The Advocacy Letter
Dear Sir or Madam
Re: Advocacy in Accessing Mental Health Services
I am writing to enquire as to my rights and to what extent you can assist me in accessing the services to which I am entitled. I am diagnosed with borderline personality disorder with psychotic features with a possible co-morbidity of bipolar disorder, type II. I take anti-depressant and anti-psychotic medication, and although I only received the diagnoses in June 2009, I have been utilising mental health services both on the NHS and in the private sector since 1998 (having originally been diagnosed with clinical depression and social anxiety). The care that the NHS has provided has always been wholly inadequate; until recently, any therapy I have been offered has either not come to fruition, has ended abruptly or, in one incident, has seen me being regarded with outright hostility.
Since 29 February 2009 I have been seeing a clinical psychologist on a weekly basis for psychotherapy broadly of a psychodynamic nature (though the approach is integrative). As of today’s date, we have had 35 sessions in total. It has taken me some time to fully open up to and to trust this psychotherapist, but now that I have, I feel that progress is being made, albeit slowly. I believe that further progress can be made through this relationship.
Unfortunately, my psychologist has informed me that he can only continue to offer me therapy for 24 further weeks (starting from the next session). This would, of course, equal 59 total weeks of therapy (including three assessment sessions at the start, and four sessions to end the therapy).
As you will be aware, all published research on borderline personality disorder strongly recommends long-term therapy for the condition. Indeed, NHS and NICE guidelines on this illness and on personality disorders in general completely contradict the view that one year’s worth of psychotherapy is remotely adequate treatment. I believe that the New Horizons consultation recently undertaken by the health service would not support this situation either. I strongly believe that not only is long-term treatment advisable, it is in fact necessary to deal effectively with my condition and therefore I feel that it is my entitlement.
Whilst I appreciate that resources are limited, I am frankly disgusted by the postcode lottery that seems to be in operation. For example, I am aware that there is a specific self-harm team within the <other NI area> Trust – whilst self-harm is not, of course, by any means the only symptom of BPD, I am sure that this team would work frequently with individuals with this diagnosis and would thus understand it well. Furthermore, I am familiar with several other individuals that have this (and other) disorders – in most cases less severe than mine – that have received guarantees of treatment lasting at least two years (in some cases) and three years (in one). I have yet to encounter a single other individual who has received only a year’s guaranteed treatment. My psychologist himself admits that ideally BPD should be treated twice a week for a minimum of 18 months.
I believe that if therapy comes to an end as proposed that I will in fact undergo a significant regression, and probably end up utilising yet more NHS resources. I am unable to work, and am in the regrettable position of being dependant on state benefits – a situation that I abhor. Any saving of government resources in cutting short my treatment is, therefore, a false economy. I also feel that the worry of treatment coming to a close will overshadow my relationship with my therapist thus preventing us from tackling more substantive issues together in the relatively short period we have remaining.
Additionally, I understand from the various guidelines from the health service that multi-disciplinary approaches are considered desirable and indeed necessary for personality disorders. To that end, I am surprised that I have never been offered access to the CMHT’s social workers, CPNs or occupational therapists, despite presenting symptoms perhaps best dealt with by such individuals in conjunction with my psychologist. Although I have had one experience of the Crisis Response Team (which, I might add, was an utterly appalling meeting), I have never been advised on how to contact them again in an emergency, of which I have had several in the past year.
I am not prepared for the NHS to once again treat me as a second class service user and am prepared to contact MLAs, MPs, the relevant Minister and Permanent Secretary, and indeed the media in order to obtain the treatment to which I am entitled. I would therefore be strongly grateful for your advice and assistance on (a) ensuring that I obtain a guarantee of continued psychotherapy, in line with NHS guidelines on the longevity of same; (b) ensuring that said psychotherapy can preferably continue with the therapist I presently see, as of course issues of trust and abandonment are a big part of this illness; and (c) ensuring that I can have access to the full range of services from the CMHT and the Crisis Team in an emergency.
As you know, borderline personality disorder, especially when psychosis is involved, is a severe mental illness and in this case has not been taken seriously. I feel that this matter is urgent and desperate, and to that end would be very grateful for your help and advice. Should you require further details, or if you would simply prefer to correspond via another medium, please do not hesitate to contact me via email on <my email address>. I look forward to hearing from you.
Thank you in advance.
This entry was posted on Thursday, 17 December, 2009 at 11:35 am and is filed under C, Context, Everyday Life, psychiatry, Psychotherapy with tags anger, bipolar disorder, borderline personality disorder, bpd, clinical depression, depression, major depressive disorder, mental health, mental health services, mental illness, nhs, Psychotherapy, rant, social anxiety, the NHS is shit, therapy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.