The latest draft.
Dear Mr Director Person
Re: Accessing Mental Health 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 apparently exists. I am cautiously encouraged by this information.
However, you will recall that in my letter of 11 March, I specifically requested details on what is being done at this time to adequately govern the treatment for the serious difficulties faced by people with mental health issues in Northern Ireland. I would hope that your lack of a response to this question was an oversight and, therefore, I look forward to hearing from you in this connection by return. I would ask that you also detail how the rights of such individuals are secured within the community mental health system.
In relation to my own case specifically, you may be aware that <NewVCB> considers that I am afflicted with (amongst several other conditions) 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 (and a multitude of other literature) on this subject. As I am sure you are aware, these sources (and many others) quite definitively assert that whilst psychotherapy is a vehicle to recovery, the inadequate provision of same can lead to re-traumatisation of the patient to whom the therapy is provided. I would assume that an explanation of the potential dangers of such a scenario is not necessary.
Given your evident familiarity with my case and your contact with C, it will probably come as no surprise to you that I have become thoroughly re-traumatised as a result of recent work with him. This is, I acknowledge, often a necessary step in the therapeutic process. My dissatisfaction with the service provided by the Trust stems from the fact that the Trust is allotting me very little time, by way of further psychotherapy, to address this. In short, the Trust is effectively releasing from therapy a patient who, as a result of the therapy being cut short, is in poorer health than at the beginning of the therapeutic process. Is it the Trust’s intention to discourage healing and indeed bring about psychological damage to ill and traumatised individuals? I do not believe that it is possible for even the most gifted therapist to alleviate this trauma within a matter of weeks, and have today discussed this issue with C, a meeting wherein it was agreed that my precarious situation within the Trust is, to put it diplomatically, “less than ideal”.
The Trust may, of course, claim that it is not bringing my treatment to an end. It is, I note, proposing to refer me to a CPN or mental health social worker after my contact with C ceases. With the greatest of respect to such members of the CMHT, I feel that this is far from adequate. Given my re-traumatisation, I would enquire as to how a CPN or SW could (on their own, at least) possibly be considered a better choice than a qualified psychologist as my primary contact within the system, particularly given that such individuals often practice the supposedly panaceatic techniques of CBT or DBT, which I have found to be extremely unhelpful and indeed counter-productive in the past. I am not entirely sure what other kind of work such individuals could help me with, and would appreciate your kind clarification on same.
If the Trust’s actions are being determined by concerns around costs and NHS targets, then I would at least appreciate an acknowledgement of this. If, alternatively, the Trust considers that my therapy should end as a result of perceived psychotherapeutic attachment or reliance, perhaps you could admit to that fact (though of course most research in the area agrees that these issues, if present, should be fully explored rather than ignored). In short, please advise on exactly why my psychotherapy is being cut so profoundly short and why my case is being transferred to an as yet unknown individual who may lack the expertise to deal with the kind of conditions with which I am diagnosed and indeed with the severe re-traumatisation of the kind that I am now experiencing.
For the avoidance of doubt, whilst I am willing to try to engage with a CPN or SW, I would strongly prefer that my psychological therapy with C continues past the currently proposed end date (circa September; in terms of actual meetings, this contact amounts to one year). Furthermore, I would also request that said therapy continues for as long as is necessary, bearing in mind two important factors. Firstly, it took over 12 years to finally be assigned any type of useful therapy, despite my having been referred by my GP to a number of other mental health practitioners (who, for various reasons for which I am not responsible, failed to be of any assistance). Secondly, as discussed with both C and <NewVCB>, it is highly likely that in the event of my discharge now, I will, in future, merely be re-referred for psychological therapy, thus rendering pointless any supposed cost-saving efforts surrounding the current process.
I would like to emphasise that I have found the current psychotherapeutic process at least modestly useful, and believe that through further contact with C, it could continue to help me.
I am certainly well aware of the strain on resources a case like mine presents, but as stated in my original correspondence to you, I am aware of quite a number of individuals in other Trusts that (have) receive(d) psychological therapy for years, if that is or has been deemed necessary (and in my own case it is accepted that long-term treatment of this nature is what is considered the best course of action). As you may be aware, mental health care receives approximately 50% less of the health service budget in Northern Ireland than it does in other parts of the UK; nevertheless, I know individuals in other Northern Ireland Trusts that still receive(d) ongoing psychotherapy for the required time (of course, by the same token, I do appreciate that some Trusts in Britain exhibit failings in mental health care too). Do you think that this postcode lottery vis a vis treatment – not necessarily PD specific – is acceptable? If not, what does the Trust propose to do to counteract the deficiency?
Finally, 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 once again. It is appreciated.
Yours sincerely etc.
Thoughts? I will detail this morning’s session with C when I have actually bothered to adequately detail the last one. As you may note from the above, I have decided to pursue therapy to the end (thanks for your advice on same), though I was completely honest with him for once and told him about my having considered cutting it short and about how re-traumatised I feel.