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NHS and bipolar


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Hi,

 

I'm new to this board, living in the UK and having some problems with the NHS mental health services, not sure what to do about it. Sorry if this turns out to be a ridiculously long post I'm just hoping someone from the UK might have some insight into the system because I'm a bit lost in it.

 

I've had mood problems for as long as I can remember... long story short, I have major ups and downs, usually lasting months at a time. I'm not going to go down the route of asking 'am I bipolar' because I know it's not a question that can be answered on a forum like this, however the 'ups' or 'highs' follow the criteria for hypomania and sometimes even mania from all the information I've read, and the way it impacts my functionality (and believe me, I've read a lot!)

 

I recently had to spend a few days in a psychiatric hospital, where they told me I was 'a bit manic', gave me olanzapine and lorazepam while I was there, and sent me on my way with enough 5mg pills of olanzapine to last a week.

 

The problem I'm having is the fact that last year I was severely depressed, after a suicide attempt I was referred to the 'crisis team' who referred me to their psychiatrist. After a 20 minute appointment with her where I was not functioning well enough to even formulate a proper sentence (I spent a lot of time saying nothing), I was sent away with no idea what she'd decided. Didn't find out about my 'emotionally unstable personality disorder' diagnosis until I read it on my GP's notes (I wasn't actually informed of it at all)

                                                                               

After reading this, I did some research into it, and it doesn't fit my symptoms at all. So I asked for a second opinion, following another severely depressed episode at the beginning of this year (this followed a month-long period where I was extremely high and sleeping roughly once every 3 days). This psychiatrist disregarded anything I said about the 'highs' and after one hour with him, he said 'you're not bipolar, you don't have a personality disorder but you do have periods of time when you're unwell and you act like you do then'. He then discharged me and I wasn't offered any further support, treatment or referral. I've since found out that despite the psychiatrist telling me I don't have a personality disorder, it's still on my medical notes that I have.

 

Back to the present day, I've been taking the olanzapine (which the GP was reluctant to prescribe despite my recent hospital stay) it's made me a bit more level headed, makes me sleep at least a few hours every night and calmed my thoughts down a bit so they're not racing quite as much. It's not perfect, I still spend most of the day feeling like I've overdosed on caffeine, but my family and boyfriend say they've noticed a difference in me since I've started taking it, which is good.

 

But the GP will only prescribe it in the short term on the basis that he's referred me back to the same psychiatrist, which I'm concerned about because I had such a bad experience with him last time, and my main concerns (sleep disturbances and periods where I'm unusually high folllowed by severe depression) were disregarded the first time so I feel I might have the same experience again.

 

I'm a student and at the end of last year was required to temporarily discontinue my course after an assessment by an occupational therapy doctor decided I was not able to continue due to my mental condition. I want to be able to return to study in September, but they're requiring that I prove that I'm stable and receiving adequate treatment which I didn't realise would be so difficult.

 

So I guess after all that what I'm really asking is, has anyone got any experience of misdiagnosis in the NHS? And is there a way I can request to be referred to someone different/an expert in bipolar disorder? If not... is there a way I can be referred to a private psychiatrist? And how much does it cost? I don't have a lot of money but I'd be willing to pay everything I’ve got at this point, if it means I’ll be able to go back to my studying soon. 

Edited by RedPanda
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Thanks for the advice Manic Maverick, I have a GP appointment on Thursday so I'll ask him then to be referred to a different person. I need to be more demanding probably, I've never really been before because I've always used services when I was in crisis and either too depressed to stand up for myself properly or when I was in the hospital I kept maintaining I was fine, even though I realise now I wasn't, at all. 

 

The reason he was was reluctant to prescribe the olanzapine is because he said it doesn't fit with the diagnosis on my notes which is still BPD, even though it was originally prescribed by a psychiatrist at the hospital who prescribed it for bipolar (that being agreed by three psychiatrists I saw over those few days). The fact it's working well enough for me to be functioning a lot better than before should be reason enough to continue to prescribe it, particularly as I've been told the focus of NHS psychiatry is to treat symptoms, rather than diagnoses per se.

 

helenllama that was enlightening to read - it's strange that they're reluctant to diagnose most disorders apart from BPD, when that's a diagnosis that can carry a lot of stigma so it seems to me should be one that is diagnosed with extra caution, and perhaps not at all if it's not going to be followed up with further discussion and treatment. And I also wonder, do they often make diagnoses without informing the person? It seems that keeping it secret from a person truly suffering from BPD could actually be destructive, considering the paranoid ideation and difficulties with self-image that are sometimes characteristic of that disorder. I've always thought that NHS mental health services are lacking in many ways but this truly shocks me. 

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GP's are really supposed to make psychiatric medication prescription decisions without a consultant, not for Olanzapine anyway. Your GP is doing it short term to keep you out of crisis services, but cannot continue to do so legally without a consultant to take that over.

 

I would look into getting an advocate (your local MIND centre ought to be able to help) or speaking to your local patient advisory liaison service, as well as taking a trusted friend/relative to your appt. I would also recommend making a diary of your symptoms for the few weeks prior to the appt and written notes in case you calm up when you get in. I would also advise that mental health treatment is hard to get and takes a long time to complete, if you do have bipolar, you cannot just get a pill to control it and go back in September. I was in your position in my second year of Uni in 2005, it took me till 2009 to function on the right meds enough to think about studying. The waiting lists for treatment are long, if you want to see a consultant and still expect to leave in a few months, they won't bother to treat you, as you'll have changed NHS trusts when you change locations. I stayed in my home town, pursued treatment, got a decent consultant and took the therapy on offer, which meant sacrificing my studies. I don't regrat it.

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helenllama that was enlightening to read - it's strange that they're reluctant to diagnose most disorders apart from BPD, when that's a diagnosis that can carry a lot of stigma so it seems to me should be one that is diagnosed with extra caution, and perhaps not at all if it's not going to be followed up with further discussion and treatment. And I also wonder, do they often make diagnoses without informing the person? It seems that keeping it secret from a person truly suffering from BPD could actually be destructive, considering the paranoid ideation and difficulties with self-image that are sometimes characteristic of that disorder. I've always thought that NHS mental health services are lacking in many ways but this truly shocks me. 

 

It's to use Titania's description - a weapon in the hands of the NHS. But it should never be diagnosed so quickly.  

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Titania, thanks for your reply, I didn't realise that GP's weren't supposed to prescribe that. I saw a different one earlier this week who actually increased the dose, he said 5mg was very low and it was only supposed to be a starting dose, so he increased it but this was apparently based on the recommendation of the consultant at the hospital because I was there so recently.

 

I'm aware that it's a long process and not looking for some kinda 'magic pill', I know it doesn't work like that, but my situation is a bit complicated. I've lived in or near London all my life but because I was in crisis at the end of last year I had to leave where I was living and am staying with my parents temporarily. But they moved up north a few years ago (I'd already moved out by this point, I was 20 at the time) and so it's not where I'm from, and everyone I know, including my boyfriend, lives in the south. I have no life up here so either way, I'm going to be moving back to where I was within the next few months, unsure where this puts me in terms of NHS trusts and stuff, you'd think that with a nationalised health system they'd still be able to deal with patients who move across the country wouldn't you...but maybe it doesn't work like that? 

 

I would take someone along to appointments but I only have my mum here and the last time I saw a psychiatrist, she came with me because I was still very unwell at the time - the second time a few weeks later I went by myself and was bombarded with questions about how I must find my mother 'interfering' and asking me loads of questions about my relationship with her. Which was irrelevant, she was there to support me but it just seemed to make things worse. I also thought about writing things down... and now I have about 15 unfinished word documents which make no sense but I'll somehow collate them into something coherent before I see a psychiatrist again!

 

I'm not sure what the role of an advocate is, I thought about contacting MIND a few months ago but didn't, what do they do?

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