Bristol Mental Health: is support and treatment for suicidal and depressed people who struggle on to fulfill their duties going to be available only in the private sector?

Having used clinic 7 over many years and been refused any help by (AWP) Community Mental Health in 2003, I have very little confidence in there being adequate service provision in the future, if "clinic 7" goes. I was offered 24 weeks CAT therapy by (AWP) in 2011, after many grim years. This was ended abruptly with substantial pressure to move into the private sector. Sorting out and paying for a new therapistis a big ask in depression and contravenes the most basic NHS principles when suicide lives on your shoulder, tantamount to unethical actually.

With the community teams moving to a new base, it is already noticeable how dramatically less accessible they are. Any suggestion that Community Mental Health will step in should be refuted immediately and is already a joke.

Clinic 7 accepted my GPs referral and has offered support for many years, without threatening deadlines. Clinic 7 doesn't evict you after a preset time or when a patient still is in a bad or even worse place. Remarkably. Dr Malizia keeps trying and I need his confidence that a solution can be found. Dr Malizia has an ongoing input on a regular basis trying to help me cope with this depressive episode, I have minimal expectation of adequate alternatives being offered come September. His experience and expertise does of course have a price but his input has kept me working and paying taxes, so I am sure it is cost effective at a societal level.

No-one I work with has any idea of my health issues; the latter primarily resulting from bereavement which left me bringing up small children on my own.

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Abandoning Clinic 7 patients will cost so much more elsewhere and in the health service, very quickly I suspect.

How I feel now- from a clinic attender who is unwell

Saturday 16th June

"Upon waking in the morning, I am always aware of my body feeling electrified, like I have ants crawling on my sweat sodden body.  My mind is uncontrolable from minute one, ruminating over and over the same visual "stories".  Thoughts of suicide in numerous ways; hanging, train tracks, cutting my wrists - anything that will release me from this terrible mindset.  I will swiftly rise from bed and find myself wishing that "GOD" or someone will do something about this.  I am completely preoccupied with the reason as to why is this happening to me and why is it so bad, why am I not responding to medication.  Daily life is so very difficult, my new behaviours are so far removed from normal it is ridiculously challenging.  A walk to the shop is filled with panic attacks, a visit from a friend is pondered over and often I will try and cancel - I don't want people seeing me in this horrendous state.  My whole family are at a loss as to what to do - all they can do is watch from the sidelines unable to comprehend what on earth is going on for me.  To say I am suicidal is an understatement.  I keep saying this - "I don't know how much more I can take".  My thoughts are attrocious, angry, scared, terrified, sad, lonely, death, dreams of a final funeral.  Continually finding two reasons I don't commit suicide and they are selfless.  I don't want someone to have to go through the horror of finding me, and It would destroy so many in my family.  I am embroiled in a seemingly pointless battle, both with my own mind and with the doctors that make up my own community mental health team.  I want something very swift to happen to me; an effective antidepressant? ECT?  SURGERY?  Anything to stop this.  I have tried every intervention I think known to man; Mindfulness, meditation, CBT, EMDR, Vitamins, Minerals, Activities, Walking, running, weight training, riding bike, sleeping (when my mind lets me) to name but a few because I am forgetting some.  I had problems before this recent situation but two and a half years ago my mind suddenly turned into a scene from a horror movie.  If I am not put straight then I am afraid I will find a way of dying that means no-one will find my body.  Only another sufferer of this condition would truly understand my plight, or maybe in addition a very well versed and practiced doctor.  It is shocking to think that the mind could be so very powerful and turn in on oneself in such a negative way.  As a result of being ill I have lost everything, my Wife, my children, my home, my friends.  I am struggling to stay on the bottom rungs of the social ladder and it hurts so much and is so very hard to interact with other humans I often wonder why I still try."

You can respond to Benn with comments below

Personal experience of the illness of depression and of the Psychopharmacology Clinic in Bristol

My Experience of Depression

The Distress of Depression

It would appear to me that depression is very variable in terms of its intensity and effect upon the sufferer.  The two extremes ranging from feeling low and sad through to utter despair where only suicide would bring an end to the suffering.

I have experienced depression to varying degrees for much of my adult life, although I do recall at school being bullied psychologically as I sought to adhere and live out my Christian beliefs; my response was to withdraw into myself.  The net result was that I left school at the earliest opportunity with very limited academic qualifications.  It was only later in life through extensive self study that I ultimately gained a Masters degree in economics from the University of ….  When I felt well enough I have found academic study to be a “balm” to my troubled mind, at other times I have been too depressed even to read.  With this qualification I was able to pursue a career as an academic.  During much of this time I was free of the most severe symptoms of my illness.  This continued for over a decade interspersed with periods of depression and as a result I resorted to alcohol in order to soothe my troubled mind.  This period also included times of extreme lethargy.  Despite setbacks I was successful in my career and was promoted to Principal Lecturer in .. at a very early age.  However, my depressive illness increased and I was very debilitated by it, to the point where I would just sit and stare into space unable to do the simplest of tasks.  I was also very ‘slowed up’ both physically and mentally.  By this time I was receiving hospital treatment but I was unresponsive to anti-depressants.  My doctor advised me to give up work at college which was a great sadness for me, although it was a relief to not longer have to battle to keep going when I felt so ill.

By this time I felt very ill and I had various physical symptoms such as stomach pains and flu like symptoms and I was convinced that I had cancer.  My doctor referred my to a specialist physician who after thorough investigation ruled out a physical cause for my feeling so ill. The distress of low mood has been linked with periods of intense anxiety.  At such times this was so great that I was obsessed with ending my life to escape this distressed experience which included repetitive painful thoughts and anxiety attacks. These thoughts of suicide in my worst times have escalated to planning how I would actually do it.  What actually stopped me doing this were the dual thoughts that it would be wrong to do as a Christian to the extent that I would lose my eternal inheritance and secondly I would be unsuccessful and end up just damaging myself. Never the less there are many times when  if I could have had an injection that would just put me to sleep, such as that administered to a dog, I would have done it.

My self esteem is low and of late it has felt even lower together with a lack of confidence and forgetfulness which has resulted in my checking everything I do which I find very tiresome.  As to the future I would love to improve my health to the point where I could return to my career, as I write, this still seems a long way off.  One problem is that I have been off work for so long that I have de-skilled particularly with computing which has now become such a feature in the academic world; I would also need to be able to concentrate for longer times that at present.

Treatment

The treatment I have received through the NHS has been very good.   My GP is very sympathetic, caring and patient and readily changes my medications as directed by my consultant Psychopharmacologist  (to whom I was referred by my consultant psychiatrist as my depressive illness was proving difficult to treat.)

My only criticism was three to four years ago when my consultant psychiatrist prescribed a course of Electro Convulsive Therapy (ECT) for me.  I raised my concern that I was on Monoamine Oxidase Inhibitors (MAOIs) and there could be an adverse reaction with the general anaesthetic that would be given.  I was assured on more than one occasion that all would be well, unfortunately this was not the case as my blood pressure, and resting pulse went up to very high levels and I was admitted to the acute assessment unit at …. Hospital.

I have found my treatment at clinic 7 very beneficial as the  consultant (Dr Mlaizia), has tried different  types of anti-depressants at varying levels both to lessen my depression and increase my general motivation and activity. This has met with some success.

Several years ago my then consultant psychiatrist referred me for a course of treatment at the Priory Bristol, and I’m afraid to report that I found this stay unhelpful.

Depression Society Spirituality and Philosophy

To many the notion that the human mind can be in a state of anguish, when there is nothing to agonise about and find that this same tormented mind can ransack the body and soul and suck out strength, feelings and positive emotion, or indeed any hint of happiness is hard to contemplate. Indeed to the many who have not passed through this dark valley of doubt and fear, and at times total despair such an illness would seem beyond belief. Why even the complexity, the qualitative, some may say anecdotal nature of medical opinion provides the opportunity for perplexing doubts and misleading interpretations as to the true nature of this morbidity.  No peaceful reassurance of an absolute quantitative diagnosis, thus leaving sufferer and casual observer to ask the question, is this an illness?  Is this idleness? Is this self pity or some other deceitfully constructed malaise of avoidance to life? Or is depression all of these and more.

If this apparently meaningless mental torment is indeed genuine, is it a malfunction of mind, body or spirit? Again the answer is all three, for the mind controls the body and the brain gives us the ability to comprehend mankind’s unique relationship with our creator, thus mind and spirit are linked through comprehension and faith. Spiritual depression is sometimes quoted in isolation from mind and body as if some act of disbelief has been the prerequisite to the specific state of spiritual depression. To claim that such a person is suffering in this way adds much to the despair and crushing guilt. For to study the Bible, and thereby feed the soul requires an element of focus and concentration much greater than a few fleeting moments, a basic function so often denied the depressed mind. This failure can so increase the sense of guilt, of sin, to the point where the despair and the sense of eternal death trouble the mind to a very great extent. Bertrand Russell in his essay “a free man’s society” so clearly articulates these, where in deep depression he claims, “all the inspiration, all the devotion, all the labour of the ages, all the noonday brightness of human genius are destined to extinction in the vast death of the solar system”, in spite of doubts, deep down inside the Christian depressive can know that Bertrand Russell’s terminal pessimism is incorrect, for the Bible claims an undeniable redemption for all of us’ right through from the book of Genesis to Revelation, regardless of  our mortal state.

So why do so many Christians focus upon depression in a manner that infers some error on the part of the sufferer that needs “spiritual healing”. It has been said that depression is the only physical illness that has spiritual symptoms, how true I have found this to be. Yes there is the physical dimension of bio-chemical imbalance, but it would seem that there is much we do not know about depression, it is therefore also a mystery.

However what many do not accept or comprehend is that until the mood is lifted through medication to the extent of rationally being able to comprehend Biblical truths one cannot hope to improve the spiritual state, indeed not to accept this relationship is at best distressing, and at worst fatal.

In spite of an awareness of depression only those who have experienced severe clinical depression over prolonged periods of time to the extent that they would rather stop living, have the right and “qualification” to testify to the trauma it can bring.  Indeed some medical opinion states that depression in its severest form constitutes one of the worst forms of suffering know to man.  This view is vividly demonstrated by Primo Levi who in the last few years of his life confessed that “it is a fact that one who has not been profoundly depressed is not able to comprehend its horror and loneliness, they can listen, sympathise and imagine, but they cannot feel”.  Primo Levi has said that what he experienced in Auschwitz was not as bad as when he was in the grip of deep depression.

Planes, trains, automobiles and Durkheim

Imagine a businessman that flies regularly across the Atlantic. Sitting next to him on the airplane you chat over a meal. At one point he says: ‘I think any pregnant woman should be banned from flying way before 36 weeks. They are a real nuisance. We have had to turn back and land in Ireland twice in 12 months as these idiots went into labour. Last time the woman gave birth on the plane. It was truly inconsiderate. What is worse is that they brought her to business class as “there was more space” – I couldn’t even enjoy my film with all the screaming first her and then her baby girl. You would have thought the plane would carry on to NY as she had given birth- but some other cretin said we had to land as the baby was premature and it was important to check her out as soon as possible. To top it all up the steward who had delivered her went off. With all this going on I had to wait for 30 minutes to get my G&T and nobody apologised’. Preposterous? Read on..

Ms A.B. arrived late for work, for the third time in a week, on Wednesday saying that there had been a pile up on the M15. On Thursday you are having a break with her and she points to an article in the local newspaper reporting the facts of the previous day’s pile up. ‘I think people like this should be more thoughtful and travel outside rush hour; cripples should not drive anyway’. A diabetic amputee had become drowsy and died as he was driving back home from a night shift; colleagues said that he was thirsty but had not stopped to drink as he felt the urge to go home and rest; he probably had high blood sugar that caused him to lose control of the car causing the pile up. ‘The worst thing is that I will have to pay back the time as the boss won’t budge!’  Another sick fantasy?

At the jubilee week-end I went for lunch with friends. At the table, I was sitting next to a new acquaintance that seemed smart and cordial. One of the topics was train commuting as the man on her left had recently moved to one of the home counties but worked in London. She confessed that she had commuted for a number of years and that she found the carriages stifling so that she would always try to be next to a window. Luckily the commute was no more than 35 minutes except on those occasions when some joker would jump in front of the train during the morning rush hour. These people are so inconsiderate: they seem to get up early in order to carry out their overly dramatic business at a time when it caused most inconvenience. Distressed, I pointed out that many depressed people wake up early in the morning when they often feel worse, that it may be easier to find an opportunity to jump when there are more trains and that anyhow this act that seems so deliberate is intimately linked with uncontrollable unpleasant thoughts and feelings. The response was ‘woo, who takes things too seriously then?’. She moved on.

This is a clear example of the cultural discrimination that people with severe depression are subject to and shows double standards compared with other conditions; sadly many people make and have made similar quips in my presence. My daughter who has been brought up to think about psychiatric illness, was horrified when she heard.

Over two thirds of suicides are associated with depression and its co-morbidities. There is great ignorance about the individual torment associated with suicide and the fact that the illness in itself makes people think repeatedly about it. For as long as people will focus on Durkheim (social anomie being one of the core causes of suicide), the sin of killing oneself and mendacious associations with ‘seeking attention’  it will carry on being the object of inappropriate attitudes that can extend also to professionals.

Andrea Malizia

Dr Malizia, this blog, Bob Geldof and Her Majesty's Diamond jubilee

First of all thank you for inviting me to write something- I will make my contribution a regular one and I will reflect upon aspects of treatment refractory depression or psychopharmacology.

While this blog site has been started to help people who will be abandoned by the unilateral decision of the Avon and Wiltshire Partnership NHS Trust not to support our twenty-two year old psychopharmacology clinic, I will make no direct comments about it. I am still trying to find alternative solutions and a polemical approach may distress potential ‘white knights’.

As we approach a long bank holiday week-end for Her Majesty’s diamond jubilee, I thought I would post my first blog for this site. People around the country are preparing for a ‘fun break’. I am also aware that this could be one of the worst times for people with severe and chronic depression. The inability to feel alive, described by someone recently as ‘being like a piece of furniture that is capable of breathing and excreting’ can become even more painful when others expect the ’normal’ range of emotional reactivity. I know many of you will be either steer clear of contacts or put on a ‘brave face’ and feel exhausted afterwards.

I have worked in this field for about 25 years and what is clear to me is that the ‘local’ problem is the product of generic misinformation and misunderstanding complicated by the peculiarities of the modern NHS. So while I have seen some progress in the treatment of chronic and severe depression/anxiety or of disorders of sleep/wakefulness in other countries, the situation has become even worse in England; GPs report great difficulty in getting help from secondary care for these disorders. This gap is compounded by ‘therapeutic nihilism’ whereby even the secondary services who take on people with these conditions soon say that ‘nothing else’ can be done.

I went to see Bob Geldof perform with the ‘new Boomtownrats’ at St George’s in Bristol on Tuesday night. It was great  and it made me reflect upon the fact that nobody has taken on the illness of depression as being something worth shouting about and getting money for in spite the fact that when severe and or chronic it has enormous impact on people’s lives. I have many explanation for this which can be grouped into

            the nature of the illness,

            what the public thinks of depression

            how people and relatives feel when they have this illness

            perceptions about treatments and outcomes.

Next blog is going to explore these; in the meantime contribute, if you can, by commenting on the above. If you want to read something else relevant go to http://www.colorsmagazine.com/stories/magazine/83/story/switch-on-your-brightest-smile  I am sure that you will identify easily with it.

Keep up the fight

andrea malizia