letter of appeal

[bitomato]

Hi Auror,
First off- I am sorry that you are experiencing this.
I think you should consider how much energy you need to expend responding once again to the Director. I think that you are entitled to respond, but you need to consider that it may not change the decision. You are also entitled to feel frustrated about the situation- and that is something that you do have control over in terms of how you feel.

All medication is not the same, and all services are not the same. By attending your appointment with the psychiatrist- and being as forthcoming as you are comfortable with, you can look at changing your current situation.
Persons would not be "students" without being introduced as such. Maybe you can gather together issues that you think matter to you- what you need help with- what you have issues with.

I would also note that you are experiencing a form of grief terminating services with the Doctor Lady, so you will be going through the stages of anger denial etc.....

What do you want to get out of responding once again to the Director?
What do you want to get addressed in treatment? I get the impression that you do not view yourself as having mental health issues- and would prefer to engage with a medical doctor with mental health experience, rather than a mental health specialist e.g. psychiatrist. Am I correct? Do you consider yourself as having mental health issues?

[Aubergine]

Hey.


I think one of the main reasons for Dr Lady terminating her services is your risk. It's great that you have managed to reduce it and that is commendable, but from what I've read of your posts, there is still quite a severe risk to your health due to your behaviours. If you are still ODing despite her intervention and she does not feel she can manage that, then she is well within her rights to not work with your further. The director, as I understand it, is protecting Dr Lady as is his job. As he has said, it is unethical for them to continue therapy if they do not feel that they can manage your risk to a satisfactory (to them) level.


It is very unfortunate that he has included stuff that is untrue, but the risk to your health is very real and that bit of his response will stand up regardless of your objections to his other reasons.


I really hope that you are able to meet with the psychiatrist and that you are able to figure out a way forward. Thinking of you.

[Auror.]

Sorry. I really appreciate all the replies and I am sorry for not responding properly. I will try to when I can. Things just seem very overwhelming right now. I do not want to seem ungrateful. It means a lot. <3

[Snow White.]

Be gentle with yourself xx

[mikey]

Reuben sends cuddles and licks. Hope you're okay xx

[EyelinerAndCigarettes]

How are you doing lovely?

Been thinking of you.
x x x

[Auror.]

thank you aimee, ang, reuben :P , and helen.

things are sort of not good. i am definitely not really focusing on writing the letter right now. sorry for still not responding proper.

[EyelinerAndCigarettes]

Don't be sorry for not responding properly lovely, I'm sorry you're not so good.
You talk when you feel ready, we're all here for you.
x x x

[Dreamer And Believer]

Glad you remember me :) I am doing okay thank you! As others have said, here to listen/talk if or when you want xx

[Auror.]

I seem to be not dead and it is not acceptable. None of this is manageable. I am having a very hard time going to classes and doing the work. I kind of had a meltdown yesterday morning and finally went in but just talked to S for a bit about things and did not actually go to class. I managed to do an assignment in the computer lab and go to my shift at work, but drama happened at work and I ended up having another meltdown when I got home. I have managed to not self harm or od but I doubt I can keep this up.

I have not gone to any of my classes today. I got an email that I have a quiz to do before my night class and I have not done the reading. I have to lie to my mother so she does not pick the dog up at doggie daycare, since we are still home in bed.

This is not really appropriate for this thread/forum most likely but I can't deal with making a new thread right now.

I may need to be dead in which case a letter is kind of silly. I emailed doctor lady to try to figure out how to find out if medical doctor is dead because she has not read or responded to my emails and she said she was not dead. I want to find out about the sudden death thing because an od would not be a pleasant way to die but it might be effective.

[mikey]

I'm so sorry to hear you're having such an awful time right now Carmen.
I think YOU come first here: not your classes. Is there any way you can get in touch with your tutor or somebody like that perhaps and explain why you haven't been attending and why you can't cope with your work atm?
If it makes you feel better to lie in bed and cuddle your dog then do that. Remember that she loves you.
Probably medical doctor is extremely busy. Could you email doctor lady again and tell her how much you're struggling?
You're right. An OD would NOT be a pleasant way to die. I don't want you to die in any way, pleasant or not, and actually I think you want things to be different and better and easier. Being dead will not achieve that.
Can you keep writing here and tell us how you've feeling? Can you reach out in person to ANYone and tell them how you're feeling?
Things do get better, Carmen. I've been there and I won't say 'I know how you feel' because I'm not you, but I do know how it feels to want to be dead. That feeling for me has now gone and I'm very glad I'm not dead. In order for things to get better you need to be alive. I understand things are **** atm but things can and do get better, with help.

Thinking of you.

[Auror.]

I cannot see doctor lady anymore so I probably should not be emailing her at all. But I emailed her to find out who to ask about things now, since I know she is probably not the right person and she just told me that medical doctor is not dead instead of directing me to someone else. Medical doctor cannot do anything about mental health things. I just wanted to know about the sudden death thing.

I do not have a tutor? I am unsure who I can talk to at school that can actually do anything. Most people know they just obviously can't help and/or do not understand.

I have gotten a coffee and am in the building where my night class is but now I can't do this stupid quiz. I texted S because she wanted to know where I was and why I was not in class. She said to definitely try to stay and do the quiz and stuff, and that it is better to at least try and come for one class than miss all of them.

I want to go home. The dog was lying in bed with me before I left, and she was so cute. She was under the blankets with her head on the pillow and I had to put her in the crate when I left. I am a horrible person.

[mikey]

You don't appear like a horrible person to me. Not at all. I have to leave my dog sometimes when I go to appointments or need to go into town, and he doesn't like it that much, but does that make me a horrible person? Not at all. I know how much you love her and SHE knows how much you love her and that's what matters.

Is there a teacher or lecturer you like? Perhaps you could talk to them. I do think it's important they have at least a little understanding that you're struggling a lot. My experience is that they will try to help in whatever way they can.

If you feel up to trying to take the quiz then try. If you think it will make you feel worse then honestly, I personally wouldn't go, but it is your decision. Hopefully you can go home soon and lie in bed with your dog again and have dog cuddles (which cure all ills) and get some rest.

I'm worried about you Carmen. I know it's scary to reach out in person to someone but it is really important. Keep talking on here, we're here for you anytime.

[Dreamer And Believer]

At the end of the day, your health (physical and mental) is the priority. I know it can be difficult to see that and I know that you may find it easier to fixate on your coursework if it keeps you distracted from your health, but if your health is poor you will struggle with everything else. It might be worthwhile sending an email to all your professors--you don't have to say in detail what is going on, but just explain you are having some mental health problems and would like some extensions/flexibility on deadlines and such. I've found professors in the past have tended to surprise me with things like this.

It would be worth getting in touch with your college's disability services as well. They would be able to support you with this. If it was a route you were willing to go down, sometimes getting your mental health diagnoses officially recognized by disability services can mean professors will be a lot more flexible in general (they have to be if it's seen as a disability), and the university may provide you with more support as well.

It sounds like S is someone you trust. Would you be comfortable asking her for some support with dealing with all of this? It would be good for you to have someone close by, she could be emotional support for you if you choose to go speak to professors, go to meetings, etc.

[Auror.]

Almost all of my professors know what is going on and do try to work with me. I am registered with disability services.

I made it to work and to my class today. The professor told me not to worry about one of the new things we were working on. Originally he told another student to explain the new things to me and the other person who had missed class, and she took the other person aside and ignored me completely. So I think the professor noticed, because he told me not to worry about it and I can just focus on what we had been doing, and he let me make up the quiz I missed.

I am meeting with S tomorrow after class. She said she has a therapist she wants to recommend to me and that she wants to try and help. She also said it would be better to email the professor whose class I may need to drop to discuss it in person. There is a test in that class tomorrow though so I have no idea what to say.

I feel like the more I try to do things the more overwhelming it all gets and it is never ending.

[bitomato]

I sympathise with this. However, it does sound like you are making progress even if it may not feel like you are.
Mental health emotional challenges rage while everyone else seems to not appreciate the urgency.
However, utilise disability service if you do not know what exactly to say to professor.
Try to give yourself congrats for the things accomplished- even if it is one thing here and there; rather than focus and fixate on things to do as it can overwhelm.

[Dreamer And Believer]

What bitomato said is right. It may be overwhelming to think about everything you have to do, but remember it does not all need to be done at once. Focus on one day at a time. It sounds like you got a lot done today by going to work and class, and it's really great that your professor is being flexible with you. I'm glad you have someone like S who sounds like she is really supportive, too.

If you feel up to it, you can contact disability services to see if they can help you with dropping the class. But really it is your decision to drop the class--you don't need the professor's permission, just a quick note to explain to them that you've decided to drop it would be fine. However if you're undecided it would be good to email her and explain that you're overwhelmed with things at the minute, tell her you are thinking of dropping the class but would like to know what your other options are--extensions on assignments and that sort of thing.

[Auror.]

Disability Services at my uni here doesn't work like that at all. They allow you to have accommodations and are the ones who set it up originally, but anytime I've asked for help with anything they've had to refer me to someplace else. So it just comes down to dealing with things on my own.

I've emailed some of my professors but they can't meet with me until next week, understandably.

I did not make it to my classes or meeting with S today. S said she is concerned and asked if I had taken anything. I said no and I was trying not to. I am really struggling not to do anything. I have emails to respond to and schoolwork to do but I have not even been out of bed for long and may not be much longer. It seems safer there for now.

edit:
I am going to write the director back tonight. This is what I am sending:

The following content has been hidden - Reason : long, letter to medical director

Dr. X,

I appreciate your taking the time to respond to me so thoroughly. However, the majority of things you mention as being fact I was never aware of, nor was that my understanding of the situation. I am still urging you to reconsider this decision. Let me explain what I understand as fact, and hopefully you will understand better why I think it important for you to reconsider.

If I saw someone in mental health before 2012 it would have been when I was a student for only a short time, i.e. less than a semester, and would have been discontinued for that reason. I did see someone in mental health in 2012, when I started back at Uni. They eventually said that until I got my anxiety better under control they would not be able to help. Even though I asked them for help with specific anxiety issues, I was told they could not do this. So I discontinued seeing them.

Last year, 2014, is when I started again at Mental Health and saw Doctor Lady, and this is the only time I have been referring to. I was not made aware that anything previous had ever been an issue. Up until seeing Doctor Lady for the last time, when I asked about seeing a psychiatrist, she said she did not think it would be helpful for me. Because I trusted Doctor Lady's opinion about this more than Medical Doctor's due to the fact that she is more aware of my mental health issues, I did not see the need to seek a psychiatrist. It was not until I last saw her that she recommended this, and I do have an appointment scheduled with someone in psychiatry. This is the first time that both she and Medical Doctor have recommended it, and thus, it is something I am following through with.

This past spring it was my understanding that I was not discharged from mental health, but that the reason there was concern was because I was not attending regular appointments or engaging properly. Nothing has ever been mentioned to me about seeking care at a facility elsewhere as a requirement, nor has it ever been recommended to me. From what I understood, I was allowed to come for free for the summer to remove the financial barrier, and see if I could make progress. I did come on a regular basis, and it is my understanding that Doctor Lady knew I was trying to engage and I did make some very slow progress. It was mentioned to me that she could tell I was trying to engage. Again, I am not sure what other recommendations you were referring to in your email, because those were the requirements as I understood them, which I did follow through with. I have not been able to see her on a regular basis since due to financial issues, which have now been sorted. I am going to post at the bottom of this part of an email that I received from Doctor Lady showing the reasons why she was considering discharge in the spring, and what the terms were for continuing, which I did meet.

In terms of requiring emergency psychiatric care, I respectfully disagree. When I present at the hospital, it is because I am in need of emergency medical care for physical health reasons. The psychiatric issues behind the behaviors are longstanding issues that I have been trying to deal with, and they are not indicative of being in crisis. Every time I am in the hospital I do speak to either a social worker or a psychiatrist, and it is clear that they understand that I am not experiencing a mental health emergency. Not once has it been recommended that I stay for anything other than medical reasons, and I do follow up with care like the hospital staff recommends.

While I am not disagreeing that my actions are dangerous, expecting that the behaviors stop immediately is not realistic. However as I have mentioned, they have decreased in frequency, which is improvement. I emailed Doctor Lady to ask something pertaining to this appeal recently, and she stated that she understands that I have “intense difficulty” participating in therapy. I would like to mention that having difficulty participating is not the same thing as non-compliance, and the fact that I am still trying to participate and engage even when difficult shows progress as well. I know it may be hard to see that, but I do think progress has been made, even though it has been slow, and I would very much like to have the ability to continue to work with Doctor Lady. Slow progress is still progress, and the fact that I am self harming and needing emergency care less often, and was attending sessions and building up trust with someone should not be overlooked.

Again, I want to thank you for your time in responding, and I hope this additional information will help you to again reconsider this decision.

Thanks very much.


PS. This is part of an email I received from Doctor Lady on the 13th of May about returning to see her again in the spring and summer. As you can see, nothing was ever mentioned about needing to receive care elsewhere:

I'm happy to schedule a session with you that could just be spent discussing your concerns. It would be much easier to do in person than by e-mail--especially since we've already communicated by e-mail extensively about what would be required for you to return to treatment. I can summarize them here briefly, but if you'd like to ask questions and talk about them, I really feel like we should do that in person.

Terms of return to treatment:
1) Attend regularly scheduled appointments no less frequently than every other week, with the exception of the typical circumstances that may modify that schedule (emergencies, clinician out of office, client out of town, etc). If a longer or shorter time between appointments is agreed upon, it will not be considered a violation of this condition.
2) Agreement to prioritize personal safety and reduction of self-harm as an active treatment goal. This would involve active discussion about self-harm behaviors and patterns.
3) This will be your final chance to appropriately engage with treatment in this clinic. You will not be held to unreasonably high standards for improvement or engagement with treatment. However, you will have to show good faith efforts to engage in treatment according to these conditions.
4) If you do not comply with treatment recommendations to a reasonable degree (i.e. No attempt to engage in recommended interventions outside of session, no progress toward goals, frequently missing appointments), treatment can be ethically terminated and you will be discharged from care at this clinic.
5) If you prematurely, non-mutually terminate treatment on your own, you will be discharged from care at this clinic. This means that if you leave treatment by cancelling and declining to reschedule appointments, or otherwise ending your treatment without us agreeing to the end of your treatment, you will not be permitted to return to our care in this clinic.

[Dreamer And Believer]

I think that letter was so thorough, honest, and respectful while still getting your point across and emphasizing how you feel you've been miscommunicated with (the 'conditions' the director claimed you hadn't met, that you didn't know about). Have you received a reply?

[Auror.]

I have not gotten a reply.

If he still says no, I'm requesting my notes because I want to know where all this information I supposedly should have been told is, and I have a right to see it and be aware of it.