I've now had a chance to process my discharge appointment with the psychiatrist, and I suppose it went okay. It was amicable enough, which I'm pleased about because I am actually grateful for all that Dr T has done for me, and I do actually like her as a person even though I've felt let down by her in recent times. I didn't say to Dr T how surprised I've been by the rapid discharge, especially after explicitly saying in my letter to her that I was having a tough time, but I did say that I felt that 'low priority' had come to mean 'no priority'. She agreed that it had. I suppose it's good that she acknowledged that, but slightly shocking too.
Dr T spent some time talking about the pressures on the mental health services and some of the changes in the psychiatric services, in which it seems that it's only those with schizophrenia or bipolar disorder who remain under long-term care of a psychiatrist. Others, it seems, are given short-term intervention (perhaps as little as six sessions), discharged back to their primary care team, and readmitted to the psych services when they relapse. I said that I think this 'wait for them to relapse' approach was rather dangerous, and I find it somewhat alarming, although sadly not very surprising as my experiences with the mental health services over the years have been very erratic and, at times, very unsatisfactory. To be fair to Dr T, she didn't seem to think it was necessarily the best approach, but as one doctor in a faulty system she can't do anything about it.
Regarding my own situation, well ... I'm on my own now. No, not completely on my own, because I have good friends and my GP practice is very good, but for the first time in seventeen years I no longer have input from the psychiatric services and that feels rather odd. Good in some ways, but odd. I know that I have the referral to health psychology in progress, but I haven't yet heard anything about that, but then it's only 12 days since my GP said he'd refer me. Dr T said she thinks that health psychology is what I could probably do with, and I told her about the referral. She was pleased. I still feel that she should have instigated this referral herself and most definitely that she ought to have ensured that the support was in place before she'd discharged me, but I didn't say any of that. Perhaps I ought to have done. I suppose that one of the things that stopped me was that I was again rather shocked by her wishing me luck in finding 'appropriate support' for myself. I do think that should have been in her remit as my psychiatrist. She even said that I might need to be persistent and that it could take some energy to find the appropriate support. Where does she expect me to get this energy? How does she expect me to know where to go to push for the appropriate support? Sure, I can go to my GP, but what if they don't get anywhere themselves? It's all very strange.
When I came out of the appointment I felt ... I dunno, deflated ... a bit scared ... oddly liberated ... like a grown-up. That sounds very strange, doesn't it, but when you think about it, I've had input from a psychiatrist since I was twenty, which is barely adulthood. Having said that, the input has sometimes been more detrimental than helpful, and it's certainly been very erratic. I've lost count of how many psychiatrists have passed through the acute services here, but it must be something like fifteen in seventeen years. The shortest length of time I remember one psychiatrist staying was one week! There is no stability in the services, and that can be - and has been to me at times - detrimental to the well-being of the patients. So I guess this is another good reason for me to be out of it now.
Dr T had a student in with her. She did ask if that was okay and I consented because I have a general ethos that medical students need every opportunity to learn. However, I don't think I actually did myself any favours on this occasion. I didn't hold back from saying anything because the student was with us, but it does change the dynamics of any consultation and I really could have done with having the final meeting with my psychiatrist on my own with her. In some ways I'm annoyed with myself for agreeing to the student being present, but in someways I'm also annoyed with Dr T for not thinking that it might be important for me to have that final discharge appointment alone with her. It surprises me that a psychiatrist can appear to be lacking such insight ... but maybe it shouldn't...
You may have gathered that I'm still feeling rather confused by the whole thing. I don't know what my GP will think of it either, but I suspect that they'll all be surprised. They, after all, are the ones who would have to deal with any fall-out, and they are the ones who dealt with me during so many dreadful times of crisis in the past. Of course, I sincerely hope that I never ever end up in that awful situation again, but even though I've been depression-free for nine years, I still don't fully trust it. And I suppose that's the crux of my apprehension about being discharged from the psych services - fear that they'll be nobody to catch me if I fall...
I guess now is the time that find out if I've learnt to fly.