Dis-engaing with second line services (possible triggers here)

Hi everyone,

My partner wants/needs to disengage with second-line services as it's just not working for her. Her psychiatric team want to take her plan in a direction that she doesn't want, but they won't budge, so we need to disengage. The fear is that this will cause them to try to section so as to force their plan. Because she is now on Lithium second-line services have a hold on her, and the constant pressure that comes from knowing they could force hospitalisation is the main trigger for my partner at the moment, so it's just not helping.

We know and understand all the dangers involved in trying to get off Lithium, but being on Lithium is the only real thing that allows second line services to have a hold on her, so they want to keep her on lithium no matter what her wishes are.

I would really like to hear from anyone who has successfully de-escaled their case from second-line back to their GP's control, as this is what we want.

I'm sure many people will want to tell me about the dangers of coming off Lithium, and let me assure everyone we have no intention of just stopping, we hope to taper down under the supervision of the GP, but what I would really love to hear from you lovely people is that there is hope of breaking away from second-line care and that maybe some of you have successfully managed to do this. I'd just like to know that it is possible. Thanks.

15 Replies

  • Is lthium helping her? Why doesn't she want to go in the direction her team want her to go in? Counselling is usually very painful - is this the reason why she doesn't want to go in this direction?

    What meds could she use instead of lithium to control her symptoms? I presume she is pretty bad as they only section patients who are. Do you think sectioning would help her or quite the reverse?

    Lots of questions but things I you need to think about.

  • Just looked up lithium and I see it's used to treat bi-polar. Most bi-polar people need medication from what I have heard to control their symptoms.

  • Lithium seems to be ok at stabilising things but doesn't address the depression, she's currently on Metazapine along with the Lithium. Is it helping? Maybe, she hasn't been on it long. But, they want her to volunteer for hospitalisation so that they can pursue their plan of action, she made it clear from the start she didn't ever want that. She volunteered to have the GP refer her to 2nd line originally, so it was her choice, but now they want her to go in for a stay in hospital. She always said she didn't want that, it was made very clear, but now that they are in control they keep pushing for it, so basically they are not listening to what the patient wants and now that they have her on Lithium they can call the shots. The feeling of betrayal and the feeling they are not keeping to their side of the deal has destroyed the trust, so now they are not in a position to help, and my partner is certainly not going to go into hospital if she doesn't trust them. Now she fears everyday that 2nd line are making plans to section her as she is saying she doesn't want Lithium any more. It's a disaster. The fear of 2nd line taking control is by far the biggest trigger now so she just wants to get away from them and cut off contact, get off Lithium with the GP's help and disengage with 2nd line. But trying to do that in itself could cause reason for 2nd line to say "she's refusing meds and putting herself in danger" which is a possible reason to try and section her. Circular problem :(

  • How difficult. I do think though that they don't offer hospital stays these days unless they consider them essential. It does sound like they are trying to get her stablised which surely is for her own good? I know she doesn't want to go in a hospital but sometimes this is not as important as the need for her to have treatment which will help her.

    Sometimes when people are very unwell they don't want intervention like this and I know it's common for bi-polar sufferers to stop their meds coz they enjoy the highs too much and don't want to lose them.

    Do you think this is the case for your partner? What do you think about it? Sometimes you have to be cruel to be kind which I know is very difficult but needs must on occasion.

    For example my old mother lived in a 1 bedroom flat on her own until she had a fall and was on the floor all night. Now she always said she would hate to go into a home but she was our responsibility and we had to do this for her own safetly and against her will. It broke our hearts but we had no choice.

    Do you see what I am saying? I don't envy you the position you find yourself in but you have to do what you think is right for her.

    Let us know how you get on.

  • she's certainly not thinking about quitting ads because she feels better, she's never felt so bad overall. The lithium is stabilising things, which is good, but the approach taken by 2nd line is having a far far worse effect on her, she needs to get away from them. The GP has been so supportive and on two occasions has said that she will support our wish to leave 2nd line and return to GP care, but the psychiatrist blocked that and refused to agree. Psych has now set up an appointment for us to go see her. We have said we won't go and they should cancel the appointment. They have refused to cancel the appointment, so now my partner will be seen as "having missed an appointment". This again sounds like they are trying to create a situation where they can try to justify a sectioning order. No wonder we are worried.

  • Hi im sorry to hear about your partners situation, as I have been lead to believe if she goes into hospital voluntarily she can refuse ANY treatment that is offered to her (only reason I know this is because I went in voluntarily many years ago). However it was many years ago so things may have changed since then so I'm not entirely sure, but I will check with my daughter as she is a mental health nurse if you would like me to. Anyway good luck and I hope things get better for you both. Take care both.

  • Hi, thanks for your reply. Yes, everyone is entitled to refuse treatment, but they don't have to let you go, if they feel you should stay in they can form a group and decide to section, so volunteering to go into hospital is too much to ask my partner at the moment. Hospital would bring out the worst in her and that's what she's worried about. They already admitted (in a round-about way) that they want to push her buttons so as to provoke the worst reaction, that way they can assess her properly. This simply isn't an approach that we can agree to. it's exactly what she always said she didn't ever want and, at first, they made out that this would be fine, now they keep trying to change her mind which is why she needs to get away from them so as escape the constant dread that they might be planning this behind her back. I know that can sound paranoid, but I have attended all the appointments with my partner and I can confirm that they have tried to be sneaky a couple of times by saying one thing to keep us happy but then completely changing their mind at the last minute and insisting that she come and see them.

    May I ask how long you went in for? And was it easy for you to leave or was it really up to them if you left

  • Hi, I was in for around 6 weeks and yes I left of my own accord they really were quite good tbh. I also refused ALL treatment they recommended other than the anti-depressants, but like I said it was a long time ago when I went in. I am in secondary care myself at the moment seeing a psychiatrist and a psychologist for EMDR treatment too. Maybe you and your partner can ask for the home treatment team to come and see you this way she will avoid going into hospital, I myself had this to begin with and it worked pretty well. I'm not saying its a cure or anything at all but it helped immensely knowing that I wouldn't have to go into hospital and they were treating me at home. My husband has also supported me with attending appointments etc in case I have missed anything they said and even put an abrupt stop to certain lines of questioning. I am just wondering if you could change psychiatrist maybe. There is another avenue you can try, you can speak to the crisis team and tell them everything that's going on and don't keep anything back they will come and assess her to establish if she is in crisis ,( its not a mental health act assessment) there will be a different psychiatrist on their team which will allow you to get another opinion on her presentation and the treatment she needs. This would be your first port of call, you can get the number from the GP surgery. The worst thing you can do is lower her medication while she is not well as this will cause her to become more unwell. I hope this is helpful to you and wish you both the best of luck.

  • Thank you for sharing Nessie.I agree with everything you said. The only difference is that with Lithium they consider anyone on it (or considering coming off it) as higher risk, so they become a lot more insistent with things. Really, what would be good would be to have them change the lithium to something else that doesn't raise the stakes. Thanks again, I'll look into the crisis angle too.

  • thanks Bluetooth. Please don't worry on our behalf, my partner is well loved by me and I am here to help and protect her. She feels hounded at the moment, but I know the health services are not "out to get her", its just sometimes hard to explain that their solution is not always practical. Don't worry for us, it will work out eventually.

  • Having a good relationship and avoiding confrontation is best, but once the psych services label you as awkward/personality disorder etc, they will view refusal of treatment as a challenge. A very delicate path to tread

  • exactly where we are at, hence the worry about wheels turning behind the scenes.

  • May I ask what you are referring to when you say second-line? It sounds similar to CSB/Pact team model.

    Before I answer I want to understand:)

  • Also if she is her own legal guardian, she can make her own decisions. The problem with psychotropics is that GP's will not prescribe in general especially Lithium so if a psychiatrist is needed, that could be problematic. Titraiting down of course (hopefully she is still getting her levels checked) is what her current psychiatrist should be doing if that is her wish. Despite whether a client is doing their best on whatever medication or program it IS THEIR CHOICE. A client advocate seems needed for her. I can at least tell you how to go about finding one and it's free.

  • Also every area has a local human rights advocate to contact which should be posted at the place she receives services and/or you can google it. (In the US) they will immediately help you.

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