Response

This is a reply to the comments I received on my post before last. I was writing it as a comment, but it got a bit long so I thought I may as well make it into a post.

Karita - essentially trusts will fund treatment out of area if they think it will be more cost efficient for them in the long run, so for example if someone frequently presents at A&E and has regular admissions to acute wards, and often has crisis team intervention, then they may well look into funding a therapeutic community, because it will probably not cost them any more in the short term, and in the long run should save them money. As Harriet said, these places do produce statistics showing that treatment with them is more cost efficient than frequent crisis intervention.

However, I am in the fortunate/unfortunate position (depending on how you look at it) of not having frequent crisis intervention, which is obviously a good thing in many ways, but unhelpful in this situation. I have the issue of not being your 'stereotypical' Borderline - I have been told this several times, and as a result I really don't cost the trust very much at all, and so there would be no reason for them to fund an expensive treatment programme for me. I have never been the type to self harm a lot, or take non suicidal overdoses and then present at A&E, so that isn't an issue for them. For reasons I discussed recently I am not referred to the crisis team - essentially L thinks they would do more harm than good, as they have a tendency to see everything other than psychotic illnesses and bipolar as being too insignificant to require their input, and therefore treat you like shit (I have experienced this), and they are also gatekeepers for acute wards. On paper the bosses of the trust, who make the decisions on matters like this, would see me as a stable patient, who copes with weekly or fortnightly appointments with her care coordinator, and doesn't require any other input, so they would be likely to see me as not needing intensive, expensive treatment. I don't even see a psychiatrist any longer, since she took me off my meds, so I am basically as straight forward as it comes in terms of the treatment I am receiving.

What I find very frustrating, is that if I acted on all the suicidal thoughts I have, then I would constantly be at A&E, I would be deemed higher risk and so would probably have acute admissions and crisis team intervention, and would be far more likely to be able to access appropriate treatment. However, because I am able to contain my behaviours generally to those not requiring medical intervention, ie superficial cuts, small overdoses that I don't seek treatment for as they are self harm rather than anything else etc, I look to be coping. But I have no standard of life, and I have been under services for 7 and a half years, and am as bad as I have ever been. This is something that came up in a session with L once, and she said something along the lines of me being equally as unwell as those with the same diagnosis who do fit the more traditional borderline pattern, but that obviously on paper it doesn't appear that way as I have become very good at containing it. But that doesn't help, as it leaves me with this nothing of a life, where I am unable to progress or do anything I planned, and yet because I don't 'act out' I will probably never be able to access the more appropriate types of treatment for me.

L actually agrees very strongly with the therapeutic community approach - she thinks it is very effective, and I know it is something she is very interested in, and would actually like to work in herself. However, it isn't her who has the power to make the decision, and there is no point in referring me if there is no chance of getting funding. My county is also particularly underfunded - I know they all are, but there really are no specialist services at all in the county - if children/adolescents need inpatient treatment they have to go to another county, same for eating disorder patients, there are no specialist personality disorder treatments, etc etc. They have the very basic services - the CMHTs, an outpatient ED service, and one EIPS team on the other side of the county, and that is more or less it. You can't even access the Crisis Team without a referral - there is no option of calling them when in crisis like you can in virtually every other area - you have to be referred first.

Pandora - I think at this point there would be very little point in getting my MP involved, largely for the reasons above - on paper everything looks fine, and I haven't been referred to any services but denied on grounds of cost, so I have no cause for complaint. Also, he is a typical Tory twat (who manages to vote in the opposite way to what I believe on every single bloody vote in parliament) who would probably consider me scum for scrounging off the state, and would probably think it better if I just killed myself rather than cost the government the sort of money that therapeutic community treatment costs!

I may be rather cynical over the whole thing, but I think that realistically a therapeutic community is never going to be an option for me unless I win the lottery, or some philanthropic millionaire comes along and wants to pay for my treatment! DBT and MBT aren't even options in the next trust, so even going out of area for those isn't an option. Essentially, nothing is an option, apart from what I have now, and I can't cope with that. I am somehow just expected to keep going, from week to week, or fortnight to fortnight, despite overwhelming suicidal thoughts, and feeling so terrible that I can't get out of bed most of the time. And this is one of the reasons why I see suicide as a valid and logical option - I have virtually exhausted my local mental health services (I say virtually, because I have not had CAT, which I believe is the only therapy other than CBT that is offered, but I don't realistically see 16 sessions of that changing things dramatically) and I have no other options treatment wise, I don't consider carrying on like this to be an option, and since nothing has changed for the good in the last 7 and a half years, I sincerely doubt it is suddenly going to happen now.