NHS therapy

[Em00]

Hi folks. I was wondering if anyone could help. I'm currently seeing an NHS psychologist. I've seen her for about 18 sessions. I have co-morbid conditions of Aspergers syndrome, bipolar and bpd. My ocd has repeatedly made me suicidal and engage in dangerous behaviour. I've previously had dialectical behaviour therapy. I've also had one lot of cbt for contamination ocd (not touching my main issue of responsibility /harm) 

Long story short - psychologist has been quite broad in what she's doing with me - dbt and cbt to address the suicidal and other issues. However they're only giving me a few more sessions as I've already exceeded their limit. They said I'd then have to wait over a year before I'd be considered for any 'further' therapy. What we've done so far has been really helpful (finally taking ALL of my issues into consideration) but now they want to stop. The psychologist isn't happy with it and neither am I. She said she's going to try and pull everything together and do a plan for when we finish. We haven't even started to address my obsessive thinking. Do I have a leg to stand on to argue against their limits? It's sent my anxiety spiking again and it seems pointless and illogical not doing things properly. ?

[BelAnna]

Yes, of course you do. You have multiple, complex disorders and need long-term treatment for them. Ask your Psychologist if there is any appeal's process for requesting further treatment. 

Having intensive treatment for a shortish period followed by a whole year without any is not adequate. Perhaps you can also insist that only one or two of your disorders were addressed and you need more time to address the bipolar or something. 

I only have OCD with Depression but had five years of appointments with one NHS Psychologist at the CMHT a few years ago. 

Edited May 6, 2018 by BelAnna

[Em00]

They're just obsessed with because I've had 'lots' of therapy before, I shouldn't have more. This has been the constant fight for five years (apart from the one lot of cbt), I've been acutely unwell, in and out of hospital and they've just said no. They finally agreed to see me after a big meeting deciding I was going to get referred out of area, and now they're cutting it short because we all just need 20 sessions of cbt... ? During that time I've never put in a complaint. I don't know if that would just make it worse. 

[Lynz]

I'm really sorry to hear you're going through all this .

I can't offer any advice unfortunately but I think @Ashley would be your best bet for advice regarding the procedures for therapy and what your rights are etc.

Good luck x

[Em00]

Thanks Lynz. 

[kaheath80]

I got 20 sessions too and then I wasn’t allowed any more. I made some good progress with my OCD but the other stuff I need a lot more help with. But I do get it, I was on the waiting list for 18 months so they do need to set a limit I guess otherwise the waiting list will just get worse. 

[Ashley]

22 hours ago, Em00 said:

Do I have a leg to stand on to argue against their limits?

You have four, your own two and my two!!!

 

22 hours ago, Em00 said:

They said I'd then have to wait over a year before I'd be considered for any 'further' therapy.

Absolutely wrong, in accurate and inappropriate.  Get them to confirm that in writing Em, I am pretty sure they won't because it's simply not true.  What should happen is not straight forward wither, but being told you have to wait a year is just wrong.

Assuming this is IAPT, once a patient reaches the end of therapy (6-18 sessions), one of three things should happen:

1 - If therapy is going well, they should offer another few sessions with the same therapist (i.e. 6-10 more).

2 - If they feel they cant take you any further they should recommend your GP refer you to local secondary care (sadly that may mean a wait for that service).

3 - In some rare cases, if the service feels the patient needs a national specialist they may suggest a referral to the national clinic (again this may involve a wait).

So there are a few options, don't accept what they haver told you Em, it's simply not true.

[Em00]

18 minutes ago, Ashley said:

You have four, your own two and my two!!!

 

Absolutely wrong, in accurate and inappropriate.  Get them to confirm that in writing Em, I am pretty sure they won't because it's simply not true.  What should happen is not straight forward wither, but being told you have to wait a year is just wrong.

Assuming this is IAPT, once a patient reaches the end of therapy (6-18 sessions), one of three things should happen:

1 - If therapy is going well, they should offer another few sessions with the same therapist (i.e. 6-10 more).

2 - If they feel they cant take you any further they should recommend your GP refer you to local secondary care (sadly that may mean a wait for that service).

3 - In some rare cases, if the service feels the patient needs a national specialist they may suggest a referral to the national clinic (again this may involve a wait).

So there are a few options, don't accept what they haver told you Em, it's simply not true.

Thanks Ashley - I'm already under secondary services, so this is with the psychology dept of the cmht. I get that there are limits on services, but I don't get why you wouldn't let someone properly finish the work they are doing. 

First they were looking at referral to the Maudsley, then they offered more local cbt, the psychologist was then thinking of getting me to do more dbt as that would be more intensive and I'd work on the ocd under that service also. But now looks like they won't consider anything else for at least a year. It's taken so much fighting to get to this point already, I can't face arguing with them anymore... ?

[Angst]

I think that there is a difference between the IAPT treatment route and the CMHT treatment route. I started a treatment request on the IAPT route and got re-routed to CMHT and got a poor deal because of age discrimination. I need to go back to the IAPT request stage and not get re-routed.

This sounds abstract but accessing therapy can be a maze. In my case with IAPT, wellbeing centre, the local commissioning group, the treatment provider and the CMHT.

An advocate has suggested IN MY CASE  not allowing myself to being re routed via CMHT. I need an advocate and you need an advocate with experience of the system especially in cases of ‘complex’ cases. I fall into this category as well.

But I reckon you need to remain with your CMHT given the nature of your complex case. Given funding problems over the years, a lot of people have been referred back to their GP. I fully support the NHS but we have the lowest expenditure per head in Western Europe.

It is good that your psychologist will act as an internally placed advocate in the team meetings that will discuss your case at the CMHT. Could you discuss with him or her how to strengthen your position? But you need an experienced advocate who knows the system. You have done well so far and like you I am weary. But accessing a service at times we need help from a person who knows how to strategically apply pressure.

[Ashley]

20 hours ago, Em00 said:

But now looks like they won't consider anything else for at least a year. It's taken so much fighting to get to this point already, I can't face arguing with them anymore... ?

 

Then let me argue with them for you (or ask a family member to be your advocate).  The truth is they will only not consider anything else for a year if you let them get away with that.  Maybe it boils down to this, they feel they don't know how to treat you?  Is that possible?  If so, then you need to pressure them to refer you to somewhere that does. 

That's where it may be worth seeking a referral to a specialist service like CADAT, they will of course have links with other MH specialist clinics at the Maudsley and can often create a package of treatment around your varied co-morbidity. Then when that specialist service is ready to discharge you back to the CMHT hopefully it can be a seamless referral back to the CMHT and with you needing only minimal therapy input.... in theory of course   But it is an option.

 

[Em00]

2 hours ago, Ashley said:

 

Then let me argue with them for you (or ask a family member to be your advocate).  The truth is they will only not consider anything else for a year if you let them get away with that.  Maybe it boils down to this, they feel they don't know how to treat you?  Is that possible?  If so, then you need to pressure them to refer you to somewhere that does. 

That's where it may be worth seeking a referral to a specialist service like CADAT, they will of course have links with other MH specialist clinics at the Maudsley and can often create a package of treatment around your varied co-morbidity. Then when that specialist service is ready to discharge you back to the CMHT hopefully it can be a seamless referral back to the CMHT and with you needing only minimal therapy input.... in theory of course   But it is an option.

 

The stressful thing is the work I've been doing with this psychologist has been helpful. I was anxious at first because it wasn't typical prescriptive cbt, but then I realised she was taking everything into consideration. Nothing I've done before has been particularly holistic. So they give me this and are now going to take it away. My intrusive thoughts have shot up. I'm really struggling to understand why they have to be so inflexible. I've had therapy before, that's all they care about. 

Maudsley was the option like I mentioned, but I'm not sure what they think of that anymore.