“My psychiatrist and care coordinator have admitted that the CMHT is overwhelmed with new referrals, who are suffering mentally as a result of the pandemic. How do they make room for this coronavirus influx? By getting rid of their long-termers.”

@lucywriter’s #MadCovidDiaries 05.02.2021

TW: Suicide, Self-Harm

‘It was a pleasure talking to you, Lucy,’ he says on the phone. ‘I hope not to see you again.’

And just like that, after seven years, my psychiatrist has discharged me from secondary mental health services in one 20-minute phone call.

I knew it was coming; it was mooted at my previous appointment (also on the phone), and my care co-ordinator has been preparing me, too (again, by phone).  

My feelings? Mixed. I was referred to the CMHT years ago after a suicide attempt, my mental health having worsened to the point that I was regularly in crisis, my life in danger.

Since then, there have been ups and downs – both in my mental health, and in my experience with services. I’ve been very, very poorly at times: taken to hospital by ambulance bleeding, my head full of bad thoughts; rushed into ITU with a GCS of 3 and put on a ventilator; sectioned for my own safety.

The failings of the CMHT have far outweighed its successes. I’ve been through a string of psychiatrists, most of them moving on within six to 12 months, meaning I’ve had to go over my story over and over again, with no consistency of care. I’ve had one care coordinator who was always prepared to fight my corner, but several who have been lazy and unreliable, seemingly with no knowledge of what it’s actually like to be mental. I’ve had my life saved by the crisis team, but also been told that if I want to kill myself, that’s my responsibility.

I’ve also been deeply, irreparably harmed by the application of a BPD label, which found its way into my notes by stealth, and from that point on, shaped the ‘care’ I was given, resulting in casual contempt from mental health professionals, cruel and dismissive contact with crisis teams, and premature discharge from hospital: ‘There’s nothing we can do for you here.’

Even though during a period of good health, I contested the diagnosis and eventually had it removed, I don’t think I’ll ever recover from being told my personality was disordered, diseased: something poisonous at my very core, the essence of who I am.

But there have been positives, too, a handful of people who genuinely saved my life: that kick-ass care coordinator, a crisis team nurse who treated me as a human being rather than a diagnosis, and the psychologist who, when I turned up for an appointment bleeding and consumed by the evil in me, refused to let me leave until she’d found me a hospital bed.

Leaving secondary services, even though they’ve caused turmoil on many occasions, feels daunting, then: the removal of a safety net that while full of gaping holes, also had the ability to stop me crashing to the ground.

No longer will I have the security of seeing a psychiatrist every few months, or being able to phone my care coordinator for support. I’m going it alone, and it’s somewhat galling that discharge happened by phone, not having seen anyone from my team in person, or even on a video call, since the start of 2020.

There’s also the simmering resentment that this should not be happening, and wouldn’t in non-Covid times. Both my psychiatrist and care coordinator have admitted that the CMHT is overwhelmed with new referrals who are suffering mentally as a result of the pandemic, whether they be frontline workers, bereaved family members, or people overwhelmed by fear and loneliness.

How do they make room for this coronavirus influx? By getting rid of their long-termers, we troublesome service users who aren’t an easy fix, and as a result, make their figures look bad, making way for people who are likely to be ‘cured’ in 12 months with some antidepressants and CBT.

I sympathise with people who’ve been so badly affected by Covid. I don’t doubt the huge emotional impact it’s had on many. But the fact that more people are in need of mental health services doesn’t mean that those of us who’ve been under services for years are no longer in need. It simply doesn’t make sense.

I dislike making parallels between mental and physical healthcare, but yet again the disparity makes itself known. Surely no one with a long history of type 1 diabetes would be discharged from their clinician to make way for someone with newly developed type 2? So why should it be different for people with long-term mental illnesses?

It’s a rhetorical question, because we know why: money and resources. Not enough of either. So decisions have to be made: do we continue to treat someone whose condition is likely to be lifelong (my psychiatrist says as much, and expects that I’ll always need medication), or do we shuffle them out so instead people with newer, and arguably milder, illnesses can be treated?

It shouldn’t be either/or, but in a grossly underfunded system where staff burnout is a perennial problem, these decisions are inevitable – and either way, people who need support are missing out.

It worries me, too, that there’s a new hierarchy of mental illness, with people who have Covid-related emotional trauma at the top: the heroes and warriors of the pandemic. I’m fortunate that I don’t have a history of trauma, but for people who’ve been fighting for years to get the right support for PTSD and cPTSD, seeing these new referrals – deserving though they may be – being handed that support on a plate must be a particularly hefty kick in the teeth.

Aside from my worries about what’ll happen if I become ill again, being discharged from the CMHT has also shaken my sense of identity. I know plenty of people say their mental illness doesn’t define them, but mine does. How could it not, when it’s dictated the course of my life? Now, suddenly, I’m not sure where my identity lies. Am I still part of #MadTwitter, for example? Can I still define myself as someone with severe mental illness if I no longer have a psychiatrist?

Still, though, I must think positive (sigh). And there are positives, without a doubt. No more pressure to go through more psychology sessions that I don’t want or need. No more of the overwhelming anxiety that I get before every psych appointment. No more the endless, endless fight to justify why that bloody BPD label doesn’t apply to me, because while it’s no longer a formal diagnosis, its spectre hangs over my every interaction with the CMHT.

It’s in many ways a relief, and also some sort of triumph. Covid or not, I don’t suppose I’d have been discharged had my mental health been erratic. I didn’t have a hospital admission for the whole of 2020 (with the exception of a period in the day hospital, which I don’t really count), and my last episode of crisis was nine months ago. I’m more stable than I have been in years, and while I put it down to medication rather than anything I’ve done, it’s a small and liberating victory to be capable of managing under primary care.

I’ll try to hang onto that as I await the letter formally discharging me from the CMHT. I’ll try to frame it as a good thing, rather than a scary one. I’ll try not to get hung up on the injustice of a system that has to kick some people out to let others in, and try not to hold a grudge against my psych for putting me on the off-roll list.

It is what it is. I just hope it works out, because I really don’t want to be another Covid casualty, albeit mentally rather than physically.

@lucywriter

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