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>This is a reply to the comments I received on my post before last. I was writing it as a comment, but it got a bit long so I thought I may as well make it into a post.

Karita – essentially trusts will fund treatment out of area if they think it will be more cost efficient for them in the long run, so for example if someone frequently presents at A&E and has regular admissions to acute wards, and often has crisis team intervention, then they may well look into funding a therapeutic community, because it will probably not cost them any more in the short term, and in the long run should save them money. As Harriet said, these places do produce statistics showing that treatment with them is more cost efficient than frequent crisis intervention.

However, I am in the fortunate/unfortunate position (depending on how you look at it) of not having frequent crisis intervention, which is obviously a good thing in many ways, but unhelpful in this situation. I have the issue of not being your ‘stereotypical’ Borderline – I have been told this several times, and as a result I really don’t cost the trust very much at all, and so there would be no reason for them to fund an expensive treatment programme for me. I have never been the type to self harm a lot, or take non suicidal overdoses and then present at A&E, so that isn’t an issue for them. For reasons I discussed recently I am not referred to the crisis team – essentially L thinks they would do more harm than good, as they have a tendency to see everything other than psychotic illnesses and bipolar as being too insignificant to require their input, and therefore treat you like shit (I have experienced this), and they are also gatekeepers for acute wards. On paper the bosses of the trust, who make the decisions on matters like this, would see me as a stable patient, who copes with weekly or fortnightly appointments with her care coordinator, and doesn’t require any other input, so they would be likely to see me as not needing intensive, expensive treatment. I don’t even see a psychiatrist any longer, since she took me off my meds, so I am basically as straight forward as it comes in terms of the treatment I am receiving.

What I find very frustrating, is that if I acted on all the suicidal thoughts I have, then I would constantly be at A&E, I would be deemed higher risk and so would probably have acute admissions and crisis team intervention, and would be far more likely to be able to access appropriate treatment. However, because I am able to contain my behaviours generally to those not requiring medical intervention, ie superficial cuts, small overdoses that I don’t seek treatment for as they are self harm rather than anything else etc, I look to be coping. But I have no standard of life, and I have been under services for 7 and a half years, and am as bad as I have ever been. This is something that came up in a session with L once, and she said something along the lines of me being equally as unwell as those with the same diagnosis who do fit the more traditional borderline pattern, but that obviously on paper it doesn’t appear that way as I have become very good at containing it. But that doesn’t help, as it leaves me with this nothing of a life, where I am unable to progress or do anything I planned, and yet because I don’t ‘act out’ I will probably never be able to access the more appropriate types of treatment for me.

L actually agrees very strongly with the therapeutic community approach – she thinks it is very effective, and I know it is something she is very interested in, and would actually like to work in herself. However, it isn’t her who has the power to make the decision, and there is no point in referring me if there is no chance of getting funding. My county is also particularly underfunded – I know they all are, but there really are no specialist services at all in the county – if children/adolescents need inpatient treatment they have to go to another county, same for eating disorder patients, there are no specialist personality disorder treatments, etc etc. They have the very basic services – the CMHTs, an outpatient ED service, and one EIPS team on the other side of the county, and that is more or less it. You can’t even access the Crisis Team without a referral – there is no option of calling them when in crisis like you can in virtually every other area – you have to be referred first.

Pandora – I think at this point there would be very little point in getting my MP involved, largely for the reasons above – on paper everything looks fine, and I haven’t been referred to any services but denied on grounds of cost, so I have no cause for complaint. Also, he is a typical Tory twat (who manages to vote in the opposite way to what I believe on every single bloody vote in parliament) who would probably consider me scum for scrounging off the state, and would probably think it better if I just killed myself rather than cost the government the sort of money that therapeutic community treatment costs!

I may be rather cynical over the whole thing, but I think that realistically a therapeutic community is never going to be an option for me unless I win the lottery, or some philanthropic millionaire comes along and wants to pay for my treatment! DBT and MBT aren’t even options in the next trust, so even going out of area for those isn’t an option. Essentially, nothing is an option, apart from what I have now, and I can’t cope with that. I am somehow just expected to keep going, from week to week, or fortnight to fortnight, despite overwhelming suicidal thoughts, and feeling so terrible that I can’t get out of bed most of the time. And this is one of the reasons why I see suicide as a valid and logical option – I have virtually exhausted my local mental health services (I say virtually, because I have not had CAT, which I believe is the only therapy other than CBT that is offered, but I don’t realistically see 16 sessions of that changing things dramatically) and I have no other options treatment wise, I don’t consider carrying on like this to be an option, and since nothing has changed for the good in the last 7 and a half years, I sincerely doubt it is suddenly going to happen now.

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>Shiny thing of shininess

>I am rather late with this, but it is time to display and show off about my shiny thing of shininess, as awarded by Mental Nurse. I won this in the annual TWIM awards, for being runner up in Best Personality Disorder Blog. I was amazed to receive so many nominations, particularly given that I am in the same category as Pandora, who is the author of what is, in my opinion, one of the best mental health blogs around, and who rightfully won the category. I am always shocked that people even read the drivel that I write on here, as essentially I just come on here to brain fart – I don’t have a wonderfully articulate, well written, thought through blog like lots of other people do, and even after writing it for a year it still surprises me that people make the effort to comment on what I write, and the nominations I received for the TWIM awards were even more surprising. So thank you to everyone who voted, and thank you to everyone who comments or reads – it all means a lot to me. Congratulations to all of the other winners in all of the categories – many of my favourite blogs scooped awards, and lots of others received nominations – there is a full list of winners here for anyone who wants to check out some of the other brilliant blogs.

As I said recently my blog, and the rest of the Madosphere, has come to mean a lot to me over the last year, and has been one of my biggest sources of support, so thank you for that. I genuinely don’t know where I would be without all of the support I get from this blog, and people I have met through writing it. Winning an award for something that has helped me so much almost feels wrong, as I write for entirely selfish means, but I appreciate it very much.

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>I talked in my last post about relationships with friends etc being complicated. At the moment I am feeling like relationships with professionals are just as complicated – sometimes more so. I said recently that I feel like my relationship with L, or how I feel about it, has changed, and I wasn’t sure how or why, and I have been thinking about that. I think it is probably partly because I haven’t seen her as regularly lately – she has had to cancel several appointments, and she has also had leave, and that has left me partly not feeling quite as comfortable with her because of having been seeing her less, and also quite let down and rejected because of the cancelled appointments. I find it very difficult to trust people, and there are very few people that I do completely trust, and I usually end up getting very attached to those people, as I have with L, and so then when I feel rejected by them I tend to back right off, to stop myself getting more hurt. I do know that the cancelled appointments haven’t been her fault, and that it has been because she has had other patients in crisis etc, but know it is related to other patients that she sees makes it even harder in some ways, because I feel intensely jealous of them – I suppose for being in the type of crisis that means she has to cancel all of her other appointments. It makes me feel like they are important, and I’m not – nobody has ever cancelled all their other appointments when I have been in crisis. It sounds very petty and childish, but that is the way I feel. I also seem to see her for less time now even when I do see her. I usually used to see her for about an hour and a half – then there was the period when I was supposed to see her twice a week (which only actually happened twice, as the other times she had to cancel the other appointment that week), and so the appointments were shorter, only an hourish, but there were 2 of them (or supposed to be). Now it has gone back to once a week, but the appointments are still shorter – the week before last was just about an hour, then last weeks was cancelled, and then this weeks was about 50 minutes. Again, I know it sounds minor, but it makes me feel like she doesn’t think it is worth seeing me for longer like she used to. And then there is the whole making goals and setting targets thing that was brought up at my CPA, and that L has been talking about since. I just can’t seem to do it – I can’t think of any goals or targets to make at all, but L wants them to come from me. And I am constantly worried that if I can’t think of anything, and I am not making any progress, then she will discharge me. It is a cliche, but I am terrified of being abandoned by her, I really am. And I keep wondering if that is why she is seeing me less lately etc – because she doesn’t see the point when nothing changes and I don’t make any progress. I think all of those things are affecting my relationship with her, because I am scared of being too reliant on her, as I think I am, and then being dropped, so I am subconsciously trying to distance myself a bit. Relationships with therapists and other professionals are really hard, because they are the people you are meant to be able to trust, and rely on, and be honest with more than anyone else, and yet there is always fear, for me anyway, that they will leave, or something will happen that will stop you seeing them etc, and it is incredibly hard to deal with that when it does happen, so part of you doesn’t want to let them in, or let yourself get reliant on them, because then it hurts too much when they leave, or you can’t see them anymore.

I have an appointment with my GP tomorrow. I have mixed feelings about her at the moment. I started thinking about my relationship with her after reading DeeDee’s post on Mental Nurse about GPs and Mental Illness. I can’t decide what I think about my GP. She is nice, she tries to understand, and when I was first seeing her and waiting on an appointment with the psychiatrist, she pushed for that etc. So in some ways she is good. On the other hand, I get the impression sometimes that she thinks I just need to pull myself together and stop being a mentalist, which is obviously not as simple as it sounds. When I saw her and was very suicidal she told me to replace the obsessive thoughts about suicide with obsessive thoughts about something else – I like dogs was her suggestion I believe… She claimed not to notice when I gained 25lbs, and yet recently when I mentioned my weight having gone down slightly (2lbs), she said she had thought I looked like I had lost weight. Last time I saw her she asked if I had had CBT – I said that I had and thought that it was patronising crap for the most part. She then asked me if there were any other types of therapy. Whilst she is not a specialist, I would expect a GP to know that more types of therapy than CBT exist. I said that DBT is usually the recommended treatment (in the NICE guidelines) for BPD, and she asked what that was. I gave a little explanation (bearing in mind I have never had any DBT myself) and she said she thought that sounded really good and would really help me. I explained that it wasn’t available in our area, and her suggestion was that I become a DBT therapist so that I can run DBT sessions in our area?! This was one of the most bizarre suggestions I have ever had from any professional, ever. I think that she probably mainly has experience with IAPT, and I believe some of the people who deliver that do literally just do like a short course in basic CBT etc, which I can only assume was her reasoning for thinking I could become a DBT therapist. She didn’t seem to realise that even if it was that simple, it wouldn’t actually help me, as I need therapy myself – not to become a therapist for others. So she says some pretty ridiculous and unhelpful things at times. But she is nice, and I think she does genuinely want me to get better – she just seems to have very little knowledge past the absolute basics about mental health problems, and so I think doesn’t know what to say a lot of the time. I have considered seeing another GP, but I do like her, and it is a small practice of 3 Doctors, and she is the only female. I am generally more comfortable with females, and one of the others I wouldn’t consider seeing, as he was the first GP I ever spoke to about my mental health problems, back when I was 17, and was very unhelpful and unsympathetic. The other I think may possibly be the best where mental health is concerned, but I used to know him outside of the Dr/patient relationship (which is what happens when you live in a rural area!), and have therefore always felt slightly uncomfortable talking to him. But I don’t know if my GP is right for me really, and I do sometimes feel like she doesn’t grasp how desperate and suicidal I am feeling when things are really bad etc. I miss my old GP. She was the perfect combination of caring and knowledgable. Living where I do I don’t have much choice in terms of GPs, and I do like Dr O, as I have said. But for example if L was on leave, and I was having a very bad, suicidal episode or something, and really needed help, the person I would try to speak to would probably be my GP, as I would rather speak to someone I know than a random CMHT member that I don’t know, or even worse, my ex CCO, who really was a chocolate teapot. And I know that I wouldn’t get anything in the way of help or suggestions from Dr O, except to talk to L when she was back. She wouldn’t speak to the CMHT or Crisis Team or actually do anything. Maybe that is ok, and normal for GPs, and I expect too much after my old, fantastic GP. It just doesn’t feel quite right. As I said, I have an appointment with her tomorrow, so I will see how that goes. I did think about seeing the GP there that I used to know, but if it felt too uncomfortable then I would then feel really awkward about going back to Dr O. Maybe better the devil you know?

Then there is Dr E, my psychiatrist. Again, she is nice, but is completely unwilling to try me on any medications, even though both L and I feel that I have been worse overall since coming off anti depressants, and I don’t think would ever admit me to hospital or refer me to the Crisis Team however bad things were. So basically she does absolutely nothing, and therefore I am not going to be seeing her anymore, unless I want to for something in particular, in which case L will get me an appointment with her. So basically she is out of the picture now, and I am not sure how I feel about not being under the care of a psychiatrist, particularly since Dr O won’t ever touch my medication, or rather she would never change anything when I was on medication – now I only have Diazepam there isn’t much to touch I suppose.

I think overall I just have this feeling of being stuck, and general dissatisfaction at the moment with my mental health and treatment for it, or some of the time, lack of. I still think L is great, and I am still very attached to her, but for the reasons I talked about above I feel like things have gone slightly off with her, and given that she is now the only person I see about my mental health problems, this feels like a problem. I can’t see anything changing for me with my current treatment, and that makes me feel very hopeless, as I can’t cope with living like this, which in turn leads to suicidal thoughts. And that is why relationships with professionals are so complicated!

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>Finding it hard to concentrate enough to write, so I will do bullet points.

– Purged twice so far this week. This is good that it is better than last week, but bad as I hadn’t done it at all for months before last week. And I am wanting to do it more and more often – the only thing that stops me most of the time is my parents being around, and not wanting them to know what I am doing.

– My weight is definitely an issue at the moment. Although I try not to let it, it does impact on my mood for sure, and I have ‘rules’ around it that I make before I step on the scales in the morning, like if I weigh less than X I am not allowed to kill myself, if I weigh less than X I have to go to ballet, etc etc. I am not getting dressed at the moment unless I absolutely have to, because clothes make me feel too uncomfortable. I can’t deal with them feeling tighter than I am used to, so I just stay in my PJs.

– Despite all the issues with weight I said above, I don’t seem to be able to stop eating. I know it is comfort eating, and it really isn’t helping matters, because obviously I am not losing weight, which is about the only thing that might make me feel more in control of things. I hate the doctors for not giving me the Tryptophan. Rationally I suppose I can understand why they wouldn’t, but I feel like it would help me with my depression if I could get my eating a bit under control.

– My mood has been very, very low. I have been having very strong suicidal thoughts the whole time, and it has been incredibly difficult to not act on them. Diazepam has helped me enormously. There is no way that I would have got through the night I last posted without it. It doesn’t take the feelings away, but it does take the edge off, and 2 managed to calm me down enough that I could sleep, which was by far the safest thing for me to do.

– L and I are both thinking that perhaps anti depressants do help me after all. Probably only a very tiny bit, as I still have very bad patches when on them, and have still attempted suicide when taking them etc, but right now things are the worst they have ever been, and this is the first time in 6 years that I haven’t been on anti depressants. She is going to speak to Dr E about restarting them, which I kind of have mixed feelings about, but if they can stop things from getting this bad I will take them, even if they only help by half a percent.

– Being included in TWIM on this week made me feel good. I wasn’t expecting it when I went to read it, as I had basically just written moany crap this week. It always means a lot to be included in TWIM, because it was Mental Nurse that got me into the world of mental health blogging, and I never expected to see myself on there when I started blogging. May only be a small thing, but I can see so little positive at the moment that I really need to grasp hold of the little things.

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