you ask them to and they don’t, try approaching PALS for support in getting things moving.

Use cows milk. Sorry you’re going through this OP.

@JonSnowedUnder what? Lie to the GP? Great idea.

Op, on the legal side you will struggle to make a case as yo to prove that the doctors have n

She has been told that she can take the medication and BF from another professional - the GP has decided to not listen to that recommendation. I wouldn't say lie if she hadn't already been advised by another medical professional.

You should stop breastfeeding. You don’t have a right for them to give you the treatment you want though on the NHS. Unfortunately mh care is often not up to much.

hope you get it sorted op.

Sorry, posted too soon!

You have to prove the doctors have treated you incorrectly. The fact that you feel they have and being able to prove that are worlds apart.

You need to find a doctor who can give you a second opinion and who will back you up.

It does seem like you are being treated, just that the doctors have come to the conclusion that the health of the baby has greater weight than you feel it should have.

I would ask for help stopping breastfeeding. Your baby can have milk and food, no need for bottles at all.

How old is your DC? You say she is approaching one; once she is 12 months old the switch from breastfeeding to bottles should be easier as she will be able to drink regular whole cows milk so no Ned to buy or make up formula and it will be fine not to sterilise the bottles once she’s a year old.

Just to add, I am not saying it is right that you are being treated this way or being pushed to stop breastfeeding if the drug won’t come through in the milk anyway. But if your DD is almost one and the main issues stopping you from switching to formula are having to make up formula to instructions and sterilise bottles etc you may find it easier once she can have cows milk and doesn’t need things sterilised so at least an end may be in sight.

Can yourvperinatal psychiatrist not prescribe medication?

Hiya OP. Have you seen a Dr or Consultant in the mental health team who has specifically refused to prescribe the medication? I doubt you can force an individual Dr to prescribe medication if they think it is dangerous because the risk is on them if something happens. Have you asked for a 2nd opinion from another Dr? Are you speaking to the Dr or are you having information relayed through MH nurses? Do you have a care coordinator? Have you been told you are on the Care Programme Approach? I'm trying to understand if a Dr has looked at the situation thoroughly and made a definite decision not to prescribe, despite other opinions or if a decision just hasnt really been made because you are getting passed around different teams.

I think though that you do need to consider an advocate, despite how much you can clearly explain your situation, or consider making a complaint. Have you been communicating on the phone? In email? Have you asked for your notes? I appreciate this is a lot to think about when you have so much going on. Who referred to SS?

Hi, I read the OPs post but took it that making the bottles (keeping them the right temperature and mixing up in advance etc) was the key challenge. A 12 month old doesn’t have much formula milk as they can also have cows milk so it would not be too tricky. My DD isn’t yet 12 months so I wasn’t sure of this but another poster mentioned you don’t need to sterilise bottles after 12 months as long as obviously they are clean. Agree OP needs to be advised by medical professionals though.

Please don’t stop breastfeeding abruptly without support. Even if stopping would automatically make you re-eligible for your ADHD meds. From your post it sounds like your husband isn’t being entirely supportive and your medical professionals are letting you down right now. There’s a massive emotional and hormonal component to stopping breastfeeding.

I’ve been suicidal with PND and breastfeeding my twins was the only tangible reason I couldn’t make an actual plan to end my life. My feeding them was the one thing I could easily say was a reason they needed me (as opposed to anyone else). I was convinced everyone around me would be better with me dead except for the breastfeeding. (Obviously now I’m in a sound mind I know this wasn’t true.)

Stopping breastfeeding appears to be the appropriate solution here, but it needs to happen in a controlled manner with the support of the people around you.

OP, please remember suicide is a permanent solution to a temporary problem.

You need to speak to PALs and/or your local Integrated Care System ASAP. If you want to PM me I’ll happily dig out some email addresses for you. Even help you draft an email.

I’m sorry this is happening. And I’m sorry for the tone deaf pile-on with regards to your decision to keep breastfeeding for the moment.

Op those sources do not say the medication is undetectable in breast milk. They say there is low levels in breast milk and undetectable in infant serum levels. However there is a lack of information about safety. For methylphenidate it says it’s not a reason to stop, but you are proposing to start taking it which is different. You have been prescribed olanzapine but you disagree with the dose. These are clinical decisions, you can’t force them to increase your dose or prescribe something and I think they could easily justify their choices. What you can do is insist on a second opinion and they can not deny you that. Have you taken that option?
is your partner able to support with the areas that you struggle with? A 12 month old can have cows milk in a cup, no need for formula or sterilising bottles. Perhaps your partner could prepare things with stickers of when to give them? Or both prepare the days food and snacks with a checklist?
personally I’d give up the bf and then there will be less need for caution around the medication

She is under the CMH rather than the GP for this specifically though by the sounds of it. The psychiatrist who has advised she can take it, is not the prescribing service, that would be the CMH in her case, she isnt under peri natal as she wa passed back to CMH

I have traits of both ADHD and bipolar. My current psychiatrist won't prescribe ADHD meds until my mood is stable, so I'm starting back on lithium.

That's sensible. ADHD meds can trigger mania. So can SSRIs. I have no idea why you've been prescribed an SSRI let alone with rapid cycling and mixed episodes.

Can you speak to a psychiatrist about tapering off the SSRI? It seems to be doing you no good as an antidepressant.

This is my question. If you need to stop BF to get the meds you need, but can’t get on a bottle schedule without the meds, then he is going to have to make time to prep the bottles for you everyday.

Legally you cannot demand a treatment. Whether to give a treatment or not is entirely down to the HCP who would be prescribing it and therefore legally responsible for it.
You can legally decline treatment offered but not demand any particular treatment.