Mental health help in the UK
February 26, 2016 4:51 AM Subscribe
Got mental health needs. Don't know how to start getting them met with the NHS, can't really afford to go private. What do?
Ever since childhood I've been affected by what feels like a host of issues surrounding my mental health. Investigating, filling out tests, comparing experiences with my diagnosed family members etc, would seem to at least suggest the presence of:
* ADD. I could write a book about all the ways I have trouble with staying focussed on anything, keeping track of things, keeping appointments, holding down jobs, making and sticking to plans, etc etc; it's heavily affected my 'career' such as it is. I have an intensely vivid imagination that often intrudes into my thoughts, I have solid creative skills and a billion project ideas, but usually zero ability to bring myself to produce anything, no matter what approach I try.
* ASD or something. I seem to process things differently from most people. I find it hard to make connections with people or get much out of social interaction that's not directly tied to my interests. I sometimes go mostly mute for long periods out of frustration with language. I become fascinated by things I can't begin to explain. I have an intense (sometimes almost debilitating) 'spiritual' experience of the world that I've likewise never really been able to begin to explain to anyone or relate to any particular religion.
* Social anxiety, often crippling. Parties or even utterly mundane encounters can lead to freakouts and dropping out of social circles, and now I have basically none left (except online), including my family who I've dropped out of contact with. I'm actually fine with the hermit lifestyle in itself, but I'd like to not be forced into it.
* Depression. I don't get happy, relaxed, comfortable. I self-medicate with cannabis - I'm aware this can exacerbate symptoms in the long term but it's the only thing that brings me any serious relief (I mean, other than the cornucopia of other things I've taken at one time or another, but which are even worse news to self-medicate with).
* Sleep issues. Especially when more heavily depressed I'll fall asleep at the drop of a hat when trying to accomplish anything even vaguely difficult. But at night, I never feel sleepy until 4-5am and have had huge problems with getting to work on time, no matter what I try.
* Queerness; I'm trans (genderqueer), pan, kinky as hell, and have explored those things to an extent (especially online) but could do with support on figuring out more about this part of myself, doing more to make it part of my life, and relating it to everything else and the rest of my life. I'm cool with it in itself, but having that subject mixed in with everything else has made seeking help more intimidating.
I've tried explaining all this stuff this to my GP but couldn't get any traction; she told me to 'adjust my life expectations' and gave my a scrip for citalopram, still ongoing, which helped take the edge of the worst of the depression (and especially helped with the 'falling asleep when trying to accomplish anything') but not much else, and it's heavily dampened my libido. I got a referral to the IAPT but found the passive talk therapy and generic life completely useless, and keeping the phone appointments filled me with anxiety. This has really shaken my confidence in trying to get more help through the NHS.
(Possibly this is because, despite all the above - whether its my inclination towards a 'taoistic' attitude, or my intense efforts as a teenager to hammer despair-and-suicide-resistance into myself, or my subdued presentation, I rarely suffer urgent, dangerous crises.)
I've looked at some private therapists (gender-related, ASD related and more general) but besides the massive mental hurdles of trying to persuade myself to approach them, I'm on a low income and just don't have much cash to spare.
So. I'm not sure how to proceed. I'm in London, UK, btw. I'm looking for advice on how to engage with professional services, rather than lifestyle or outlook advice on its own, which I already have more than enough of and which has never really done much to help me in the long term.
Ever since childhood I've been affected by what feels like a host of issues surrounding my mental health. Investigating, filling out tests, comparing experiences with my diagnosed family members etc, would seem to at least suggest the presence of:
* ADD. I could write a book about all the ways I have trouble with staying focussed on anything, keeping track of things, keeping appointments, holding down jobs, making and sticking to plans, etc etc; it's heavily affected my 'career' such as it is. I have an intensely vivid imagination that often intrudes into my thoughts, I have solid creative skills and a billion project ideas, but usually zero ability to bring myself to produce anything, no matter what approach I try.
* ASD or something. I seem to process things differently from most people. I find it hard to make connections with people or get much out of social interaction that's not directly tied to my interests. I sometimes go mostly mute for long periods out of frustration with language. I become fascinated by things I can't begin to explain. I have an intense (sometimes almost debilitating) 'spiritual' experience of the world that I've likewise never really been able to begin to explain to anyone or relate to any particular religion.
* Social anxiety, often crippling. Parties or even utterly mundane encounters can lead to freakouts and dropping out of social circles, and now I have basically none left (except online), including my family who I've dropped out of contact with. I'm actually fine with the hermit lifestyle in itself, but I'd like to not be forced into it.
* Depression. I don't get happy, relaxed, comfortable. I self-medicate with cannabis - I'm aware this can exacerbate symptoms in the long term but it's the only thing that brings me any serious relief (I mean, other than the cornucopia of other things I've taken at one time or another, but which are even worse news to self-medicate with).
* Sleep issues. Especially when more heavily depressed I'll fall asleep at the drop of a hat when trying to accomplish anything even vaguely difficult. But at night, I never feel sleepy until 4-5am and have had huge problems with getting to work on time, no matter what I try.
* Queerness; I'm trans (genderqueer), pan, kinky as hell, and have explored those things to an extent (especially online) but could do with support on figuring out more about this part of myself, doing more to make it part of my life, and relating it to everything else and the rest of my life. I'm cool with it in itself, but having that subject mixed in with everything else has made seeking help more intimidating.
I've tried explaining all this stuff this to my GP but couldn't get any traction; she told me to 'adjust my life expectations' and gave my a scrip for citalopram, still ongoing, which helped take the edge of the worst of the depression (and especially helped with the 'falling asleep when trying to accomplish anything') but not much else, and it's heavily dampened my libido. I got a referral to the IAPT but found the passive talk therapy and generic life completely useless, and keeping the phone appointments filled me with anxiety. This has really shaken my confidence in trying to get more help through the NHS.
(Possibly this is because, despite all the above - whether its my inclination towards a 'taoistic' attitude, or my intense efforts as a teenager to hammer despair-and-suicide-resistance into myself, or my subdued presentation, I rarely suffer urgent, dangerous crises.)
I've looked at some private therapists (gender-related, ASD related and more general) but besides the massive mental hurdles of trying to persuade myself to approach them, I'm on a low income and just don't have much cash to spare.
So. I'm not sure how to proceed. I'm in London, UK, btw. I'm looking for advice on how to engage with professional services, rather than lifestyle or outlook advice on its own, which I already have more than enough of and which has never really done much to help me in the long term.
My experience with private counselling/therapy is that they often operate a "pay as much as you can afford". Like Seldomseenkid said, get in touch with Mind if you feel your GP isn't helping; unless you are a very serious case, you won't get an NHS counselling/therapist without a huge long wait anyway.
(Don't forget that you can change GP very easily, both within the same surgery and to a different surgery, you don't have to give anyone a reason. But you might not get a better experience.)
Also - charities that provide therapy are set up to help people exactly like yourself. The first time I approached one, I actually sat down and wrote a letter rather than phone or email, and they got back in touch quickly and with a good therapist. Getting in touch with them is a big first step but I hope the first one on the way to feeling better.
posted by sarahdal at 6:56 AM on February 26, 2016 [2 favorites]
(Don't forget that you can change GP very easily, both within the same surgery and to a different surgery, you don't have to give anyone a reason. But you might not get a better experience.)
Also - charities that provide therapy are set up to help people exactly like yourself. The first time I approached one, I actually sat down and wrote a letter rather than phone or email, and they got back in touch quickly and with a good therapist. Getting in touch with them is a big first step but I hope the first one on the way to feeling better.
posted by sarahdal at 6:56 AM on February 26, 2016 [2 favorites]
I'm in Scotland and don't know much about how things operate in England (the Scottish NHS is a different organisation). But FWIW - yes to switching GP, it's crazy how much they vary in their ability/willingness to deal with this, rather than palming you off with the insult of "adjust your expectations".
Then try a couple of things, the second might have to wait until after you've tried the first: 1. Tell them the Citalopram isn't working, ask to try something else. You might have to work your way slowly through a lot of different drugs, but there might be one that works much better for you. Different GPs also seem to have different 'favourites' for second-line prescriptions (ie. what they give you if their first choice doesn't work) so this can also be a good reason to change GPs. 2. If you've worked your way through various medications and none has worked, you'll have a stronger argument when you come to ask your GP specifically for a referral for a psychiatric assessment with a consultant. FWIW, for me the magic word that secured that referral for me was when I mentioned that someone in my family had been diagnosed with Bipolar II. Turns out that dealing with bipolar was deemed above the pay grade of my GP, so she went straight for the referral. It took months, and at the end of it, I just ended up being handed the photocopied list of counsellors in my city that my GP also gives out, so didn't actually get me anywhere, but YMMV.
One thing to look out for might be a charity (Mind, or a local charity to you) that can provide mental health advocates/buddies - someone who could come to appointments with you and help you stand your ground if you feel your GP is not listening.
And I know you know this already, but knocking off the weed is going to make a huge difference in the long term. Also, I'm very aware that telling seriously depressed people to exercise regularly when they can barely get out of bed is worse than insulting, but if you can manage it, it really does make a difference. Good luck.
posted by smock puppet at 8:47 AM on February 26, 2016 [1 favorite]
Then try a couple of things, the second might have to wait until after you've tried the first: 1. Tell them the Citalopram isn't working, ask to try something else. You might have to work your way slowly through a lot of different drugs, but there might be one that works much better for you. Different GPs also seem to have different 'favourites' for second-line prescriptions (ie. what they give you if their first choice doesn't work) so this can also be a good reason to change GPs. 2. If you've worked your way through various medications and none has worked, you'll have a stronger argument when you come to ask your GP specifically for a referral for a psychiatric assessment with a consultant. FWIW, for me the magic word that secured that referral for me was when I mentioned that someone in my family had been diagnosed with Bipolar II. Turns out that dealing with bipolar was deemed above the pay grade of my GP, so she went straight for the referral. It took months, and at the end of it, I just ended up being handed the photocopied list of counsellors in my city that my GP also gives out, so didn't actually get me anywhere, but YMMV.
One thing to look out for might be a charity (Mind, or a local charity to you) that can provide mental health advocates/buddies - someone who could come to appointments with you and help you stand your ground if you feel your GP is not listening.
And I know you know this already, but knocking off the weed is going to make a huge difference in the long term. Also, I'm very aware that telling seriously depressed people to exercise regularly when they can barely get out of bed is worse than insulting, but if you can manage it, it really does make a difference. Good luck.
posted by smock puppet at 8:47 AM on February 26, 2016 [1 favorite]
For the ADHD and also the ASD stuff, contact ADDISS. They will point you in the right direction.
posted by tel3path at 1:55 PM on February 26, 2016 [2 favorites]
posted by tel3path at 1:55 PM on February 26, 2016 [2 favorites]
I actually can't particularly remember how I got my referral, in the English NHS, but basically I think if you ask your GP for a referral to your mental health primary care liaison service, they're quite likely to refer you to primary care liaison. The primary care liaison are the people who direct mental health referrals, and when I saw them, 18 months ago, I was in quite a state, and they duly referred me to my local adult ASD service, who assessed me 13 months later and my local ADHD service, who have yet to assess me (I am on their waiting list, apparently).
But I also know that there wasn't an ASD service where I live 5 years ago, and the ADHD service where I work has been withdrawn, as these things are on the margin of sustainability.
So if you go to your GP saying "I need a referral to primary care liaison, because my anxiety isn't responsive to IAPT", they will probably write you that PCLS referral, and the PCLS team will hopefully agree with your assessment of the situation. If not, your NHS mental health provider will have a patient advice and liaison service (PALS), who anyone can call, and they may well talk you through this process.
The ASD service where I live seems pretty good. I've gone to 6 weeks of post-diagnostic group work where we talk through issues with peers. It was well worth it. And they have 1-1 support services for specific issues. I've not used those yet, because the main reason I sought a diagnosis was so I could take it easier on myself when I didn't do exactly the same as everyone else.
And yeah, your specific social anxiety symptoms seem ASDish. Freakouts are not usual social anxiety symptoms.
posted by ambrosen at 3:49 PM on February 26, 2016 [3 favorites]
But I also know that there wasn't an ASD service where I live 5 years ago, and the ADHD service where I work has been withdrawn, as these things are on the margin of sustainability.
So if you go to your GP saying "I need a referral to primary care liaison, because my anxiety isn't responsive to IAPT", they will probably write you that PCLS referral, and the PCLS team will hopefully agree with your assessment of the situation. If not, your NHS mental health provider will have a patient advice and liaison service (PALS), who anyone can call, and they may well talk you through this process.
The ASD service where I live seems pretty good. I've gone to 6 weeks of post-diagnostic group work where we talk through issues with peers. It was well worth it. And they have 1-1 support services for specific issues. I've not used those yet, because the main reason I sought a diagnosis was so I could take it easier on myself when I didn't do exactly the same as everyone else.
And yeah, your specific social anxiety symptoms seem ASDish. Freakouts are not usual social anxiety symptoms.
posted by ambrosen at 3:49 PM on February 26, 2016 [3 favorites]
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0300 123 3393
info@mind.org.uk
Text: 86463
Switchboard may also be able to help, they are LGBT+ and provide a listening service but may also be able to signpost you to resources.
posted by theseldomseenkid at 5:14 AM on February 26, 2016 [4 favorites]