Discourage Partner Getting Themselves Discharged from CMHT

Specific disabilities and conditions
1

Hi.

I have some caring responsibilities for my partner, and I am looking for advice from experienced carers on how to discourage partners getting themselves discharged from community mental health teams.

My partner has PTSD and severe depression, has active suicidal thoughts, and has recently started to develop disassociation and derealisation. My partner was with the home-based treatment team for a few months and has been transferred to the CMHT two months ago.

My partner wants to be discharged from the CMHT as they don’t think they will get better, they don’t trust their carer and staff at the CMHT (due to pass incompetence and staff problems at the CMHT), and they don’t think the CMHT will provide the (long-term) therapeutical support that they need to get better (due to limited numbers of sessions available at the CMHT). Therefore, my partner wants to be left alone.

I strongly oppose that. I still see the value from the CMHT and believe they are making slow yet steady progress. Also, due to Covid-19, if they get discharged then there will be months of waiting list if they want to go back in the system again.

However, I share their concerns with the CMHT as well. For example, we recently asked for a care plan, but only given a very short document that basically says what my partner’s current issues are - without any mention of what the future treatment plan is. There are also limited resources within the NHS, and I am aware that the systems is not fit to provide a long term support that my partner needs. I want to go private, my partner doesn’t trust private services either / or doesn’t know where to start from.

I want to know whether there are other carers here who are also partners who manage their relationship as well as provide support for their partners. Also, if people can share some good practice examples of encouraging partner to stay put and not get themselves discharged from the CMHT, that would be appreciated.

Cheers.

2

Hi Ozan

You might find additional help and/or support on…

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I have similar issues looking after carees with long term chronic mental health issues, what they need is long term therapy and support but the mental health services offer limited help. 6 Sessions then you are dumped often leaving you in a worse place than before.

PTSD and Severe depression needs long term therapy, months even years of therapy to resolve and yes like you say the CMHT just does not provide long term support.
They provide an intervention, in the hope that people will get better, resolve their own issues.

I would say your partner needs Dialectical Behaviour Therapy Prolonged Exposure, that is suitable for people with long term complex multi-illness issues.
DBT-PE it is called for short.

But trying to get it, in very short supply, long waiting lists and does your mental health trust supply it?
PTSD and severe depression just does not get better with no treatment, help and support.
So i would say ask the CMHT for this therapy, your partner needs it, the CMHT will argue but that’s what your partner needs.

THE CMHT is maybe too lower service for your partner, suitable for maybe mild depression which can be resolved with 6 sessions and changes in lifestyle.
PTSD and severe depression needs psychiatry and Psychotherapy.
.

If you can find a private therapist , EMDR is suitable for PTSD, Eye movement and desensitisation and reprocessing is the longer name.
But do quite a bit of research about private therapists, look for ones that specialise in complex long term multi issue conditions

What is the GP doing in all this, the GP has a duty of care to ensure the patient is getting the right treatment?
The CMHT aren’t perfect they do mistakes and are limited to what they can do, your partner needs i think more than just the CMHT.

But quitting the CMHT, not a good idea, your partner is in the system, getting out will mean no help and waiting for months like you say to get back in.

Ask to meet the CMHT, ask for a reassessment or an assessment with a psychiatrist, has your partner seen a psychiatrist? and ask for this DBT-PE treatment.
DBT-PE is available, staff are being trained for this treatment.

Contact your MP about this, the more people contact the MP, the better.

And contact PALS, Patient Liaison, all mental health trusts have to have a PALS. You are very unhappy , The CMHT have made mistakes in the past, your partner needs the right treatment, help and support and so do you as the unpaid carer.

Your last statement, we have the opposite here in our area, my carees can’t even get into the CMHT as they are not unwell enough, they have to be more unwell then the CMHT can help.

So getting into the CMHT that is good, the CMHT realise your partner is very unwell and needs the right help, it is up to the CMHT to sort out the right help for your partner. The right treatment for your partner EMDR or DBT-PE, more long term therapy, not a short term intervention.

The staff at the CMHT often know what their patients need but its not the nurses that decide, it’s the people up top sitting in the offices who make the decisions but they never meet the patients.

So instead of getting discharged, ask for an upgrade to the next level, Psychiatry and long term therapy.

You might have to fight ( i don’t mean physically) but it is often the people who shout the loudest that get the help.

If you have a Rethink in your area, they might be able to provide an advocate.

I hope all this helps, i am fighting the same battle trying to get my carees the right treatment and support.

Finally whereabouts are you in the country, who provides the mental health services in your area?

I can look at the website, see what services they provide or you have a look, see if DBT-PE is advertised on the website.

4

@Londonbound - many thanks for this - lots of useful information.

My partner receives care from the Greater Manchester Mental Health NHS Foundation - their website is: https://www.gmmh.nhs.uk/ - I can’t seem to find whether they offer DBT-PE or EMDR - is there a specific section that lists if these treatments are available here? I found this, but is useless: https://www.gmmh.nhs.uk/dialectical-behaviour-therapy/

My partner has not seen a psychiatrist in the CMHT as they struggle to speak with someone they don’t trust and the CMHT hasn’t been able to build this trust yet. The psychiatrist from the home-based treatment team was very good and there was strong rapport between them - however since the transfer from HBT to CMHT, my partner hasn’t been able to trust any other health professional (due to again past incompetencies at the CMHT).

I suppose the best way to request your suggested therapies is to ask for a re-assessment from a psychiatrist within the CMHT (previous assessment done by HBT)? I will discuss this option with the care coordinator asap.

I will check Rethink’s website whether we can get an advocate.

The GP is excellent - they were there when no one else was helping - however, I am aware of the limits of mental health that a GP can provide.

I have raised my concerns with PALS and received a decision - in summary, they apologise for miscommunication and some of their mistakes, blame Covid-19 for numerous other mistakes, and blame my partner for not engaging enough with their care workers. The problem is that my partner can’t engage with care workers because of the symptoms of their depression / PTSD - it is like asking a wheelchair user to walk to get better - if they could have walked they wouldn’t need your help in the first place!

Cheers.

5

Mental health often blame the patient/service user as they call them for not engaging, easy way of not providing treatment and support.
When you have been let down all your life, sent around services like a parcel then it is natural to not engage/trust workers.

I have had a very good look at the Manchester mental health website, i can’t see DBT on the site.

Ask Pals about DBT, if not why not?

If they care about their patients, they should be giving the best and most effective treatments.

The blog above says that the person attended DBT for 14 months , thats a long long time and Mental Health services don’t like giving long treatments, prefer a quick fix but quick fixes just don’t work.

Your partner needs to move on from the bad past treatment , which i agree its very difficult and trust the mental health services again very difficult .
And Needs the right treatment as the person from the blog says, the right treatment will get good results, the wrong treatment just makes people 10 times worse.

And you the unpaid carer need help and support as well, ask PALS what help is available for you.

Can I ask why your partner has these problems, what caused the PTSD? , again trauma, a short term intervention just won’t help, long term therapy really is the answer.

Let us know how you get on?