The internet is a great way of making connections. I blog and tweet primarily because writing about how I’m feeling (even when it’s only in 140 character bursts!) helps me to deal with my experiences, but it’s always great when someone contacts me to say that what I write has helped them have a better understanding of bipolar disorder and its effects. It’s quite common for people to approach me, either on the blog or on Twitter, to tell me that they think that they might have bipolar, but that they are anxious about speaking to their doctor about it. It happened again this morning so, having been through the assessment process more times than I care to think about, I think it’s time to share my tips on how to get the best from initial contact and assessment.
The idea of approaching a doctor to say that you think you could have a mental health problem is something that would probably make most people nervous, if not downright scared. If you haven’t ever been in the mental health system before, you have no way of knowing how it works, and what it might feel like to become a part of it. Many people worry that they won’t taken seriously, while others are anxious that they might have some form of treatment imposed upon them against their will.
Most people start their journey to diagnosis by approaching their GP. Remember that GPs have to have a very wide knowledge base, and this means your doctor is unlikely to have any in-depth knowledge of mental health. What a GP needs from you, is sufficient information to be able to make a sensible decision about whether you should be referred onward for further assessment. It’s worth pointing out that the majority of people with mental distress are dealt with as primary care cases – by GPs and allied community professionals such as practice nurses, counsellors, etc – and will never need to see a specialist (secondary) mental health trust. Initiatives such as the IAPT (Improving Access to Psychological Therapies) scheme and community exercise programmes have been developed specifically to support patients in primary care, in conjunction with GP prescribing of frontline mental health medications if required.
However, your GP may decide on the basis of what you tell them that you might have a condition that needs more specialist input – and suspected bipolar should always be treated as such. The National Institute of Health and Clinical Excellence (NICE) published a guideline on the management of bipolar in 2006, which states that GPs should refer patients for an assessment and the development of a mental health treatment plan if:
– they suspect the presence of mania or hypomania (“overactive, disinhibited behaviour”) that’s been going for four days or more, OR
– the patient reports a history of recurrent depressive episodes and a history of overactive, disinhibited behaviour.
If a GP believes someone is either manic or severely depressed, especially if they believe there is a suicide risk, this referral should be treated as urgent. If you find you are thinking seriously about suicide, or if you those around you suggest you may be experiencing psychotic symptoms, don’t wait around for a routine appointment. Make sure you get an emergency appointment with your GP, or at night/weekends consider going to A&E. Some people hold back from disclosing suicidal thoughts to a healthcare professional, for fear they could be “sectioned.” Please don’t; your doctor really needs to know what is going on with you, and I promise that telling your GP about your thoughts will not get you “locked up”. The only healthcare professional who has the power to detain you under the Mental Health Act is a psychiatrist, and they can only do this if an AHMP (Approved Mental Health Professional) has formally assessed you and recommended that detention is necessary, and a second doctor has agreed. I’ve been in the mental health system for 18 years now, actively suicidal on more occasions than I can count, and this has never yet happened to me.
What happens after you see your GP is, to a degree, dependant on where you live, in terms of how long you will have to wait before you are seen, and who you initially see. In some areas, you will be seen by a psychiatrist straight away; others may use other healthcare professionals such as specialist nurses or social workers to determine whether or not you need to see a Consultant.
What I finds works best is when I think through my concerns, as systematically as I can, before speaking to any health care professional. Noting down my thoughts is especially helpful – not only is there less chance that I will forget something that I really wanted to say, but the process of writing thing down can also help me spot themes or clusters in my symptoms. I have learned over the years not to leave anything out that may be bothering me, even if I think it sounds stupid or that it’s probably not important. Bipolar has a huge range of possible symptoms, and that one snippet of information might just be the piece that helps a healthcare professional put the puzzle together. The more open and honest you can be, the more chance the clinician has of making the correct diagnosis.
Here are some things to think about ahead of any appointment:
1) Try to pinpoint what it is that makes you think you might have bipolar, rather than another diagnosis. Can you recall anything you have read/heard/seen that made you think, “wow, that’s just like me”? If it’s in a book, or is something you can print out, you could highlight the parts that particularly resonate with you.
2) When did your symptoms first start? Can you see any sort of a pattern, stretching back over weeks, months, or years?
3) What is the impact of your mood swings on your family, your relationships, or your work? Has anyone close to you commented on your moods and, if so, what were their concerns?
4) Have you tried any self-help measures for your symptoms? Were they effective?
5) What has made you decide to seek help now? Have things got worse lately? Has someone said something to spur you into action?
One more thing you should think about before attending an assessment, is the fact that there is a lot of overlap between bipolar and other conditions (for example, borderline personality disorder, as I discussed here, but also diagnoses such as schizophrenia, schizo-affective disorder, clinical anxiety, and major depression). You may go into an assessment with bipolar in your mind, but come out of it with quite a different diagnostic label. It’s important to remember that the aim of the whole process is to identify what you symptoms are, and what treatments might best target them. In other words, it’s more important to get a clear diagnosis and treatment plan than it is to be right!
For more information on diagnosis of bipolar, check out Mind’s guide: http://www.mind.org.uk/help/diagnoses_and_conditions/bipolar_disorder_manic_depression