Any other mental health professionals on here?

[ShrinkInterrupted]

Psychiatrist here. Not finding it easy at the moment (understatement) and thinking of leaving. Difficult to work out if it's me, or the job. Just wondered how everyone else is finding it.

@JudyGemstone ooh I missed that you're IAPT too - how do you find it? (Apart from the inappropriate referrals - I'm well used to that in my line of work, and also in the sometimes taking them because there's literally nowhere else for the poor patient to go...)

@whatwouldnigellado

That must be so frustrating constantly having to address inappropriate referrals. My friend worked in a similar team and confirmed to me that the high numbers of children being parented ineffectively (putting it politely) was a huge factor in the long waiting lists.

I’ve looked at the private sector but for now am giving the NHS one final shot but at a band lower.

I left my medical training in 2016. Penultimate year of med school. Now retraining to become a psychotherapist. Qualify next year. Best decision I ever made.

I'm a trainee clinical psychologist (just started) and I'm scared I'm going to burn out before I've even started my career properly. I've worked on inpatient acute services during covid and I am completely exhausted. This is not the training experience I'd hoped for, both for me and my patients

[quote ShrinkInterrupted]@JudyGemstone ooh I missed that you're IAPT too - how do you find it? (Apart from the inappropriate referrals - I'm well used to that in my line of work, and also in the sometimes taking them because there's literally nowhere else for the poor patient to go...)[/quote]
So my service existed a good 10 years pre IAPT coming in, but we sort of absorbed it into our set up. We have psychologists, counsellors/psychotherapists and low/high intensity CBT therapists.

There is a lot that i like about it, I am responsible for projects that are in line with my interests so thats good. I’m a B7 but doing at least half a B8a role really. I really like the head of service and everyone is supportive.

The downside is the KPI targets, recovery rates are unrealistic at the best of times, let alone in a pandemic.
As pp have said, a lot of the difficulties are social/environmental and not something a therapist can do a lot with (think Maslows hierarchy) and I feel more like a social worker half the time.

Staff are getting burned out due to relentlessness of need, client dissatisfaction that we’re not offering long term weekly therapy, trying to do more with less resource all the time.

Not a psychiatrist but I run two mental health community projects funded by the NHS.

I have started to look for new roles.

I am being asked to work with people who have committed serious offenses and also have severe mental health issues without much support and this is starting to get to me.

I am also waiting for counselling myself after being sexually assaulted (not by a client) and this has made the job almost impossible and I have no idea of long this will take.

So why I am looking for a new role I am toying with the idea of just going on long term sick leave. I have already had to stop myself from handing out my resignation without another job to go to but I will do this if I need to.

This really will be my last job working for mental health services/projects.

Goodness @wingscrow I’m truly impressed you are hanging on in their given your experiences-
IME trusts have very visible policies re staff wellness but in reality this is very detached from
the reality of existing day to day in these difficult circumstances-
Take care of yourself

Just place marking

I've name changed for this post as what I say it's likely to be unpopular. I'm a mental health professional of 23 years (not Dr). I no longer work on the clinical front line.

I've had various roles but by far the worst was 10 years as a senior CAMHS practitioner. It was horrific. I only stuck with it so long as the hours suited me with young DC and it was near to home. The team I worked with was amazing but the work was quite simply awful. It's not a doable job. I hour a week "support" won't address the social issues that get dumped on your doorstep. I was abused, criticised, threatened by various parents and other professionals Inc teachers. A lot of people who go up mental health services don't want to do the work, they want a figurative hand hold through their shitty lives. I think "therapy" is disingenuous, it has poor outcomes and can actually be harmful. Even though I'm trained to diploma level in 2 therapies I'm very much a therapy sceptic.

We weren't able to have honest conversations with families due to fear of reprisal and losing the "engagement" and were forced by senior management to carry on with pointless appointments with people where there was zero capacity for change.

@Swanwithtwonecks Interesting and I can imagine it being like this even though I'm not a professional in the mental health field.

[quote sharkyandme]@Swanwithtwonecks Interesting and I can imagine it being like this even though I'm not a professional in the mental health field.

[/quote]
The majority of CAMHS is a social issues. Practitioners need to be streamlined to deal with risk and doing the neurodevelopmental assessments. They don't have the capacity or resources to deal with all the complex safeguarding/social care stuff. These families do need support but not from clinicians. CAMHS work is too messy and unfocused. I'm not surprised families complain, they're sold an intervention that doesn't exist.

I don't think anyone has the capacity to deal with social problems at the moment. Did a stint in social services. Lasted a month 🙈.

“A lot of people who go up mental health services don't want to do the work, they want a figurative hand hold through their shitty lives.”

No judgement from me, I said as much up thread.

As a therapist I have seen some real life changing outcomes for some clients though, so I’m not sure the issue is that therapy is disingenuous in itself, just that there’s no point shovelling snow while it’s still snowing.

Interesting thread. I currently work in a role supporting people with disabilities and mental health issues with setting up direct payments. I’m also doing a degree in mental health and wellbeing (currently off sick/suspended studies while I’m being treated for cancer but that’s a different story) and have been considering what roles I may be applying for when I graduate. The more I read and the more my current role has changed makes me think whether it’s worth all the stress. I hear so many stories about burn out, funding cuts, and being unhappy in jobs. I wanted to go into social prescribing but it seems impossible to combat poverty, poor housing, unemployment etc… I do wonder if that job in Waitrose is a better option.

@TwoBigNoisyBoys

Interesting thread. I currently work in a role supporting people with disabilities and mental health issues with setting up direct payments. I’m also doing a degree in mental health and wellbeing (currently off sick/suspended studies while I’m being treated for cancer but that’s a different story) and have been considering what roles I may be applying for when I graduate. The more I read and the more my current role has changed makes me think whether it’s worth all the stress. I hear so many stories about burn out, funding cuts, and being unhappy in jobs. I wanted to go into social prescribing but it seems impossible to combat poverty, poor housing, unemployment etc… I do wonder if that job in Waitrose is a better option.

I'm very interested in social prescribing, it's where I'd go next if I went back to clinical. I've worked in loads of different environments, you'd think from the outside looking in that working in a medium secure setting would be more challenging. It's not, was a doddle compared to CAMHS.

@Swanwithtwonecks

I've name changed for this post as what I say it's likely to be unpopular. I'm a mental health professional of 23 years (not Dr). I no longer work on the clinical front line.

I've had various roles but by far the worst was 10 years as a senior CAMHS practitioner. It was horrific. I only stuck with it so long as the hours suited me with young DC and it was near to home. The team I worked with was amazing but the work was quite simply awful. It's not a doable job. I hour a week "support" won't address the social issues that get dumped on your doorstep. I was abused, criticised, threatened by various parents and other professionals Inc teachers. A lot of people who go up mental health services don't want to do the work, they want a figurative hand hold through their shitty lives. I think "therapy" is disingenuous, it has poor outcomes and can actually be harmful. Even though I'm trained to diploma level in 2 therapies I'm very much a therapy sceptic.

We weren't able to have honest conversations with families due to fear of reprisal and losing the "engagement" and were forced by senior management to carry on with pointless appointments with people where there was zero capacity for change.

No criticism from me either. I recognise a lot of what you wrote. Especially being unable to have honest conversations with families (still a lot of this even though I work in adult services, and one of the most stressful parts of my job).

I also think we medicalise social problems far too much. I still remember the overnight recovery of a patients with years of severe treatment-resistant depression when she was finally rehomed from a horrible place with nasty neighbours to a nice safe flat. Who'd have thought it eh

“I also think we medicalise social problems far too much.”

Absolutely this. There’s an essay called ‘Beck never lived in Birmingham’ about how CBT is only reliably effective for the privileged.

midpsy.org/beck_never_lived_in_birmingham.doc

[quote JudyGemstone]“I also think we medicalise social problems far too much.”

Absolutely this. There’s an essay called ‘Beck never lived in Birmingham’ about how CBT is only reliably effective for the privileged.

midpsy.org/beck_never_lived_in_birmingham.doc[/quote]
Thanks for that link that's brilliant! I'm CBT trained, it only ever seems to "work" when most things in life are ticking along ok, and the person is motivated and committed. It sure as hell doesn't work for shit life syndrome! I've gone off it as a treatment to be honest and wouldn't offer it now.

I worked in a crisis service some 20 years ago and even then we were all relieved if someone presented who didn't have a housing problem.

And that was in the days when you would eventually be housed if you were vulnerable and had been on 'the list' long enough.

I can't imagine how difficult it is now.

CBT therapist here : CBT works very well for those with primary anxiety / mood disorders
Unfortunately in secondary mental health most patients do not have a primary anxiety or mood disorder-
They have very difficult lives, ASD, poor relationships etc etc that causes anxiety / low mood
They can benefit from skills based interventions
But look being fixed, long term support, unrealistic outcomes due to ongoing crappy life circumstances !

Regarding having honest conversations with patients/ families:

A huge part of my role is dealing with increasing numbers of complaints. Mainly due to unrealistic expectations from patients.
I am very ‘good’ with people and an experienced communicator but it is increasingly hard to find appropriate ways to manage people’s expectations.

Many have a very unrealistic view of what an inpatient stay might be like, they seem to think an NHS inpatient unit is like a spa hotel with therapy on tap. I sense that (particularly for clients with unhappy lives and/or eupd) they really want an admission to ‘prove’ to others how unwell they are. Plus the added advantage of being able to opt out temporarily of the less pleasant aspects of their lives.

To be clear, I absolutely think there is a need for admission in some circumstances. But predominantly for people (most of whom may well need detaining) who are seriously unwell for example with clinically diagnosed mania, severe depression, psychosis with no insight.
Imo if there are lots of inappropriately admissions this hinders the wards from offering effective treatment and management for people that really need to be in hospital.

@onepieceoflollipop

Regarding having honest conversations with patients/ families:

A huge part of my role is dealing with increasing numbers of complaints. Mainly due to unrealistic expectations from patients.
I am very ‘good’ with people and an experienced communicator but it is increasingly hard to find appropriate ways to manage people’s expectations.

Many have a very unrealistic view of what an inpatient stay might be like, they seem to think an NHS inpatient unit is like a spa hotel with therapy on tap. I sense that (particularly for clients with unhappy lives and/or eupd) they really want an admission to ‘prove’ to others how unwell they are. Plus the added advantage of being able to opt out temporarily of the less pleasant aspects of their lives.

To be clear, I absolutely think there is a need for admission in some circumstances. But predominantly for people (most of whom may well need detaining) who are seriously unwell for example with clinically diagnosed mania, severe depression, psychosis with no insight.
Imo if there are lots of inappropriately admissions this hinders the wards from offering effective treatment and management for people that really need to be in hospital.

I agree so much with this. It would really help to have better public education around what inpatient units are like, and what they are for. Also the fact that they don't prevent drug use (sometimes quite the opposite), can be a breeding ground for learning new and more dangerous ways of self-harming, and are not infrequently unsafe.

I would also add the unrealistic expectation that we can Do Therapy "to" an unwilling patient (psychology, drug and alcohol work etc). Managing expectations around this is an increasing challenge. "He needs to be sectioned to stop him getting drugs and make him do therapy" is a common conversation.

I tend to be quite upfront and honest with people about the realities of inpatient admission. Including the fact that even if admission is indicated, a bed may not be available immediately- in fact there may be a wait of days (sometimes longer)

It's not just complaints I've been threatened with letters being written to mps, and contacting the local news paper because I haven't done what patients relatives are quite frankly trying to bully me to do. I understand people are desperate but much of the reasons that people are in the state they're in are societal NOT due to perceived lack of support.

I had multiple parents take their kids to a and e, tell them to say they felt suicidal (even if they didn't) therefore getting an emergency appointment and then being able to fast track into the CAMHS appointment system. It was a strategy that was widely shared amongst parents in the locality.

I think there is a discrepancy between
People wishing to access NHS mental health services for support
And NHS mental health services being treatment focused

You can’t ‘treat’ social issues, neurodevopmental problems, making bad choices with a medication or psychological treatment

People are care / support seeking for many reasons

Mental health services in NHS was one a supportive service, that is long gone.
It’s treats what there are evidence based treatment for
And responds to crisis