Last Friday I had a discharge planning meeting with my Consultant Psychiatrist, Social Worker (who’s my Care Co-ordinator) and my GP. This is because I’m being discharged from the CMHT very shortly. In fact, the plan is that I will see my SW twice more – to finalise my discharge paperwork/plans and then I’m out of the CMHT. I’ll continue to see my consultant to be reviewed for my ‘mood disorder’ – more about this below.
Unlike stories I hear elsewhere, I’m not being “forced out” of the CMHT. In fact, my SW and consultant have slight reservations because it’s not long since I finished DBT and the new job wasn’t on the cards when I initially asked for discharge. They wanted me to remain under the CMHT for a while longer. I don’t feel this is necessary or helpful really. Yes, I’ve just started a new job and my anxiety/panic has been extreme, I’m exhausted etc and therefore I’m more at risk of a relapse in terms of my ‘mood disorder’. However, the way I see it, my recovery journey means that there are going to be lots of changes in the near future. If I keep waiting to see how a big change will affect me, I might never get out from under the clutches of the CMHT. I don’t want to be indefinitely under the CMHT because for me it would be me being too entrenched in an “unwell” role and that wouldn’t be helpful. Part of recovery is developing resilience and to truly develop that I need to be going it alone. I say ‘alone’ but this really means me + my informal support – close friends, church, and even family (although in a healthy way and not becoming entangled in any chaos).
The usual method of discharge from the CMHT is a vague letter as to where I am currently at with the option for a fast-track to the CMHT within 6 months of discharge if there are any problems. I was actually horrified to find out that this was the case when I was told this a few months ago. How can that ever provide a satisfactory structure to help an individual and support them in a transition from intensive secondary care services to primary care? Upon hearing this and not feeling this was sufficient, I asked for a discharge planning meeting. In a way, I suppose I’m lucky because the GP who is taking over my care was keen to be involved in this process and I am the kind of person who is assertive and feels able to ask for this.
I had some tasks for my SW in the months leading up to the meeting last Friday and like the trooper she always has been since she took over my care-co-ordination, she sorted these out. I found myself chairing the meeting. This hadn’t been planned but someone had to take charge to make sure things were properly dealt with and that naturally fell to me due to my bossy nature 🙂
What came out of the meeting? Well:
- My BPD label is indeed in my past history rather than my current diagnosis or problems. This was a massive thing for me. If I do become very unwell with my depression in the future, I don’t want someone picking up my file and seeing current problem as BPD. A BPD label is basically a licence for a mental health professional to treat you like crap, make negative assumptions about you and not listen to any concerns you have or consider valid distress;
- I know my consultant had been considering a diagnosis of Bipolar since some time last year however I wasn’t aware that this had been officially my diagnosis for a number of months. Finding out at this meeting (although I was able to discuss and question this) was perhaps not the best way for someone to find out about a diagnosis. I’ll probably blog on the ‘new’ label in the very near future;
- My GP and consultant were able to discuss what each of them was happy to do in terms of any medication tweeks/changes in the future and communication lines between them. In fact, my consultant said that he has no problem me contacting him via his secretary between outpatient appointments if needed!
- My GP has put me in his diary for a regular appointment for the 1st Friday of every month at 10.30am to keep an eye on my mood and how I’m doing generally. I expressed concerns re wasting an appointment if I was well at the time and my GP reassured me and I feel comfortable because he said that he’d be pleased to see me when I’m well and it’s not at all a waste of an appointment for him. He seemed very genuine when telling me this 🙂
- It will be specifically stated in my discharge letter that I will not be excluded from primary psychology services for anxiety/depression/sleep intervention etc in the future because of my past diagnosis of BPD or self harm/suicidal behaviours. My SW prior to this meeting had been given the task of contacting the head of primary care psychological services and obtained that reassurance from her and this was documented in writing (at my request); and
- It will be made clear that although I want to self-manage, if I am asking for help in the future that means I am clearly in need of it even if not self-harming etc and I am not just to be left to my own devices.
Other things were discussed as well but I think the above ones are vital in my move from secondary services back to primary care. I don’t see how that can be achieved by the usual vague discharge letter from CMHT to GP.
My aim is to stay out of secondary services wherever possible and along with the points highlighted above, this will also be clearly stated in my discharge letter – a letter that my SW is drafting and I will get to check and approve before it is finalised and sent out. As my DBT therapist said “for want of a better word, some people are ‘allergic’ to mental health services and you’re one of those”.
I feel positive about moving out of services and it is the right thing for me. I got to direct the meeting and the groundwork was done by my SW prior to this. The discharge meeting, the plans and my approval of these plans have helped me feel secure. I feel confident that my GP will support me in this and he seemed happy at the meeting to have been included in this process.