Monthly Archives: December 2012

Booking an assessment with Mind.

The day after my first GP appointment, I called Mind to arrange counselling. I made the call sitting outside in the cold on my lunch break, trying to find a place where no one would hear me. I was anxious. The first time I saw a GP about my mental health, in 2003, I was also given a number for counselling. Back then, I was similarly sitting on a park bench making the call from my mobile. The receptionist who took my call insisted that I do an assessment over the phone, including the question: “Do you have any suicide plans?” I did. It threw me to be asked it so blatantly. I now know to be prepared for that, but back then it was my first ever contact with mental health services. I didn’t want to discuss my suicide plans over the phone, in a public place, and I was living in a house with 7 other people so there was nowhere I could go to make a private call. I asked her whether I had to answer, she said yes, and I hung up. She hadn’t taken my contact details and I didn’t seek help again for 6 months.

This time, the Mind receptionist put me straight through to the counselling coordinator, but I got her voicemail and left  a message. I was nervous about that because it meant I then couldn’t control when I took the call, but I didn’t want to put it off. Ten days later, I hadn’t been called back so I tried again. Again, it went to voicemail, I left my details again and waited for a callback.

This time, the coordinator responded the following day. Apparently she couldn’t make out my number in the first voicemail, so she was glad I called back. This seems likely: my phone is on its last legs and I’m hanging out for an upgrade. She took some basic contact details and said they can offer out-of-hours appointments if I can “make the time” to come in for an assessment during working hours. Because of the Christmas break, the next available appointment wouldn’t be for three weeks.

So my assessment is booked for 7th January and I received a confirmation letter to my home address, with a leaflet explaining Mind’s counselling services. It will be £15 per session as I’m working full time (significantly cheaper than if I went private), but there’s a limit of 8-12 sessions. I’m hopeful that will be enough, but if it’s not, I’m concerned that I will have built rapport with this counsellor and then have to stop and find someone else. They offer group therapy after individual counselling is finished, but group therapy sounds like my worst nightmare. My other concern about Mind is not being able to choose my counsellor. If I was going private, I would research counsellors beforehand, but here I have to go with what I’m given.

It’s a week now until my assessment. I still don’t know what to expect; the leaflet says it’s to “assess your needs appropriately”, but who knows what that means? I would have liked more specific information, such as what sort of questions I will be asked. The coordinator was also vague about how long I’ll have to wait to see a counsellor, as it depends on how “flexible” I am. I suppose that means I choosing between a short waiting time and seeing a female counsellor in the evening (my minimum requirement).

But I appreciated that the coordinator was kind, and at least she didn’t ask me to be assessed over the phone.

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What happened next.

I went for my first GP appointment three weeks ago, you can read the full transcript here. Overall, it was more positive than I had hoped for. The GP was sensitive and took me seriously, and I was pleased to be offered counselling. I felt a bit pressured into taking antidepressants, and that he wasn’t really open to engaging with my concerns about medication. I also felt it would have been helpful if he’d been a bit more informed about the service that Mind offers, in particular what type of counselling it is (I’m assuming CBT) and whether they offer out-of-hours appointments.

The day after my appointment, I called Mind during my lunchbreak. The receptionist put me through to the counselling team and their phone number rang through to voicemail, so I left a message.

The following afternoon I still hadn’t had  a callback from Mind. I was feeling numb and tired; I had the Citalopram prescription sitting in my bag. I hadn’t thought I would ever take antidepressants again, but the lack of a call-back about counselling made me think that that could be a long process and I’d already waited so long to seek help. Although I know medication can be harmful, I hadn’t had unmanageable side effects previously and this was a significantly lower dose than I’d been on in the past (10mg compared with 40mg), so I figured I’d give it a go.

I filled the prescription and started taking it the next morning. After problems with extreme tiredness – falling asleep by 9pm every night – I switched to taking the medication in the evening. I then started having problems with waking up very early, which I thought may have been a side effect but the GP later explained that this isn’t a known side effect and my sleeping problems are most likely just due to the depression.

Twelve days after beginning on Citalopram I had my follow-up appointment. This time it was very brief. I’d had a blood test in the interim with a lovely nurse (a Bangladeshi doctor who was working through her qualifications to become a doctor in the UK) and the GP confirmed that I’m not even remotely anaemic. He asked how the medication was going, and I replied that so far I’d not noticed any difference. He didn’t ask about the counselling, but I volunteered that I now had an initial assessment booked for 7th January. He asked that I make an appointment with him for another month’s time and if I’m feeling a bit better but not a lot, then he will increase the Citalopram dose.

I also asked how he had made the decision to put me on Citalopram and not something else. He replied that GPs generally now prescribe SSRIs instead of the older TCAs, and its usually Sertraline or Citalopram. I said that I understood that, but wanted to know how he decided on Citalopram rather than Sertraline or something else such as Escitalopram. He explained that it really just comes down to professional experience, and that he’s had good results on Citalopram with his patients. He added that Escitalopram is expensive, so it would never be the first choice. This seems to be broadly in line with the NICE Guidance, which is fine, but I am left with the feeling that my GP views antidepressants as the central treatment option, with counselling as a slightly hippy-ish add-on.

It’s now just over three weeks since my first appointment. I’ve had some days of feeling quite a bit better, but today I’m feeling quite a lot worse, and I never know whether to attribute any gains to treatment or not. While Christmas is hard for many people, it’s a good time of year for me and I always feel better with time off work spent with loved ones, cooking for them and socialising. Today is the first day that all my family have gone home, and the numbness has descended again.

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Black Dog Tribe.

Just a quick update to thank the wonderful Black Dog Tribe, who have featured my first blog post. Read it here.

My first GP appointment, transcribed.

Two weeks ago, I went to see the GP about my mental health for the first time in 7 years and I decided to audio record the interview. I was conscious that my memory of what happened would be influenced by my experience of it, so I wanted a more objective record of exactly how it went. And I wanted to be able to share it here, to give a better account of how it happened. This is my experience, not necessarily a representation of the service anyone else would get from a doctor in their local NHS practice, but it’s one example.

—————————————————————————————————————————

GP: Hi, come in.

Me: Hi.

GP: Hi, take a seat. [inaudible].

Me: Um. [pause]. I’ve had low mood for about 18 months now and I’m just a bit tired so [laughs], I thought I’d come to the GP and talk about it and see if there’s anything I can do.

GP: Okay. So what’s been going on?

Me: Um [sighs]. I don’t know if there’s anything in particular that’s been going on, it’s just, um [pause], yeah, I dunno, it’s just kind of [pause] continuous, so I don’t know [laughs].

GP: Right.

Me: It kind of goes up and down and it’s not as bad as it has been, but…

GP: Hmm.

Me: Um, I think, last time I came to the GP it was a while ago…

GP: Yep.

Me: I was going to talk about it then but I didn’t feel able to…

GP: Right.

Me: So it’s taken me a while to come back.

GP: Okay, right.

Me: Um. [pause] I’ve had depression in the past but that was quite a while ago.

GP: Okay. Were you on medication?

Me: Yeah. I was on Zoloft, and then on Citalopram.

GP: Okay. And how long was the treatment for?

Me: Um, it was probably, I think I was on it for a couple of years.

GP: Right, okay. And then did you finish the last treatment?

Me: Um, it was 2005.

GP: 2005?

Me: Yeah, a long time ago.

GP: So you’ve been okay since then?

Me: Yeah, ah, yeah, I’ve been okay, yeah. I was fine for a long time and so, yeah.

GP: Okay. So when did this current low mood start?

Me: Um, about 18 months ago.

GP: And ah, are you able to sleep okay?

Me: Um, it, it comes and goes. It’s not so bad at the moment, but it, sometimes it, I’ll wake up in the night. Like I’m fine falling asleep, but it’s just that I wake up quite early.

GP: Right, okay. So how many hours of sleep would you say you get?

Me: Um. At the moment it’s okay, I’m getting about 7 hours of sleep at the moment…

GP: Right, okay.

Me: But other times it will be 4 or 5.

GP: Right, okay. And your appetite?

Me: Appetite is fine.

GP: [inaudible]

Me: Ah, I have lost a bit of weight, but I think that’s just because I’ve been exercising.

GP: Okay, okay. Right. And any thoughts of self harm?

Me: Ah [pause]. I think about it but it’s not something I’m doing.

GP: Right. How often do you think about it?

Me: [pause] Um. Quite a lot, like it’s always sort of there, but I.

GP: Okay, right. But you haven’t got, haven’t got any kind of plans or anything? No? Okay. But have you self harmed, cut yourself or…?

Me: I have in the past, but not this time.

GP: Not now, okay. Are you in a relationship currently?

Me: Yes.

GP: And does he support you?

Me: Yeah. I’ve spoken to my partner about it, but only recently.

GP: [inaudible] right. Now, how are your energy levels?

Me: Not great [laughs]

GP: Right.

Me: I’ve just got that feeling of being kind of heavy, all the time.

GP: Right, yeah, okay. Are you enjoying things you normally enjoy, like going out with friends and things?

Me: Not really. Like, yeah [pause]. Not as much as, everything’s just more of an effort.

GP: Right, okay, okay.

Me: [inaudible]

GP: And alcohol?

Me: Um, I’ve been managing it, it’s not too, yeah. I probably should drink less.

GP: Ah okay, right. Drugs…?

Me: No.

GP: Smoking?

Me: Oh smoking, yeah.

GP: Right, okay. Now, um, the other thing is that obviously, you know, with a history of depression and the way you are feeling as well, I think you would know [inaudible]. Now compared to the last time you started on medication…

Me: Yeah?

GP: Do you think you are feeling the same or getting towards feeling, you know, the same again?

Me: Um [pause], yeah, it’s pretty similar.

GP: Okay. Did you have any counselling or…?

Me: Yeah.

GP: You did? Okay, right. Did you find it helpful?

Me: Um [pause]. Not [pause] hmm. I, well, I had counselling and then I was referred to a psychiatrist as well…

GP: Right.

Me: It [pause]. Yeah. I think I would like counselling again, but I didn’t have a very good relationship with my psychiatrist.

GP: Right, okay. Yes. Now, with the counselling, we can refer you to our psychologist.

Me: Mmm.

GP: And the waiting period is normally a couple of months or something.

Me: Okay.

GP: But then there’s a, a place called Mind.

Me: Yeah, I know Mind.

GP: Then they can give you, you know [inaudible]. And they charge, I think it’s £5 a session.

Me: Okay, so it’s not expensive.

GP:  So I can actually give you their number, and then if you would like I could [inaudible] probably you can do…

Me: Right, okay. I might give Mind a go.

GP: Yes, you’ll get in quicker.

Me: What sort of counselling is it?

GP: Ah, I think it’s one-on-one, yeah [inaudible] they decide the number of sessions you need to do, and then in combination with that kind of treatment I think maybe we’ll start you on some antidepressants as well.

Me: Okay.

GP: Because the last time we saw you was May last year, and if at the time you were having these issues and you couldn’t talk about it and it’s still the same now, then I think we should start you on some Citalopram maybe?

Me: Okay.

GP: But it depends on you, if you want to give the counselling a go first or whether…

Me: Yeah.

GP: …or do you want to, it depends on how you feel, you know?

Me: Yeah.

GP: The thing is, I think that you are probably moderately depressed.

Me: Mmm.

GP: And drug treatment may be beneficial.

Me: Yeah. I suppose I’m not quite sure about antidepressants, I’m sort of [pause]. Yeah. Are they really effective or not, you know?

GP: Yeah they are, they are. Because for somebody who’s had depression in the past, sometimes there could be a physiological reason, or an underlying cause for it.

Me: Yeah.

GP: And it’s due to the seratonin production. Sometimes, for some reason it does not produce enough, and if it does not produce enough, there’s nothing you can do. You can try everything to lift up your mood, but it still doesn’t [inaudible]. Your body for some reason doesn’t produce enough serotonin, so therefore when you do take the medication it stops the breakdown of seratonin and therefore you take that and it elevates the mood. So it will help. The thing is, ah, [pause] you know that people, some people think, oh well it’s…

Me: It’s not a happy pill!

GP: Yeah. But we find, it depends [inaudible] initially it takes about two weeks for it to kick in and then it starts to accumulate and then the way that people realise that, you know, its effect, is when they stop.

Me: Yeah.

GP: Sometimes they’ve been taking it for a while and they’re feeling alright and then they stop and when they start getting depressed again they know, that’s when they realise it was working.

Me: Yeah.

GP: So it’s a slow, you know, kind of treatment. It takes time to build it up. But it depends if you want to give Mind a go first, or whether you want to start, you know, on the antidepressants.

Me: Um. And Mind, they usually don’t have a waiting time, is that?

GP: Ah, I think, Mind’s probably shorter than our psychologist. A week or two.

Me: Ah, okay.

GP: So if you like, you can wait and see them, that would be fine.

Me: And do they have, do you know, do they have appointments only in office hours, or..?

GP: I think probably. I think it’s probably that, 9 to 5. I mean you’ll find all the psychologists will be in office hours.

Me: Yeah. It’s a bit hard for me.

GP: Yeah.

Me: I don’t like, telling people at work that…

GP: Yeah. So that’s what it is. Now ah, it’s entirely, I think you know maybe the antidepressants are [inaudible]. Because you’ve got a strong history, a past history of depression, I think you know you may benefit from, ah, [inaudible].

Me: Mmm. [pause] Can I take a prescription and then…

GP: Yeah, I can give you a prescription now, start you out on the lowest dose, and then I’d like to see you in a couple of weeks time.

Me: Okay.

GP: And see how you’re getting on [inaudible].

Me: Yeah, okay. Thank you.

[GP typing]

GP: Are you on the pill?

Me: No. I’ve got the coil.

GP: Ah, okay. And how are your periods?

Me: Yeah, they’re fine.

GP: Not heavy at all?

Me: No, they are. But it’s been like that since I got the coil.

GP: Mmm, riiight. Because you look a bit pale to me, you know, you may have anaemia or…

[checks my eyes]

GP: Are you feeling more tired than usual?

Me: Yeah.

GP: I think we’ll just get a blood test done to check your iron levels.

Me: Okay.

GP: Because sometimes a combination of factors, you know, can actually affect your mood. You know, being tired already from iron deficiency, and that can also make your mood a bit lower.

Me: Mmm, okay.

[GP writing]

GP: And how’s your self esteem? Your confidence?

Me: Mmm, could be better [laughs]

[GP typing]

GP: Do you know which antidepressants you were on in the past?

Me: Yeah, I was on Zoloft to start with, then I changed to Citalopram.

GP: Right, okay.

[GP printing prescription]

GP: Now the Citalopram is one a day. If you take it during the day and you feel, you know, a bit tired, then take it in the evening.

Me: Okay.

GP: And then let me get you the number for Mind.

[pause]

GP: [inaudible]

Me: Okay

GP: That’s the Citalopram, 10mg is the lowest dose, and I will see you in a couple of weeks.

Me: Okay, alright, thank you.

GP: Okay

[inaudible short conversation as I’m getting up to leave]

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Preparing to disclose.

Tomorrow morning I have the appointment with my GP. Since I made the appointment, I’ve been mulling over a couple of questions: Firstly, what am I going to tell? And then, what help do I actually want?

What am I going to tell? When I moved to the UK and registered with my GP, I was asked to make an appointment with a nurse to give my medical history. I never did. Partly because I never got around to it, but also partly because I was worried about disclosing my history of mental health problems and having that on my patient record. That’s still worrying me now.

Tomorrow, I will most likely tell the doctor that I’ve been feeling low for over 18 months and that I don’t feel that I’m getting better. It’s pretty vague, and I wonder whether it will be taken seriously enough to get me the help I want. I could disclose my suicidal thoughts, but although they’re preoccupying, I haven’t got a plan right now and I know that’s the question I’ll be asked as the measure of whether things are really serious.

Alternatively, I could disclose my mental health history. This may result in me being taken more seriously, but then that information is on my patient record and every time I seek help (for anything, not just my mental health) it may be seen through the lens of those previous diagnoses – diagnoses which I actually disputed at the time. Realistically, I feel okay about disclosing that I’ve had depression and that I’ve been prescribed Sertraline and Citalopram previously. Depression feels more acceptable, normal even. It’s what most people think of when we say ‘1 in 4’ of us will have a mental health problem. But I’m not okay with disclosing that I was treated by a psychiatrist and diagnosed with BPD and a borderline eating disorder, that I have a history of cutting, nor that I was diagnosed as alcohol dependent and attended alcohol counselling and AA.

And what help do I actually want? I know that I’m tired of feeling like this, and I want to be happy again. But I’m still not convinced that the GP can offer me anything that will help me achieve this. I expect that I will either not be offered any help, or if I am, it will be either anti-depressants or a referral for a few sessions of CBT that I may have to wait months for. CBT has not been hugely helpful for me in the past and I’ve already worked my way through plenty of online resources with little result. I’m not sure what face-to-face has to add. What I really want is a referral to a therapist, sometime quite soon, and a choice of who that therapist is and what type of therapy they’re offering.

There’s actually one other question on my mind: who will I be telling? I visit my GP so rarely that I don’t know any of the doctors and they don’t know me. I don’t know if the doctor I’m going to see has any expertise in dealing with mental health, or if they hold judgemental beliefs about people with mental health problems. This makes me feel like seeking help through my GP is actually a big risk: a negative experience could set me back, rather than moving me forward. Tomorrow will tell.

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Sectioned

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