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Posts Tagged ‘mental health’

Personal Health Budgets for Mental Health – Part 3

24 Mar

It has been a while since I last posted about the Personal Health Budget (PHB) that I was applying for. To recap, there was a new mental health scheme in my area that was looking to give individualised budgets to help reduce a patients overall cost to the NHS (including things such as a&e visits and inpatient stays). After lots of different consultations with different professionals (my care coordinator, therapist, a person from the local commissioning group and a budget broker), a support plan was put together. This included having extra support around my therapy sessions so that I could go ahead with trauma work and also having a personal trainer so that I could restart my healthy ways in a safe environment (he works out of his own private studio so I wouldn’t have to go to a gym which is an issue).

In my original assessment, it was worked out that I had cost the NHS around £17,000 in the last financial year and so the budget set was 15% of this (£2,550 for a year). The aim of spending this money was to reduce the £17k cost and the plan we put together was an excellent one to reduce this. The problem was, it was going to cost around £8,000.

The application is taken to the local CCG funding panel (they agree local spending within the health budget) and the actual plan we had put together was agreed. The problem was the shortfall between the £2,550 and the £8k that was needed. Because of this, it was taken to a second panel and today I found out the results. They have rejected the difference and just given the £2,550.

I am extremely disappointed for a number of reasons. Firstly, this whole process has been going on since August. My therapy has been put on hold until this support had been put in place and so now I am 7 months behind. I don’t know what my therapist is going to say as she wanted the plan in place before she began the work. With £2,550, we can’t even put that support bit in place – they might as well have given a zero budget for the use it can be. And so I am left with the question, will my therapy be cancelled?

Secondly, I feel that the CCG have no real concept of the problems that people with mental health issues have and therefore are not willing to spend the money on us to give us a brighter future. I understand there are cuts everywhere right now, but by spending £8k, they would essentially be saving £9,000 in the year.

The measurable outcomes set against the budget were given as follows:

  • reduction in care co-ordinator contacts
  • reduction in home treatment team contacts
  • reduction in incidents of self harm
  • reduction in a&e attendances
  • reduction in acute in-patient bed days
  • positive changes in body mass index (BMI)
  • improvement in ability to carry out everyday activities and to go outside more
  • time spent per week doing changes in physical activity

Are they really serious? They expect all this on the measly sum of £2550? Do they truly understand the issues here, I don’t think so!

I don’t actually know what is next on my journey, I am having to sit with this for a while to digest it. We have spent 7 months saying this is the answer and it being a light at the end of the tunnel. It now feels like the light has gone out.

 
 

Dissociation and PTSD 

02 Sep

The past few days have been very strange and I’m not too sure what to make of them yet and to be honest, they have been extremely worrying. 
It started with a call from duty at my community mental health team (cmht). My therapist had been in touch and had been worried about me in the session. That would be fine but I have no recollection of being at therapy, getting there or coming home. 

Then things become a bit more blurred. Somewhere over the next day, I’d decided that 2 universes existed, the one we are in and another one that for me would be a better place where no trauma had occurred. Cmht called me again yesterday to follow up after the therapy incident and the two universes was brought up in conversation as I felt I’d had an epiphany of sorts. 

In my head, I had to get over to this other universe and then everything would be ok. But that could only happen if I was unconscious in this world. Duty asked me to let them know when I would try to do this crossover and when I asked why, was told so they could make it safer. This all made sense in my head, that I would call and tell someone, I’d make myself unconscious and then be in the other universe – straight forward right??

Well, I’d been thinking it was very simple and had such clarity about what had to happen. What I didn’t envision was 4 policemen and 2 paramedics arriving at my door and looking at me very strangely when I tried to tell them this. I explained I was ok and there was nothing for them to be concerned about but they called the psychiatric liaison team at my local hospital who wanted me to come in and be seen by them. 

After talking to the team at the hospital for well over an hour, they both agreed that I wasn’t safe to go home but if I’d agree to go in to hospital until later that day (it was now 3am), then I could see my psychiatrist and sort it from there. I declined and they said there would have to be a mental health act assessment done then as they didn’t think I was ok. I was adamant that everything was fine and they actually said my matter of factness is what was one of the most worrying signs. I then agreed as I didn’t want an assessment and if I went in on my own, it was literally for a few hours. I got to the ward, took some chlorpromazine and got my head down. 

When I woke up a few hours later, I felt like everything had been a dream and if it wasn’t for the fact I wasn’t in my own bed, I would have assumed it had been. I started to think that maybe I couldn’t cross over to the other universe as I initially thought I could and that maybe there was something not quite right with my thinking. I saw my psychiatrist who said she believes I was in a dissociative state and that something must have triggered it off earlier in the week, but I have no recollection of that period of time so I’ve no idea. She said that my thinking had become a bit ‘off’ but part of me must have known that as I told people about it. 

I’ll be honest, it’s really scared me. I was willing to stop living in this world, thinking there was another one to go to. What if I hadn’t told anyone? What if it happens again and I actually do something to myself believing it to be the answer? I’m having trouble digesting this latest thing, was it really a dissociative state? Will I be ok? 

 
 

Is PTSD a mental illness?

02 Aug

The subject of this blog says it all really; is PTSD a mental illness? I’ll set out by saying I’m not too sure of the answer. This morning I was adamant that my problems aren’t a mental illness (and I can only speak of my PTSD, so please don’t take offence at anything I write). However after being called obstinant and always think I’m right by my psychiatrist, I’m opening my mind to other answers.

This is my original stance. Before the 2 years of pretty much continual trauma, I was ok. I was living quite a decent life and moving in the direction I wanted to be going and then I got in with a bad bunch for people and, well, you know the rest! And then we have the after effects, the fact that I’m openly not coping very well with what happened to me and I struggle on a daily basis to even function at a low level (in terms of not going out, not seeing people, not eating properly etc). To me though, this is because of what happened and therefore is me struggling with life events, not suffering from a mental illness.

And then we have the other side of the argument. I have been diagnosed with PTSD, it’s an illness in the ICD 10 (the International Classification of Diseases by the World Health Organisation). As a side note, some countries use the DSM IV (or V). There is a overwhelming amount of evidence that says when you suffer from PTSD, the areas of your brain actually become more/less active than before – just like with depression. So surely with this amount of evidence, it should be easy to answer my original question and say of course it is; it’s an illness and also to do with the brain and so therefore classed as a mental illness.

The problem I have here, is one of those arguments is based in science and other in life – if I hadn’t have had my trauma, I wouldn’t be asking this question. But it’s the same with the depression element of my diagnosis. It isn’t an organic depression (ie, it’s not come about on its own), it is based on social circumstances and if I didn’t have PTSD, I wouldn’t have depression either and so it’s the same question – is that depression mental illness or just not reacting well with the way my life has gone?

I had this conversation with my care co-ordinator as she said I am poorly and if I asked 20 lay people if I had a mental illness they would say yes. And so I took to twitter and actually, some people said no, I didn’t. Which begs the next question. If PTSD is a mental illness, why don’t people recognise it as such? And these were people who have either an interest in or illnesses themselves by the way!

So is PTSD a highly stigmatised diagnosis in the mental health field? I’ve got a feeling that I’m not helping my cause by saying I’m just reacting badly to a situation and not giving my diagnosis the respect I should. But by doing that and accepting something is actually mentally wrong with me, I think I’m giving up control of something I’m not quite ready to do yet. Is this having a detrimental effect on my treatment and life? I’m really not sure!

Sorry if I’ve not expressed myself very well, as always I write as I think and don’t edit to make sure I don’t lose the point I’m trying to make.

I’d be interested to hear other viewpoints on this.

 
 

New Therapist

02 Jan

Today I went to meet my new therapist. My last session with my previous therapist was in November before she went on maternity leave, so it’s been a couple of months. I’ll admit to feeling rather anxious, things haven’t been easy over the Christmas/New Year period and I feel on a very tight rope at the moment.

Taking all this in to account, I still went along today with an open mind. I remember first meeting my last therapist and having reservations about her. I thought she was too ‘fragile’ and didn’t feel able to speak my mind. Once I overcame this obstacle though, we forged a good relationship and by the end, she knew how to help me and get the best from me.

I know this took time to grow and so I knew that any new therapist I met I’d have to go through this process with. If I’m being honest, I don’t think I ever accepted the end of that last relationship. It has felt more like she has been on holiday and it was only going back to the offices today and seeing someone else that it has sunk in.

The fact is, the new therapist needs to understand me by asking me questions, being around me and seeing how I work. No amount of notes will give that kind of information and I understand this and am ok with it. What I don’t want to go over is the facts and basics of why I’m there, they won’t change from what is written down.

Today, I feel like I’ve had to explain my situation to someone who has never heard it before and that takes a lot from me. I don’t need right now to be reminded of it all, I need help to deal with the thoughts, the nightmares, the flashbacks – not to be triggered to all this.

This is personal preference, but when in therapy, I don’t like note taking. I feel it creates a barrier and on a number of occasions I had to repeat myself as she was writing previous thoughts whilst I’d moved on. That’s fine for some, but it takes me a lot to say it the first time and I just don’t feel like I want to sit repeating myself.

I know each therapist has their own style and no two are ever the same but I thought there were certain things they are trained in. For example, if unclear, ask and don’t make assumptions. This didn’t seem to be true today and I found myself getting frustrated because I kept having to say no. For example (and this is a stupid example) but I told her I felt being back in therapy was like having a mountain in front of me and that the top of the mountain was feeling how I did with previous therapist and therefore able to carry on where I left off. She thought I meant that therapy as a whole was a mountain and so I tried to clarify that I meant coming back in to therapy, not the process as a whole. After 10 mins of trying to explain what I meant, I gave up. The problem is, I generally work in analogies, it allows me to express my thoughts and everyone I’ve worked with so far has got this part of me straight away. However she seemed to make assumptions and once that had been made, wouldn’t change from it.

To be honest, after the appointment today, I have been left thinking that I don’t know if therapy is the right thing for me at the minute. I feel in too vulnerable a place for this. It has left me in a very low place.

 
 

TW: Feeling Suicidal

30 Nov

**TRIGGER WARNING – SUICIDAL THOUGHTS**

Those who have read my previous posts will know this is a particular tough time of year for me. I’m coming up to an anniversary and last year around this time, I completely lost the year we were in, believing it to be the year before the trauma happened. I’m really scared what might happen this year and I’m just on the verge of giving up.

I saw my care coordinator yesterday and spent most of the time talking about my diagnosis and when she left I realised I am using that as a front so I don’t have to discuss my true feelings. So I did something I never normally and called to tell her this (before I lost my bottle). She was in a meeting and so called me back today instead. I explained and she said its not difficult to see how much I’m struggling at the moment, that I’m not reactive to her jokey ways and couldn’t even look her in the eye. She asked if I wanted to go back on the ward, I obviously I said no!! She asked if some respite time might help (the crisis place I’ve stayed at before), but I don’t see how that could help me.

I’ve felt like I’ve really tried their way of coping; mindfulness, relaxation, sleep hygiene, my 10 steps plan and yet nothing can draw me out of where I am at the moment. We’ve added in prn of one of my meds but even that is having no effect and so that leaves me with my old coping strategy. I know if I just took these tablets then I could get a few hours of solid sleep but I also know they class it as a non-suicidal overdose and am very much advised against it. But I am feeling so low and can’t be certain of my actions so surely this is a lesser of two evils?

 
 

Borderline Personality Disorder Vs Complex PTSD

02 Oct

I know I have covered this in a previous post where I discussed the DSM IV and how I felt the diagnosis of borderline personality disorder didn’t fit my symptoms. This diagnosis is only a recent one (within the past few months) as my psychiatrist thought I was displaying behaviours that weren’t part of either PTSD or depression.

I had a good chat with her at my last appointment before my last hospitalisation and she agreed to re-look over my notes and see about the diagnosis. However, I then saw her un-expectantly the week after when I had taken a turn for the worse and was told I was going in to hospital. Due to this, our conversation has been forgotten about and so here I am again, trying to get the diagnosis changed.

Since my last conversation with my psychiatrist I have done a lot of reading and watching of seminars to truly understand the different diagnoses so I can still keep our conversations at an educational level and not just about me saying I don’t agree. And so I have put together this diagram that uses the DSM IV criteria for BPD (I know in the UK, we use the ICD-10 but for this, the list of criteria is easier to work with). I have then listed the symptoms of complex-ptsd as written by the Royal College of Psychiatrists and then married the two together. There are a lot of similarities, but they also have their differences and it came as no surprise to me that the behaviours my psychiatrist said didn’t fit anywhere were in fact the ones that were in both bpd and c-ptsd (the ones in the middle in the below diagram (you might need to click on the actual picture to see it fully).

I am fully aware that complex-ptsd isn’t in either the DSM IV (or upcoming V) or the ICD-10, however it does have its own section on the Royal College of Psychiatrists leaflet for PTSD. My main point of doing this is to show that just because 4 of the 9 behaviours are shown as BPD, there are actually other explanations for them (I am not even touching on the fact you need 5 or more of the behaviours to be diagnosed!)

OK, so that’s ok if I was in America, but I’m not and the DSM IV doesn’t apply and so I have taken the diagnostic guidelines of the ICD-10 for Emotionally Unstable Personality Disorder, also known as Borderline Personality Disorder, and made 5 citations (not sure if you can see on the picture so will write below as well) of how I don’t fit this:

1) ‘Conditions not directly attributable to another psychiatric disorder’ – I have answered this above.

2) ‘abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness’ – This is not long standing, the behaviours my psychiatrist mentions are purely since my trauma and to be honest, even more recent than that.

3) ‘abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations’ – They are basing this diagnosis purely on seeing one hour per week where we discuss my trauma. Absolutely none of the behaviours are outside of this (ie in social situations).

4) ‘the manifestations ALWAYS appear during childhood or adolescence and continue in to adulthood’ – I have capitalised always as this is extremely important. Until the age of 30 I had never come in to contact with secondary mental health services. I had never cut myself, wanted to take my own life or struggled with inter-personal relationships. Until I pushed people away after my trauma, I had a large set of friends in different social circles and never struggled in this area. I had been to university and got a decent degree and grown a successful business, which involved a lot of rejection, as does every business, and never once did I see or feel worried about rejection in any area of my life. Since my trauma, this has all changed; I cut myself (the reasons of which are outside this remit), always fighting suicidal thoughts and have pushed everyone away so I don’t have to deal with people. My business is also very close to failing. This is all SINCE my trauma, not ALWAYS!

5) ‘the disorder is usually associated with significant problems in occupational and social performance’ – I think I’ve answered this one above. I’ve never had problems with my occupation and stayed in employment long term until I started my own business, which I have run for 7 years. Socially, before the trauma I was out most weekends with friends, I was the secretary of my football team and had a lot of goals that I was working successfully towards.

So, all in all, as you can probably see from this post, I strongly disagree with the diagnosis. I have only had these behaviours since the trauma and so I struggle to see how a developmental illness can be diagnosed. Some people will argue that this trauma triggered this illness but all I can say is I am the expert in me and I know how I used to be – my mental health team can only see me now and therefore might assume this is how I have always been. I think it is up to me to show them this isn’t the case hence all of the above.

I am seeing my care co-ordinator tomorrow and want to show this to her and ask that she relays it to my psychiatrist so I can discuss it at my next appointment in November.

 
 

Therapy & Pushing Myself

25 Sep

A brief update after yesterday’s post about being scared for today’s therapy session and revisiting the nightmares etc. I think I’d worked myself up so much that by the time I got to therapy I was actually quite detached from everything.

We had a weekly catch up as usual and then she asked if I was ok to carry on where we left off. I told her I was scared about being there but I think we just needed to get on with it. And so for the first time since my last session, I read my nightmare over again. And this is where it got a bit strange – I felt no fear! I read it, and nothing! I’m asked to rate 0-10 what the fear factor is and I rated it zero. I thought seriously, that’s all it took, one session and I’m free to read it all.

But no, my therapist wasn’t quite so positive about it. She asked me to read it again and this time add in any extra details I’d missed out – sounds, sensations etc. Yet again, I did it with a zero rating. And then my therapist explained that she thought I’d completely detached from it and this in fact wasn’t me dealing with it but in fact the opposite, that I wasn’t ready to work through it. I was really disappointed, I wanted to fight this and have one less thing in my daily life to worry about.

My therapist suggested we do some more work on coping strategies and come back to the nightmare at a later appointment. If I’m honest, I would have gone along with this if I didn’t know she was going on leave, but as she was, I asked how I could ‘reattach’ myself to that memory – I needed to work on this today! She talked to me about recreating a certain part of the nightmare to see if that invoked any feeling but explained it wasn’t something she felt capable of doing. I suggested maybe going through a different memory and seeing if I could bring the fear back and so she agreed we could try that.

And so I did, I thought of another hot spot as they call it (when the fear is at the worst) and talked through it. It worked and yet again I found myself reaching for the tissue box as the tears just started. By this time we only had about 30 mins left of our session and so we went straight back to the nightmare. It was at this point that I wished I hadn’t pushed for me to carry on. It’s every bit as scary as I thought it would be and I found it really hard. My therapist is off next week so I’ve got 2 weeks before I see her again and this is what I was fearful of – opening this can of worms and not being able to close it when I’m on my own. I know it’s only two weeks but sometimes I just wish my stubbornness backed off and I didn’t push myself so hard!

 
 

Nightmares and PTSD

24 Sep

Nightmares and night terrors in PTSD are really common and although I’m not too sure on the difference between a nightmare and a night terror, I tend to use my own language when describing what happens.

For me, it is like having a flashback in my sleep with the main difference being the fact that I have no control over it and the first I know is when I have woken up screaming, in tears and sometimes out of bed. They are so bad that I have become fearful of actually going to sleep and so my nights are very much my worst time. It is when, trying to stay awake, I think too much and my mood dips a lot!

So, knowing I don’t have many therapy sessions left, this was an area I knew needed addressing. My main concern was that I would open a can of worms and in the short time left, wouldn’t be able to close it again and would be left with no therapy sessions left and in the middle of something I couldn’t cope with.

Me and my therapist spoke about it at length and we decided we were going to give it a go. We were to use graded exposure to help with them and the plan was for me to write down the nightmare the day before my next therapy session. Then in session I was to read it (either to myself or out loud) and deal with emotions it brought up. Once the emotions settled down, I would read again and again until the fear associated with the nightmare was diminished enough for it not to be a problem.

This was the plan, but firstly the task of writing it down took a lot more effort than I thought! The first week I tried, I failed spectacularly. I just couldn’t get the words on to paper and I ended up dissociating really badly. I did go to therapy that week but only managed to stay for 30 mins as I just felt so unreal, I needed to get back to my apartment to be safe again.

The next week, I managed to write it down but if I’m being honest, part of me was scared of having the conversation with my therapist. I had never spoken about any details that had happened and I didn’t know how to. What language would I use? How would I get over the feeling of being judged? Or the disgust and shame behind my words?

I explained this to my therapist and told her although I knew it was her job not to judge me, I was still scared. On top of that fear was the fear that the actual nightmare made me feel. But we pushed through, with her reading it herself so I didn’t have to say it out loud.

I’m not going to lie, it was one of the hardest things I have done. Reliving a tiny part of my trauma elicited so many emotions I can’t begin to list them. But yet again, in session, I started to become detached and feeling like I wasn’t really sure where I was. I remember looking round the room and there was one of those springy door stops attached to the skirting board and that was all I could see, everything else seemed to just disappear. I am aware that this sounds absolutely ridiculous but it’s the only way I can describe it.

I managed to read through my nightmare 3 times in the session before it got too much. I have therapy tomorrow and already I am really scared. I haven’t looked at the nightmare since and I’m not supposed to but just thinking of reading those words again scares me so much!

 
 

Psychiatry Appointment

17 Jul

For people who follow me on twitter, you will know how difficult this past week has been for me. For the first time since I joined, I actually had to stop going on as I was worried people would see how close to suicide I was. I don’t know how, but with the help of some really good friends on twitter, I managed to get through it. I think it was the closest I’ve been to non-impulsive suicide plans. However, I am now coming out the other side and want to write a more positive post.

Today I had the long awaited psychiatry appointment where I wanted to discuss the bpd diagnosis that I accidentally found out about on my records. My appointment was only half an hour long and I was conscious that once we had gone through the ‘usual’ questions I wouldn’t have much time. However, I was proven very wrong!

When I brought it up she apologised for how I found out. This really didn’t bother me, it was a total misunderstanding and I get that these things happen. She went through my diagnoses and explained briefly each one:

PTSD – delayed onset
Recurrent major depressive episode
Emotional instability disorder

I asked her to expand her reasoning behind the last one as I wasn’t entirely sure I understood it. She asked what I did know and I explained I looked at the ICD-10 (International Classification of Diseases from the World Health Authority) but it was so wooly that I looked to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association) for a more in depth diagnosis criteria. As a side point, it was also the DSM-IV that I used on my previous post on bpd.

I had taken my iPad a long and we looked at my last post and she said she could understand why I had been so put out as she didn’t believe I fitted in to 5 of the criteria which you need for a diagnosis. She explained how she perceives (using the ICD-10) the diagnosis and that I have things going on that she can’t put under the PTSD or depression heading and therefore used bpd. So essentially here is her reasoning:

– I can be push and pull with help. Sometimes my cc visits and I’m all ready to do whatever is asked of me and another time it can seem like I’m just going through the motions.

– The fact that I feel like I’m unhelpable (if that’s even a word!!) makes me extremely difficult to manage.

– That I visit my abusers to be re-abused because I feel I deserve it and am not worth better. She said that’s really complex and doesn’t fit anywhere.

– That when I was in hospital, I didn’t eat for 5 days because I wouldn’t go up to the dining room and then within a week I was asking for leave so I could go to an important business meeting.

– That I feel so hopeless about it all that I’m constantly battling suicidal thoughts.

I thanked her for explaining and said in my head they were all for different reasons than she is seeing:

– I agree I’m push-pull but I am so scared of letting people in to help as its something I have never done before. I’ve always just got on with things and dealt with them in my own way and that this is a learning curve for me.

– points 2 & 3 are really together. I feel worthless. That’s the basis of my belief system and it drives the things I do. So yeah, I don’t feel I’m worth helping and revisiting them just backs up that belief – gives me another stick to add to my collection for beating myself up with.

– I realised in hospital that the sooner you adhered to their rules, the sooner you would be discharged. So for example asking for leave to do with work showed I was thinking of the future.

I also explained that I felt like because they didn’t fit anywhere else, I was being put in to a box that doesn’t fit purely for labelling purposes. She told me that if both herself and my cc were off and someone needed to know more about me, that there had to be something in the diagnosis area for these other symptoms and that was another reason it was there.

We discussed the points for quite a while and at no time did she cut me off or make me feel like she’s the doctor and therefore how dare I be questioning her. Instead, she listened and took my views on board. She said maybe she should have used traits rather than disorder (so emotional instability traits) and I said I’d be a lot happier with that as a diagnosis.

The outcome was that she promised to revisit my notes and give it a lot more thought. I personally believe this was the system working as it should. My appointment lasted close to an hour and not once did she look at her watch or make me feel hurried for which I was truly grateful.

So i guess my point is, just because it has been given as a diagnosis, if you don’t agree with it or need more explanation then please ask. However, as with anything in life, go in to the conversation knowing that a) there might be things said that make you feel uncomfortable (it wasn’t pleasant hearing some of the things about me) and b) that the best approach is a civilised, adult one. It is not about arguing, it’s about discussing. And remember the psychiatrist is on our side – although I admit at times it’s not felt like that!

 
 

Is There a Void in the System?

24 Mar

Last week my cc (care coordinator) was off sick for the first couple of days and I was supposed to have an appointment with her Monday, so obviously it was cancelled (someone called and left a voicemail saying my cc would contact me to reschedule.)

Obviously people are going to be off sick. We are all human and this is in no way about that. It’s about the procedures in place when someone is.

It was actually Friday before I got a call from my cc and this was after a friend (who happens to be a community psychiatric nurse) had called to tell her that I was really struggling. She has known me for about 10 years and knows my character traits before all this happened. For example she knows I struggle to ask for help. As an example, when I was starting my business, I used to drive a mini-van delivering ironing for some extra cash. One day I was reversing it down a farm driveway in the snow and it was a tight turn that I made too early and I ended up with back wheels over the edge of a well that belonged to the farm. Instead of asking for help from the farmer (who was really nice), I got out and managed to push it out myself.

So when I say I don’t ask for help, it’s not being stubborn, it’s how I am. On the flip side, in the above example, if I couldn’t do it myself I would have had no qualms about seeking help. And that is exactly the same for where I’m at now. I’ll try to do it alone but if things get too bad I will try and ask for help!

During the call with my cc, I told her I had felt very isolated from the service. She had been on holiday the previous week, and my therapist is away for 2 weeks as well so I’d had no contact from anyone for 2 weeks (bear in mind it’d only been 4 weeks since my discharge from hospital when I last saw someone). She replied saying that they can’t be mind readers and if I’m having a tough time I need to call and speak to a duty worker or her if she is in. And this is where my issue begins.

There is one underlying point in all this… When I am in a low place and needing help, the thing I’m incapable of doing is picking up a phone and making a call to ask for help. I just can’t do it – it’s as simple as that. Unfortunately that’s all the system is set up for. If you can’t manage to phone then you don’t get the help. So whilst I was struggling away for two weeks, they thought I was ticking along without any major problems. I can see their point that if they don’t know anything is wrong then what can they do? But is it right that a whole support network revolves around a service user calling in? That there is such inflexibility in reaching the support?

To me there seems to be a huge void here. I’m not sure if it is just me, but I can only assume I’m not the only person who feels they can’t call the service when in a bad place? So what’s the answer? I don’t think there is one. Unfortunately I think if you don’t call, you don’t get support – simple as that!!