Letter From DPM to Dr T and GP

Here is a letter I have received from the person I saw from Psychological Medicine.

Dear Dr T,

I assessed GP on the ward at the hospital on the 20/07/11. She had been admitted at aprox 1am on the 19/07/11 following a planned suicide attempt. She told me she did not know how she had got to the hospital but the ED notes indicate she was found in a bus shelter by an ambulance crew after a phone call had been received by them. When she was found her GCS was 3 and remained at a lower consciousness level for approximately 10-11 hours after the event. GP told me she had the intent to die and once she had made the decision to attempt she felt calm and wanted it to work.

Mental Health History

GP told me she was under the care of the CAT team and the counselling service. She told me she is currently being treated with Quetiapine 400mg. She sees Sam at the counselling service for therapy sessions and was last seen on the 8/07/11 (the day of the attempt) by Dr T. She told me she self harmed about 5 times per month (it's actually a week, she got that bit wrong) by blood letting with a needle. However, she said that for the past 4 months she had been feeling "suicidal" and that her moods can drop for long periods of time. She told me she had attempted on Monday as she had the opportunity to do it whilst her parents were away. I believe GP has attempted a number of times in the past and she told me earlier this year she was placed on a S136 after telling people she was suicidal.

 Mental State

At the assessment GP appeared coherent, rational and was able to express her self well. She appeared reactive in mood and told me she had not been feeling depressed recently. She told me she is a Masters student and plans to be a mental health social worker and was up to date with her work. She told me she continues to have periods of what she describes as dysthymia, when her mood can drop for long periods of time and she will have more active suicidal thoughts. She described feeling that during periods of time when her family are with her she is more able to control and manages these thoughts, also she can distract herself by keeping busy with uni work. GP denied feeling depressed at the present time. GP told me the self harm thoughts can come on very quickly and create a sense of agitation and distress, she told me that once she had made the decision to act on the thoughts, she feels more calm and that once the decision has been made she cannot then control it. She told me she could "not guarantee" that she would not attempt again. She told me she had no active plan or intent to self harm again over the next few weeks as she planned to spend time with her brother and his family and had plans to go to France next week. She also had plans to finish her coursework and see her boyfriend (I don't know how many times I have said he is not my boyfriend but a guy I am seeing).

GP agreed that her risk of self harm remained high and she is aware of the risk of death due to her current self harm behaviour. We discussed the need for her to identify the triggers to her more serious self harm behaviour at an earlier stage and to use the resources available to her to try and prevent her acting on thoughts.

GP did not want to be admitted to hospital and was very keen to be discharged home as she had plans for the evening. She told me she does not want to use the Crisis team number as she finds it difficult to discuss her feelings over the phone. She plans to continue with therapy and is willing to see you at another out patient appointment.

As discussed with you the following plan was agreed with GP

1) GP has been given the number of the mental health crisis team and I have encouraged her to use this if she starts to have thoughts of serious self harm.

2) I advised her in the absence of doing she could also self present at the ED and ask to speak to our team.

3) I advised her to keep the next outpatient appointment with you.

4) Advised her to keep next counselling appointment and she agreed I could phone her worker to discuss the situation.

So that's it. I got the feeling she got a bit mixed up with some of the things I said but on the whole it's not too bad. I don't know where people get that I am agitated from. I don't think I have ever said that. Dr T thinks that also. I wish in a way they would just tape record the appointment and provide a transcript. That way things that I have never said wouldn't be put there.

Oh well.