Considering your options – CMHT’s, are they worth it?

Well I assume since you are reading this you may be considering the possibility of life without the services and intervention offered by your community mental health team (CMHT).

Firstly, you must ask yourself the question: What do I need from my CMHT, and one step further than this, can I get this from any other person or service?

Now I’m quite confident that CMHT’s have their uses but it very much depends on the services you are being offered. Most would have the use of a community psychiatric nurse (CPN), and just as with any person who is a professional, it very much depends on their character as to whether you get on with them or not.  Some will meet you at the local pub and have a lunch time meal with you, whilst discussing how things are going for you.  At the same time they may let you have a glimpse of their humanity. On the other hand you may have someone who is very strict in their boundaries and not so comfortable in sharing with you. They may wish to meet with you at the local hospital or in your own home.

Of course, its horses for courses but this is someone who you may wish to share the most intimate of information with. What hurts you and why can be very sensitive for you. How well you get on with your worker will be very important to how useful they will be to you.

Nurses can be useful for supporting your application for benefits, someone you can learn to trust and rely on, someone you can share with. Also they can be a validation for you, a validation that you are unwell enough to need the services of a professional. Yes it may be hard to admit this but just think of all the times you have been told you are an attention seeker, a time waster, hard work etc. Having a nurse is recognition that you have some form of a problem that requires their help.

The downsides to having a CPN include the inconsistency, lateness and them not showing up is common. This is due to the very high case loads.  Also, due to the ability of someone with bpd to bring their nurse down to the level of a friend or at least see them as someone who is a lot more sharing and open with them.

 You have the issue of your nurse realising this, and when this happens you will suddenly start to think my nurse seems to be cold with me, they must hate me etc. Your nurse on the other hand will be thinking I’ve let my guard down, my boundaries drop. I must be careful comes to the forefront of their mind.  There is the real chance you may actually forget who they are and how you came to meet them. As time goes by they will become an important part of your life, and as time has gone on you both have shared a lot with each other. Then, one day reality sets back in as you realise that they are indeed a nurse and being paid to befriend you. This may always have been in the back of your mind, but over time it seems to get pushed further back. One day you may have to face the news that they have been offered another job, they have to leave due to illness or due to financial restraint or illness. Then you are offered someone else, another nurse, it may seem to you that the nurse you have had for so long has betrayed you, let you down and is inconsiderate of the impact this will have on you. Of course this is just one possibility, but in very rare circumstances you will have the same CPN who is consistent, well rounded, strong and easy to get on with.  They may be in your life and a part of your care team for many years to come. What is inevitable is that one day you will be discharged; they will move on, case loads will be changed. Lastly, when you’re in the services you may have the quite common concern of where you constantly worry about being discharged.  The day when they say there is no more that we can do for you or your ‘all better’.  Although they may see you as ‘all better’ you certainly don’t feel that way. You may be scared about the prospect of doing things alone; it may be the first time you have had to survive/exist without the input from a professional person. This leaves you with a problem; do you tell your CPN that you’re having a good day? A good week? For the risk is that they may discharge you. How do they judge it? How many days do you have to be having a good day before it hits the threshold for being discharged? On the other hand what about if you never say you’re having a bad day, are you then un-helpable/untreatable? It’s hard to know where you need to set the threshold for how to behave with your nurse. Then you risk going down the road of dishonesty and distrust. This is also not a way to proceed. It may be worth seeking reassurance and clarification when you’re feeling this way.

So now we have discussed both sides of the coin, where does this leave you? I suspect you are already a part of the local services and you may be reading this due to a recent event that’s made you think “I cannot be bothered with this any longer, what’s the use..” at this point I hope what directly follows your thoughts is to take it easy, try not to make any reckless, impulsive decision that may not be good for you in the longer term. Think about things and give yourself some time.  There is no rush to make an immediate call to tell your nurse or his colleague to shove it!

As discussed earlier, think about what it is you get from your nurse that you cannot get from someone different. There are many support organisations that offer support workers.  On the other hand, if it’s a counsellor/therapist you require this is also not such a hard service to access. Many charities offer a free counselling service and others offer discounted places. A simple search on Google may help you.

In summary I would submit that CMHT’s are not the best set of services for those diagnosed with borderline personality disorder. They are not trained to work with people who have this diagnosis, although training is becoming more available. There case loads are far too high to have the time required to do this work. Finally some have a mind-set that they are the experts in mental health and trained to help, but in working with bpd they feel helpless or useless. This is not an issue that’s easy to get over for them.

Please do not take away from reading this that CMHT’s are not for those diagnosed with bpd as everything works well for some people. For some, CMHT’s are a lifeline, for others they are a web that is counter productive.

The moral of the story is: Think long and hard about what is best for YOU.