Wednesday, 17 August 2011

What Happens in a CMHT Mental Health Assessment?

(Please note that this was written in 2011. A lot has changed in service provision across the country since then, and some things may have changed. But I still think that the assessment process outlined in this post is how community mental health assessments ought to be, and if your own assessment falls short of this, then you should complain. January 2015)

When someone with a mental health problem goes to their GP, they are often apprehensive about what will happen next. Who will they be referred to in order to help them with their problems? Will they have to wait months, then see a psychiatrist in an office in a hospital many miles away? Or will they be asked to wait in a side room while the GP surreptitiously calls for men in white coats to drag them off in a strait jacket?

Let me reassure you: the last scenario is very unlikely to happen: for a start, psychiatrists and AMHP’s do not wear white coats. And I have never in the 30+ years I have been working with people with mental health problems seen a strait jacket in use in a psychiatric setting; I think nowadays they are only used by escapologists and stage illusionists!

Routes for referrals from GP’s to secondary mental health services for adults vary across the country, so it’s difficult to generalise. Many people will not even get as far as a Community Mental Health Team. Although approximately one in four people will experience some sort of mental health problem during the course of their lifetime, most commonly depression or anxiety disorders, most of those people will be treated solely by their GP.

In the last few years the focus of intervention for common mental health problems has been in Primary Care. The nationwide Improving Access to Psychological Therapies (IAPT) scheme has created teams of practitioners whose remit is to accept referrals from GP’s, or even directly from members of the public, for assessment and treatment for mild to moderate depression and other common mental health problems. They will then provide fairly short term treatment via talking therapies such as Cognitive Behavioural Therapy.

Many Mental Health Trusts also provide mental health link workers who work within GP practices and engage in brief assessment, treatment and sign-posting of patients referred to them directly by the GP.

Assuming that it is decided that a particular person’s problems are too complex or acute for intervention in Primary Care, they will, at least in the Charwood area, be referred for assessment by the Charwood Community Mental Health Team.

The Team will then arrange for an assessment appointment within two weeks of referral, or within 3 days if the GP considers it is urgent. Dire emergencies will go directly to the local Crisis Team for assessment the same day. The Charwood CMHT team consists of:
• a consultant psychiatrist
• a senior registrar, who is in the advanced stages of training
• a junior doctor, who may be a GP trainee or in the earlier stages of psychiatric training
• a clinical psychologist
• a cognitive behavioural therapist
• an occupational therapist
• several community mental health nurses
• several social workers, some of whom are also AMHP’s
• a couple of support workers

Any one of those may undertake the initial assessment. A person referred to a CMHT is unlikely to see a psychiatrist on the first occasion, unless the GP has specifically asked for a review of medication, or for confirmation of a formal diagnosis, or if the person has a complex presentation of a mixture of physical and mental health problems.

Millie – an example
Millie is 22 years old. She has presented to her GP in tears, saying she has been cutting herself because she feels so bad. She has felt like ending her life, but has made no actual plans. She has recently split up from her partner after he assaulted her. She is sleeping poorly, has lost weight, and is currently off sick from work. She had been on an antidepressant for about a year, and the GP had changed this about 3 months ago, as her mood had not improved.

Millie comes to the CMHT in some trepidation, not sure what to expect. In fact, the CMHT is one department in a modern, light and airy centre, which includes a GP surgery, a physiotherapy department, the community alcohol and drug service, a dentist, podiatry, and various outpatient departments. (However, you should have seen our old offices.)

The Masked AMHP greets Millie and invites her into a small but pleasant interview room. I begin by explaining to her what a CMHT is, and how any one member of the team may make an initial assessment, and that she is seeing me not because I am a social worker, but because I am a member of the multidisciplinary team.

There is a standard assessment process, as we have an electronic form that we have to fill in which covers a wide range of factors, including past and present risk behaviour, any forensic history, the use of alcohol or non-prescribed drugs, etc. But I begin with some obligatory basic information giving and gathering: I explain our confidentiality procedures, and ask her about her next of kin, religion, employment status, ethnic origins, and make sure we have contact phone numbers for her. I then read her a prĂ©cis of the GP’s letter (leaving out statements like “I would be grateful if you could see this sorry young lass”).

I then ask her to tell me in her own words what problems she has that she would like help with. I feel it is always best to begin with open questions which allow the person to unfold and explain their problems in their own way. Sometimes people are very reticent about talking about their problems; at other times, it is difficult to shut them up or keep them on track.

Millie is neatly and appropriately dressed. She is wearing makeup. She looks underweight. She has poor eye contact. She looks down most of the time, wringing her hands unconsciously. She speaks quietly and haltingly. All these observations are relevant to the assessment, as they help to give an impression of the person’s mood, and what their level of personal care is.

Millie says that she has felt low “for most of my life”. I ask her to tell me more about her life, beginning from birth. Does she have siblings? Did her parents live together, or did they separate during her childhood? How would she describe her childhood? Did she ever experience any form of abuse as a child?

As she talks she reveals that, although she had supportive parents, she experienced years of bullying at secondary school. That was when she first began to cut herself. She was intelligent, and obtained 10 A-C grades at GCSE. She started doing A levels, but then became pregnant at 17 by her boyfriend at the time and decided to leave school and move in with him. However, she lost the baby at 5 months, and the relationship broke down. She took a serious overdose, and needed medical intervention, although there was no mental health follow up at the time.

Millie moved back in with her parents for a few months, and got a job doing office administration. She has been working in the same work setting for over 3 years She then moved in with another boyfriend, and they lived together for a year, but he began drinking heavily and 6 months ago he beat her up quite badly. She has lived alone since then. She is still waiting for the court hearing, but in the meantime he has been harassing her by phoning and texting her, often when drunk, sometimes pleading with her to take him back, and sometimes making threats.

Any person’s life story is important: it can reveal a lot about the origins of current mental health problems. Gradually, using a combination of open and closed questions, Millie reveals important factors which can help to identify exactly what her problems are and how best to manage them.

There is no evidence on assessment of any psychotic illness. However, she does have symptoms of clinical depression, including sleep disturbance, loss of appetite with accompanying weight loss, and some suicidal ideation.

Towards the end of the assessment, which takes about an hour, I ask her if there is anything else she would like to tell me, or if there is anything she would like to ask me. She tells me that misses her baby, and starts to cry. She says she wants to join him. We talk some more about this. I am particularly keen to understand what she means by “joining”. She says she has been considering taking another overdose, but feels she is too cowardly to try it again. I then conclude the assessment and I inform her that the assessment will be discussed in the multidisciplinary team and she will be informed within a week or so what the outcome of the assessment was.

Although I have been developing a formulation of her problems during the assessment, it is afterwards, when writing it up, that I draw all the factors together and come to a conclusion to present to the team meeting. What is important is not just to know what her mental health symptoms are, but what caused them in the first place.

The bullying at school was clearly a significant factor. Her unhappiness and sense of powerlessness led to her beginning to self harm as a soothing strategy to release these emotions. Although she stopped by the time she entered 6th form, she has now returned to this strategy as a means of coping with her current feelings.

The miscarriage was also a key life event, and it had become clear that she was still grieving the loss of this baby. This sense of loss may have been reawakened by the ending of the second major relationship in her life.

Additionally, she was experiencing some signs of post traumatic stress as a result of the assault by her boyfriend. He had attempted to strangle her, and at one point she had thought she was going to die. This can be a risk indicator for the development of a subsequent full blown post traumatic stress disorder, although a formal diagnosis would not normally be made until symptoms had been in existence for at least 6 months. It was probably too early to decide this, especially as the trauma was being kept alive by having to wait for a court hearing for his assault, and her apprehension at having to give evidence. She was, however, receiving input from Victim Support. They were also helping her to deal with the ongoing issues of harassment.

All these factors had led to Millie experiencing chronic low level depression, which had now become worse due to the combination of adverse life events.

The final part of my assessment is to devise a draft plan for intervention. There are clear risk issues to consider: Millie has taken an overdose in the past, and is thinking of doing this again. She consequently needs ongoing involvement with the CMHT, with work to reduce risk. She also needs help to identify other ways of dealing with negative emotion other than self harming. The immediate plan would therefore involve the allocation of a care coordinator, as well as arranging for a medical review by one of the team psychiatrists, as Millie does not seem to be responding very well to her current medication. In the longer term, she may benefit from cognitive behavioural therapy, especially if her symptoms of post traumatic stress become chronic. This can also help her to change the thinking patterns which have led to chronic and recurrent depressive feelings. She may also need help relating to the loss of her unborn baby. There may be external services available for her to be referred to as part of her treatment.

I hope this example shows the thinking and reasoning that goes into a mental health assessment. It is vital to get the overall picture, and not just focus on identifying behaviours or signs that might indicate the existence the symptoms of a specific mental disorder. Labelling is not the most important thing.

I’m afraid that I can only describe my own experiences of assessment. I would like to think that every Mental Health Trust has thorough, consistent and comprehensive assessment processes, designed to meet the needs of people with mental health problems. All I can really say is this is what you should expect.

46 comments:

  1. Hmmmmmm, this has just made me realise how crap my CMHT is. No explanation. Read my GP referral?...ha. No interest in me as a person or my life story. Said I was actively suicidal, was ignored. Sorry, rant. Just need permission to recognise they are useless.

    ReplyDelete
    Replies
    1. that happened to me totally let down by nhs psycologists report most lies and has had a detrimental affect on my health now have to go for cmht medication review i dont want to go lost all faith in proffession my life means nothing to them its a 9 to 5 job for them and a big salary caring profession?no such thing making money out of peoples misery.

      Delete
    2. Same here. I suffer with depression and anxiety and in the past I've taken an overdose 4 times and I keep being refused help. I have been told by a doctor on my CMHT that exercise and healthy eating will make me better. I've also been told to stop taking medication and that I won't be receiving any further help. Easy for them to say, but i struggle getting out of bed, let alone actually eating something and going out the house to exercise. The whole system is a joke and when I've tried complaining I get nowhere. I completely agree with the above comments; they have no interest in anyone and it's just a job to them.

      Delete
    3. I have been rejected by the CMHT with no treatment offered. I have BPD. Psychiatrist recommended DBT, CMHT refused to pay for it and said they would offer access to a Thereaputic Community, but then withdrew this and recommened treatement under primary care. The reason they gave verbally was and I quote word for word "You don't seem very impressed with us and we don't think you want our help" when challenged on this they denied it and said "I didn't say that I said the only reason you want the help from the CMHT is to access the thereaputic community..." I said YES that is right as it is the only way to access the TC. In their written explanation of why I wasn't accepted, there was no reason... They are a bunch of idiots. The only thing they did do was threaten me with my driving licence because of anxiety,,,.

      Delete
    4. They are totally useless, the psychiatrist I had was more interested in talking about herself than listening to me objectively, it was abundantly clear that she herself needed psychiatric treatment not me! She was so comfortable comfortable that she revealed she was attending a conference laid on by the drug companies to entice medical professionals to prescribe their particular brand!

      Delete
    5. Yea I went to doctors today with suicidal tnoughts and the doctor was gonna get the police to escort me to a and e I went voluntary I was left for over 3 hours to be seen by the crisis team ive been telling Em the last week I'm having thoughts of hurting myself or someone and tonight told em I've actually wrote a suicide note out and they gave me one sleeping pill which I couldn't collect as it was late and no chemist open I've been treated terribly by crisis team and my thoughts are getting worst and worst

      Delete
    6. My daughter died in December 2016. She was only offered a telephone assessment and she would not talk on the phone. The police were called and took her to hospital in Section 136, she was assessed but not sectioned. 4 weeks later she killed herself.

      Delete
    7. The CMHT AND MENTAL HEALTH SERVICES IN THE UK, sorry left caps on... the service is a joke. I have had suicidal thoughts for 11 years; I attempted to gain a referall to get help and wow what a let down. I have seveere depression and I after two months of waiting recieved a telephone interview to try and offer me help. So what happened ? I had 10 mood swings within 5 minuites became distressed and eratic and did the best to explain my situation to the woman down the phone. This resulted in me getting a prompt face to face interview. I attened an apointment with the As One group who now offer the local mental health services treatment and therapy within south east of England. I compiled a 5 page document with all of my problems and issues and sat down for an hour with a clinical therapist for an hour. She said my leter was well written informative and a wonder to read. (being articulate is of course one of my skills) So I then got a new apointment for diagnosis from a Psychiaitrist. Great right it sound's like things are happening and I am going to get some help? WRONG. I get a diagnosis for BPD which is a broad "condition" and I and others believe it is a miss-diagnosis. All of my possible flaws ie reasons why I have my problems because of my attitude and cannibas use were clearly stated as if to suggest that I brought the condition on myself and am not fit for any further help or treatment. My isues of depression were recognized but the diagnosis was not factual and was written in the way that if I were to kill myself she nor her team would be liable. My GP stated I needed CBT Therapy and applied on my behalf to get funding, as so this application was denied. Alltherapists I spoke to and my GP advised against anti depressants / mind seddatives as they probably wont remove my depression and will more than likely be a seddative to my brain. I had 3 visits to the GP, o2 the As One group and one to a mental health nurse who works for the CMHT. Did I get offered any help no ? Any further treatment or support ? No Did the mental health nurse even ask me how I WAS feeling or about my problme sno ? They just denied me from their service in the blink of an eye. My mood swings and depression effect me everyday; they have prevented me from furthering my life and I get suicidal thoughts daily. The CMHT is a joke. It's sad and for anyone who has lost someone I feel your pain. Terrible and flawed service; drugs and persciptions are not the answer... I havn't smoked cannibas for 5 months now and myy sate has not improved; it just acts as a wonderful scapegoat.

      Delete
  2. "... psychiatrists and AMHP’s do not wear white coats..."

    You know, a couple of years ago, I bought a shortish off-white raincoat, totally oblivious to the "man in a white coat" gags I inevitably got at work first time I wore it...

    ReplyDelete
  3. nice piece. i do a lot of initial assessments in my cmht and its very similar, wonder if it has to do with the assesor, referring to butterfly wings above. us social workers are by definition nosy which helps when listening to and exploring peoples stories with them.
    http://twitter.com/#!/lizzydripping

    ReplyDelete
  4. actually never say never... straitjackets do still get used... but if you want one, you might have to borrow it from somewhere like Rampton or Broadmoor - I actually witnessed this happen a few months ago in a forensic setting... where they had tried everything else they could think of.... and nothing had worked...

    ReplyDelete
  5. I am a volunteer at a centre in Liverpool, we wish to get an assessment done for a service user who originally came to England from Russia. We would like his mental health and ability to care for himself without the care of his mother assessed, where do we start?

    ReplyDelete
  6. If she was under my CMHT they'd just say "oh, another BPD attention-seeker" and ignore her, making her feel more alone, worthless and desperate than ever.
    This fictional life-story nearly made me cry as I see similarities to myself, but no care or even basic respect from professionals.

    ReplyDelete
    Replies
    1. Totally agree. I got my diagnosis just over a year ago and I now the meaning of the word Stigma!! CMHT are the worst health professionals I have ever known. In my experience they are jobs worths who don't give a dam!

      Delete
    2. I have to agree as well, as a client with my cmht being treated for depression anxiety social exclusion hearing voices self harm and suicide attempts I had a great help from them, frequent visits from CPN and when I was feeling suicidal or low I could pick a phone up and my cpn would come out to see me on some occasions I would be asked to go into hospital for my own safety or the crisis team would be involved and I was told time and again I was not a burdon, well all that changed when I was diagnosed with bpd and ptsd, cpn visits reduced.. calls I made were sometimes not returned, and I was once told to stop crying and calm down while I was on the phone, before my BPD was diagnosed I would've been treated with a bit more compassion and care, so after seven years with my CHMT they discharged me from their care and returned me to my GP, my GP has said I wasn't ready to be discharged from cmht and tried to refer me back to them a couple of times which has been refused, The cmht say they're a recovery team now, Being giving this bpd tag has done nothing but give me a stigma and no support.

      Delete
    3. Oh yes, this sounds so familiar. Really confused at minute. Not sure if I'm evil or not. Feels like I'm banging my head against a brick wall. I can take it, but kids and husband are suffering

      Delete
    4. I hv seen 3 different psychiatrists and only had 4 appointments am not get better 2 different medications and then told they don't think any tablets are going to work for me although my psych stopped one of them and said she wouldn't of prescribed that to even a family member I even got ignored by psych in a session because she didn't like my behavior they where my symptoms omg am at the stage of no return I don't think they believe me oh please what have I got to do I even offered to take overdose to be treated and spoken to properly I told them how my mind just exploded and I tried to stab my 20 yr old son because my anger and am so agitated he was lucky enough at the time that he got out quick AND THE REPLY OFF MY psychiatrists WAS COULD YOU HURRY UP IVE GOT ANOTHER PATIENT TO SEE

      Delete
  7. Having been re-referred to a CMHT earlier this year (I've moved, so couldn't go back to my original team, even though I'm probably no further away). I got my first meeting with a psychiatrist over two months ago, and I'm still waiting to find out if or when anyone will be seeing me again. I have the particular feeling that my BPD is the reason for this, and its not helping the self harm either. I'm glad that there are good CMHT's out there.

    ReplyDelete
  8. in mental health issues in a work tribunal who's word would be taken my gp or psychiatrist my gp says I'm not able to do my job but my psychiatrist says different

    ReplyDelete
  9. so after i have seen the senior triage nurse, does she have a meeting with my GP? and discuss the outcome and then let me know?

    ReplyDelete
  10. Just took my daughter to gp to get her referred to a mht she has been a bit odd most of her life and I always tried to protect her from everything
    Since she left home and moved in with her violent boyfriend who was on a kerfew when she introduced him to us just out of prison so she left home under a cloud
    He is now back in prison and she has been seeing her support worker and fell pregnant by Him he has since died she was still surrounded by violence
    Now in another relationship he is too old for her as was the support worker
    So two terminations and a miscarriage numerous beatings from the jail bird who she said she has finished with
    If the sinareo is correct she may get some long needed help but what if she lies her way through and denies everything she was terrified at the thought of the word mental health and I feel like I have just fed her to the lions
    Heartbroken mum

    ReplyDelete
  11. Just be encouraging towards her an give her your support, if she doesn't want help it can't be forced upon her, unless you an 2-3 doctors agree that she is an extreme danger to herself or others? I've recently been referred to mental health team and my worker is lovely she asks me questions and gets me thinking.....nothing to worry about. She also asked me to keep a mood diary.
    Could i just ask if you actually think she has mental health problems i.e hallucinations severe depression any strange behaviour? as this is what they normally focus on and will usually brush you off if you just have general problems in life.....Maybe counselling would be a better option for your daughter? Hope all goes well keep me posted *HUGS MOTHER*

    ReplyDelete
  12. Thankyou for your hug
    I'm not sure what really qualifies as mental health maby she is bipolar deffinately no hallucInations
    My parents and myself have tried to protect her as she was growing up really storage behavior at times
    But everyone we know thinks she is a bit strange
    She has a lot of panic attacks not sure they are real at times but since I last spoke 3 more boyfriends and more odd behaviuor and not always answering my calls
    No referral has cone through yet

    ReplyDelete
  13. I actually witnessed this happen a few months ago in a forensic setting... where they had tried everything else they could think of.... and nothing had worked...
    Glyn Willmoth

    ReplyDelete
    Replies
    1. You can only try so much. If a patient refuses to take part, then I think that more or less tells you everything. Silence is much more of a dead giveaway, than any amount of talking. I guess some are fed up. Nothing new. Though, I can understand why some patients wouldn't want to get back out into the terrifying modern world.

      Delete
  14. hi literally terrified becaus ei have been refered to MHT and havnt got a clue what is going on. This helped though. My symptoms are largely paranoia so this is process is scary. I have hallucinations only twice (voices) and thought disorder, depression, anxiety and paranoia. Anyone similar? What can i expect?

    ReplyDelete
  15. In my experience the Assessment team conclusions went entirely against the evidence presented to it by the family plus they totally ignored the recommendations of the GP and Psychiatrist...... absolutely Useless!

    ReplyDelete
  16. I agree with the last post. I as referred to CHMT in December 2013 as after nearly 2 years of different drugs they were not working. they saw me (nurse and social worker) and I went through all my abusive past, 1 week later I get a one sentence letter telling me they are referring me to counselling with the mental health nurse and will receive an appointment soon, IM STILL WAITING. No surprise in Feb 2014 I went downhill further, having relived all the experiences I was trying to forget and then being ignored by CHMT I considered jumping off a bridge. I was rightly referred by GP to the crisis team. They are wonderful, went as an out patient for 5 weeks and by the end, I could communicate, go shopping and return to work, albeit only for 16 hours, that is all I can cope with at present. So when I get discharged from there they confirmed I needed to keep to my CHMT appointment and they will follow up on the counselling. After my 4th cancelled appointment and they wonder why im worse and now angry. I have no faith in the NHS system, I am pretty sure the social worker who I finally saw yesterday after 6 months of hell was left in no doubt of my opinion of their services and I see no pojunt in seeing a consultant pschatrist who just passes the buck and apologised for cancelling all the other urgent appointments as he has other patients and stuff. YES stuff, would that be the stuff where for some insane reason they allowed both psychiatrist's to take the whole of April off on annual leave??

    ReplyDelete
  17. I saw this thread where someone in the UK(I am in the US) has been refused all help by her CMHT. This is not right. I though our services here in the US was bad enough until I read this thread,
    Poppy, Florida USA.

    ReplyDelete
  18. Yes I saw that thread. the poster is actually on other forums. It's a great pity the online community cannot do more to help and change the shambles we have called the NHS.

    ReplyDelete
  19. I was refferred urgently did I get an appointment in three days no.. it was a month wait so clearly not urgent and only to see a social worker when I've had an assessment and seen a psychiatrist before! Ridiculous them helping people they make you more angry

    ReplyDelete
  20. I wish you were there when I went for an assessment. I was shouted at, told I was wasting their time coming, shouted because I had given the name I use, not the one on my birth certificate. I left realising that I'm never going to get better because the place that specialises in mental health, not only turned me away, but made things worse. I'm back with the team now but wish that 5 years ago they had listened, would have saved so much pain :(

    ReplyDelete
  21. I have never seen the same gp more than once or twice before they go off somewhere else. Notes are sketchy. Nothing I have said is documented. Every gp has given a different diagnosis, another label. So many times that as I was keeping my employer up to date I was feeling like I was just making it up and pulling random names out of a hat. I saw a councillor through work that was organised for me after a particularly stressful incident. This led to me discussing a lot more. She gave me the information I need to visit my gp but I didn't see the point so I didn't. After all, I'd just get another label and no help. Lots of scars later and a couple of failed suicide attempts I was at my gp about another matter. I bit the bullet and let it all out. I now see that same gp every 4 weeks. I have had a referral and telephone assessment with the mht who made me feel at ease. And I am now awaiting a face to face assessment in a couple of weeks. I am.on medication which appears to be just starting to help. I have not been given another label although they have told me what they think it may be. This also backs up what 2 different counsellors have suggested as well. And it does ring true to how I feel, it matches my behaviours and the traits that I have dealt with for as long as I can remember. I no longer feel like nobody cares because my gp does and it actually seems the mht does. I am anxious about the appointment especially as I was told it would be in my own gp surgery and it isn't, it is at the local primary care centre. A place I have been before but it is a big building and I don't know where I am going. I struggle with strangers so I have been advised to bring a friend or family member so there is someone I know. As awareness of mental health has increased the quality of care and support available also seems to have improved massively. Time will tell what will happen but hopefully it will be a positive experience despite my anxieties. I hope my story so far gives courage to other people who have been ignored to try again and not give up because as I have found someone does care

    ReplyDelete
  22. I would like to say that Community MH services are now RECOVERY based and encourage people towards recovery and independence. There are some people who unfortunately seem to think that it is not their (own|)responsibility to manage their own health - and consequently will always look to others to to do it for them and 'blame'others if they do not recover. Today's MHS services are for people who want to move forward and manage their own health, encouraging inependence . Everyone can recover ,no-one is, or should expect to be,a patient for life (A change from the thinking of 50 years ago)!

    ReplyDelete
    Replies
    1. I'm shocked you think it appropriate to write that when people on here have posted about not receiving any help or therapy at all. People do actually need treatment, in order to recover.
      MH services don't encourage "recovery"; they have hijacked the word. Instead, they encourage not trying to access help, nevermind that you need some. Bottle it up, basically.

      I'm self-aware enough to know I am traumatised and need to work through some things, I have no idea how to make sense of certain experiences that cause me flashbacks and nightmares and general fear and depression. I know I need therapy, that would aid "recovery". Can I get it from the MH team? No.

      And a note to the MaskedAMHP: I see your update re. services, and wanted to point out my experiences with the CMHT began in 2004/5 (several attempts to access help, not ongoing.) Complaints lead one to be labelled as a trouble-maker and lied about by staff who also practice misdirection in their letters to others (eg. claiming they've offered a therapy they haven't, but only if you know about that type of therapy would you spot the misdirection.)

      Delete
    2. I have lived with acute paranoid schizophrenia for all my life..at 49 yrs of age ,my age is effecting me physically and mentally and body getting older ..we all slow down..its part of aging, but with my illness its a demon on its own course and is as relentless and extreme yoday as when i was in my 20`s ... my memory loss over the last yeaars..is of serious xoncern and also my community care over the last 4 or more yrs consisted of a cpn who as a person she was lovely..as a professional she was inept..my support worker saw me every 2 weeks to help me go through the shopping in asda senario..which is very hars and frustrating to get from strart to finish .with issues constantly occuring.. but her input and level of care began to slip and ..the beginning of this yr after 3 yrs of her ..she would shop for herself and so asda or any supermarket shop was out of my ability ..i left it to just trying to see what i could in pound land... to last.... most days i go without eating..as i can never work out what i need and how much or understand how long things will last... as for social worker that was not a part of my support ..i was aware though my care plan was enhanced level.. ..but as a result of struggling to try cope ..and live .. i clearly have failed.. my flat is a place i have not allowed anyone in for over 3 yrs..and i am living in a place with rubbish and accumilation of what comes into the flat..but never leaves..i walk on top of piles of bad bag of food..month old and rubbish stacking .or piling up to ceiling... no one knows i libve like this ..and ive noticed ,y mental health is kind of out of reality,., i was stopped all support a few m

      Delete
  23. This was not the type of experience I had at all. I was referred to my cmht for assessment but I wasn't informed what was going on at all, I was just told I'd been referred to them and then it was 2 months before I was actually assessed. The assessment was carried out by a clinical psychologist who seemed nice and gave me information about what would happen next but what she described in terms of the treatment I'd get and where I'd have to go to get it, didn't happen at all and I ended up being put under a trainee psychologist who seemed out of his depths with me and when I tell him about certain issues he's visibly unsure in the situation and even asked me what I thought needed to happen next with my care. After seeing him for a couple of months, he's now leaving and he's talking about me being discharged when he leaves even though I've made it clear that I am not better and that I actually feel worse as it's made me feel more confused and misunderstood. I'm not sure what's going to happen next. I know people have different experiences with the cmht and I'm not trying to demonise them because I've spoken to people who've had high quality care from them but my point is, everyone who is referred to them should have a positive experience with this.

    ReplyDelete
    Replies
    1. onths ago.. and without records or reports...mentally statementt on discharge form the dr from wild card ..chose mental health i was well... and life style well.. im going to die if this goes much longer.. as for looking after and managing my own care.. im sorry you think...that we depend on you people way too much and you talk as if we are lazt and expect you to do everything.... well i dont!!! ..do you even know what it feels like to fear you are unable..and being assessed for early dememntia ..i have tried and i cant acheive what i use4d to be like ...idependance is someones pride and diginity... do you think we do care..and want you to think and do for us..? you sound typically like system care worker.. ignorant ..you need rto know living with all the noise and ashouting in my head and my paranoia .. and unable to complete tasks as forget what to do.. and lost my flat in a rubbish tipo..im ashamed ive not had a shower ..as my bathroom is to bad to get intpo and shower is block with rubbish..since last year.... im living now.. with no one ..i have nobody ..having lost my closest friend and my little dog with in a month.. and now.. i am in the flat ..no one phones..why i have a phone is stupid...as theres no one to ring me.. and i try to be ok... and try to get up.. and struggle as the medication is so strong im drowsy and numb.. i try..... i say im ok.... im NOT!... everything i had that gave reason to get up and eating food etc...company and talking ...has been taken away ,,,my life is being destroyed bit by bit..i have a psychiatrist who has a low opinion of me in my life style and how i dress and ..his attitude and opionion of me takes priority over his job.. im losing all i had ..why live?...im not going to kill myself..but i hope i die soon er .....as life is horrible awake of dark..

      and people like you who just take for granted getting up and dressed breakfast then work.. as a normal routine...then try doing it with schizophrenia and take the medication i have to take ..and trty... you would not function... we all try and do out best.. all we seek is support in wanting to be seen as people wqho need that little bit of help so we can live a quality of life..the same as you live... and as i see my world ms mental health professional... .. i can say... quality ...does not exiast in my life... i try....i never complain never rude ,,dont moan and dont feel piyty or sorry for myself.. im drowning ..and its frightening... so sorry some of us just cant quite live up to your expectations as how much we depend and lazy attitudes.. of self help.. you are stigma in a nut shell

      Delete
  24. I went to CMHT today after attempting to commit suicide. They did not take me seriously, they just thought I was some attention seeking teenager. The person there I spoke to was patronising and thought he knew everything. They told me I did not meet their criteria which I'm glad with because by the end of my session, I was fuming. I hope this is not the case for all young people being referred to CMHT. I'm going to get the help I need elsewhere.

    ReplyDelete
  25. I'm so confused with the CMHT at the moment and feel let down by them since of my loss back in 2013 I couldn't bare being alive and I was close to my grandpa .I have thoughts of suicide for sometime now and yet they admitted that I could of done of being on the ward yet I was told to go home and I'm still the same been selfharming by starving and and harming in other areas to .and yet there's a person that I know that's a attention seeking so they get admitted in to hospital for nothing .and the CMHT knows I'm genuine and it.has upset me .as they know I need there help and support when they see that I was in a state and yet they rejected me and let this person in .that would do just anything to get admitted I'm bit confused and they turn away genuine people away .

    ReplyDelete
  26. I am so fed up with the mental health services. I thought things would be different in a different city but its exactly the same. It took 6 weeks for PIER Team (Early Intervention in Psychosis) to refer me back to the outpatient mental health team that is so far away from me. It is like no one cares. I just want to get better. I hate feeling this way. Now I am being told I won't receive an appointment with the CMHT outpatient service until 2-4 months from now. I am in my final year of University, I am literally going insane. I don't know what to do. I called PALS and was told they would call me back in 24-48 hours. Its the same cycle over and over again, I've been doing this dance for 6 years now with the mental health services across 2 cities. I am so tired.

    ReplyDelete
    Replies
    1. Have you tried talking to mind there OK to chat to or Samaritan's they listen to anyone .I agree it is tiring when no one gets back to you .sometimes you just want to be heared I hope these people will help you .

      Delete
  27. They are useless. My GP has referred me so many times and they just make me so frustrated. Keep speaking to a different person each time, going over the same stuff and not getting anywhere - honestly only one person I felt comfortable with. I have not seen a psychiatrist and tell them I am suicidal but think that they think I am an attention seeker and won't do anything. The next time they hear my name will be when I am dead.

    ReplyDelete
  28. My experiences with my local CMHT are not very good unlike the LD service which have been excellent and continue to be excellent. I was first assessed by the LD psychologist while inpatient on a generic MH ward and he come to the conclusion from school reports and my results from the IQ test I had a mild Learning Disability and I was promptly moved to a Assessment Treatment Unit. Unlike the staff on the MH ward the Nurses and HCA's at the ATU were by fare the most friendliest and didn't spent unnecessary time chatting away in the nurses hub unlike the MH lot, they actually spent time with the patients. They are way more holistic and treat everything instead of just the mental illness. The CLDT continue to support me in the community which is not time related like in the CMHT.

    ReplyDelete
  29. I am not a mental health worker. I am a carer.
    In my opinion, personality disorder level mental states are not like a broken clock that can be mended by an external clockmaker. There are no tools/devices that someone can use to take the 'faulty' mind apart and put it back together again. In reality, the mind has to fix itself. Most people can't do this on their own but they have to want to. A therapist will work with you in a structured way to help you to fix yourself. But there are no guarantees unlike the clock idea.

    It helped me to understand the mind this way...

    The mind is not put into your brain/body by some outside force or being. Your mind emerges from the very complex connections of neurons in your brain. These connections are not fixed and change all the time. As you grow and experience the world, the connections are setup in patterns. Small changes to these patterns occur all the time. If we repeatedly experience 'negative' situations some patterns are made stronger. All these negative and positive patterns are not really thoughts as we know them in our inner voice. When we experience a situation, many patterns get excited (the connections start signalling each other) and some don't but the strongest few patterns dominate to become a thought or emotion causing action/behaviour. Luckily, because the brain is changeable, we can, with help, cause better patterns to become stronger and allow the not so good patterns to weaken.This applies to our cleverness too, use it and we get sharper and the opposite happens too.

    These are my ideas on the mind/brain and are based on neuroscience from the last few years. Google for 'neuroscience and brain plasticity' for details.

    I hope this helps someone to understand why they need to want to change their brain.

    ReplyDelete