About, almost two years ago to the day, I was living abroad and suffered a nervous breakdown as a result of long standing psychological issues that were left untreated.
I was flown back to Ireland, and initially applied for admission to a hospital in Dublin. However, due to insurance complications, admission was refused.
They referred me to services locally here in Sligo.
I was given an initial assessment, and prescribed a low dose of anti-psychotic medication, to assist with the intense anxiety and distress I was experiencing at the time. I was also referred for CBT. This was in April of 2014. It would be about 6 months before I received a phone call for an initial CBT consultation.
Upon that meeting, I was told CBT was not the correct form of therapy for my issues, and was immediately discharged. I had another consultation with the local consultant, who saw me for, about 2 to 3 minutes.
I was prescribed a high dose of another different anti-psychotic drug, and the anti-depressant drug, which I had been also administered previously, and showed no effect on my symptoms - them being - constant and intense distress, anxiety, social withdrawal, hourly crying spells (persisting for months), chronic fatigue, IBS, inability to eat, and general lack of functionality.
My parents became so disillusioned with the lack of success of treatment, they stood in on my behalf, due to my inability to function and therefore implement these changes myself, and arranged an outpatient consultation for me with a private facility in Dublin.
Upon seeing the doctor there, he told me that I had been misdiagnosed with a terminal mental health illness, thus the high doses of anti-psychotics I was being prescribed. Bear in mind, this diagnosis was made during the 2 to 3 minutes meeting I had had previously.
He took me off the one of the drugs, and due to my complaints of ineffectiveness of the other at a high dose, also removed that from my regiment.
He then scheduled a hospital admission, to conduct further assessments and treatment.
Administration at the private facility I attended was in my experience woefully lacking, so it took about, 3 months, under constant daily duress from myself, for them to finally get back to me telling me again, that insurance complications would not allow my hospital admission, and I was to be again discharged to the care of HSE Sligo mental health services. During the time, I also made a trip to the ER in Sligo General Hospital, for an overwhelming onset of suicidal ideation.
The team was dispatched from the mental health sector to meet with me, upon which time I was told that, due to being, "under the care" of Dublin services, whilst waiting for results of my admission application there, they, in effect, could not treat me or deal with my case in any capacity. Two months on from this, I would get a letter confirming my discharge from the private facility , and return to the HSE.
I went in personally to the HSE administration building in Sligo, to insist on a meeting with the consultant. My time previously with them, I had been seen by an intern GP, doing his mandatory 6 months in the mental health sector - who seemed to me, to have an almost non-existent understanding of in depth mental health issues. I found him extremely brief and dismissive.
I must confess though, for someone such as myself in that position - which was very much teetering on the edge, not to be dramatic about it - this was not sufficient care.
The clinical nurse manager in Sligo's HSE, arranged an appointment for me with the consultant psychiatrist, which came up in about a week of being re-referred to their service. At that meeting, I was told that I would be referred to their clinical psychologist for assessments. This was made available to me on this occasion, where it was not available previously -due to staff not being available. To be totally clear about that situation; it is my understanding that Sligo's HSE and some patients under its umbrella, had no psychological treatment available for a one period year.
4 months from that point, I would begin treatment with their psychologist.
We are now in April of 2015, one year on from my initial crises.
Treatment began with a series of written assessments, to allow the psychologist to gain insight into my situation. They pointedly noted that, the results of the tests, were markedly different from my, "personal presentation" - in that, I did not present/look like as either being either mentally ill, anxious, or depressed.
Yet the results clearly showed severity in each of those areas.
This would be a definite criticism I have to the nature of psychiatry - in that, a psychiatrist will make an assessment in a 10 to 15 (in my initial case, 2 to 3) minute period, based purely on what they see i.e. the patient "presentation". And then they will administer power medications based on what is in my view, a paltry evaluation.
After the initial few weeks of written assessments, the psychologist I was attending began treatment. Progress was hugely inhibited by my lack of personal functionality, translating into the therapy sessions themselves - to a large degree, I was unable to interact sufficiently with the therapist, and constant and relentless presentation of distress.
At this time, through personal research and suggestion from those close to me, I became aware that, I should make notes outside of the therapy, on issues I felt were prevalent, that may be contributing to my situation. The notes consisting of, events in the past, the nature of my interaction with those around me, my inhibitions, fears, traumatic events, personal ideals etc. I would then bring these written notes into therapy, and use them to assist the therapist in my treatment. The therapy improved tenfold when this approach was incorporated. At this time, I was completely unmedicated. Despite the improvement in therapy, I was experiencing intensely all my previous symptoms, most notably overwhelming suicidal ideation.
I began to research thoroughly into various suicidal methods, and organised various ways to end my own life, as quickly, painlessly and efficiently as possible.
Previous to committing to the implementation of one of these methods, I personally resolved to have my case examined from every possible point of view, and empty my bank account attempting to resolve my issues, before I went past the point of no return.
I had thorough health screenings with leading consultants around the country.
My physical health was revealed as being pristine.
During one particularly severe bout, I contemplated the idea of turning myself into a medicated vegetable - simply to alleviate the distress. On this note, I scheduled another appointment with a HSE doctor, who saw me on short notice, and requested to be put on a new or different anti-depressant. On the third day of this medication, the suicidal ideation lifted. This was the first glimpse of success I had, since my initial crises and referral to mental health services. For the next 6 months, I would continue to be seen by the clinical psychologist with Sligo's HSE.
I will say, I found the psychologist to exhibit an outstanding level of professionalism. I will also say that, during the 6 months of treatment, where I received 45 to 50 minutes of therapy a week.
I resolved, throughout this time that, despite the relief I found in attending therapy, it did not seem to be having an actual impact on my symptoms.
I was not eating better, nor sleeping better. It did not improve my functionality, and it did not serve to reintegrate me socially, as severe social withdrawal and a resentment and hatred for people in general, seemed to be a very prevalent symptom of my condition.
As a result of the slight improvement with the trial of a different anti-depressant medication, and research revealing that oftentimes patients may go through several of these medications before experiencing full remission, I began the process of augmenting and varying my intake of medications.
Another meeting with the psychiatrist, which was much improved from previous meetings, due to my improved functionality as a result of the medication I was on, and thus my ability to speak and convey myself much more clearly and coherently, the psychiatrist augmented my regiment with a starter dose of another drug
This served to induce somnolence at this starter dose. It had been about 8 years since I was able to sleep properly, and had been chronic for the past 4, so taking this felt like a miracle.
Despite objections, I scheduled another appointment with the good doctor about 6 weeks later, and insisted on a dose increase. Following this, I would begin to return to physical activity and exercise, for the first time in years, for short periods in the evening.
In terms of attending therapy, the psychologist informed me that, our time was drawing to a close, due to the fact that they would be off work for an extended period of time. I was informed that they were not to be replaced whilst they were off. Again, my understanding is that this resulted in the entire area of Sligo/Leitrim and that area covered by the HSE, being without psychological treatment available to its patients. Moreover, upon discussions with members of the team there I was informed that, even when they did have an active psychologist, the waiting period to see them, was normally about 12 months from time of referral. I had been seen in 4 months previously, as I had been actually admitted to the HSE a significant time previous to that, and due to the fact that the doctor from the private facility had contacted Sligo services, stressing the importance of opening my case in the immediate future, due to the severity he felt my case comprised of. As I understand it at the moment, there is still no replacement psychologist with Sligo's HSE, nor is their plans to introduce one. I believe it will be another 6 to 8 months before the return of their own psychologist.
For me personally, my dose of mirtazipine was again increased to the maximum licensed dose, and again, another leap of improvement occurred. Unfortunately, in terms of cycling through these different medications to find a point where I have achieved full remission and can return to my work etc., I have met significant resistance, as it seems to be a policy within the field of psychiatry, whether improvements are observed or not, to keep a patient on a sole medication for 6 months to a year. What's the reason for this? Your guess is as good as mine.
I have an acquaintance whom I met through an occupational therapy group, who told me he had spent 5 years, highly sedated on anti-psychotics, which were notorious also for inducing weight gain.
The doctors refused a medication modification, until he changed services.
Under extreme duress, I obtained a script from my doctor for, from what I have researched, could potentially be a more potent and efficacious anti-depressant medication, which I will be beginning shortly, when I taper off my current drugs which, despite alleviating my initial distress, proved not to be nearly as efficacious in terms of restoring my functionality. I believe a large part of the difficulty I encountered in terms of in terms of obtaining this medication adjustment, stemmed from what I mentioned earlier, regarding the nature of psychiatric assessment. The doctor told me outright, that I didn’t present as being depressed. For that reason, they could not administer this more potent anti-depressant.
This is despite the psychologist’s report that, a plethora of the most in depth and comprehensive written psychological examinations, revealed my anxiety and depression as lying on the highly severe end of the scale.
It effectively took the 20-minute consultation of persistent arguing, for the doctor to eventually to write the script and dismiss my presence, out of what seemed in my opinion to be frustration and exasperation. I was informed that, if I returned the next meeting, 3 months from now, requesting further augmentation, that I would be discharged as a patient.
All that being said, I am no longer in the hopeless black hole I was in for so long.
I am still in the receipt of disability allowance, which is infinitely appreciated and a credit in one way to the running of this country.
I have achieved significant improvement of my situation, and still live in hope that, with the implementation of a functional combination of medications for myself, that I can obtain 100% remission, and return to my life.
"Sligo Mental Health services"
About: Sligo General Hospital / Psychiatry Sligo General Hospital Psychiatry Sligo Town 0501-2700 Sligo/Leitrim Mental Health Services / Sligo Adult Community Mental Health Services Sligo/Leitrim Mental Health Services Sligo Adult Community Mental Health Services
Posted by James (as ),