Battling The System For Help

Having re-entered the mental health system via Crisis Resolution I was assigned a psychiatrist (Dr P) but I’m assuming it was supposed to be for the short-term. It’s become apparent that with trialling new medications and the decline in my mental health that I’m going to require more long-term input. Dr P therefor requested I be put on their case load which meant I was assigned a ‘case manager’ and no longer needed my single point of entry (SPOE) appointment in December.
I met my case manager (K) briefly before Christmas during one of my psychiatrist appointments but I wasn’t in a space to be able to engage with her and spent a lot of the time during that appointment dissociating.

I had been in touch with K via email over the previous week trying to organise medications and reaching out because I was feeling extremely depressed and hopeless, wasn’t sleeping, my job was being affected and I was ‘done’ with it all. Her response to that email was to confirm my appointment in two days time and say she’d ask Dr P about the meds. Completely blew me off, did not engage in any discussion and did not attempt to contact me via phone to follow up or discuss. I also never had a phone call from Dr P that week when he explicitly told me twice before Christmas that he would follow up in the first week of January.
I also emailed him out of desperation, just to get something to help me sleep and he did eventually arrange for a script to be sent to my pharmacy, (which I had to leave work early on a busy night to collect due to his late reply) but he still did not call or ask how I was doing despite knowing about my email to K and knowing I was in distress before Christmas.

You are told to ask for help when you’re feeling depressed or at risk yet when you get responses like that it’s no wonder people don’t bother and get to the point they take their own lives. This is our mental health system, where you go when you’ve hit rock bottom and need specialist input, where is the support?

I met with K for the first time on Thursday, we talked for an hour. I provided her with a letter outlining my disappointment in follow up, input and treatment plan. I wrote exactly how I was feeling, I wrote that I had suicidal thoughts every day interrupting my life, that I had a plan for suicide and the means to carry it out. That if I didn’t get some real help soon I was at risk of carrying out my plan.
I wrote that I felt I was having to come up with all the treatment suggestions, that Dr P was basically throwing meds at me and expecting to see improvement.
I made further suggestions:
1) Testing for androgen deficiency (low testosterone) which in women can cause low mood, weight gain, low energy and low sex drive.
2) Going back on Amisulpride with added Cabergoline to counteract the hyperprolactinaemia it causes.
3) Exploring transcranial magnetic stimulation (TMS).
4) Whether electroconvulsive therapy (ECT) is an option as a last resort given my intolerance and lack of response to medications.
5) Psychotherapy. I have ACC therapy lined up but it hasn’t started yet and I’ve been told that my mental health team cannot have any input or communication with my therapist as it’s not the done thing, they must be separate. So what are my mental health team going to offer me in the way of therapy to adjunct my medication?

She thanked me for the letter. Understandably she has to take my questions on medications and treatment to Dr P (who I don’t see for another week and won’t hear from before then). She attempted to discuss my suicide plans but I didn’t feel able to discuss this with her as I feel shame and embarrassed. She pushed that she might be able to put things in place to make me safer like taking away medications etc. I said I didn’t plan on overdosing as I’ve done that several times in the past and I know it doesn’t work, that I found some comfort in having a plan and not wanting it to be interfered with and that there was actually nothing she could do to make me safe anyway. She seemed to accept this.

I was also told by K that she would NOT be engaging in email conversation. Email is my preferred method of contact as I can think carefully about what I say before I submit it, get all my thoughts out without being put on the spot and it also means there is a paper trail. K told me she would not be engaging via email and that if I needed her she would phone me or make an earlier appointment, both of which are difficult for me as I work full time and I feel she’s avoiding the paper trail because it’s already showing my desperation and their lack of care and proactiveness.

We discussed my previous Dialectical Behaviour Therapy (DBT) and what worked for me. She thinks we should go over some of this at our meetings though acknowledges she is not a therapist and doesn’t know anything about DBT. She says I need to work on things that make me feel better and distract me from my thoughts. I agreed but also explained that there comes a point where I’m so low that none of that matters anymore, it stops working and my head is flooded with negativity. Any small thing could trigger me to act impulsively, coping skills and wanting to use them go out the window when you lose all hope.

I see Dr P next Thursday and K the following Tuesday. My negative thoughts are still there though less intense at this time.