What to expect from the NHS for mental health in London?
July 17, 2013 5:08 PM Subscribe
What should I expect if I go to my GP in East London about my mental health?
Basically, I am horribly depressed, and have been forever and it is wrecking my life. I have no idea if I just need a regular counsellor for a few months to talk stuff out, or a short/long run of meds, or both, or (I suspect) some magician to say 'you have these three things feeding into each other but the root cause is classic lifelong undiagnosed ADD (or something) so short term solutions for the secondary problems and pills/CBT for the big one'
If I go to my GP...what then? Should I expect to be fobbed of with Prozac for a few month s? Wait three months to speak to someone who makes me wait another three to speak to a specialist? Worse?
If I am impatient and can afford to go private...where would I start?
Most of my experience with NHS care is getting any cheap pill from a GP on the day, waiting many months to see anyone else unless an emergency. I am not an immediate physical danger to myself (or anyone else), just in danger of things getting worse up to that point if I have to wait too long.
I just want to know what to expect...and possibly any 'do say --- and don't say---' advice.
Thanks!
Basically, I am horribly depressed, and have been forever and it is wrecking my life. I have no idea if I just need a regular counsellor for a few months to talk stuff out, or a short/long run of meds, or both, or (I suspect) some magician to say 'you have these three things feeding into each other but the root cause is classic lifelong undiagnosed ADD (or something) so short term solutions for the secondary problems and pills/CBT for the big one'
If I go to my GP...what then? Should I expect to be fobbed of with Prozac for a few month s? Wait three months to speak to someone who makes me wait another three to speak to a specialist? Worse?
If I am impatient and can afford to go private...where would I start?
Most of my experience with NHS care is getting any cheap pill from a GP on the day, waiting many months to see anyone else unless an emergency. I am not an immediate physical danger to myself (or anyone else), just in danger of things getting worse up to that point if I have to wait too long.
I just want to know what to expect...and possibly any 'do say --- and don't say---' advice.
Thanks!
GPs can follow NICE guidelines and prescribe certain anti-depressants for you to try if you are happy with that. Some GPs will have a special interest in mental health and may be more willing to step off the most commonly prescribed path if it looks like you aren't getting on well with those, but you're more likely to need a specialist mental health service.
Getting into a more specialist service can be a slow process because they triage and prioritise people in crisis, which is the correct way to do it. Although the UK are trying to move away from government targets being the big thing, you should still expect to be seen within 18 weeks, but it may be nearly that long if you're waiting to see a psychiatrist in some parts of the country. If you get to be under one then they will co-ordinate your care with the GP playing a supporting role.
There was a big initiative a few years back called Improving Access to Psychological Therapies that paid for a lot of CBT services, so depending on where you are there may be relatively fast access to one of those. In most cases that would be a short set of sessions (around 6-8 in a lot of areas) focused on finding practical solutions to your most common problems.
Other types of counselling are available on the NHS, but the access criteria for those will depend on the area. I did mentor someone who had twice weekly therapy but she was in tertiary care for long term eating disorders and other mental health problems.
You can obtain both psychiatric input and counselling privately. Your GP would be able to refer you to a private psychiatrist but you may need to research and prompt this. You can pick any counsellor yourself and start seeing them and there are various registers that you can use to find one, depending on what type of therapy you want. The last time I knew someone doing this in London they were paying £50-70 per hour, but you may be able to find cheaper.
posted by kadia_a at 11:10 PM on July 17, 2013
Getting into a more specialist service can be a slow process because they triage and prioritise people in crisis, which is the correct way to do it. Although the UK are trying to move away from government targets being the big thing, you should still expect to be seen within 18 weeks, but it may be nearly that long if you're waiting to see a psychiatrist in some parts of the country. If you get to be under one then they will co-ordinate your care with the GP playing a supporting role.
There was a big initiative a few years back called Improving Access to Psychological Therapies that paid for a lot of CBT services, so depending on where you are there may be relatively fast access to one of those. In most cases that would be a short set of sessions (around 6-8 in a lot of areas) focused on finding practical solutions to your most common problems.
Other types of counselling are available on the NHS, but the access criteria for those will depend on the area. I did mentor someone who had twice weekly therapy but she was in tertiary care for long term eating disorders and other mental health problems.
You can obtain both psychiatric input and counselling privately. Your GP would be able to refer you to a private psychiatrist but you may need to research and prompt this. You can pick any counsellor yourself and start seeing them and there are various registers that you can use to find one, depending on what type of therapy you want. The last time I knew someone doing this in London they were paying £50-70 per hour, but you may be able to find cheaper.
posted by kadia_a at 11:10 PM on July 17, 2013
I agree with DarlingBri that a course of antidepressants is an excellent place to start. They may be able to offer you group CBT counseling earlier than individual, equally telephone counseling is another service that GPs can offer on shorter notice.
Both of these options, along with antidepressants are much better than staying in a depressed state while waiting for either NHS one to one counseling or a private referral, and aside from a prescription cost, they're free!
posted by ellieBOA at 12:09 AM on July 18, 2013
Both of these options, along with antidepressants are much better than staying in a depressed state while waiting for either NHS one to one counseling or a private referral, and aside from a prescription cost, they're free!
posted by ellieBOA at 12:09 AM on July 18, 2013
Agreeing that GPs are likely to start with the suggestion of anti-depressants, but in my experience if you say you don't want to try that at the moment they are happy to refer you for counselling. Your GP surgery may also have its own counsellor, though there may be a long wait to see that person. My experience is also that the conversations with GPs are usually extremely short and they don't ask for any more information than can be expressed by you saying "I am feeling very low and this has gone on for xx time". If you have an opportunity or feel able to say that you are worried about getting to the stage of being suicidal if you have to wait too long (as you say in your post), that may make them refer you faster or to higher-tier services (depending what is available in your area).
With the fobbed off by Prozac comment, I think you are saying that Prozac may not be effective for your long-standing depression. I think you are right that many GPs will use Prozac as a first line of approach. You could say that you believe your depression is severe and that Prozac may not be effective and you would rather try something else first (you could suggest something such as sertraline or venlafaxine for instance) but a lot of GPs will still want to try Prozac first and to be honest if you have never tried anti-depressants, as you imply, that may be a good starting place.
If you want to look for private counselling, The British Association for Counselling and Psychotherapy is a good place to start. You could also ask a further question in a week specifically about recommendations for counsellors in East London.
posted by sock of ages at 12:30 AM on July 18, 2013
With the fobbed off by Prozac comment, I think you are saying that Prozac may not be effective for your long-standing depression. I think you are right that many GPs will use Prozac as a first line of approach. You could say that you believe your depression is severe and that Prozac may not be effective and you would rather try something else first (you could suggest something such as sertraline or venlafaxine for instance) but a lot of GPs will still want to try Prozac first and to be honest if you have never tried anti-depressants, as you imply, that may be a good starting place.
If you want to look for private counselling, The British Association for Counselling and Psychotherapy is a good place to start. You could also ask a further question in a week specifically about recommendations for counsellors in East London.
posted by sock of ages at 12:30 AM on July 18, 2013
It may help if you know the Nice guidelines. Here is a link.
http://publications.nice.org.uk/depression-in-adults-cg90/key-priorities-for-implementation
As you can see the recommended approach includes stuff other than drugs.
If I were to spend money to supplement the process it would be to spèed up access to talking therapies which are woefully underfunded. I wouldn't bother seeing a psychiatrist as a GP should be able to manage the treatment. The key to not being "fobbed off with Prozac" is to engage with you GP, ensuring that they realise that you want to work with them to manage your illness.
Good luck.
posted by BenPens at 3:00 AM on July 18, 2013
http://publications.nice.org.uk/depression-in-adults-cg90/key-priorities-for-implementation
As you can see the recommended approach includes stuff other than drugs.
If I were to spend money to supplement the process it would be to spèed up access to talking therapies which are woefully underfunded. I wouldn't bother seeing a psychiatrist as a GP should be able to manage the treatment. The key to not being "fobbed off with Prozac" is to engage with you GP, ensuring that they realise that you want to work with them to manage your illness.
Good luck.
posted by BenPens at 3:00 AM on July 18, 2013
My GP was AMAZING when I went to her with depression. Others of my friends have had varying levels of care. You should push for a referral for CBT at the first appointment if you can - it takes ages to make it through the waiting lists. I would take the pills they give you, in the first instance - if you are indeed 'horribly' depressed, particularly if it's been going on for a while, your chances of beating it without any chemical assistance are poor. If your GP prescribes you Prozac/fluoxetene, they will not be 'fobbing you off', they will be prescribing you something that appears to be quite effective for many people with a minimal side effect profile. It actually isn't very easy to predict what will work for whom, so they tend to go with whatever has the fewest side effects first. Whatever you do, don't stop taking them if you don't feel they're working - go back, talk to the doctor, and get them to change your prescription. My big three pieces of advice would be:
-Be persistent. Don't give up on the process. Many people take a while before they find the right antidepressant, the right therapy modality, the right therapist. It will get better than this. Keep pushing. Keep making appointments with the GP every 1-2 weeks until you feel like you're improving.
-Be patient. Therapy in particular is not a quick thing to obtain on the NHS, but it's good, and often better than anything you'll get privately unless you're paying unbelievable amounts. You're probably in good hands. Your GP has treated many cases of depression before.
-Be honest. If it's not working, say 'It's not working'. If the side effects are bothering you, tell your doctor. Be upfront about your suicidal thoughts. They won't section you unless they're convinced you're in imminent danger, but if you let them know you're worried you might end up there they will take that into account when planning your treatment.
Also, be kind to yourself. Getting better from depression is a long process. Particularly if you have been depressed for a long time, what you're doing is trying to learn a whole new way of being in the world. I started getting treated in 2009, and I still feel like I haven't completely found my way back home. I've been getting better every year, though. Slow and steady. Your impatience is good, and you ought to see some improvement relatively soon, but be ready for a long journey all told.
posted by Acheman at 4:20 AM on July 18, 2013
-Be persistent. Don't give up on the process. Many people take a while before they find the right antidepressant, the right therapy modality, the right therapist. It will get better than this. Keep pushing. Keep making appointments with the GP every 1-2 weeks until you feel like you're improving.
-Be patient. Therapy in particular is not a quick thing to obtain on the NHS, but it's good, and often better than anything you'll get privately unless you're paying unbelievable amounts. You're probably in good hands. Your GP has treated many cases of depression before.
-Be honest. If it's not working, say 'It's not working'. If the side effects are bothering you, tell your doctor. Be upfront about your suicidal thoughts. They won't section you unless they're convinced you're in imminent danger, but if you let them know you're worried you might end up there they will take that into account when planning your treatment.
Also, be kind to yourself. Getting better from depression is a long process. Particularly if you have been depressed for a long time, what you're doing is trying to learn a whole new way of being in the world. I started getting treated in 2009, and I still feel like I haven't completely found my way back home. I've been getting better every year, though. Slow and steady. Your impatience is good, and you ought to see some improvement relatively soon, but be ready for a long journey all told.
posted by Acheman at 4:20 AM on July 18, 2013
London-based trainee counsellor/psychotherapist here. It's great that you're seeing your GP about your depression and other issues. However, it's probably best if you don't expect your GP to be the magician who takes full and informed charge of your mental health. Most only seem to be able to prescribe medication and refer you on to your local mental health care trust. Some GPs are refreshingly clued up about mental health; some seem threatened by or even downright prejudiced against people who present with mental health complaints (mine "doesn't believe in" diagnosing or treating people for PTSD). As other commenters have said, it is a bit of a postcode lottery. Some trusts offer good IAPT services; others are swamped and have long waiting lists. It will help you HUGELY if you're prepared to be your own advocate and take charge of your own diagnosis and treatment. Be your own magician. If you've done a reasonable amount of reading about depression and ADD there's a good chance you're already more informed about it than your physician. Do not understate your symptoms. Be pushy if you have to.
The good news is that there are a lot more options out there than your GP may be aware of or have the means to refer you to. Mental health treatment in London, especially for something as common as depression, goes a lot wider than what's available on the NHS and if you're willing to get informed and take charge, your chances of getting help, especially if you have even a limited ability to self-fund, are good.
I don't know who you would need to talk to in order to get a full diagnosis, but if you want counselling and the options your GP offers you are not to your liking, you can self-refer to the private sector and be seen fairly quickly.
Finding a therapist can be difficult. The "therapist finder" websites for the UKCP and BACP are punishingly user-hostile; I can't imagine what it would be like trying to navigate them with depression. Also, a lot of UK therapists seem not to feel the need to have their own websites for some reason. Persevere.
There is quite a lot of low-cost/sliding scale counselling available in London, if you're willing to travel. Training institutions like CCPE (Little Venice) and WPF (Southwark) will assess you and match you with a fully qualified or trainee therapist from a stable of professionals. WPF I think operates a sliding fee scale. CCPE also has a low-cost option called Fresh Start. There's also HELP Counselling on Portobello Road. Google low-cost counselling in your borough and see what they have to offer; Camden also offers a huge amount of mental health services you may be able to avail yourself of. Try calling your local branch of MIND to see what services are available in your borough.
Above all, don't be discouraged if your visit to your GP doesn't immediately yield you the help you need. Your GP is not the sole guardian of the gate to care of your mental health. Help is out there and you can and deserve to get it.
Memail me if you want to talk.
posted by stuck on an island at 6:20 AM on July 18, 2013 [2 favorites]
The good news is that there are a lot more options out there than your GP may be aware of or have the means to refer you to. Mental health treatment in London, especially for something as common as depression, goes a lot wider than what's available on the NHS and if you're willing to get informed and take charge, your chances of getting help, especially if you have even a limited ability to self-fund, are good.
I don't know who you would need to talk to in order to get a full diagnosis, but if you want counselling and the options your GP offers you are not to your liking, you can self-refer to the private sector and be seen fairly quickly.
Finding a therapist can be difficult. The "therapist finder" websites for the UKCP and BACP are punishingly user-hostile; I can't imagine what it would be like trying to navigate them with depression. Also, a lot of UK therapists seem not to feel the need to have their own websites for some reason. Persevere.
There is quite a lot of low-cost/sliding scale counselling available in London, if you're willing to travel. Training institutions like CCPE (Little Venice) and WPF (Southwark) will assess you and match you with a fully qualified or trainee therapist from a stable of professionals. WPF I think operates a sliding fee scale. CCPE also has a low-cost option called Fresh Start. There's also HELP Counselling on Portobello Road. Google low-cost counselling in your borough and see what they have to offer; Camden also offers a huge amount of mental health services you may be able to avail yourself of. Try calling your local branch of MIND to see what services are available in your borough.
Above all, don't be discouraged if your visit to your GP doesn't immediately yield you the help you need. Your GP is not the sole guardian of the gate to care of your mental health. Help is out there and you can and deserve to get it.
Memail me if you want to talk.
posted by stuck on an island at 6:20 AM on July 18, 2013 [2 favorites]
One more thing I'll say is that I think you'll get more out of the process if, instead of waiting for someone to come along and be godlike and tell you what is wrong and how they're going to fix it, you view the GP as your partner in a process that requires both of you to actively participate. Your fantasy of having a magician come and tell you what is wrong is something I think a lot of people share, but it's ultimately rooted in a slightly outdated model of medicine which
1. doesn't exist any more and
2. more importantly, wasn't actually that great.
You may have the misfortune of running into a psychiatrist who thinks they are a magician who can tell what is wrong with people's lives at a glance; they are the worst thing. The good thing is that in the current model you are allowed to be interested in what is going on with you; you are allowed to have ideas and suggest them to your doctor; you are allowed to try out things on your own, like changes to your diet or sleep rhythm or supplements, and then discuss the results with your doctor.
Oh, and if your practice is anything like mine, there will be more than one GP working there. If the first one doesn't seem simpatico, it's all right to make your next appointment with a different doctor. When you find one that's good, keep coming back to them.
I'll also say, just to be concrete here, that I had several years of private therapy before seeking proper depression treatment on the NHS, and in retrospect I was wasting my time and money. None of it was half as effective or as focussed as the NHS treatment I received. YMMV, of course.
posted by Acheman at 3:35 PM on July 18, 2013
1. doesn't exist any more and
2. more importantly, wasn't actually that great.
You may have the misfortune of running into a psychiatrist who thinks they are a magician who can tell what is wrong with people's lives at a glance; they are the worst thing. The good thing is that in the current model you are allowed to be interested in what is going on with you; you are allowed to have ideas and suggest them to your doctor; you are allowed to try out things on your own, like changes to your diet or sleep rhythm or supplements, and then discuss the results with your doctor.
Oh, and if your practice is anything like mine, there will be more than one GP working there. If the first one doesn't seem simpatico, it's all right to make your next appointment with a different doctor. When you find one that's good, keep coming back to them.
I'll also say, just to be concrete here, that I had several years of private therapy before seeking proper depression treatment on the NHS, and in retrospect I was wasting my time and money. None of it was half as effective or as focussed as the NHS treatment I received. YMMV, of course.
posted by Acheman at 3:35 PM on July 18, 2013
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Yes. That and a referral is what your GP is equipped to provide. However, I don't think you should look at antidepressants as being useless fobbing off; they can be tremendously useful for pulling many, many folks out of depression. Do not discount them out of hand.
Wait three months to speak to someone who makes me wait another three to speak to a specialist? Worse?
Yes. It's very dependent on where you live, it is genuinely something of a postcode lottery.
If I am impatient and can afford to go private...where would I start?
Your GP can also make private referrals which is actually very expedient and useful.
posted by DarlingBri at 5:32 PM on July 17, 2013 [2 favorites]