Note ; I’m not going to use any identifying information, so I’ll refer to each person by a letter+ number to tell them apart, as it does get rather confusing. The colour-coding is also just to keep track.
K1– university counsellor
K2– university wellbeing practitioner
L– a close friend who I needed to bring with me to some meetings.
C1– first mental health assessor at the community services.
C2– second assessor at the community services.
C3– final assessor at the community services.
Community Mental Health Services
I was referred to the community mental health services (CMS for short) 3 separate times; once from the hospital, once when I finished seeing K1, and by K2 during the relapse I mentioned earlier. This meant I had 3 separate mental health assessments in just over a year.
Each time I was assessed like I’d never been there before, with a different staff member. This seemed really inefficient, especially as each asked me the same questions and mentioned me having used the services recently.
My first assessor C1 was friendly, and I was able to talk to her. However, while I went in assuming my issue was solely/mostly depression and I would be offered CBT, C1 threw a curveball by giving me a leaflet for Mentalization Based Therapy, a treatment for Borderline Personality Disorder.
She made it sound like I almost certainly had BPD, something I struggled to get my head around. While I did show many of the traits to some extent, the diagnosis would not be accurate or useful, something I know concretely now but couldn’t have verbalised then. I panicked at this, which affected my answers to her questions.
My second assessor, a few months later, was C2. C2 was the first mental health person to believe medication could be prescribed to me, as long as L looked after any medication. As the medication was very helpful for a short amount of time, I’m glad she made that potentially risky call, and respect her for trusting me.
One less clear area was her reaction to C1. When I mentioned the previous referral, C2 instantly dismissed all mention of BPD, saying that C1 may have had a vested interest in promoting the mentalization treatment and leapt to the BPD conclusion based on limited evidence. While I was relieved that C2 didn’t think I had BPD, having the opportunity to at least discuss the traits I did have and how to deal with them would have been more useful than ignoring it completely. Also, bringing what felt like clinician infighting into a patient’s assessment just didn’t feel right.
My third assessment was after the relapse mentioned earlier. The assessor this time, C3, was my most negative experience overall.
Firstly, the good part: C3 was the only person who recognised that my experiences could fit the profile of a dissociative disorder. Getting this recognised officially would have been incredibly useful. But I didn’t feel able to go back and see her enough to get that finalised, so my doctors notes only say Depression NOS, which isn’t the whole truth. In retrospect, I should have pressed on with getting that sorted, but by the time I realised, I didn’t know how to get back to the CMS to ask them.
I didn’t feel able to go back because I found actually talking to C3 difficult; while she was obviously knowledgeable, this sometimes came across as condescending whenever I asked for clarification or explanation. Being a psychology student with an interest in mental health, I already had some knowledge that an average client may not, which meant getting stuck didn’t happen often: still, having that experience when politely questioning something didn’t help.
I also got the impression of her using my own experiences against me. For example, the first event that brought me to mental health services involved painkillers. In later meetings, she would always use painkillers as her example whenever she needed to explain something medication-related. When another event involved antihistamines, she switched to always using antihistamines as her example, in a way that felt pointedly aimed.
For both of these points, I assumed my feelings were wrong, or I was interpreting everything wrongly, as I don’t understand certain social areas very well so often find working out factors like tone of voice difficult. It wasn’t until I had to bring L to a meeting with C3, in order to get medication sorted, that I had an outside input.
L made the same interpretation of C3 that I did, and had wanted to interrupt her to defend my points during the meeting. It was validating to know that I wasn’t imagining things, but I know that others using the services may not have that option. (This isn’t everything about C3, but I’ll leave it here for now.)
Overall, seeing the CMS was a double-edged sword: they had the knowledge and the ability to make the diagnoses I needed, but they were also the least accessible, least supportive-feeling service I used. They feel like a microcosm of the NHS as a whole; a service with a great potential to help people, but that potential being distorted by bureaucracy and detachment from individuals experiences.