Expert: Libby Bonner - 3/18/2009

Question
Hi

You answered a question from me on 16/03. Thank you for your reply. But I have a few more questions. The reason I'm worried that being diagnosed will cause problems for me is that the career I want to go into is very competitive and they have to have people with clean records. If they discover I have a mental illness i'll never get a good job and that's what I'm working towards.

The other problem is that my doctors at my local practice are useless. They only allow you a ten minute consultation. I don't think that's enough time for me to tell them about everything. They are also often very impatient and not very approachable and they don't tend to listen to you. They are more eager just to prescribe you some drugs so they can move onto the next patient. The other thing is that in this country the NHS is useless with mental illness. I've had a few friends who have gone through the system and come out worse than when they went in. There's about a year waiting list to even get a first consultation with a psychologist and, even then, the psychologists they hire aren't very good. I know because I did go to the doctors a long time ago for my OCD. Know what happened when I got to pschologist? They asked me: Do you have any friends? Do you go to school reguarly? When I answered yes to those two questions they dismissed me and told me I haven't got a problem. I burst into tears that day because I was struggling so much at home. But they didn't care. I begged them - I said - but I have these compulsions and these obsessions - surely something isn't right? And they dismissed me. That's what the NHS is like in this country.

Answer
I wish I knew more about health care in the UK and about the NHS, but I know practically nothing.  However, I do know about mental illness and about finding reliable information.  I think this site has quite a lot of information that will be useful to you:  www.mentalhealth.org.uk/   I think this will be useful as well, esp about putting you in touch w/ resources near you:  www.rethink.org.  This latter group might get you in touch, in person or online, w/ persons being treated for mental illnesses.  They are the real experts on how to make the system work for you.  And they will know the names, perhaps of the most useful/sympathetic docs and psychiatrists.

Now a question.  Where you are, can psychologists prescribe medicine?  Here, they cannot, and so if one needs psychiatric meds one goes to a pyschiatrist.  Psychologists here do some testing and evaluations, and also "talk therapy" for personality disorders, and as an additional treatments to Rxs [prescriptions], for certain mental illnesses.

Your system may require GP referral to a psychologist who then refers you to a psychiatrist.  I don't know.  Or, it may be that the GP can refer directly to a psychiatrist.  You should be sure which way this works, so that you can be assertive in by-passing a psychologist IF [and I don't know] going to a psychologist would just add delay into thing.

Now, let's back up to your email.  They do only allow you 10 minutes - that's how the system works.  So - it is up to you to summarize the MOST IMPORTANT things that are going on NOW....the symptoms that caused you to write me.  Plan to use no more than 5 minutes.   Be clear, be concise.  Be brief in touching on the OCD.  Don't complain to the doc.  You want his/her help here.  If you think it will be acceptable to the doc, you can write down some main points - points, not long paragraphs - and give doc a copy and keep one in hand to refer to.  I do this, and docs usually apppreciate it...but it might not go there.

Use one additional minute to explain that you have been going back and forth about getting help, and that being there at this time was hard to do, BUT that you are willing and anxious to go forward with expert diagnosis and expert treatment.  [This is where, if applicable, you state your wish for a referral to a psychiatrist.]  That leaves some minutes during which the doc asks you questions.  Try hard to treat this as a timed exam, where you must chose and present the material that meets your and the doc's need today:  I feel bad [describe]; these things happen [describe]; I want to feel better and I NEED YOUR HELP.  

Above all, your appointment is your chance to make this point to the GP: I am not here for pills.  I am here as a first step to finding out what, if any, psychiatric illness I have.  I need to know so that I can begin proper treatment and so that I can make any adjustments to my educational plans.

As to your career.  "The reason I'm worried that being diagnosed will cause problems for me is that the career I want to go into is very competitive and they have to have people with clean records. If they discover I have a mental illness i'll never get a good job and that's what I'm working towards."  Well, yes, and I do sympathize.  BUT if you are now a star athlete, looking forward to making your living on a team, but then have an injury that makes that no longer possible....one has to re-think.   

I'm sorry, truly, but you have only told me that you can't have certain illnesses because it will screw up your plans.  Well, yes.   And you may or may not be able to hide your illness if your treatment goes really well; I don't know what field you hope to enter, nor do I know if UK law protects mental illness in the workplace or not...we have some small protections here.

I really am so sorry.  Mental illnesses do usually start just as young adults are starting to realize some of their hopes and goals, and it often disrupts them.  However, ignoring you problems isn't really an option.  There are two reasons.  One is that your chances of making a good recovery [even though you still will have the mental illness and still will need to take meds] are much, much better the sooner the right meds, right doses are found.  It is believed that the earliest possible treatment will 1] bring the best outcomes and 2] will probably increase the length of time between any flare-ups.

The second reason is that it seems unlikely that the behaviors that your first email described [with you currently untreated and wanting not to be treated] will not be flagged, either in school, or in a training program, or in the workplace.....leaving you still without the career you had wished for - and with whatever consequences delayed treatment might bring.

I am much older than you, but not so old that I cannot understand completely how urgently one wants dreams to come to fruition when younger.  And to recall that it seems hopeless if that one door shuts.  It is a very unwelcome business to get a chronic illness at a young age, and I sympathize.  But there are other doors and some may have behind them some very desirable work that you have not yet considered.

I wish you very good luck, and bravery.  Write anytime.