The cost of care

Was listening to the radio yesterday as you do and one of the main local news stories was how my local PCT spend less than the rest of the county on mental health care. A grand total of £136 per person per year. This may explain a lot. According to the BNF my medication, Efexor XL, costs £39.03 a month, that’s £468.36 a year. This means that even before I start accessing therapy, I’m already using more than three times my annual quota of funding. And when you start considering the cost of people resident in psych hospitals… OK, it is an average and so the effect is dampened by people who take a 69p box of fluoxetine 20mg a month but still. It’s no wonder I can’t access any help. I despair I really do. Until mental health is properly understood and accepted  people won’t realise that the large initial cost for therapy is sill less than the long term cost of keeping people medicated and hours lost through an inability to work etc, never mind the personal cost to sufferers. I know therapy isn’t a perfect solution and won’t work for everyone, but for a lot of cases…

Oh, and before the rest of you start celebrating that you live somewhere with better funding, the average spend nationwide is still only £168 per person per year. Not a lot is it?

Woo, damn, woo, damn

So, I had my interview after a deadly dull three hour drive to get there. The A1 really is the most sleep inducing piece of road I’ve ever had the misfortune to experience. Interview was a joke to be honest – a completely informal 10 minute chat along the lines of “why do you want to be a nurse” and “where do you want to be in 5 years time”. Long and short of it is I got an offer. Woo! Don’t mean to sound arrogant but they seemed pretty desperate to have me, even wondering if I wanted to start in March rather than September.

The only issue is that the offer is conditional on enhanced CRB disclosure and occy health clearance. The CRB bit shouldn’t be a problem unless I murder someone in the intervening 6 months which is unlilely but the occy health bit is pretty much a no go. Doesn’t help that I was reading advice online, looking for info on the format of interviews and read something about someone concerned about an interview with occy health. Response was “don’t worry, you’ll be fine unless you have a personality disorder or something”. Great, just great. Still by then I’ll have a brand new shrink, maybe a new diagnosis (I do have a habit of accumulating them) and hopefully a piece of paper to say that I’m stable enough to survive the course that occy health will listen to.

In other news, my jewellery making course has been cancelled due to not enough people sgining up. TO be honest the way my life is, I should really have expected that. Something I’m looking forward to actually happening, don’t be daft.

I got a letter through from SJA occy health witch to confirm my fitness (or lack thereof). It’s ridiculous, the only thing she’s stopping me doing is the advanced training. So I’m still allowed to go out on duty, where the likelihood is I’ll be the person making ultimate clinical judgements on casualties. There’s a fair chance there will only be 1 or 2 other members present so think what chaos I could cause! But I’m not allowed to do a course that will give me some more advanced skills in order to better treat and assess people when on those duties. The decision seems to have been based on a complete lack of understanding of mental health, but again, what was I expecting.

And the worst part of it all is I just don’t care. My life is disintegrating around me and I can’t summon up the energy to give a damn. I know it’s the drugs. Without them I can’t function. I end up collapsed in a corner crying continuously, screaming at everyone, being desperately dependant on or passionately hating Nick (and switching between the two at 5 minute intervals) or better yet start hallucinating. But at least I feel. With them, there’s nothing. In a detatched way I know everything’s broken but it’s like it doesn’t matter (even though I know it does). And conversely when I got the offer I should have been delighted, but it was just another pointless event in another pointless existence. So there’s just nothing, no real emotion on the surface, although deep down it is there and I feel like crap. At least it makes it easy to act like everythings fine, put on a front so the world doesn’t know what it’s done to me.

Oh and today is the first day I officially have more debt on my credit card than money to pay it back in my current account. I am officially broke and still as close as you can get to unemployed. I do have a couple of first aid companies wanting to pay me to do freelance training which is good but it’s taking a long time to get everything set up, and even when it is, I don’t know if there will be enough work to pay the bills. Still, one of them wants to pay me £lots/hr so I suppose there wouldn’t need to be that much work in order to get by.

And back to normal…

I have my first interview for nursing tomorrow afternoon and it’s occurred to me that in all the recent stress and upset I haven’t even remotely prepared for it. On paper I massively exceed the entry requirements, but in practice it may turn out very different. I’m sure I’ll be able to answer all the standard “why do you want to be a nurse” type questions to some degree but other than that I don’t really know what to expect.

And even if I get an offer, I still have to clear the major hurdle of occy health. I’m starting to wonder if I should even bother. If St John won’t let me do advanced training, that’s only a couple of weekends and in a voluntary capacity, why are the NHS and unis going to let me lose on a 3 year degree with real people? And there’s a part of me thinks that if I’m going to be disappointed at the last hurdle, then why bother at all. At least that way I’d be letting myself down on my terms rather than having what I want snatched away again.

Of course by then I should have had some therapy but I’m really beginning to doubt myself. All the psychiatrists I’ve seen think there should be no barrier to me doing nursing, but all the occy health advisors seem to disagree. In a few weeks I have my assessment appointment with shiny, private therapy place which should lead on to talky therapy. I’m hoping from this I’ll come away with some definitive answers as well as a report that says I’m stable enough to do the course. But even with that, will occy health listen? I have to say I’m sceptical.

This is all in the future anyway. I need to get in first before starting to consider how to tackle the occy health devils.

And now for something completely different…

Because I felt it’s about time this blog had a vaguely positive, fluffy post on it, here’s what I spent yesterday afternoon playing with:

8 mini daschunds at just over 24 hours over. Squee, mini sausages! You can’t get much fluffier than puppies now can you? Here are some up close pics of the babies:

And just incase you’re suffering from cuteness overload, here’s one of dad in all his glory:

There, that’s better. Normal mad ranting will be resumed shortly!

Unfit to practice

So I had my response to the health declaration and it’s a no. I can still do duties and stuff, maybe if I’m a really good girl and promise not to do too much damage and as long as someone keeps an eye on me but apparently now is not the best time for me to do a “difficult and intense course”. I’d argue now was the very best time for me to do said course as it’ll be a great distraction and is what I want to do. Surely I’m the best judge of what I am and am not capable of, i have insight remember?

Honesty

I had to fill in a health declaration for St John last night. This scares me so much. St John is my escape, it makes me feel better, I genuinely enjoy the looking after people. Without the politics it would be my perfect pasttime. It’s what started me down the long road to nursing in the first place, it’s my passion. So anyway, I have a place to do PTA (patient transport attendant), the lower level of ambulance crew course within St John. I really want to do this, it will give me a few extra skills, and allow me to use some of the ones I already have without getting frowned at for acting above my station. I hoped I’d get away with never doing another health dec for them so they couldn’t see how much my mentl health has deteriorated since I joined, and have no reason to rescind my membership but no such luck.

I have a feeling this is not going to end well. I’ve been completely honest. Why yes, I have been turned down from a job becasue of a medical condition. Yes, I do have a mental problem. I can’t see them liking this, and I don’t think it would help if I told them not to worry because the psych said I’m only a danger to myself not to others. I gues there are two points this leads to. The first is the way the form was worded really angered me. One of the questions was

“do you suffer from stress, anxiety, depression, mental conditions?”

It’s that last phrase I have a problem with. I have a mental health condition, not a mental condition. I think it’s the negative connotations of the word mental on its own, without the fluffier health tacked on after it. Now I don’t know if this is just me being over sensitive?

Another question reads

“Do you have any mental and / or physical problems at the present time?”

As Nick pointed out I’ve no problem with them using physical without health after it, but then and again that doesn’t have the negative asssociations of mental. Any views? This is a standard SJA form and I don’t like it but I don’t want to just be horribly misinterpreting as per usual.

The second thing this raised is my complete black and white thinking. In this case, my desire to be honest on the form nearly made it read even worse than it already does. I wanted to be so honest. I felt I needed to tell them I’d been hospitalised following a suicide attempt in the last month, that I didn’t want to live anymore, that I’m crazy, that the job I’d been turned down for was directly relevant to St John. This information wasn’t asked for per se, but missing it out felt like lying, manipulating the truth for my own ends.

Anyway, it’s in the post now so just have to wait. I’ve said they can phone me if they need further details but giving my habit of babbling incoherently on the phone, it probably won’t help my case. To be fair, St John is full of the mad, the broken and the generally disturbed, in some cases it seems to be a condition of membership. I don’t feel my health stops me carrying out the role but NHS occy health felt I couldn’t work in a hospital, so why are SJA going to let me lose on the public in an even less protected setting?

Holding.

Just to let you all know I’m still out here on the off chance that anyone cares. I’m avoiding posting as I feel I have to be positive in them which would just be a lie. I don’t want to be seen as a whinger with made up problems blogging about how much their life sucks when there’s people out there actually suffering. Now I’m sounding like my mum with the ‘what right do i have to be depressed’ line. As I said in the last post, it’s just me reading too much into what people who read this think and being too afraid of being judged. So why blog online at all? I don’t know. I enjoy it but now I’m too afraid to. WHat sort of person does that make me?

Putting on a front

I’ve actually had a fairly productive weekend. Went along to a taster day for adult education courses and did some creativey stuff. Made a pair of silver earrings and what is goign to be a felt bag when I finish sewing it up. My parents have even paid for me to do a 10 week evening course in jewellery making which should be fun.*

Then I went to IKEA and bought new furniture so I actually have storage space rather than piles of rubbish everywhere. So building that took up most of Sunday. Then I went out for dinner. It was nice.

You see, all this sounds like the sort of weekend anyone would have. I mean I even almost enjoyed it. But the fact is it’s not real. I don’t really feel happy. I’m doing all these things that imply having a future – buying furniture, signing up for courses – when I really don’t see a future for me. Who knows, now I just sound like I’m whinging. But it’s important to me that everyone thinks I’m fine. I need people to believe I’m coping. I don’t know why, maybe if they didn’t I’d have more chance accessing help and understanding. But I’ve been doing this most my life, putting on a front, pretending everything’s ok. I suppose in some way it makes me feel stronger, maybe if I can act everything being ok well enough, it will actually become true.

* I’m actually really scared of posting this because it gives more of an insight into the sort of person I am and what I do for fun. It’s strange that I can be totally upfront about my mentalness online but posting something like that scares the hell out of me. I’m worried people will judge me on the activities I do, think I’m some sort of freak and then stop “talking” to me. You see, I’m doing what I always do, imagining a relationship with the people who read this that probably isn’t even there. I always do this, meet people, make “friends”, go above and beyond for them, get betrayed, get heart broken, cry. I know that’s what I do, that’s why I try to not have any friends as they invariably let you down. And I’m terrified I’m doing the same thing here.

Occy health vs. mental health

Today I’m completely devoid of inspiration/motivation or anything positive. I had been doing so well. I went to the interview and answered the questions with some form of sanity. The issue is it’s clear from my age and looking at my CV that the job would very much be a stepping stone and I suspect they wanted someone who they know will be there for the long run. I tried to convince them but I don’t think I had much luck. I was also a bit dissociated so to me my voice felt slightly slurry and wirds kept tripping over each other and I think I rambled somewhat. But what’s done is done and I’m unlikely to know until early next week anywho.

I’m starting to realise that bad experiences with NHS occy health and mental health are not confined to me. This scares me. I want to be a nurse, in as much as I want to be alive that is what I want. I’m starting to realise this is going to be a lot more difficult than I initially anticipated. I have the experience and the passion but I also have the crazy. I think we’re on a cusp with the NHS and crazy. In the past, you wouldn’t have a hope and would probably just be locked up for life anyway. Now new anti-discrimination legislation and the power of lawyers, means they have to start taking it slightly more seriously. If anyone cares, the relevant policy can be found here. Basically it states what rights you have and what occupational health have to do. However, a lot of occy health people seem to be living in the past and basing their views on The Clothier Inquiry, 1994, an investigation into a truly crazy nurse who turned out to be a serial killer.

The report recomended that people with mental health difficulties be completely free of symptoms and treatment for at least 2 years prior to be considered for NHS employment. As stated in the above policy, this recommendation was never adopted by the NHS. However, occy health drs and nurses tend to get scared by crazy, something of which they generally have no knowledge, and go for the option of signing you off or not clearing you in the first place. Now technically they can’t do that. You have to have a psych review and all sorts according to the policy. Unfortunately, it doesn’t seem to be being followed, certainly not in my case. They told me I needed a psych review but then fired me before I had one, as I shouldn’t have had occy health clearance in the first place. But according to the policy, you need a psych review before occy health clearance can be rejected anyway. This is a shame as all my many and varied psychs have said there’s nothing whatsoever to stop me working in health care yet I’ve clearly been stopped and will probably be stopped again.

Now back to what I said about being on the cusp, enough people have to be prepared to fight their treatment by occy health at this stage in order to change the prevailing climate and make it easier for people in the future where policies are actually followed and discrimination is not allowed. Now this is just my opinion, I could be misinterpreting the information. I’m sure there must be good occy health staff out there, I’m just yet to meet them.

Which leads to the question of am I strong enough to take up the fight? I don’t feel like it. I spent last night in tears again because of the lack of support I’m getting. I was being truly obnoxious to Nick because I was after a fight. I end up saying whatever the most hurtful thing I could possibly say in any situation whether I mean it or not.

I still have no support network in place. Given I got a crisis referral to CMHT last Friday and a standard referral about a week before that you think they’d have got back to be by now. I need someone to talk to/at and to make me feel a bit less bonkers. I’m at home on me own all day as everyone has now gone back to work full time. Nick’s even doing an extra shift on Saturday so I won’t even get a weekend with him. He’d agreed it before I really flipped, but I’m feeling very needy at the moment, and selfishly I wish he’d pull out. But he needs space from me because I’m not a very nice person at the moment.

I’m glad my pills have been taken away from me because I’m really unstable again right now. I’d go down and see my GP, but I’ll just get sent home again no matter what I say or do. I did consider smashing up the surgery but thought I’d probably just end up in prison and that would really ruin any maybe future.

On the plus side, it’s snowing again, I like the snow.

Thanks

A huge thank you to all the incredible people out there who have reached out to me over the last few days. Thank you for all the offers of email addresses and phone numbers and everything else. I’m afraid I don’t feel strong enough to use them right now but it does mean so much to me that there are people who I’ve never even met who are thinking of me and caring.

I feel a little more positive right now. My mum came home to keep me company this afternoon which was really sweet of her. We do find it hard to communicate with each other but we’re both trying and maybe getting there a little bit. I made a big decision at the doctors. I didn’t take my prescription home with me as I knew what I’d do with it. I’m going to let someone else pick it up and dispense them to me daily. So maybe I don’t want to quit this world quite as much as I thought.

I have a couple of active referrals out there so will see what happens with those. Hell, I even have a job interview tomorrow afternoon. I even quite fancy the job. It’s a dispensing technician at a pharmacy, so probably mentioning the last weeks events wouldn’t be too clever… I don’t hold out much hope for actually getting the job but if I can get there, give relatively coherent answers and not burst into tears then I will have achieved a lot for me.  And that’s all I can hope for right now. To keep surviving. Just a little bit.