Divided They Stand: How The NHS And Private Sector Cannot Work In Tandem

I got my care plan through the post from the CPA meeting that was held whilst I was in the Priory. I already had the Priory’s copy as my named nurse and I went through and wrote it up whilst I was still an inpatient. The copy I got through the post was my NHS version, a little late admittedly, and unsigned by me.

There are huge discrepancies between the two. Dr Mc and the Priory have listed me with a diagnosis of bipolar affective disorder with emotionally unstable (borderline) traits. The NHS say that my diagnoses (most significant first) are emotionally unstable personality disorder and bipolar affective disorder. In fact Allison has written in the CPA review “Ruth had been anxious to obtain a diagnosis of bipolar affective disorder as opposed to Borderline Personality Disorder. Dr Mc reiterated a diagnosis of bipolar affective disorder with emotionally unstable traits”.

Traits are just that. Things in my personality that mean I am emotionally unstable at times but not enough to fulfil the criteria for a personality disorder. Allison has been doubting Dr Mc’s diagnosis since day one, this is one of the reasons that I have found it so hard to grasp the fact that I actually do have bipolar (told to me by Dr Mc, Jane, all the nurses at the Priory and my GP) rather than just seeing myself as a hopeless personality disorder case. Allison has written in the review that I should consider the NHS group therapy programme for BPD, even though at the review Dr Mc and the therapy team at the Priory thought it was an inherently bad idea.

I still do not know where I stand. I know I was admitted into hospital before Christmas with severe depression and Dr Mc said I had bipolar 2. This was then reviewed and changed to bipolar 1 when I went manic and had hallucinations. I was admitted last time due to mania, which Dr Mc and Allison both agreed I had. Now I know that Allison isn’t denying the fact I have bipolar, although I do think that she does doubt the diagnosis and has only written it down because Dr Mc told her that was what is wrong with me, but she seems obsessed by giving me a full BPD diagnosis rather than allowing it just to be traits, as Dr Mc wants.

The NHS and the Priory are getting worse at keeping in touch with each other. Last time I saw Dr Mc he had received a phone call from Allison less than an hour after I had seen her because she was concerned about one thing or another and decided that it was a matter of safety so he needed to know. This was over a week ago. Now Allison seems to want to get me to do the liaising between the two of them and when I saw her on Friday told me to tell him a couple of things from her. I felt like saying that if she could go behind my back to inform him of things that I had already agreed I would tell him (she clearly just didn’t trust me) why should I act like the gobetween now?

I have no idea why I see Allison really. The Priory give me most of the support via Dr Mc and Jane and the NHS just seems to be getting in the way. When I rang the CMHT a few days ago to speak with Allison, as she is listed as my first point of telephone contact, and she wasn’t there, instead of the duty worker speaking with me (as he should have done) he decided to look at my notes and tell my that I should just ring the Priory. The crisis team refused to assist me after my discharge because I was discharged by the Priory and it was up to them to sort out aftercare, which they are doing in the form of daypatient care, but that still leaves the weekend. I know I can phone the ward at the Priory day or night and someone will talk with me, but the staff on the ward are there for the inpatients. It should be the Community Mental Health Team that deals with problems in the community, hence the name.

I need to keep seeing Allison as I do not know how much longer my parents will be able to fund the Priory, particularly daycare, and so keeping in with the NHS trust means that when I need them fulltime they will already be there, rather than me having to wait weeks/months to be re-referred to the NHS. However, at present I feel she is detrimental to my recovery as she is always very hesitant about what I can and cannot do or am capable of. The Priory support me massively and are keen to see me do things and lead a ‘normal’ life, but Allison always has her doubts, and she voices them. I am not saying that the Priory is the be all and end all, god it has it’s own little brand of politics that is difficult to fathom at first and hugely irritating when grasped, but they seem to be a lot more focused on making me well, rather than keeping me in the unwell mould.

I have also crashed down from my (hypo)mania. It was slow and steady and I could feel it coming. First I went hypomanic, then I had a period of relative normality where I was on an even level and quite happy, then I could feel the signs of depression creeping up on me. The wanting to stay in bed and perpetually tired. The not caring about what I wear or washing my hair. The comfort eating (when I am mild-moderately depressed I eat a lot, when I am severely depressed I stop eating) and craving for chocolate and carbohydrate. The apathy towards whatever I am doing and nonchalent attitud as to whether it is completed to a good standard or not.

I am nowhere near severely depressed but I am depressed and if current trends are anything to go by it will continue to slide. I see Dr Mc and Jane on Tuesday so will mention it to both of them. I don’t know if Dr Mc will put me back on an antidepressant. I desperately want venlafaxine so I can shift the weight I’ve gained, but then I shouldn’t be picking my possible treatments on account of me liking the side effects. Part of me wants to get through it with no antidepressants, or indeed medication at all, but then part of me knows I should accept whatever help is given to me.

In better news, I haven’t self-harmed for 2 weeks – the last time I self-harmed was when I was an inpatient. I haven’t actually even wanted to cut/burn myself so there must be some improvement somewhere. I want that feeling to last, this is why I’m scared of the depression creeping back in.

Ruth

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7 Responses to “Divided They Stand: How The NHS And Private Sector Cannot Work In Tandem”

  1. intothesystem Says:

    *hugs* I know how it feels. The NHS and Priory just don’t seem to be able to work together and I find it so difficult. My funding expires in a couple of weeks and the NHS still aren’t talking to The Priory. It feels like I’m just going to slip between the two in the end.

    As for the battles about your diagnosis I understand your confusion. Sounds like a nightmare. I think my consultant and GP still have doubts about my bipolar diagnosis too. I was given the diagnosis by a bipolar specialist who had been asked by my consultant to give a second opinion, but I’m still not sure they’re convinced by it.

    I hope your mood doesn’t continue to slide. I hope you can get back on that even keel.

    Take care, x

  2. eccedentesiast Says:

    Well done on the self harm front. For me there just came a point when I didn’t feel I needed it anymore despite being stuck in a severe depressive episode. Things are odd like that.
    I’m still in the middle of a diagnosis battle myself. The private psych, my NHS CPN and my GP agree with the bipolar whilst my NHS psych changes her mind with each session. Even so I’m being treated for it. Luckily I won’t be seeing her for 2 months for obv reasons.

    The venlafaxine I’m not sure about. I don’t know if my appetite has buggered off because food isn’t for hunger at the moment. I’m not motivated by it at all and there are the vicious and continuing side effects I’m having to contend with. I do see why it’s favourable though and I’d probably like it if it didn’t mess my body up so much.

    Anyway, I’ve rambled sorry. I hope your mood doesn’t slip too much. Definitely a good idea to try and catch it early on with some treatment. Look after yourself you x

  3. Hannah Says:

    Well done for not selfharming and the fact that you don’t even want to selfharm is really good. I hope the feeling lasts.

  4. ScienceGirl Says:

    Hey, Im glad you havent harmed, I agree with eccedentesiast, one time I used to literally rip myself to pieces, then came a day that I just didn’t feel the need to do it anymore. Recently I have harmed and I feel awful for it, but those days I didn’t harm still count, just like it you relapse, you still have these days to think of.

    I like reading your blog, mostly to see how you get on with your CPN and how she helps. I have a CPN and I see her every few days, and have done for ages, I don’t know why I see her so often and I don’t know exactly what she is doing to help me, most days it feels like nothing at all. When I ask to be discharged, she doesn’t really listen and I feel like she just wants to keep me on her caseload, but I am not sure why.

    Anyway, sorry for rambling, and I apologise for not making ANY sense, I am feeling a bit surreal, don’t know if it’s the meds or dissasociation, as the CPN said.

  5. Pole to Polar: The Secret Life of a Manic Depressive Says:

    I got the traits thing too, but it was eventually scrapped as Bullshit.

    Very well done on the self harm, lady! Been struggling with that one myself recently xx

  6. Ruth Says:

    Intothesystem – my psych’s main speciality is addictions, with a sub-speciality is affective disorders. I think this is why he was allocated as my psych when I was admitted. I think Allison just doesn’t want to be proved wrong as she was so convinced I was BPD from the moment I met her.
    The NHS/Priory working relationship is shocking. I saw my GP this morning who didn’t want to give me a prescription as I see Dr Mc later, she told me that he could fax the meds across and she’d issue a prescription… and if that works I’ve suddenly moved to Outer Mongolia!

    Emma – I’m being treated for bipolar as well and all my notes on the GP’s computer and at the Priory clearly state that it is my diagnosis. As I have mentioned in this post, I am actually not sure what use Allison serves, but keep seeing her as I feel it is the “right” thing to do.

    Hannah – thank you. The feelings are creeping in again but I’m still managing to resist.

    Amy – it’s the days where I haven’t done it that are keeping me from doing it at the moment!
    It’s stange to read that someone actually likes reading my blog, I’d never thought of people getting enjoyment from it. I hope you feel less surreal today.

    Seaneen – personally I think they’re total bullshit as well, but my psych seems to think they are there and as long as he thinks that they will be written down and inevitably misinterpreted by my CPN.
    Sorry to hear you’re struggling on the self-harm front, hope it gets easier soon.

    xx

  7. Alison Says:

    Although only being in hospital for three weeks I too experienced the NHS and Priory not being able to work together and was told numerous times by nursing staff I should be seeing my private consultant when I was an inpatient, however my priory consultant did talk to the NHS consultant and they have agreed to work together and forward copies of correspondence so hopefully it will run smoothly… **fingers crossed** I guess for yourself Ruth and others in the priory as inpatients it becomes more complicated…

    As for the diagnosis issues it must be so frustrating to be told one thing from someone and something else from someone else… my priory consultant agrees with my BPD diagnosis and I don’t doubt it and never have but I also realise from day one she’s been swaying towards a Bipolar diagnosis which I’ve suspected for years myself and there is a strong family history but the NHS refuse to see my mood swings as hyper enough for Bipolar II, in fact they seem to be completely blind to half the things I do when I am Hypomanic but since the Priory consultant is happily trying out mood stabilisers the NHS can kiss my ass about a correct diagnosis.


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