Latest in the Ongoing Me v NHS Saga – MORE ADVICE NEEDED!

I should turn this into a series of posts.  It’s becoming something of a recurring theme, my own little comedy of errors if you will.  It frustrates me endlessly, of course, but if you dig a little deeper there is something pathetically amusing about the whole sorry business, in a sort of wry, dark kind of way.

Anyway, here is the latest letter from Mr Director-Person, in response to my correspondence of 11 March.  I am very impressed with his wonderfully speedy return on this.

Dear Pandora

Re Accessing Mental Health Services

Thank you for your letter of 11 March 2010 and I apologise for the delay in replying.  As we have acknowledged previously you are correct in your interpretation of the NICE Guidelines in relation to personality disorders.  However NICE does not apply automatically in Northern Ireland.  Currently a Regional Personality Disorder Group, brought together by the Department of Health, Social Services and Public Safety is considering the Knowledge and Understanding Framework (KUF) as a way forward to developing better services in Northern Ireland.

Locally, a group run by <Mr Twathead>, Head of Mental Health Nursing in our Trust, is working on a plan to improve services for people with personality disorders.  This service will support the objectives of the Northern Ireland Strategy for Personality Disorder.  The Trust is also in the process of recruiting Personality Disorder Practitioners who will work with community teams to provide a more locally responsive service.

As a Trust we are committed [hahaha!] to user involvement in the planning, delivery and monitoring of our services so we would be grateful if you could get back to us with an expression of interest in helping us develop better services for people with personality disorders – please contact <BitchBrain>, Assistant Director Mental Health Services, <Big Bin>, <phone number blah blah>.

In relation to your own treatment and care, <C> has spoken to <NewVCB> about follow-up sessions.  It was agreed that there would be a seamless [*explodes laughing*] transition at that time [<pedantry>at what time?  What point of your letter are you referring back to?</pedantry>] to the provision of support from either a community psychiatric nurse or a social worker from the community mental health team.  The details of who this will be and the extent of the contact will be negotiated closer to the time of transfer.

Yours sincerely

Mr Asshole Director-Person Cunt.

One thing that really annoyed me that has no relation to that actual content of the letter was that he addressed me as ‘Mrs <my new surname>’, assuming that any female changing their name must be doing so owing to marriage.  My cunting bank did this as well, which send me into a spiralling fury of ranty anti-capitalist rage.  What a pile of outdated, presumptuous, misogynistic crap.

Anyhow, this is my proposed response.

Dear Mr Director-Person

Re: Accessing MH Services

Previous correspondence refers.  Thank you for your eventual response of 12 May 2010.

I note with interest your willingness to point out that NICE guidelines are not always applicable in this jurisdiction, and that a regional team is “considering” the application of the KUF.  I also have taken note of the information that a plan is being “worked on” to develop services in this Trust and that a NI Strategy for PD apparent exists.  However, you will recall that in my letter of 11 March, I specifically requested details on how the treatment of the very real challenges faced by Northern Ireland individuals with mental health difficulties (not just personality disorders) is being adequately governed and protected now.  I am disappointed to note that you have failed to provide this information.

You may be aware that <NewVCB>, whilst reluctant to continue the tradition inherent in the system of providing stigmatic diagnoses, felt that I am afflicted with a form of complex post-traumatic stress disorder.  I would refer you to Trauma and Recovery by Judith Herman and The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart on this subject.  As I am sure you are aware, these sources (and many others) quite definitively feel that whilst psychotherapy is a vehicle to recovery, the inadequate provision of same can lead to re-traumatisation.  Given your apparent familiarity with my case, I believe that I can fairly reasonably conclude that you will be aware that I am thoroughly re-traumatised thanks to recent work with C.

To that end, I should be grateful if you could clarify the mandate of mental health services within your Trust.  Is it your actual goal to discourage healing and indeed bring about psychological damage to ill and traumatised individuals?

In particular, I must question the decision to refer me to a CPN or mental health social worker after my contact with C ceases.  I must confess to being amused at your contention that the transition from C to this person would be “seamless” – aside from the fact that it is impossible for you to predict the level of “seamlessness”, and the fact that I am well acquainted with C without any knowledge of his “successor” (and bearing in mind social anxiety is one of my many diagnoses), as yet no one has been able to tell me exactly what such individuals do other than to attempt to encourage their charges to complete day to day activities.  C-PTSD and BPD, as you know, require significant psychotherapy, not reminders to undertake simple tasks (which, I might add, are often impossible regardless of external encouragement).  Whilst there is arguably a place for such professionals as adjunctive workers involved in a person’s treatment, at present I utterly fail to see how assigning them as the primary contact can be of significant benefit, at least to someone someone such as myself.

On the other hand, I am also aware that certain individuals of these specialisms practice the supposedly panaceatic techniques of cognitive and dialectical behavioural therapy.  After my 12 years of being richocheted around your system – and of being forced into the private sector thanks to its failings – I have experience of these “therapies” and feel strongly that not only are they ineffective and patronising, they are indeed offensive.  Their practice is in keeping with the victim-blaming culture that seems inherent in psychiatry and allied professions in reference to BPD.

Whilst I accept that the above view is personal and not held by everyone, and that these techniques can have at least temporary usefulness for some sufferers of mental illness, it has been accepted by those involved in my own case that this would not be appropriate for me.  I would therefore hope and expect that it is not suggested.

I would, ergo, again enquire as to the relevance of a CPN or SW as opposed to a qualified psychotherapist as my primary case worker.

I would like to convey my sincere thanks to you for inviting me to express interest in your user involvement scheme.  I shall be writing to your AD, <BitchBrain>, with said expression forthwith, and look forward to hopefully making a worthwhile contribution to personality disorder services within our Trust.

Thank you for your time.


Pandora (Ms)

I whacked this response out on a secluded beach on the Turkish Mediterranean.  My God, what a sad, pointless life I lead!

I’m seeking advice on this one because, although I feel my letter is fairly good, it doesn’t ask many direct questions, meaning that Mr D-P can cleverly wriggle out of answers yet again.  To this end, I wonder if any of you would like to suggest amendments, additions or direct questions that I could use when writing back to him.  As with the last post, all views are most welcome.

Thanks again lovelies.  x


21 thoughts on “Latest in the Ongoing Me v NHS Saga – MORE ADVICE NEEDED!

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  5. Crikes, Pandora! You write a damn good letter. I’m not sure what my suggestions will be. I’ll think on it, and get back to you via computer(instead of phone)

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  8. hi, newish reader here. if you are asking for honest opinions i admire that you’re trying to challenge crap pd provisons but your conduct kinda makes you seem abrasive, arrogant and laden with a sense of entitlement. why do you always call people dr insulting name? or slur them if they disagree with you. don’t say its a bpd thing because you can take responsiblity for it. i know you feel let down and traumatised but i think you should give ita a week and stop going on the attack.

    my 2¢. sorry if i offend.

    • Blame BPD! No, not at all. It’s most assuredly not a BPD thing at all, unless you feel that BPD = Me, which I suppose is arguable. Nevertheless, I take full responsibility for it. Mr D-P may blame BPD, owing to the usual reputation the illness has, but I don’t.

      I’m not sure if you’re coming from an NHS background, but the thing is there is only one way to get noticed in the whole sorry system, and that is to SHOUT. That doesn’t always – or even often – work, but being nice and deferential most certainly won’t. I agree that the writing is abrasive and arrogant; that’s not unintentional, and previous correspondences with Mr D-P (and to be honest, many people/organisations over the years – doctors, banks, universities etc) have been written in a similar vein. It’s OK that you don’t like or agree with it, but it’s my style and I don’t apologise for it. (For the record, I write nice letters when they’re deserved too, for example when my ESA Advisor was very understanding regarding my mental ill health).

      As for using swear words to address them, well, again, it’s just my style. Until they prove otherwise, my default position is to assume that they’re twats (and they have very much yet to prove otherwise). Once more I don’t feel that has anything to do with BPD necessarily – just mistrustful misanthropy. And it’s not as if they’re going to read this copy of the letter; they will of course be addressed normally in the copy they receive 🙂

      Still, I will wait before sending it, mainly as I feel that it doesn’t specifically address anything, and I don’t want him dodging the hopefully entrenched bullets.

      No offence taken at all, I appreciate you taking the time to leave your opinion 🙂 Would be glad to hear from you again.

      • As you absolutely should. The health service may mutter about being ‘free’- but we all know its not- they damn well charge us enough through NI and are so often useless =(

        I dont think the letter is arrogant or abraisive- it’s well-informed and clearly frustrated, yes, but I don’t see what’s wrong with that. You are right to be annoyed and being well-informed is surely a _good_ thing??

        As for direct questions- well you have asked him to a. give you specific details on NI provision for BPD _and_ why they are referring you elsewhere- can ge really get out of answering these? Is there anything you need to add- not that I can think of Pan, not in relation to what he’s written.

        Really hope the user involvement thing will work out for you. Keep fighting the fight!

        Best wishes

      • Thanks Kate – I appreciate your support as ever.

        I was wondering, because I know you are friends – have you heard from Serotonin Seeker recently? I haven’t seen him commenting here or writing on his own blog for a worryingly long time :-/ I hope he’s OK.

        Thanks again hun xxx

      • To be honest Pandora I am really worried about him. We used to email weekly and chat on msn every now and again- for about six weeks I’ve had no emails, he’s never online =| I’ve sent him loads of msgs to check he’s alright but there has been no reply.

        I know his name and _roughly_ where he lives but it’s a big place and his name is fairly common so I cant find any relatives. Hes not on facebook but I still emailed some peeps there in the area that had his surname just in case- but it was in vain.

        Dunno what I can do from here =( I just hope he’s been sectioned or something- it’s horrible if so but I can’t bear the alternative…

        Take care

  9. I think it is a good letter. I doubt it is any consolation to you, but the PD provision in my area is also non existant, and I am in England as you know, so don’t think it is just Norn Iron that is suffering. The problem with the NICE guidelines is that they are that – guidelines. They are advising on the appropriate treatment, but no Trust is under any obligation to follow them. There is absolutely no specialist services for PDs in my Trust, or the one I was under before this one. Neither do I know of anyone who has had long(ish) term psychotherapy like you have had with C in my trust – the Psychologist in my CMHT only sees people for short term therapies like CBT and CAT. There is nothing in the way of a DBT service even anywhere in the trust, which is obviously one of the main recommendations for BPD (although I know it is one you dislike – I can’t comment as I have zero experience of it). The vast majority of people in MH services see a CPN or Social Worker, and then a Psychiatrist for meds. Unfortunately Psychologists are just so expensive that they only seem to use them for short term treatments, rather than ongoing psychotherapy, or that is certainly the case in my Trust. I know you think a CPN or Social Worker would be useless, but some are actually very good, and do actually ‘do’ therapy. Others are complete fucking wastes of space who do the encouraging you to get dressed and go out etc like you talked about in your letter. In my experience it is hit and miss as to which you get. But as I have said before, L is a CPN, and is definitely the best person I have seen, and I have seen various people, including 3 Clinical Psychologists, over the years. She does go into things in detail with me, and we actually spend very little time talking about my routine etc – she focuses far more on how I am feeling and trying to discover the causes behind it etc etc, so basically therapy. I do think it is really shit that they are stopping your sessions with C, as you are clearly not ready, but I just thought I would let you know that PD provisions are just as bad over here in England as they are over there. In fact, my Psychiatrist once told me how lucky I was that I was being seen by the CMHT, as they generally turn away PD referrals…!

    • I suppose I should make clear that I’m not suggesting that NI is the only place that’s sidelined; clearly some services in Britain are shit too (although as my election posts point out mental health receives almost 50% less health service funding here than it does in the rest of the UK).

      In real terms, my issue is not so much the provision of specialist services, but the adequate provision of therapy. Since that angle didn’t work, this one has to be explored. For what it’s worth, I actually know several people under the NHS that received therapyof well over a year. One person received seven – I shit you not.

      This goes right back to the original point I made to Mr D-P and friends. The whole pathetic thing is a postcode lottery, and that more than anything else is what is most unacceptable about it.

      • Yes, it absolutely is a postcode lottery. I know some people do have therapy more long term – I was just talking about what happens in my area. The problem with if they even did establish a specialist service in NI, that would probably mean a DBT approach, as that is what NICE recommend, and I know you dislike that. Have you ever had DBT by the way, or is it the concept of it you dislike? x

      • It is what NICE primarily recommend, but I believe that TFP, schema therapy and a number of other techniques are considered permissible for those for whom DBT is inappropriate.

        I haven’t had the full whack of DBT, at least in part because I wouldn’t have accepted it owing to how shite it is. It started way back in week 12 of my therapy with C. I hated it instantly. I’d read about the concept and thought it was utter toss, and this session convinced me. I have to admit that I grew to hate it slightly less – in part because of some of the philosophical background to it – and if it was a choice between DBT and CBT, I’d choose the former in a second. But it’s still patronising, victim-blaming wank. It’s basically a modified version of CBT that is only slightly less shit than its parent therapy.

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  11. Psychiatry is the Cinderella service. Treatment of PDs is the sub-cinderella service. They say PD is not a diagnosis of exclusion but that message is taking its time to reach the lower ranks of the NHS.

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