Mental health services in the UK

It’s pretty cool that we don’t have to pay for medical treatment, but for things like therapy that require time to be effective, it can mean that waiting lists are long and you may not have a choice about your therapist.
For me the most important step was seeing the GP but this can be problematic if your doctor has little experience with mental health disorders. But remember, you can ask for who is good with mh conditions, and make another appointment you don’t have to settle for being misunderstood and turned away.
The NHS does have some brilliant therapists, psychiatrists and psychologists, but you have to get into the system first.

For anyone who suffers with depression or anxiety, you will likely be put onto a cbt programme. Initially I had six “low intensity” sessions, and as I understand it, it’s commonly used as a way to give you a point of contact during the wait for the longer cbt.
For some people the 6 sessions are enough, but for me it wasn’t.
“High intensity” IAPT meant meeting a new clinical psychologist and having around 20 sessions over a period of about 9 months. This was good because you have more time, and therefore more chance to develop a better relationship and trust with your therapist. They also assess risk and ask about medications and you can ask them to phone your GP if you are thinking about going on medication. This took away the element of fear over explaining my situation in detail to a doctor, and made my transition onto medication much more smooth. On a personal note, I also struggle with anxiety when speaking so it was a life saver!

Child and Adolescent Mental Health Services
Oh CAHMS. Where to begin?! Well. Personally, my experience was PANTS. I felt misunderstood, belittled and let down. But that was all down to geography. Where I lived at the time, there was only a very small service. I imagine the waiting lists can be lengthy in larger cities, but the expertise and efficacy is (hopefully?!) far better.

Eating disorder services
Most treatment is outpatient in the UK. Inpatient treatment is primarily for physical management rather then therapy, aside from a few programmes for adolescents that I’ve heard of.
Again, and as with anything NHS related, the service you are referred to depends on where you live. The bigger the service, the greater the chance you can ask to change therapists if you don’t like your allocated one.
Groups and CBT are the main therapies used, but many other things are incorporated and many people (myself included) have had and continue to have treatment despite having other conditions as well.

If you are a student you can usually find a contact number or email for a youth service that’s free in your area. These are typically time limited, but it was that first counsellor that gave me the courage to go to the GP and get specialised help.
There are also counsellors at some GP services, so don’t be afraid to ask 🙂

oops.. I forget about CMHT
CMHT stands for Community Mental Health Team. Every county should have one, and they are groups of psychiatrists, psychologists, psychiatric nurses, social workers and occupational therapists. They are usually classes as secondary care- meaning you wouldn’t be sent to them if you could be helped with a lower level of care. The CMHT deal with more complex cases, often taking referrals from those seen in a and e for suicidality, psychosis etc. Because they are a team, your care is monitored and discussed with the relevant professionals meaning everyone you see is kept up to date.

I think that’s about it… If anyone has any other good knowledge or thoughts then COMMENT and spread the word.
It can suck when you’re waiting and/or when you get to see someone and they are terrible at their job. It’s taken me about 5 years to get the right help- so you can do it too!

Therapists being people

I had a session the other day, and while waiting beforehand someone I knew came in.
It was the low intensity therapist I saw before being put on the higher one. I was shocked that she remembered me after so many months!
And then it hit me: THE ONLY 2 therapists in that building today were my old one and my current one.
I know that therapists are professional and don’t blab about people, but as I left, I couldn’t help but think about what they would be saying about me. Do they talk? Do they like me?

I’ll do it tomorrow…

You mustn’t allow yourself to go back to the ed clinic until you weigh less, or you only eat x calories a day, or you waist measure x cms.

I will eat better tomorrow.

I will do more exercise tomorrow.

I will be kind to myself tomorrow.

The past few years seem to have gone in a blur of plans to make things right; plans that are never carried out. I can’t count the number of times that I have quit therapy part way through, or refused help because of my refusal to be weighed. This one ginormous hurdle has dominated me and kept the grip of my eating disorder grow tighter.

The idea of another human being knowing and monitoring my weight fills me with utter dread. Even when I was being weighed regularly in the past, it never seemed to get easier. Then, months of cancelling doctors appointment followed and made way for the fear to grow. It has now been around 2 years since I last allowed somebody to weigh me.

In those two years, I have moved out of home, made new friends in a new city, found a new doctor, been having CBT therapy, and overdosed twice. In many ways I have had two years of very exciting opportunities, and also managed to convince some people that my recovery is going well. I think that I have become better at exhibiting “normal” behaviour, while continuing to be disordered and destructive when alone. My disorder has certainly changed- but not really for better or worse- it’s just different now because my whole life is different than when it all started god knows how many years ago!

Today has been emotional because my cbt ends very soon. The next stage is that my gp and therapist want me referred to the eating disorder service in my local area. From past experience with the ed clinic back at home, I know you can’t have the treatment without allowing them to monitor your weight. Puts me in a sticky spot….

I have been avoiding this for years, and I know that is massive sign of my disorder in itself, and I know that I’m going to have to do it to get better. But I also know that the last I was weighed, I took an overdose and researched suicide methods when the drugs didn’t kill me. Putting myself in that same situation is asking for that awful reaction all over again and I wonder if it’s really worth all the distress?

Then, there’s this little part of me that has been desperate to have somebody else take charge of my eating disorder, as that seems like a futile goal for me to do myself, and I also know that being taken on by the service would reduce my doubt over the severity of my illness. I think I’m going to say yes.

Oh god help me.

Protection bubble

In therapy, I have recently been talking about how disordered behaviour of any kind is often a form of defense. Until I was spoken to and questioned, and I didn’t know that I was protecting myself from feeling like a failure, the worst person. Take my school years for example: I never had a detention or forgot my homework; in fact I wouldn’t have been able to handle being told off at all. Even when my whole class was being lectured about something or other, I always felt some level of guilt or upset about it (even though I would never have done anything wrong!)

How does this happen? How does the mind form thought processes that become so cemented, but are so abnormal? Who knows…. all I know is that this has been a problem for me since I was very young.

I have a friend who recently came out of the closet, and he always says that he would choose to be straight if he could, but he was born gay. He doesn’t believe that you can choose your sexuality- just like I believe you can be born with a high chance of developing mental illness. Regardless of the circumstances I was born in to, I’m pretty sure I would have ended up this way anyway. My personality makes me drive myself to be perfect, makes me punish and berate myself for mistakes, and makes me someone who will be treated badly to avoid conflict. I would never be somebody to voice other people’s wrong doings, I just suck it all in and translate it into some kind of personal flaw.

My bubble of ed behaviours, depressive and anxious thoughts/ actions feel safe and comfortable, and temporarily relieve whatever given emotion I feel compelled to numb, but really it is protecting me from being. I can’t think only of the present moment, and when I can do that, it is always a negative focus on a present error or imperfection. I simply don’t understand how the average person thinks and behaves, as from the moment I wake up to the moment I fall asleep my mind is full of this little voice that shouts all these horrible things.

Therapy homework

Thinking about it, a lot of mental illnesses have something related to fear of the unknown or being out of control. For me, control feels like an essential part of existence; a preventative behaviour to ward off bad things; a constant in a changing environment.
In therapy, this has to be challenged. A lot of recovery relies on the individual to put learned techniques into practice, but the best part is that it allows you to challenge yourself in a structured, controlled way.
Be it an exposure task, or eating a certain number of times a day, or sitting with my anxiety when I have to resist the urge to self harm, it is still in my control. I am doing it for myself AND for my therapist. Sometimes, I think we need somebody to give us new rules for living, instead of trying to throw us into a world of unfamiliar spontaneity.
Having homework from therapy is a really good thing for me. It gives me something to concentrate on and a way to monitor my own progress. It helps me to have a little bit of control over things, but in a positive way.
My therapy will be finishing quite soon. I absolutely love my therapist and I’m really going to miss it. Although it is very tough sometimes, I am so lucky to have a therapist who knows just when to push me, and when I need to be supported and consoled when it is all too much. This is the longest I have ever had one therapist, and it has become an important part of my life for me. I am very worried about how I will feel when that is gone. I don’t have the faith in myself to continue recovery on my own.

What is therapy anyway?

I had therapy today and had some thought provoking, and emotionally challenging discussions. I have seen quite a few different people over the years: a youth counsellor, a support worker, an eating disorders nurse, a low intensity therapist, and now this high intensity therapist ( who is a clinical psychologist.)
My experiences with them have all been very different, and few of them have actually helped me to change my attitudes and behaviours. I guess the problem is that mental illness is totally different to medical ailments; instead of medication, rest or diagnostic tests, mental illness requires time to heal.
The whole world is always racing against time and money, and so I’ve no doubt that there are millions of people who, like me, have been through several short interventions, only to find that nothing changed.
For me, the hardest part of therapy is being honest. In that hour a week, I have to answer questions that spark deeply emotional reactions that are supported by negative beliefs I’ve had since childhood. There are many things about my illness- such as weight, self harm, and feelings of fear that are almost impossible for me to be talk about. My body tenses and my words become short. It’s like there is no explanation strong enough to describe what I feel. Obviously, it is vital that I’m able to overcome that difficulty in order to question my views and take a healthier approach, but it just made me think about the whole concept of therapy. I mean it is basically an optional hour of stress in a way!
I know that left to my own devices I would not be able to make positive progress, yet it is easy to feel stupid for not seeing why my views are warped without needing someone to show me. I know it isn’t normal to do the things I do, so why is it so hard to do anything about it on my own?
I don’t really know. All that I do know, is that therapy is incredibly useful. My therapist is kind and open for a laugh at times too. She is clearly very knowledgeable about the human mind and the effect it can have on our behaviour and self worth, and I am being exposed to many new techniques to change my current outlook on life. I’m grateful for her, but I’m also aware that it isn’t too long until the end of our sessions. Scary times.

Progress means being scared first

In therapy today I was asked whether I thought her idea for my homework was good. In theory it sounded excellent; realistically speaking it sounded scary.
I have come to the conclusion that in order to overcome mental illness you have to be put in situations that are scary, and then get through them without relying on your illness. Tough stuff.
I want to rise to the occasion and face it head on, but the challenge was allowing her to weigh me. I’m not sure if I can do it. I’m genuinely concerned that I might attempt to kill myself if I don’t feel content with the number.
I can’t actually describe how utterly terrifying this will be, but my appointment is on Monday so I will soon be right in the middle of fear and anxiety.
My biggest worries about it all are around what the scales say, and what she says. What if she thinks my weight doesn’t justify my eating disorder? What if she thinks I am exaggerating everything? What will I do to myself afterwards? What if I can’t handle my emotions and she sees me having a panic attack?

To be in control there has to be no rules to break

My relationship with food and exercise is all about hyper awareness of everything. Everything is calculated and judged as good or bad accordingly.
If I feel I’ve over eaten then I would be obliged, based on my rules, to fast for a certain number of hours.
At some point, daily restriction makes me so desperate to eat that I “binge”- usually meaning a normal calorie level instead of my acceptable calorie allowance (again all this is determined by the rules).
So how the hell can the cycle be broken?! Surely if the rules are abandoned then the whole thing just flies out of control and I would eat anything and everything and become disgustingly obese … Or does it?
Therapy this week made me think that maybe if there are no rules, then no food is terrifying or off limits. Food would just what it is: food. Not a punishment or a reward; not an emotional numbing device; not the most important thing in my mind; just food.

I don’t want to lose it

Today in my therapy session we spent time talking about “normal” eating and thoughts around food. I was shocked to discover that nobody really makes judgements about the food others have. It would seem that most people enjoy food, and therefore enjoy their own with no care for anyone else’s !
This was definitely useful when trying to calm my anxiety about social eating, but it has also made me realise one of the very uncomfortable aspects of my disorder: it gives me an inner sense of validation. And because of that, I feel like my ed is only real if I get “stepped up” from iapt to the eating disorder service. How dumb is that?!
I did some extensive google searches on the nhs and mental illness and found out that one iapt service does specifically say that it treats ed patients when immediate medical complications are not severe enough for secondary care services. This made me feel like the level of therapy I’m having now is appropriate for an eating disorder and that I shouldn’t need to allow myself to get worse because of my need for justification.
My other huge worry right now is that I’m still utterly obsessed with the link between losing more weight and being happier. I logically accept that that thought is not proven to be true; yet I can’t help but feel like all the regular eating and anxiety exposure etc that I’m doing means squat if I’m still trying to lose weight.
I hope not, because I am trying to do my therapy homework and eat more regularly etc (even if I’m not increasing my calories) confused is not even the word right now … Do I actually to lose my ed or not?
The answer: yes…. And no…