Good CPNs/Social Workers/Doctors/Therapists

This’ll be badly written as I have about three minutes!

Reading around the madosphere, there is a lot of poor treatment out there.  The Crisis Team in particular seem to get various boots hoofed into them, which I understand.  On the occasions I’ve dealt with them, they’ve been rather useless, but it’s difficult to know what their use actually is.  My understanding of them has been that they come round to talk to you and check you’re not dead.  Which has a function in itself- if you don’t want to be admitted to hospital, the hour in which they say they’ll appear, genie-like, is the hour to aim for looking like you’ve had a wash and haven’t been neglecting to wipe your arse and drink fluids, even if you have.  They’re good for the facade, and the facade can be handy, it’s good to practice it, especially when you are depressed, so everybody doesn’t worry.  When you feel bad enough for the crisis team, though, you kind of want them to show up, take you very seriously (therefore not suggesting you have a bath or make tea) and then all is well.  But the zenith of, “taking seriously” seems to be hospital admittance, which is equally boring and often pointless anyway.  Apart from the first time I ever dealt with them when I was treated at home with them for six weeks (having them come to administer medication, and watch me take it, which was amusing), my dealings with them have been brief because I learned quickly what to say in order to get discharged.  There was one appointment that they couldn’t get to because someone had been stabbed outside my front door- they weren’t allowed in by the police.  I pointed out that it wasn’t me who did the stabbing so not to worry.

Psychiatrists get it, too.  I’ve never really had a psychiatrist I particularly liked, but it’s only because I’ve never gotten to know any of them well enough to like them, and the highly charged situations I’ve seen them in have been too fraught, and made me feel defensive.  Since psychiatrists largely exist to tell us things we don’t want to hear, it’s difficult to like them.  They’re like that friend that presents barbed criticism as helpful advice.  The first one I had was when I was sixteen, who slapped me with a mood disorder then bammed me on Carbamazepine then I never saw him again.  After that I saw someone else, but that period of time is so blurry (all I can really remember from it is that I thought I was in a computer game) that I don’t remember him.  I do remember the Olanzapine and the 3 stone I gained on it, though.   There was one, the geography-teacher elbow patched, tweed trouseredness of Dr. Issacs, who I liked, despite sometimes disagreeing with him.  My first impression of him still makes me laugh- he floated into the a side room at the hospital, stuck his hand out and said in the most cavalier fashion imaginable, “I’m Jack, Dr. Jack Issacs”. I half-expected his teeth to ping pearly white.  There was another who was so handsome that I would burrow into my chair to smother the shame of the faint, tangible smell of urine that clung to my legs, the sweetish smell of old sweat and clothes that hadn’t been washed in weeks, unkempt hair, and an increasingly bloated, antipsychotic face.  There’s Dr Lashes who I’d seen a few times and saw recently with the Crisis Team, who has such a low, calm voice that I nod off whenever he speaks to me.  Then there’s the consultant, the one who slammed me with BPD, who is quite chipper but doesn’t listen.  He is a consultant, though, so I think it’s in the job description.  My issue with him is the very dismissive way he told me, and not making another appointment to explain- this was partly my fault, though, as I was very late to that one.  Apart from in hospital and the crisis team afterwards (and possibly some periods before, the ones that I don’t remember much, the ones were doctors gave me things to, “calm me down” and they were heavy antipsychotics), I’ve almost never seen a psychiatrist in any state other than depressed, due to successfully dodging doctors and services otherwise, because, y’know, why wouldn’t you.

I haven’t had much dealings with therapy.  I had therapy when I was a teenager after my friend committed suicide, which involved me lying through my teeth for six weeks so that I didn’t have to endure the depressing journey in a social worker’s car to a hospital ward where people came to die, and teenagers lined up on plastic seats outside, self consciously fiddling with their sleeves.  I was transfixed by a growing mole on her chest.  The journey there was always horrible- the social worker clearly believed that because I was a self harming teenager, I was an attention seeker, and explicitly told my parents so, which made my life wonderful for a little while.

I was referred to group therapy just after I left hospital, but it never transpired.  I had a short burst of CBT with a student therapist, who I liked, and who, despite cutting the sessions short because I had slipped into depression and couldn’t engage, did help me.  The therapy was for body dysmorphic disorder, and I did learn some little things that I still use now, and still find helpful.  The going out without make up thing, even just to appointments now and then, helped, and I started increasingly the times I did that, and nothing awful happened, and now I do it fairly regularly.  I’ll always wear heavy clothing and a hat (for people who have met me and been puzzled by how much I overdress, that is why), but it’s still something, and I don’t stay indoors so much now because of it all.  The problems weren’t so much the way I felt about my looks- I’ll never think I am beautiful- but the way I dealt with it, the anxiety.  And CBT did help.

Then there was psychotherapy assessments with Marigold, who, unbeknownst to me, had been assessing me for therapy for borderline personality disorder, at least, I think she did, given some of the things she asked.   In retrospect, I now understand why she said things like, “So, you write to cover up your emptiness”, which gave birth to the world’s longest silence as I had absolutely no idea what she meant, because I’d never mentioned feeling empty, and don’t.  I answered, “Er, no”, and left it there.  She said I must react extremely to normal events, and when I pressed her for what she meant (for I was confused, as it is not true, and I thought she must be referring to life events, like my dad dying and the abortion), I didn’t know what to say.  I was upset by the implication that my reaction to the abortion (grief, sadness) was, “abnormal”, but I think I had misunderstood.  I had wanted the therapy to deal with social anxiety because I’d started throwing up and shaking when I was faced with social interaction.  The PD I thought I had been hit with was avoidant personality disorder, which is one I would wholeheartedly agree with, and it’s on my rap sheet, somewhere.  It’s why BPD confused me, the whole, “problems with relationships” thing, as it has been purely social and a lot of my self esteem is tied up with how crap I feel I am in these situations and at talking to people.  But by the time the assessments were coming to a close, I’d started just biting the bullet and was feeling more in control of my anxiety on my own, and wanted to see if I could keep that up.   We both agreed we didn’t really need to continue, and it was the best decision.  We didn’t get on- she is an icicle with a flower’s name (and someone who I referred to as having all the warmth of a mass grave)- but she was gracious and helpful in our last session.  Unless something happens, or I’m forced to (which is unlikely), I think that will be my last involvement with therapy.

Then there’s the social workers and CPNs.  The first one was a waste of time.  One of the crisis team social workers (who I liked a lot, she smoked frantically out the car window when she drove me to St. Ann’s) after hospital fought for me to get a CPN as the plan then had leave me on Lithium and other random drugs while I vomited, shook and still jumped around like a mad person.  I did, and she took notes for fifteen minutes a month, and that was that.  In a fairly bad state (as I was for the year and bit after hospital) I rang her up and angrily asked her what we were supposed to be doing, as the two buses I took to our appointments were expensive, and there was no point going there.  I regret some of my behaviour with her, not least me booting the door of one of the offices during the short period on Paroxetine which kicked me into a very angry mood episode where I was raging constantly and agitated to fuck.   She encouraged me to work, despite the fact I was clearly too unwell to, and had gotten a letter from my GP who had written to her on the sly telling her to help me get benefits because I shouldn’t be working.  So, that was Haringey, which is vaguely legendary for its bad social care.  A lot of Haringey was a bit of a mess.

When I moved borough, the quality of the care I got changed.  I got a great CPN, who was incredibly helpful from the off, especially with the practical things, which is largely what I needed help with at the time.  When she left, I got a social worker who I initially didn’t get on with due to her giving me a leaflet on, “good sunshine” on our first meeting.  But as time went on I warmed to her more and more, and now I like her immensely.  She’s supportive, she’s funny and she doesn’t mollycoddle me when I’m being a dick.  I appreciate that from people in general.   I think they assign me the Slightly Alternative Ones due to my clompy shoe feet and my youth when I entered mental health services.  And I’m grateful for that because it was comforting and calming to talk about PJ Harvey with my old CPN as an anchor, and sometimes I see my social worker bombing about on her bike in her boots and it makes me smile.

I have been luckier than most with my care,  I think.  I’ve had some bad experiences, but the good ones, in the past few years, have compensated. I’ve always had a fair amount of support when I’ve asked for it, and especially support when it comes to the practical things, which are the first to fall by the wayside with me.  I would most likely be homeless now if it weren’t for them, as they’ve advocated for me, and fought for me.  One of the most stabilising influences I’ve had in my life is having a home- just somewhere to be, that I can’t bugger up and lose (I make sure I pay rent as soon as I get it in case I do get a funny upswing and think it’s a good idea to buy a thousand cups).  They sorted out my freedom pass, which is probably the single thing that I couldn’t live without, as I wouldn’t be able to afford to leave the house otherwise.  I’ve never really minded when phone calls or emails go unanswered because I know they’re fairly busy, and if it were urgent enough I’d just go down there anyway.  I am not the type of person who asks for help anyway, but when I have, they have tried.  I like the receptionist as well, who I remember humouring me during the summer when I was apparently a bit high and trying to demonstrate to everybody there that the disabled handrail (which I had never noticed) was very fun to tumble on.  My first CPN in Islington even wrote to my family to explain my diagnosis because I was having a hard time accepting it and didn’t know how to explain it to them. I appreciated that a lot.  I also appreciated them checking that the people I was with (Rob and Robert, respectively) were okay and coping, too.  They also gave me the guided tour of the crisis centre (and we were supposed to go to the hospital, but I missed the appointment), so I would know what to expect if I was admitted, and I appreciated that, too.  The run of two excellent professionals is partly why I have wanted to get into this profession; I’ve seen first hand the impact that someone being good at their job can have on a person’s life.

I’ve asked to be discharged twice within the past six months and been miffed when they won’t- the rule was, “six months off medication, if nothing happens, cheerio!” and stuff happened.  If we’re talking good treatment, I didn’t get any psychiatric appointments during that time when I probably should have, but hey ho/  But they did honour my requests not to go to the building anymore (now we meet near my house for tea), and I have fewer appointments now, except for during the summer when I was being rang a lot, as was Robert, to be checked on, and in September with the crisis team.

Most of my bad experiences have been with shite GPs.  I still hate going to see one and put it off as long as possible, or just visit a walk-in centre.

So, in conclusion- I think since the age of about 22 I’ve had quite good care with helpful staff.  There are obviously good and bad working in the system- so tell tales of horror and heroics!

15 Responses

  1. yep, Haringey was useless to me too. My home too has been hugely helpful, giving a base, somewhere safe and I wouldn’t have got it without CPN’s help. Some mh proffs are great, some truly awful, consistency would be great but never possible somehow

  2. I’ve had a mixture of good and bad… my first psychiatrist was ok, he basically said “its bipolar, have some tegretol” and every subsequent conversation ended with “its bipolar, have some tegretol” (including my complaints about the side-effects of tegretol!), but over-all he was a good guy.
    I saw a therapist who diagnosed me with bipolar (unofficially) and if she hadnt caught it i would probably still be undiagnosed now, or in a loony bin… She was also the one who pushed to get me hospitalized when i reacted badly to risperidone and tried to kill myself, so she was awesome.
    My current shrink is disorganized, has piss-poor timekeeping and scheduling skills and doesnt really listen to you when you talk. BUT, he is also a brilliant doctor when he wants to be and is the one who got me stabilized on medication that worked. Swings and roundabouts!
    I also saw a therapist years ago who, when i told her my symptoms, told me i had read them somewhere and was now trying to get a bipolar diagnosis, when i hadnt and wasnt. I was just telling her how i felt!
    When i was in hospital the consultant psychiatrist accused me of fabricating my psychiatrist, told me i didnt have bipolar and wasnt allowed to talk about anything that pertained to bipolar disorder, and that i actually had borderline personality disorder. This was after talking to a very depressed and psychotic me for 30 minutes… he was the reason that, when they took me off risperidone and i became very manic again, i basically busted myself out of hospital, i didnt want to be around dr cunt (as i nicknamed him, his real name was dr campbell) any more. Oh, and after only seeing me the once he actually decided to pull all my medications, how very professional…

  3. It’s been a long time since I’ve seen a psychiatrist, thankfully. I still recall one in Whitechapel who was like a huge spider sat behind the desk, sucking all the life out of me. I was actually in a decent mood when I went to see him – I left his office, bought a bottle of whisky and drank till I passed out.

    Since I’ve lived in Camden I have had the most wonderful GP, and this has helped me so much with both depression and gender dysphoria (she got me appointments at Charing Cross Gender Identity Clinic in record time). We’ve always discussed as equals what actions might be helpful; consequently I have felt ’empowered’ (sorry, it’s the only word I could think of) and like I’m in control. The one serious episode I’ve had in the last few years she referred me to South Camden Crisis Team, and I was very grateful for it. They were a mixed bag, but at the time I appreciated having someone come round to check up on me (they did this every day for two weeks, then I visited them every day for another two weeks). Actually they had a very nice psychiatrist, a deeply compassionate Mexican woman. I love people who radiate strength and compassion without bullshit. My GP definitely falls into that category, but she’s off on maternity leave soon. Whoever he is, I bet he’s not good enough for her!

  4. Ah Seaneen I wish I could be arsed to go into detail about this now. I do so appreciate your lengthy blog post on this topic because I feel like I am stumbling through a minefield of exploding shit aka various mental health professionals, the worst of which bring their own medical stance and opinion of what does/doesn’t exist into any resolutions to my various brain complaints. In brief my experience so far has gone like this: GP – good but double hard bastard, psychologists (various) – exasperating, consultant psychiatrist – school masterish and I just nod/cry/take any shit he gives, therapist – just totally in the wrong century but kind and fucking weird weird weird, Crisis Team – lovely on phone but possibly pointless?
    The one person who has infinitely helped me, so continues to help me to this day, is someone from a local organisation in my Borough (Barnet aka ‘no frills’ council DIY Torybastardland) who gives me the lowdown about all the PCT and CMHT staff, calls the Crisis Team for me and is now pushing for me to be referred to the Complex CMHT rather than the private psychoanalysis that my Dr R consultant shrink wants to foist me off onto.

  5. First GP before I left uni: good, had time for me, clear. GPs since then: bad, no time for me, don’t believe me, don’t even ask about me.

    Consultant Psychiatrist: excellent, he goes beyond the call of duty, gives me extra time, really listens and understands, is honest about meds being entirely hit and miss, is honest about the limitations of the health & social care systems, and after we’ve talked about me we often end up chatting about things of interest to us both (ie not my depression).

    Private Psychotherapist: excellent, very positive relationship, I miss her since she retired. Learnt a lot about myself, but not sure if that’s helped me get better.

    CPN: mediocre, nice guy, tries his best, doesn’t really understand, doesn’t do what he says he will if I don’t remind him and follow it up, often on ‘transmit’ telling me how much he’s overworked and how bad the system is.

    Crisis Team: as Seaneen says, their role isn’t clear. If they are the final desperate alternative to hospitalisation, and are just someone to come each day and check you’re not gonna do it, then fine. But their initial assessment each time implies they offer a lot more, and why do they ask you what you want them to do (if that is all they can offer)? Any time they’ve given me suggestions/advice, it’s always been unhelpful and inappropriate – because they don’t know me. But they can never hope to get to know me, because of the way they operate in short intensive bursts during crises (and sending different people each visit). So why do they think giving suggestions/advice could be a good idea? I don’t like them, though recognise they may have a small role to play.

    CBT (Behavioural Activation in a group): theoretically flawed I think, and they wouldn’t spend the time trying to explain their rationale to me, and in practice they weren’t very good at running a group either. Their one fixed limited model only works for certain people, and so they filter out anyone for whom it wouldn’t work, which makes their success rates look so high, and so they get all the govt. money going for ‘talking’ therapies. Their “strategies” for recovery might have some value but only in a common-sense way; they ended up being inflexible in how they applied them, which hurt me coz it played on my neuroses, and appealed to others in the group because of their neuroses. I left after pushing myself through 5 out of 12 sessions. An unpleasant experience.

  6. I saw a nice counsellor when I was about 18/19. She was called Kate and if I’d seen her for longer (instead of buggering off to university) things might never have escalated the way they did. I had patchy care from a variety of locums at university. Bugger all support from the mental health team or the hospital after an overdose, and no follow up care from anyone. Fell out of the system after my psychiatrist moved abroad and was never offered a follow up appointment (why do they think mental people are capable of doing the endless legwork to get the care we need? I wasn’t, and wasn’t able to ask anyone else to advocate for me either.) At one point I was offered CBT, but there was an 18 month waiting list and it just never eventuated.

    In retrospect I should never have wasted time on the university’s medical centre as they were only really used to diagnosing pregnancy, hangovers, and syphilis.

    Now I have a team care arrangement with an awesome GP who writes letters and makes phonecalls on my behalf, and a decent psychiatrist who actually called my GP to give her an update after my initial assessment. He used to be a GP himself, so understands my other health issues as well.

    The downside is that Australian healthcare is not fully subsidized so unless you have a health care card, you either find a bulkbilling doctor or you have to pay in full & get a partial refund from Medicare. The bulkbilling doctor I saw for non-MH stuff was an arsehole who told me my physical problems were just because I was an uptight person, so I gave him the boot and found my GP. Fortunately I now have a health care card, so that will help with prescription costs as well.

  7. 🙂 nice for them to get some positive feedback!
    I know you talked about the book possibly being off the cards BUT i still think no matter what your diagnoses, that one day you will have something brilliant to share with the world, you are very brave and talented.

  8. On the few occasions that I have been hospitalized the psychiatrists I have been under(not a term I like and may return to it later) have relied 100% on a chemical cure and when you have a cocktail of 5 or 6 drugs inside you its not easy to form opinions of people if I am able to use that term to describe psychiatrists.

    On discharge they send people to my home who seem pleasant enough and I know they have a job to do but as soon as we reach the point when I have some say in things we go our separate ways.

    As per previous comments I have had dealings with a mixed bag of psychiatrists outside the hospital. One has been very caring and I felt that they were on my side, but others have made me feel that I am merely cannon fodder for their rather exceptional careers.I have got used to the same questions, and they could be noting my response but they could be writing out their shopping list. I think that I get a better deal from my GP and if I need to touch base every few months a meeting with my GP would be better than a meeting with my psychiatrist.
    As far as treatment is concerned I seem to have been left to it and I have been able to develop my own strategies for avoiding mania and curtailing it before it gets out of hand.I have a user friendly version of ECT. I have always been reluctant to seek help as I would be looking at a 3 month driving ban and my own methods have served me well and on the occasion that I have been hospitalised I don’t believe that any drug would have resulted in a different outcome.
    Changing the subject slightly – a notice that my name on the recent comments list reads as “BP24/7 under new man” I wouldn’t normally mention it but Stephen Fry’s recent outburst have probably made me a little over sensitive. Not that there’s anything wrong with it.

  9. I haven’t seen anyone bad, at all, with the exception of one GP who told me that there was nothing wrong with me and that I needed to “grow up” (this was four years ago and still annoys me – maybe I do need to grow up!)

  10. I feel I could have written quite a lot of what you said! Part of the reason I went private was because I was sick of being pushed from pillow to post with different Psychs and SHO’s who didn’t listen and certainly didn’t write things down accurately! Then I actually get a proper NHS Consultant who I see on a regular basis, although we beg to differ on diagnosis… now I have another NEW NHS Consultant who apparently is very good and looks like Mick Hucknall from Simply Red and I have to sit back and wait and see what happens…

  11. My care has been sporadic. I lost my insurance at 19, and didn’t see another doctor until I was 21 1/2 and hospitalized for a suicide attempt. (It was ‘voluntary’ by which I mean they told me I was being committed one way or the other, and doing so voluntarily would make it easy to get out. The Doctor was very firm, but also fairly nice and clear about how it worked.) Before this attempt, I had been bouncing back and forth between the University and City Mental Health Offices… the University told me to go to the City, the City told me to go to the University, and I was seen by neither.

    For the next two years I struggled to see someone, and eventually fell through the cracks again until I graduated and the City suddenly had to deal. Then, I was scooped up by that system which has been a blessing. I now have a Psychiatrist who fits me perfectly: believes what I tell her but is firm when I’m being a nutcase or whining. She got me into Therapy, which is a mixed bag. The therapy itself… not so useful most times. I have most of the coping mechanisms they suggest already set up. HOWEVER, having a Therapist who is willing to listen to me and just point out when I’m being irrational without being at all angry is priceless. I have no words for it. I can go in and vent and say what I think and she listens and helps me keep this crap from hitting my fiance in the face. He is a huge support, but she also helps me tell when I’m leaning on him too hard.

    Getting medications has been horrible from the start. I’m limited in what I can take due to blood draw issues and no money. It has been very hard to get me stable and keep me stable when medications are so difficult to get.

    All in all, I have had no issues personality wise with most folks I deal with. Dealing with someone unpleasant and not taking it personally and standing up for myself is something I’ve excelled at most of my life. GETTING any care has been the problem.

    That said, when the care has lapsed, my University friends have been a support I can’t even begin to explain. They’re here for me whether I’m mentally here or not, and they don’t seem to mind one way or the other. They say I help them; I doubt this, but they’re very insistent about how important calls to them and such are. Usually, I call because I need a distraction and ask them all about their day because I don’t want to talk about mine. If it helps, it wasn’t an intentional action! My family is strongly supportive, even when my father can’t stand my symptoms. Lately, he has finally been reading up on it (after 12 years) and taking actions to help us get along better. They have made up for years of no care or medications by holding everything together for me and getting in people’s faces to force them to hear that I need care when it has been required.

    So, mixed opinion I guess. Terrible at follow up or providing medications and care unless forced to. Actual doctors and care haven’t been an issue, but I think that is partially my personality.

    One good thing is that it has been immediately apparent to everyone since I was age 14 what the problem was. I have never had any real argument about WHAT the problem is, only WHOSE job it is to care for it!

  12. Hi there
    Sounds to me like have been having a shit of a time with professionals lately in regards to treatment and diagnoses

    I’m from Australia and echo Janeilis post in many ways. we are luck to have a team care system that is mostly subsidised. I have found though that money is power when you are not mentally well which kinda blows as of course then is when you are least likely to have it . I havent had much luck with the free services offered here but thats just me

    I have tried a few psychs and found that the best ones were
    a) Very hard to get in to see and
    b) Change like wounded bullsbut are willing to negotiate better fees if you ask nicely.

    A Psych would be the best person to check your latest diagnoses (which seems a little off to say the least) and get you a bit on an even keel with meds if thats the best bet or recomend other options such as psychotherapy if that is the better bet.

    The best one I found was recomended to me by a fellow MI person. Maybe others who live close to you could email details of good GPs or Psychs if they have one near by?

    On the money front you have thousands of readers Im guessing dont want to see you struggling and.. Asking us to chip a few dollars each in for a few visits to see good proffesionals if thats what you want to do would not to me seem in the least unfair as we all enjoy reading your blog.

    On the getting help front keep trying.. you will get the right person/ people eventually .

  13. I’ve just started blogging about my own manic break and hospitalization. It’s about recovery and treatment, but more importantly about discovery of a new post-religion faith where there is no hell, no original sin, you are God, and heaven on earth is real, radiant and right around the corner. A wild and triumphant ride…..

  14. Luckily most of the psychiatrists I have been on the caseload of, with the exception of Crisis Team psychs have been fairly useful. I have seen both sides as well, NHS and private.

    I’ve had good CPNs, crap CPNs and CPNs that make me sit up and wonder why they are in the profession, but then that’s life!

    As for the Crisis Team I am under their care at the moment and have been since Friday. They are willing to help and ring me, take me out for coffee, accompany me to psych appointments, and talk to me but apart from babysitting me to the extent that they are certain I am alive every 24 hours, like most other people I have no idea why they exist.

    It also depends on area. The Crisis Team in Kensington & Chelsea (where I am now) are much better than Battersea, but then Battersea had a better psychiatrist. It’s all a game of chance!

    I have never had a social worker, although I am due to see one on Wednesday to try and sort out my benefits and see if their is any possibility in getting housing benefit and out of living with the parents.

    Ruth x

  15. Its nice to read a fairly positive post about professionals for a change. Although I still disagree with the psych that gave you the BPD diagnosis!!!! GRR!

    I’ve had a mixture of experiences but I would say the therapists Ive had in the last few years and the awesome psychologist I had before that make up for the crappy ones! I do believe if it wasnt for them I wouldn’t have been able to make the changes I have made 🙂

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