Treating depression: psychiatrists and other mental health professionals
People can get to see a psychiatrist through a referral from their GP, or if they are in hospital. Common complaints about getting a psychiatrist were that GPs were reluctant to refer and people had to wait too long to see a psychiatrist when distressed. One woman said she felt fortunate that her GP knew his limitations and so referred her to a psychiatrist. People who are thought to be a danger to themselves or others should be able to get an urgent referral to psychiatric care.
Had a long wait to see a psychiatrist while suicidal, and so the psychiatrist's concern about his...
And to that meeting I'd gone prepared to talk about how I tried to kill myself and it was you know, really very likely I was going to, you know, try again and next time I wouldn't, I wouldn't mess up. I went prepared to the meeting with the psychiatrist and I'd actually ' the day after my suicide attempt I'd written it up and posted it to a news group and I printed that out because I knew that I wouldn't be able to talk about it, but it was something that, you know, I wanted to convey.
So I presented him with my, with my write up, and talked about how I felt and I cried and I sobbed and I filled out the mood forms and I scored in the extremely seriously mega-depressed range. And I remember he went to talk with a professor and was actually quite concerned about leaving me on my own which was [laugh] very nice but I remember thinking, 'Well actually this is quite amusing, seeing as I have managed to struggle through these last two months and then you know, by the time I come to see you, yeah, sure realistically I am on my last legs.' And he said, 'Are you going to be OK? Do you want somebody to sit with you?' [laugh] was actually kind of ironic.
Her GP knew he did not have the skills to manage her and referred her to a psychiatric team. They...
So I went along, to the assessment, and as soon as I said out, lots of things about my life and about the way I felt in my life, there was no sense of you're in the wrong place, it was, ' Fine, we think we can help you with it'. And it really was a huge relief, and they immediately put me on a proper dose of antidepressants, and saw me regularly, and I actually felt that somebody was for the first time, somebody was actually listening to me.
It was only about the third appointment that I felt brave enough to say, 'What do you think is wrong with me?' and the psychiatrist at that time said, 'I think you have what's known as a double depression. So you have dysthymia, which is chronic depression, which you've probably had since your teens' and I thought well, that makes sense - And he said, 'And at the moment you have a depressive episode.' And I thought yeah, I can understand that.
All psychiatrists can make diagnoses about mental health conditions and prescribe medication. A number of people felt that psychiatrists were very good at selecting and adjusting medication. For example, one man believed that he would not have got through his severe depression without a psychiatrist who had the skill and authority to prescribe the right 'mind bending drugs.' However, another was convinced that her psychiatrists only prescribed drugs that were heavily promoted by drug companies.
Experiences of psychiatrists were mixed. Some were anxious about the referral, but were relieved when the psychiatrist turned out to be human and took their problem seriously. Many psychiatrists were described in positive terms e.g. 'eminent', 'very down to earth… so it was easy to be real', 'we get on like a house on fire', or 'very gentle, very sympathetic'. And an advantage of the authority of psychiatrists was that they had the clout to rule-out conditions that people did not have, or classify a condition as due to a chemical imbalance, meaning the patient did not feel they were at fault.
Saw psychiatrists in London after dissatisfaction with local psychiatrists, who ruled out...
Her psychiatrist told her she had a chemical imbalance that caused anxiety and depression, which...
And she said, "You know when we find that medication that suits you, if I was you I would stay on it for the rest of your life, and I wouldn't muck about with it". And at first I said, "But, oh but there is an awful stigma to being on antidepressants and stuff".
And she said, "Well if you are a diabetic and I said you are going to need insulin for the rest of your life, you wouldn't argue would you?" And she said, "Look on this the same way, it is exactly the same thing. Your body isn't making - in your case certain neurotransmitters or enough of them - You need the medication to balance it out".
So she gave me permission really to say, "Yeah I've got an illness. You know, this is not my fault." Because I had always felt it was, and I wasn't trying hard enough you know.
Some psychiatrists are helpful in allowing people to talk through issues. One man in his 70s was relieved when his psychiatrist showed a real understanding of how he felt.
Although he denied being depressed, he was referred to a psychiatrist who understood how he felt,...
When was that?
That was in 1963 and [long pause] I was most offended. I thought I'm not, and what's he talking about. So he gave me a letter to give to my GP and my GP arranged for me to go and see a psychiatrist at a big hospital. And when I got there my wife came with me and he asked me questions about how I felt. And I should have told you that I was normally about 11 stone. But by this time I was down to about 7 stone.
And so I felt pretty ill and I got to the point where I would sit in a darkened room and not want to talk to anybody. So I was totally withdrawn, and I explained all this to the psychiatrist. And then when I'd finished, which was a terrible ordeal because I was loathed to talk about myself, he then said, 'I'll tell you a bit more about how you feel'', which was the most wonderful relief because I thought this was just peculiar to me. And he took a great burden off my shoulders.
A number of psychiatrists are also trained to provide talking therapies. Those who found a psychiatrist they liked in the NHS were sometimes frustrated that they seemed to see a different psychiatrist every time. They emphasised the need to build up rapport and trust over time with psychiatrists. One woman managed to convince her mental health team that because her condition was severe and ongoing, she should have only one psychiatrist.
She felt she was on 'crop rotation' seeing a different registrar every time she visited...
What I did do about eight years ago, and it was when I first started, when I asked to get referred to [consultant psychiatrist], because I didn't have him at the time. It's because the [hospital] have a whole teaching set up in London anyway' is that people go there for six months on rotation and it's like bloody crop rotation.
Because when I'm healthy I wasn't seeing anyone more than two or three times a year, so I could see a different, a different registrar each time I went. And I thought this was really stupid you know. I'm a long-term patient here, I don't go enough, but it would be really nice for a bit consistency. Could I get referred to a consultant?
A number of psychiatrists were described as aloof, pompous and judgemental, and people felt they had to fight to be heard. The advice for those with such doctors was to write down things you want to say, take a friend along, argue your case if you can, and/or keep diaries of medication and suspected effects.
Did not like her consultant psychiatrist who did not seem to listen to her complaints about...
Asking very general questions, and then he'd say something like, "Oh well, continue with the paroxetine." And if I said, "Look, this isn't helping me. I've been on this for eight months, it's not making me better." "It takes time, you have to have patience." You know, "You are better really" I was told by one doctor."You're not depressed, you're just a very sad lady." [laughs].
Psychiatrist. Well, the doctor who said that was doing a six month psychiatric stint, as part of his general practice. But the... the consultant was the one who said, "Oh, you've got to have patience, you know, it takes time, takes time."
I had a slightly cynical view that possibly it was something to do with money and the drug companies and the like. I don't know.
Felt misunderstood by his psychiatrist who assumed he had something like 'schizophrenia', and...
And he came and he asked me really strange questions [laughing], he was a foreign gentleman and he said.... And I said I'd heard like the nurses talking about me, which I had because like the nurses' station was quite near. And they'd been sort of saying like I was withdrawn and a couple of other things, I think.
And so when I said I'd heard some people talking about me he interpreted it as a sort of schizophrenia type thing, and he was asking me had I ever thought of cutting off my penis, which was really a rather odd thing to be asked at that time.
Criticisms of psychiatrists also included that they jumped to inappropriate conclusions, or gave advice based on non-therapy training and 'homespun wisdom.' One organised and rational woman (who had experience of running a large department at work) said her mental health team were disorganised and her psychiatrist “wet”. She reported obtaining her medical notes after she had made complaints about her hospital treatment (which the NHS later apologised for). She found that a psychiatrist had labelled her as having a personality disorder because 'she thinks the NHS is against her.' Another person said his 'faith in psychiatrists went zooming out the window' when one told him his hair loss was due to stress, when in actual fact it was due to the lithium he was on. Some people did not want to talk about uncomfortable issues with psychiatrists: for example one woman acknowledged that she had been reluctant to admit how her childhood had affected her life.
Did not like talking about feelings that were hard to pin down, and found her mental health team...
She found a psychiatrist's manner off-putting, so she put up barriers and denied that she had any...
And it was just like oh, very textbook stuff to me and it put a barrier up. I instantly thought, 'Fuck you, you know, you're not getting any where near me. There is nothing wrong with me and actually I even said it a few times,' Nothing traumatic has ever happened to me. I have, I had a very nice childhood thank you.' I said it loads of times and that was so untrue. I said it and'. and it was untrue.
But it was dealing with these kind of professional people that are asking me these professional questions about, 'What was your earliest childhood memory? What was your earliest this'. You know, I just couldn't deal with them. I instantly thought, you know, 'Fuck off I can't deal with you.' I want to deal with a human.
But the psychiatrist I had did harp on. He eventually left and somebody else came in the last two years but he was a great therapy psychiatrist. He believed in therapy and he would go on and on about how much, you know, I really needed therapy if I was ever going to recover. If this vicious pattern I was in was ever going to stop, then therapy was the answer. And I didn't just'. I just wasn't listening. And I didn't believe him.
Other professionals & mental health teams
A range of non-medical professionals are involved in mental health care. For instance, clinical psychologists, community psychiatric nurses (CPNs), occupational therapists and social workers. Some of these professionals can help support people in the community, particularly through difficult periods of their illness when problems might occur. Some people have a community mental health team supporting them, and if so, they will have a key worker (any member of the team) who coordinates the services they need (for more information see Mind's website). The help of mental health professionals and teams was invaluable to some, particularly those with less social support.
Finds that when she needs help, she can rely on her mental health team, including her doctor,...
But when I'm like that, it's reality to me and it's quite scary, it's quite scary. And my friend who... she has stood, she's been with me the last months, because I realised everybody that I helped in life when I'm looking for help, there is nobody there for me, except my doctor and my psychiatrist and my CPN. [laugh] They are there for me but not.... never anybody else' I tell Dr [name] and Dr [name] everything. I don't keep anything. [laugh] And I know that I don't lie about anything.
Mental health professionals help people to complete tasks, act as go-betweens with psychiatrists, help with medication, talk through problems with clients, educate clients and carers, and help sort out practical issues. One woman had a CPN who helped her when she developed panic attacks after leaving hospital and had to live in the community again. However, a few were dissatisfied at times when the services of professionals did not meet their needs.
A social worker visited his home and helped his father to better understand depression, as well...
And she also did have hour long sessions with me at home and I think I got, you know, I was into talking about things and possibly I was talking about the way things could go. And that was probably beneficial, actually'. I think I was completely isolated at that stage, and she would make positive suggestions. She wasn't like the psychoanalyst in that sense, she would say, 'Well, maybe you could move away from home?' And she also investigated possibilities for doing that. And I talked quite a bit about my Mum, again. And the kind of frustrations I had.
A Community Psychiatric Nurse (CPN) or social worker helped her to do everyday tasks at home when...
And she did things like, knock on my door, I mean she' but I'll start at the beginning. Before I came out of hospital she took me over and I came home for 2 afternoons to this house which was freezing because it was January. And [pause] gave me a pile of my paper and my bills and things that I needed to sort out, and I sat in the on the floor there and did that until she came back to get me. And so that one I'll throw away and that one I'll need to do something about, it's all, it's all I could do, I couldn't move. Honestly I couldn't move.
If I'd gone like that it would have burst the bubble and I was safe in this bubble. So that's what I did. And then we did that a couple of times and then I think she must have kept coming to see me.
Found it difficult to cope back in the community after being in hospital and had panic attacks,...
And I was OK if I was the one at the end of the queue, but once somebody came up behind me, I couldn't cope with it. And then I had visions of me walking out of the shop with this stuff in my bag and not paying for it, so I suddenly went into a fearful panic attack of, "Oh, I'm going to be a shoplifter," and I can understand why people do it when they're not thinking straight.
And I dropped the basket and I just ran down the road to the hospital and I was, I couldn't go out for ages. I went into a massive panic attack and they put me on medication to cope with it, which was at the time, you know I was in such a state I took it. But it wasn't until... the next time I had gone into panic attacks, anxiety, all these things had come to me, you know, I couldn't go out.
Then what happened was that they had to get a CPN, a community psychiatric nurse to bring me home for one hour, gradually to see how I could cope with being in my flat on my own. And then she'd come in here, she would spend an hour in here with me, we would do some cleaning or something and she would take me back again. Then the next time she would bring me in and we would stay 2 hours, and then the next time she would come, she would come in for 2 hours and then she'd go away for an hour and leave me here on my own and then come back.
When she left work due to work pressure, her GP arranged for a CPN (Community Psychiatric Nurse)...
And that was me. I was gone for six months and never went back'. I came home [pause]. That act somehow spurred me deeper, and I eventually thought I can't go to work. I can't get to work. I can't do it any more so that pushed me to go my GP to get a sick note, there to get signed off so I could get paid, so I could, the mortgage would be paid.
So some part of my brain was functioning [laugh]. So I went to my GP. She arranged for me to see the CPN (Community Psychiatric Nurse) again, get in contact with the CPN again. We arranged an appointment. I think the CPN rang me and came and we talked but I didn't feel at the time she was taking me seriously. I didn't think she felt [pause] I don't know. I just didn't think she was taking me seriously and, or perhaps I wasn't explaining myself very well, but I felt a lot worse than she thought I was, I think.
Feels that the occupational therapists set her challenges that were too hard, and so this...
The OTs were young in attitude I guess?
They were young. I just felt that they were very much coming from a kind of theoretical thing. And their training seemed to be' you've got to get your clients to progress every week. So every week they were setting me some sort of challenge, even if it was only to go shopping or whatever. And I look back now and think they were well intentioned, but they were pushing me too hard.
And I said to the consultant eventually when I got well and you know I.... She asked me what my kind of thoughts were about the OT department, and I kind of said well intentioned, but I'm not necessarily sure that they got it right in terms of measuring where I was up to. You know they were pushing me too hard. And of course if somebody is pushing you too hard then you feel anxious and you also feel a failure if you are not managing what they want you to do.
Last reviewed September 2017.
Last updated September 2017.