My Treatment Proposal Was Approved By My New Psychiatrist!

I self-referred to the Rapid Access Clinic at Burnaby Hospital Mental Health and Addictions Services in July 2015. Your file remains open for six months after which another self-referral is necessary. By December of that year I called Burnaby Mental Health to make an appointment with one of their psychiatrists because the treatment recommendations were not working for me. On the phone while attempting to arrange an appointment, I was told that my file was closed. I checked the dates of my referral and knew for a fact that the six month period had not yet elapsed but still my file was closed. I was forced to re-refer myself. 

My referral went through in January but it wasn’t until June 29th that I received an appointment. Rapid Access is a misnomer. Then, a couple of weeks before the June appointment, I received a call to reschedule for July 8th. I was fed up by this point and barely hanging on. My anxiety shot up, panic attacks increased, my agoraphobia worsening by the day that I feared I would not be able to make it to the appointment. It was only through being heavily medicated with benzodiazepines and the support of my mom that I succeeded in driving the seven and a half kilometres to Burnaby Hospital. 

I have been a patient at Burnaby Hospital Mental Health on and off for years. Dr. Paul Waraich is the psychiatrist I usually saw. When I called to confirm the date and time of my appointment, I was told that I wasn’t in the books. The lady on the phone checked the schedules of the other psychiatrists there and said I would be seeing someone else. I misheard her and thought I would be seeing Dr. Jerome Lee. The night before my appointment, I was having trouble falling asleep and so I looked up Dr. Lee online. I was horrified to learn that he was the doctor who had treated Eddie Young. I didn’t know Eddie personally but learned after his suicide that he was the cousin of a former tenant. Not only that, I also learned that he was being investigated by the BC Coroner’s Office in the death of Eddie Young. There was also mention about a sexual harassment suit against him. Unfounded or not, these charges made me anxious. 

Somehow, I managed to fall asleep in the early hours of the morning of July 8th and when I got to my appointment, I learned I would not be seeing Dr. Lee but Dr. Ronsley instead. Luckily, it turned out Dr. Ronsley was just the kind of psychiatrist I was hoping for. He listened to me without rushing me. He asked a lot of questions, took a lot of notes and read the proposal I had written in which I asked for a specific treatment plan that I believed I needed in order to overcome my panic disorder and agoraphobia. 

And he agreed! I was so elated and finally felt like I was on the right track. Now, together with Dr. Ronsley and my family doctor, the three of us are working together in treating me. I feel hopeful for the first time in years and I am very aware of how lucky I am to have found doctors willing to listen and work with me. 

I know the mental health system is broken here in BC as I’ve been a patient for the last sixteen years. When I first began accessing mental health services back in 2000 as a minor, I found the system easily accessible and fast. But once I aged out, things changed. The resources for adults were fewer and harder to access. Whether that was due to changes within the system or differences in available resources for adults versus children and youth, I can’t be sure. What I am sure of is that for adults with mental health issues, services are severely lacking, especially in smaller communities on the island and here on the mainland. 

I can’t help but feel utter sympathy for the countless people trying desperately to access services they need and failing. That it takes months to even access a service, to me, is a human rights violation. The only advice I can offer is don't give up. Demand access to services. It's your right. Call the many non-profit organizations and ask to speak to mental health advocates; many have them on staff or as volunteers. Contact the media. Raise a fuss. Otherwise, nothing will change.

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Treatment Proposal: Getting the Treatment YOU Want

I feel so light today--not because I'm flying high on benzo's--because I finally feel the weight of desperation, frustration, hopelessness, depression, suicidal ideation, anxiety and panic lifting. I can't even recall the last time I felt, for lack of a better term, normal. Like I could cope with life and enjoy waking up in the morning to face the day.

Ever since I was first diagnosed with GAD and Panic Disorder sixteen years ago at the age of sixteen, I have felt at the mercy of this disorder and more than that at the mercy of family physicians, psychologists, psychiatrists and therapists and social workers. Everybody to an extent had their own opinions about what I needed to do to get better, to cope.

Well, finally I had had enough. I was paralyzed with anxiety and my agoraphobia severely restricted my movements. I was in a catch-22 as I could not physically get to group or one-on-one therapy which I desperately needed in order to get over my agoraphobia.

I knew exactly what I needed to get better and so I wrote out a treatment plan and presented it to my psychiatrist. And it worked. Be firm. Stand up for yourself. I was ready to be shot down by my psychiatrist and had that been the case, I would have moved on to someone else until I got what I wanted.

Since Blogger won't let me upload a word doc or pdf file, I will post my Treatment Plan below as an example. I tend to go on and on, lol. Your letter does not need to be as long.

_________________________________________________________________________________

Treatment Proposal 

Prepared for: Dr. R******

Prepared by: Sonja J*****

Date: June 11, 2016 

Objective 

To minimize anxiety and panic attack symptoms as to allow me to fully commit to group therapy and exposure therapy. 

Proposal 

Clonazepam 0.25mg per day for three to six months in conjunction with CBT, exposure therapy and mindfulness meditation. 

Rationale 

Since the December 2015, as an adjunct to my current meds (Effexor 225mg and Quetiapine 50mg) I have first tried Escitalopram, which worked for barely a week before it suddenly stopped. Then I tried Buspar and that had no effect whatsover. Finally, I tried adding Prozac. The side effects were immediate but I stuck it out for nearly two months without any noticeable effects. 

Besides these three medications, I have, through the years, tried almost every antideppressant out there, including tricyclic antidepressants, tetracyclic antidepressants, atypical antipsychotics and even an anticonvulsant. None of these helped with my anxiety and panic attacks, not to mention my agoraphobia. 

Recently, I have tapered off Quetiapine and have replaced it with Amitriptyline 25mg for my insomnia. The only other medication that I am currently taking is Effexor 225mg per day, which only works for my depression. I know this because I twice went off Effexor thinking that it did nothing for me only to have my depressive symptoms return. Once I was back on it at my usual dosage of 225mg, the depressive symptoms ceased. 

At this point, I am wary of trying any antidepressants for my anxiety as I have no hope that these drugs will have any effect on my severe anxiety. The only medications that work for my anxiety, panic attacks and agoraphobia are anxiolytics. 

Having said that, my proposal to you is to prescribe me a very low dose of Clonazzepam (0.25mg/day) for a short period of time, two to three months. This would allow me to immediately commence group therapy here at Burnaby Hospital Mental Health. It would also allow me to start exposure therapy as well as mindfulness meditation. I believe that the reason I have not been successful with the above therapies is because my anxiety is severe. I am unable to concentrate on anything, I have trouble sleeping, feel restless most days, have difficulty eating due to constant nausea. 

I need something to take the edge off. Just a little so that I can think straight and concentrate on my therapies. Every time I try exposure therapy, I panic. My body feels disconnected from my rational brain and before I can even try to calm myself down, my legs are spiriting me away from the “threatening” situation. The terrifying thoughts come so fast and with such conviction that my body just reacts and I flee. In that moment it’s impossible—or at least feels that way—to stop and think rationally. I don’t know what to do anymore. 

For the last few weeks I have felt hopeless about the future, hopeless about ever being able to cope with my disorder and have felt an almost complete lack of motivation to even try as my anxiety just keeps getting worse. But I’ve been fighting it every single day. I am certain that I would greatly benefit from a small dose of Clonazepam. About a month ago Dr. Brar, my family physician, prescribed me 0.25mg for a few days because I was overwhelmed by intense anxiety and it helped me so much. I was able to concentrate again, to sleep soundly and a sense of hopefulness returned that I haven’t felt in almost sixteen years on antidepressants and antipsychotics. 

Exposure sessions build on each other. One session every week or so doesn’t do much good in the long run but that is all I have the energy for right now. I am hoping to make exposure a daily practice and Clonazepam would make that possible. After a while I will have the necessaty skills and confidence to continue exposure and other therapies without the use of a benzodiazepine. 

Conclusion

For me, the benefits far outweigh the potential risks of benzodiazepine use. I have never abused drugs, prescription or otherwise. I have take Ativan on an as needed basis for years without problems. But Ativan is only effective in emergencies and that’s how I take it. Clonazepam, on the other hand, is longer acting and works much better for my severe anxiety. Being able to take a low dose for a couple of months would give me the opportunity to fully commit and carry out a variety of therapies that in combination will help me to regain a sense of control over my anxiety and allow me to cope again. 

I have tried exposure therapy many times but it just does not work when my anxiety level is so severe. After exposure sessions I would feel so mentally and emotionally exhausted that I lacked the energy, strength and motivation to try again. 

In case you are worried about me being able to come off Clonazepam, that will not be a problem. I was on Ativan 2mg a day for months and I had no difficulty tapering off. It is not my intention to stay on benzos for the rest of my life. All I am asking for is a low dose on a short term basis to help me kick start exposure and cognitive behaviour therapy. 

Thank you for considering my proposal. 

Sincerely, 

Sonja J*****

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Academic Failure Due to Mental Illness - Clean Slate?

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I graduated from high school in 2002 by the skin of my teeth. In late 2001 as I started my senior year, my panic disorder worsened. Daily panic attacks at school took their toll and by winter break, I broke down and left school. Fortunately for me I was able to apply for Correspondence and continued my senior year from home. The feeling of relief was quickly replaced by a despairing depression as I sat at home while my friends were busy with school, enjoying their status as seniors, planning for prom and after prom celebrations at Whistler and of course graduation and prepping for colleges or universities.

I barely graduated. I dropped every course that wasn't a graduation requirement, leaving me with only two courses; English and Biology. I passed English easily but failed Biology because the Provincial Exam was held at my old high school. I freaked out about ten minutes into the exam and wanted to leave but the invigilator would not allow me. No one was allowed to leave the exam room within the first half hour. I panicked. I couldn't concentrate on the exam questions. I couldn't even breathe, I was so desperate to get the hell out of there. Luckily, the invigilator seemed to understand what was happening to me and she talked me through some deep breathing until she could officially allow me to leave. It was the longest twenty minutes of my life. With my friends and others looking over at me, thinking hell knows what.

That exam was worth 30% of my grade and even though I had a B in Biology, failing the exam brought my grade down to a D or whatever the equivalent is of a final grade of 51%.

I made it to my prom (somehow) but not my graduation. After graduation things went from bad to I'm-so-disgusted-with-myself-I-wanna-die bad.

I spent the summer after graduation in therapy (which started back in grade 10) but worsening panic attacks resulted in avoidance which turned into full on agoraphobia. I didn't leave the house in over a year.

I was finally able to attend college in the fall of 2004. Already two years behind my graduating class, I pushed myself so hard to catch up. I piled on 18, 21 credits per semester and didn't take breaks during the summer months. The anxiety and panic attacks were still a major issue. I couldn't concentrate on the lectures in class because I spent the entire time fighting back the rising swells of panic. Sitting through an entire lecture was an accomplishment of the highest order for me but instead of concentrating on the positive I derided myself for being weak, crazy and intellectually dumb.

Taking on so many units, trying to prove I was like everyone else, backfired. I failed miserably. Failed more courses than I passed and had numerous unsuccessful semesters, was placed on academic probation. The Registrar even got involved, telling me she had been keeping her eye on me, so to speak, and after two semesters of me taking on a huge course load and being unsuccessful, she banned me from taking more than three courses at a time.

But it didn't help. I was going downhill fast but refused to acknowledge that I just could not crack it at school. I had something to prove. To myself. To my immigrant parents. To everyone who expected so much from me. I was the smart one. The one who loved school and academics. Who wanted to go all the way up to a PhD.

By the time I left school in 2008, I had graduated with a worthless Associate's Degree in General Studies that took four bloody years, a 1.67 GPA and about $40,000 in student loan debt. Most of the debt was not for tuition but for living expenses as my parents couldn't make ends meet without my contribution to the household.

It was a complete waste of time and money. I couldn't work even if I wanted to. I couldn't go back to school either. Not financially, as the government had basically cut me off due to so many withdrawals. It didn't matter that I had a mental health disorder. You only get three chances. After that you're on your own. I couldn't even do it mentally nor could I physically attend classes.

I wish I could wipe the slate clean and start again. That shitty degree is actually a hindrance to further education. It will follow me. Wherever I apply, that shitty GPA will disqualify me from any decent university.

The bottom line (money, bloody money) is what matters. There is no incentive for individuals struggling with mental health issues to persevere. Three strikes and you're out. And you can't even pay off your student loans because you can't get a job. And if you could get some shitty minimum wage job it would probably take you 50 years to pay it off but the maximum in Canada is sixteen. And you can't even file for bankruptcy for at least 5 years. It used to be 10. If you can get your loan forgiven, you will never again be allowed to take out another one. The whole thing is just fucked up.

So without funding, there is no way I will be able to pay for it myself. I can barely get by with my disability benefit and part time job. There is nothing left over to put aside.

It depresses the hell out of me. It's just fucking money. But higher education is a business. It's not a right. It fucking should be.

Unless I win the lottery or the book I'm writing becomes a bestseller (the odds of that happening probably no better than winning the jackpot), I will never get my degree.

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