About 2 years ago, whilst living in a different region of the UK, I asked my GP for a referral to psych services for talking therapy. The referral process went like clockwork and I saw a sympathetic and professional psychiatrist who, after doing a full assessment, and hearing my experience with CBT and reluctance to go through it again, recommended cognitive analytic therapy. I was placed on the waiting list.
A year passed and I got slowly closer to the top of the list. However, I also got closer to my planned move to the south east. The same week I moved south I received a letter expressing regret for how long I had been on the waiting list and offering an interim group therapy appointment. I called them, thanked them, and explained I had moved to a different region. They offered to write a referral letter to my new GP to pass on to the psychological services in my new area, which they wrote and dispatched within a couple of weeks.
So far, so simple.
My new GP praised the letter which explicitly asked I be placed on a waiting list for CAT and the length of my wait so far be taken into account. He passed it on to the psychological services in my new area.
Which is where it all fell apart. I was rejected for CAT in this area because cyclothymia is not a “serious condition”, which was the criteria for being given CAT here. I was not seen, spoken to or assessed in any way by any mental health professional. I was just rejected wholesale and referred to a separate part of the service which only offer, you guessed it, CBT.
I kicked up a fuss, complained to PALS, calling my GP, but they wouldn’t budge – I was not ill enough to qualify for CAT. I was, however, offered an assessment interview by the folks who do CBT. The director of this service, we’ll call him Bob, offered me an alternative: Dynamic Interpersonal Therapy. Based on what Bob described, DIT sounded Freudian as hell something which, as a queer woman, I try and avoid at all costs. But it’s testament to my desperation for some support that I agreed to be placed on a waiting list for assessment. In the meantime Bob told me he,would send me some pamphlets on DIT.
The pamphlets arrived when I was up to my ears in university work so I put them to one side with the intention of reviewing them later. The assessment interview rolled round and then everything went to crap
After running through the usual questions, Bob baulked when I listed anti-psychotics as one of the medications I had taken for my condition. He expressed doubt we could continue with the assessment. “I never had psychosis,” I volunteered, desperately. He raised his eyebrows and said “ok, well, as long as you didn’t…” He asked me if I’d read the literature he posted to me, I confessed I hadn’t had the time. He leapt to the offensive “why should I believe you will be committed to this therapy if you don’t even read the leaflets?” I replied, again with a hint of desperation, “I just haven’t had time, I would be committed.” “But,” he said “what if it’s like CBT and you just say it doesn’t help you? You say you’ve had three rounds of that, perhaps you’re just not willing to make it work. How do I know you won’t give up on this like you’ve given up on that?” I’m really desperate at this point, the only support I’m being offered, however inappropriate to my needs it might be, is on the verge of being taken away because despite having been on waiting lists for over 18 months, I apparently don’t ‘want it’ enough. I promise I’ll be committed to the therapy, and assure him that what he is offering will help me if only he’ll give me the chance.
I dated a woman a few years ago with severe asthma. She was hospitalised and lost her job because she was on sick for a year. The specialist doctors in hospital gave her immediate relief from her breathing difficulties with oxygen and steroids. These doctors worked, over the next year, to find a daily drug inhalation that would keep her breathing normally. At no point did she have to prove she would use the new inhalers before they would give them to her. She wasn’t expected to provide an explanation for why the inhalers she was using before she went into hospital had failed to keep her lungs expanded. When the first drug they tried didn’t work, they adjusted the dosage; they didn’t accuse her of not trying hard enough to breathe.
There’s a lot of talk out there in the mental health activism world of getting the proverbial man on the street to understand mental ill health is not laziness and that those people with mental health issues cannot simply “get over it”. But my experience in the south east is that mental health professionals hold a good deal of prejudice. What other explanation is there for the threats of removal of access to all support, and accusations of not being willing to participate in treatments I had sought out?
I was not a “good” patient, I didn’t get better from a decades long mental health problem in 6, 50 minute CBT sessions. I was offered a therapy in one area which was denied to me in another based on arbitrary access criteria and not my personal circumstances and experiences. I had a history which included anti-psychotics which the assessor was ready to disqualify me on, but absence of psychosis would have prevented me from accessing any other treatment. I was treated as unwilling, unreliable, and difficult because I had the temerity to state that previous therapies hadn’t helped me and was seeking help living my life healthily.
I felt humiliated in that assessment. Unlike the earlier one with the psychiatrist, my experiences and needs weren’t heard. The psychiatrist in the first assessment described my request for therapeutic support as “entirely reasonable” whilst Bob implied a therapy that helped me was asking for the earth.
About 6 months later I received a letter telling me that they were clearing the waiting list and if I didn’t reply saying I still wanted therapy within 14 days, I’d be removed from list. I didn’t reply. I couldn’t face that humiliation again so I guess Bob proved himself right about me.