It was a close friend who first noticed that I was experiencing extremes of mood.
Friends, families, and carers "sense a resistance to being heard and feel their expertise isn’t being valued."
I had been in a depressive episode which was so debilitating that I had to be admitted to psychiatric hospital. And yet within days of being discharged, I was going out every night partying, with seemingly limitless energy and euphoria. The contrast was so marked that my friend commented “It’s like a miracle.” Then he thought about it and said “Do you think you might have Bipolar Disorder?”
The prospect had never occurred to me. I went to see my doctor and he started monitoring my moods. He eventually referred me for a psychiatric assessment and I was diagnosed with Bipolar Disorder Type 2. I was fortunate that he referred me to an NHS Trust in another county where they specialised in Mood Disorders.
It was also a close friend who realised that I was suffering from traumatic grief after the death of my mother, for whom I had been a full-time carer. Traumatic grief can cause symptoms of Post-Traumatic Stress Disorder which may delay the grieving process, perhaps for years. It’s important to get help for the post-traumatic symptoms but, in my experience, mental health clinicians often miss the signs of it.
My friend wrote to my local mental health service as she was very concerned that the traumatic grief was not being recognised. She had the advantage of having been a Psychiatric Nurse in another part of the UK, but her concerns were still not heeded. Five years later, my GP referred me once again to an NHS specialist service in another part of the UK for assessment, and the Psychiatrist diagnosed traumatic grief. If my friend had been listened to, I might have received help five years earlier.
The role of friends, family, and carers in diagnosis
I was fortunate that the specialist NHS service placed great importance on the input and evidence of carers, family, and friends, who had a long-term view of the patient’s presentation. The Psychiatrist asked to interview my friend alone, and the information she provided about me formed part of the assessment. I wish this would happen routinely in mental health services: that the input and expertise of carers and family/friends was recognised and considered an essential part of the assessment, diagnosis, and understanding of the patient.
Now that I run a Suicide Crisis Centre, we have regular contact with carers and the people who are closest to our clients. We frequently hear their frustrations that they feel that their loved one appears to be showing signs of a particular mental health condition, but clinicians aren’t listening to them. They sense a resistance to being heard and feel their expertise isn’t being valued.
- See more: 'If anyone is to be wearing recording equipment on psychiatric wards, it should be the patients'
- See more: An introduction to the classification of mental disorders: the DSM and the ICD
One of the greatest challenges for those of us who have Bipolar Disorder is the depressive episodes. I have experienced depressive episodes so deep that I descended into suicidal crisis. I was told by the specialist Psychiatrist that traumatic grief was also a strong contributory factor during those suicidal crises. For several years those two conditions, which impacted so severely on my risk of suicide, went unrecognised. If it hadn’t been for my friends, I might still be undiagnosed even today.
This is one of the most important reasons why mental health clinicians need to listen to and recognise the expertise of carers, family, and friends. It may make a life-saving difference.
Joy Hibbins runs the charity Suicide Crisis: http://www.suicidecrisis.co.uk