The lack of psychotherapy services

Most people who know me know that I work with eating disorders. I run a BEAT support group for those affected by eating disorders.  I have run the group for the last ten years.  The treatment for eating disorders whether anorexia, bulimia, binge eating or atypical difficulties is mainly through talking therapies. A combination of group/individual behavioural and psychotherapeutic/psychodynamic/integrative work depending on the difficulties.  Generally when I am contacted about the group most are in some sort of treatment whether it is supportive work with a specialist nurse or dietitian or seeing a psychiatrist in the eating disorders unit local to that person.  A number of issues come up repeatedly year after year.  The main one I hear which seems to be getting worse in terms of accessing- is getting skilled talking therapies with a skilled up practitioner experienced with eating disorders and for longer than 10 or twenty sessions. Despite eating disorder services being commissioned on a far greater level each year the demand is increasing especially with binge eating disorder which is coming out of the woodwork. This poses a number of issues. Services may not be geared up to take on these sufferers as they do not have the resources so the threshold for being accepted for NHS help is raised again for only the most severe get access to NHS help.  This is wrong as there are risks associated with this especially binge eating such as metabolic syndrome, coronary heart disease, high cholesterol to name a few reasons why everyone should be able to access help. Currently locally the waiting list to see a psychologist for treatment is 18 months. Even the you get a maximum of 20 sessions. May years long term work was considered one year and accessible. Psychiatrists and other members of the team feel uncomfortable saying no but have no choice and can help someone find a private therapist. This is outrageous however unless real investment is ut in place the situation will continue to get worse.

Clinical Audit, inpatients and PET time

I have started working as a clinical audit assistant with the clinical audit team with my local MH Trust. I was taken on for my service user experience. My job is surveying the inpatients on their experiences, the nursing care they receive, information given on medication, whether treated with dignity and respect, other concerning issues and surveying the patients on PET time.

Protected Engagement Time. How daft-nurses work on a ward and have to have designated time to come out the office and talk to the patients -would medical and surgical nurses get away with such madness? Oh I am sorry I could not change the IVI bag because it wasn't PET time!!

Quite..................some still struggle with such a basic concept and many patients despite PET time on the wards have no idea it exists.

I have had a shaky start as the long gap since I saw my psychiatrist the smashing Prof Anthony Bateman has been far too long. I will feel better -more contained once I have my appointment on 30th July. However it feels a tad hard....no very hard I should say.
In his absence I have been supported well by his new clinical nurse specialist manager Rory who has been extremely solid and a star. Rory took over from Catherine in managing the day hospital for those affected by severe personality disorder.
Catherine is an amazing lady but has now branched out into other areas.I wish her well in her new venture.

I have seen some difficult things in my work so far however am confident that as another pair of eyes and ears it can only do good.

Fenella

Depression and treatments

The antidepressant and depression debate

We all go through phases where we feel miserable or sad. However what happens when it becomes increasing and gets worse? What happens when you feel apathetic, exhausted, agitated, anxious at the thought of going out/meeting people/doing certain tasks, fed up and cannot get out of bed or feel life is pointless? When this is persistent over a period of time this is clinical depression. Seeking help is not easy and takes time as often the belief it is just a phase, bad weather etc. However when eventually a GP is approached there is a limited range of options. Everyone should have access to medication if they want it however what is crucial is the choice of talking treatments to work with/without the medication.

CBT -mild to moderate depression- up to ten sessions are recommended. Severe depression may need longer. Trauma Focussed CBT should be offerred for tauma related work.THis can be short or long term.
Computerised CBT -structured computer programme over 6 to 8 sessions working with a computer and graduate mental health worker.
psychotherapy -formal psychotherapy-waiting lists are usually long as this is a long term treatment of choice for many.
counselling -counselling is usually available through a GP surgery -however not for complex problems and only 6 to 8 sessions. Waiting lists vary.
supportive psychotherapy-this is supportive work by a psychotherapist or other mental health practitioner helping to manage better.
other talking and creative treatments. -there is art therapy, music therapy, drama, and other types of talking treatments for more complex issues. (CAT, SFT, DBT,MBT etc)

Treatment should be based on complexity of need not a resource issue. ie more than six sessions of SKILLED CBT not someone trained over a few hours or days . Someone experienced. Who will assess and guide through a process over the time it needs.

Contributory Factors
Housing
Work Issues
Unemployment
Debt/Financial Stress
Bereavement
Divorce
Bullying at home/work
Child Abuse/Abusive relationship
Family dysfunctional relationships
Anxiety
Chronic Pain
Chronic Physical Illness

Medication has a clear role to play. However should always be used with close supervision and adjunctive treatment (see NICE gudelines for depression http://http://www.nice.org.uk/)

Exercise has been shown to be useful as well-however that alone for many people is not enough and needs to be part of a structued treatment programme.

I was on the Jeremy Vine Show !

If anyone is interested in hearing the interview I did with Jeremy Vine on radio 2 about the value of antidepressants in my life then click on link and fast forward by one hour and five minutes. Then there is some music then the professor who wrote research paper, then me.Programme started at 12pm. Professor start talking about 1/10pm
http://www.bbc.co.uk/radio/aod/radio2_aod.shtml?radio2/r2_vine_tue

I spoke at length about the combination of psychological therapy which for me was crucial. I was fortunate in having an excellent psychiatrist Prof Anthony Bateman who is a psychotherapist as well as aconsultant psychiatrist to help me. Prior to being under his care I was under a generic team who were not overly helpful.

However the Layard initiative in IAPT has helped a lot I think for the mild to moderate group. GPs have generally nothing else to offer patients who come with mild to moderate depressive or anxiety symptoms other than pills. The long waits in secondarycare psychological therapy services also are problematic.
CBT is evidence based as is psychotherapy.
Many people though go private and need to be careful that their therapist works from an evidence base and is supervised by someone who knows the evidence based treatments and NICE guidelines well.
See http://www.nice.org.uk/ for NICE guidelines forDepression and other mental and physical health conditions.

February 19th 2008

2008 has had a mixed start. I am learning all the time. Currently I am involved with the following:

• North London Hub of the UK Mental Health Research Network, UKMHRN, based at Imperial College, London. I am the Service User lead for the Hub. My most proudest moment was when I was asked by Professor Peter Tyrer to join the Hub as a service user lead.
• Beat. Formerly the Eating Disorders Association. I am a group worker/facilitator and media rep with Beat. I co-ordinate the North London Eating Disorders Support Group.
• Barnet Voice for Mental Health- a service user group run by service users for service users to represent SUs at all levels in mental health, primary and community care.
• I have a special interest in personality disorder (non forensic), primary care , chronic disease management, psychological therapies,eating disorders, clinical governance,evidence based practice, audit and clinical effectiveness.

A few thoughts from last two weeks

I strongly believe if decent long term therapy is the recommended treatment for personality diorder why should it be denied when this what the Department of Health Policy Implementation Guide (no Longer a Diagnosis of Exclusion 2003) say you should be getting? Having heard from amazing speakers like Prof Anthony Bateman recently at BIGSPD the British and Irish Study Group for Personality Disorder Annual Conference whose mentalization based treatment is shown to reduce hospital bed occupancy significantly, and is now on an international clinical trial, reduces self harm and other destructive behaviours and far superior to that of "Treatment as Usual" (ie standard non specialist care ie CMHT managed) to the smashing health economist Barbara Barrett from the Institute of Psychiatry point out that it is the "cost benefit analysis" that makes it happen as she presented some early positive outcomes of Prof Peter Tyrer's innovative work using Nidotherapy-to Prof Sigmund Karterud of Norway talk of the Norwegian Network of Therapeutic Day Hospitals (and you stay there a lot longer than 12 weeks!!). I am urging you to make your voice heard and work hard at ensuring your local service is improved.