Monday, 8 July 2013

Anxious Boy (1)

I'm going to write about trying to get help with my panic attacks through the NHS. It's partly a processing thing for me, and partly a record. I also think it can't hurt to have this stuff out there for anyone else in a similar situation. I have no idea how this will turn out, or if I will keep writing about it. Right now it feels like I need to. Like if I don't, it will disappear, or turn into something else in my head. I need to get it down while it's still fresh. Maybe someone else will find it useful. Or maybe not.

First steps

It took me a long time to get around to, both because I'm stupidly busy and because I kept hoping I would somehow magically fix myself without help. I didn't. I went to the doctor at work, and he gave me a prescription for Propanolol and Diazepam, which I filled immediately, before I could change my mind. Sometimes I take them, and sometimes they seem to help with the symptoms, but I haven't stopped having the attacks and that's what I'm aiming for, really. They're seriously hampering my ability to, well, live my life.

So I made an appointment with my GP and I gritted my teeth and I told her the truth - well, most of the truth. She said she would refer me to the mental health team, and that I should hear from them within 10 working days. It was Friday night, and this is the NHS, so when I got a call on Monday afternoon I was amazed and impressed. It was lucky I answered the call at all - the number came up as "Blocked" on my phone and normally I would have ignored it, but I was on my way to get a glass of water at work so answered it. I spoke briefly with a very nice man, who patiently tried to accomodate my unhelpfully packed schedule, and - incredibly - booked me in for a phone assessment at 1:45 on Saturday. I wasn't overjoyed - he had said the call would take 20-30 minutes, and I had a show at 2:30. But I was so glad that I wasn't going to have to wait weeks, like I thought I might, that I took it. Knowing myself pretty well, and anticipating that the call would upset me, I asked my closest friend at work to stand by so I could get a hug or a shoulder or a cup of tea when I was done.

The first call

The man I spoke to, whose name I can't remember, called me on the dot of 1:45, while I was anxiously pacing outside the stage door in the rain. He was kind and patient and cracked a few jokes. He told me what the assessment would consist of, and then he did it - asking me two lists of questions about my recent symptoms and life situation - and then he told me that I would receive a letter with the results, a copy of which would be sent to my GP. Practically, the call was good. But there was one thing that gave me a tinge of anticipatory fear. The nice man wasn't exactly taken aback when I told him I was trans - although he literally said "oh. I actually don't have a box for that" - but he was weird about it in that way that I have learnt to treat with caution. The word "brave" was used on more than one occasion. The word "interesting" also. I'm sure he meant well and was trying to put me at my ease and reassure me that he wasn't bothered, but, well - you know what the 'but' is. I told myself that this guy probably wouldn't be talking to me again. I would slide through his little bit of the system leaving nary a hint of my presence - perhaps a suggestion for a new box? - and our paths wouldn't cross again. His well-intentioned, jarring ignorance wouldn't be my problem. I just had to get to the next stage. The stage that would help.

The letter arrived the following Saturday, listing some incomprehensible numbers and letters - the results of my assessment - and requesting that I call between 9 and 4:30 to set up a more 'in-depth' assessment. I called the number and got an answering service informing me that their business hours were 9-5 Monday-Friday, which the letter had unhelpfully not specified. I googled the mysterious letters and numbers (PHQ9 and GAD7) and found out what they meant.

I called back on Monday morning, and was happy to encounter another friendly, helpful person, and to be told that I could have this assessment over the phone too. Good news for me, with my stupid schedule. She was just as accommodating about my schedule, finally booking me in for 1:30 on the approaching Thursday and telling me that the call would take 30-40 minutes. The number would come up as "Blocked" on my phone, but it would be "Jenny" on the other end. This information would have been helpful in advance of the first call, too.

The second call

Jenny rang promptly at 1:30. I was, yet again, anxiously pacing outside work. Different work. Same pacing. After introducing herself she immediately dropped her voice to a soothing murmur, and I had to interrupt her to ask her to speak up since I was outside. She obliged. We talked for forty minutes. She took me through the same sets of questions that I had been asked on the first call, explaining that this would happen each time I spoke to someone from the service, and that it was a way of gauging my recent mental health. When we had finished she told me what my numbers were and how they compared to my numbers from the previous phone call. Again, this is something I'd have liked to have been told earlier. Perhaps when they sent me a letter with some numbers next to some unexplained acronyms. Perhaps when they 'assessed' me the first time.  But I didn't really mind - I appreciated how fast everything was happening and I understand that they must have to cut some corners to expedite these services.

But I was finding these calls upsetting. I knew I would and the first time I had been able to prepare some support for myself, in the event that I needed it. This time I couldn't do that. I was upset on the phone although I tried not to show it - tried not to feel it. I explained myself as best I could. Tried not to cry. Tried not to worry about my coworkers seeing me. Tried to concentrate on the matter at hand. Tried to hear Jenny over the traffic noise. Tried not to panic.

I have to say that it was nothing that Jenny said that I was finding upsetting, and nothing that the first guy had said either. They were both very gentle and professional. It's just that talking about the whole thing, out loud, is seemingly very difficult for me. I guess I don't like to think about it too much, or really admit it at all.

At the end of the call we talked about next steps, and Jenny told me that my treatment would probably consist of a course of Cognitive Behavioural Therapy, which could be taken over the phone. This was good news - I'd been worried about finding the time to attend regular medical appointments. Unfortunately the service was only available 9-5 Monday-Friday, all of which time I'm at work. Jenny asked if I didn't have a lunch break? I have a lunch break, I explained, but I don't have anywhere private to go during it - my building is full to capacity as it is. Could I sit in my car? I don't drive to work. Jenny was sympathetic but there aren't really any other options. Not Jenny's fault, of course, but I was getting more upset and she obviously needed to end the call. Addressing me by my legal name, she asked if I had any questions.

Yes, I said, barely coherent. Can you please not use that name any more? I know it's what you have for me, but can you use Ollie instead? Of course, she said, of course. I'm so sorry, I should have asked - No no, I reassured her, you didn't know, I haven't mentioned it, it's just, my legal name makes me really uncomfortable and I'm finding this quite hard and it somehow makes it worse when I hear that name. I understand, she said. I'll get it into your paperwork.

I don't remember what we said after that. I was desperate. We ended the call, and I hustled back into work, locked myself into a cubicle, sat on the floor and cried until my brain came back. It didn't take long to calm down - I didn't have long, I had to be back at my desk. I calmed myself down, waited for my face to feel normal, returned to work. Took two of the pills. Focused.

When "Blocked" came up on my phone 20 minutes later, I thought I had better answer it. I slipped out into the corridor and answered the call quietly. It was Jenny. Addressing me by my legal name, she told me that she was sorry but she'd forgotten to do the risk assessment. Did I have a couple of minutes? I stumbled over the answer. My throat had tightened and I was on the edge of tears. I told her I did, if it really was a couple of minutes - I was back at work. She asked me if I thought I might harm myself. I choked on no. She asked me what was stopping me from harming myself. I said what? She said, you know, family, friends, a parter - ? I sobbed no, no, no. Nothing's stopping me, I'm just - not. She apologised again for forgetting the risk assessment. She said goodbye. I hung up, went back to my cubicle floor, and succumbed to the panic attack that had been threatening since the first call. Luckily for me, nobody came into the bathroom. Then I went back to work.


I'm not as optimistic as I was. I'm scared, actually. These calls upset me. I'm prepared for that, but I don't know if I'm prepared enough - I can't have the support I need around me 9-5, and that seems to be the only option. If I could have the calls in the evenings/weekends, when I'm usually at the other job or at home, it would be ok. Maybe the actual therapy won't be upsetting? But even if it's not, I don't have a quiet place to take the calls. I don't know how to get around that.

Less tangible is my worry about how these professionals are relating to my trans-ness. Nobody has been hateful or intolerant or transphobic. But my Spidey sense is tingling. Did he call me interesting and brave? Did he just refer to my transness as "that kind of thing"? Did she really just address me by the wrong name twenty minutes after I'd told her that it bothered me?

I laughed when the guy said he didn't have a box for that. But, now that I think about it, NHS, why don't you have a box for that? You asked me my damn sexuality and religion and ethnicity. Why isn't there a box for that?

And why didn't you notice that I was crying on the phone, the first time when I told you what I wanted to be called, and then when you phoned back to check I wasn't going to kill myself? Why didn't you notice?

I'm getting cross. I'm not cross, really. Mainly I'm worried. I need this help but I'm scared to get it: scared that it won't help, or that it will throw up the need for more help, or a different kind of help. Also scared of the dysphoria which I can barely keep at bay under normal circumstances, and which this process seems bound to disturb.

1 comment:

  1. (hi, this is Carrie from the meetup at Leon in Old Compton Street a few months ago- trying to avoid leaving an electronic paper trail to discussions of me being ill)

    I'm so sorry to hear that you've had such a shit experience, I'm trying to sort out a mental health referral for myself at the moment and I'm having some very similar frustrations.

    As an NHS employee (though not for mental health) I can confirm that sometimes there really isn't a box for that- and this is really fucking STUPID.

    For example, I once spent about half an hour on the phone to another NHS employee trying to sort out a complex admin problem for a patient I've never spoken to, but who happens to be trans. Some of their letters are still under their legal name, some under their real one. I stressed this, repeatedly, to the NHS employee, because I assumed this was something they would want to make sure was flagged up on the hospital system so that the receptionist, nurse, etc didn't screw up and address them by the wrong name. Eventually, the person I was speaking to told me that it isn't physically possible for them to do anything with this information- apparently the admin staff don't see or speak to the consultant at any point, and the software they use to transfer the relevant information over is an electronic form that has literally no free text fields anywhere, and there isn't a relevant field, so it will just have to go unaddressed.

    Which makes me so fucking angry, since it doesn't take imagination to think of a whole list of things that the consultant might need to be made aware of but aren't easily addressed by means of tickbox- what if the patient needs their knee examined but their PTSD is triggered by being touched, or has a serious allergy to some seemingly-innocuous product that might be found in a doctor's office? But it's one of those situations where probably everyone who interacts with the software already knows that it's shit but no one has the authority to fix it.

    (to clarify, this is not at all intended as a plea for sympathy for NHS employees. And it does not at all explain the intake guy's comment, since he was writing his own notes.)

    But yes, much sympathy for running up against a brick wall of this sort of thing. And thank you for writing this- I'm not ready to blog about my (relatively mild but still really fucking unpleasant) trip to the psychiatrist last week, but this makes me feel a bit less lonely about it. I hope things become more manageable in future.