In Discovery, you read about how I realised that something wasn't "normal" about my brain and how I decided to pursue a professional assessment. I haven't written for a few weeks. Between getting that assessment and everything that followed, I've been finding my feet.
You may be the same - writing things out sometimes help me process, while other times, I can't write about it while I'm deep in it. After my assessment, I needed some time to reflect and begin life on the other side.
In the UK, where I live, we have the amazing National Health Service aka the NHS. Free access to medical care at all levels and subsidised prescriptions sounds incredible, and it is. However, the system was overstretched, even before 2020, and has been mismanaged over the years.
I looked into getting assessed on the NHS. This is the process:
Step 1. See your regular doctor and ask for a referral.
Step 2. Wait for the referral to come through to your local mental health services.
Step 3. See a psychiatrist for the assessment (1 or 2 appointments of 1-3 hours each).
Step 4. Wait for the treatment plan (overseen by a psychiatrist or mental health nurse).
During the pandemic, to see the doctors at our clinic, you must ring at 8am to arrange for a phone appointment later that day. At the time, I was sleeping incredibly badly, so this process was going poorly. Often, if you phone any later, there is no reply or the appointments for that day have gone. I was finding this hard.
Step 1 was going badly.
I was fairly stressed about seeking referral. I tend to downplay symptoms and go with "Well, I'm fine, I guess. I can cope." I started gathering evidence of my symptoms and their impact on my life and business. My reading suggested that some GPs are reluctant to refer adults for ADHD assessment, so I was armed with the Department of Health guidelines published by NICE, in support of referral.
To go without diagnosis for all this time, means I have strategies and life circumstances that reduce the impact of my symptoms. Or at least they did, as a student and employee. And yes, I still messed up, missed deadlines, got reprimanded for a messy desk. So I paddled harder and harder. I stayed up to get everything done. I left work later than nearly everyone else. I brought work home on the weekends, evenings and holidays. This is one of several behaviours that create protective colouring hiding ADHD and other neurodivergencies. These behaviours are called "masking". I will definitely be writing about that soon.
Once I started running my own business, some of the old strategies and circumstances so longer worked. Some things improved. This year, I started to feel that I'd got as far as I could get; something was blocking my further progress (spoiler: it was untreated ADHD). And then came the pandemic, lockdown, economic uncertainty. People with good mental health began having trouble with anxiety, focus, structuring their day, etc. And my symptoms got worse, and became unmanageable.
I read about waiting times. Six months seems to be a minimum; a two year wait is common. The way things were going for me, in this confusing year of 2020, this felt intolerable.
Step 2 seemed unattainable, or at least, unbearably distant.
I started researching private assessments. I'm very grateful that I was in a position to be able to do this. It was a squeeze to do so, and at other stages in my life, possibly even in another month or two of 2020, it wouldn't be possible financially. Right then though, it was, and I am so glad.
Step 3 was within my control.
I investigated different options. Luckily, with the pandemic, more clinics were doing video appointments. I read the clinic websites, ADHD forums and patient reviews. I found a service that works with the NHS as well as private patients. They were very clear about the pricing for different stages of the process which many kept hidden. And, importantly, they have a process for continuing your treatment with your own NHS doctor, once you're established on your treatment plan.
I pushed the button, read reviews of the psychiatrists, paid the invoice and made the appointment. Phew. It was a week away.
They sent me four forms to complete before my appointment: health check (mainly heart related, in case I needed a prescription), a symptoms scale to complete, a longer form to describe my symptoms (this is a lifelong history, as to be diagnosed as ADHD, it must be indicated in childhood and throughout adult life), and a form for someone close to me to fill out.
These forms are emotionally taxing, and can take quite a lot of work to complete, but they help build the whole picture for the psychiatrist, and can shorten the process of assessment slightly, and lower the risk of misdiagnosis. I misread the instructions and submitted them by email. I read and noted the need to bring ID to my appointment. I forgot. Embarrassing, but perhaps symptomatic.
This is already too long, so next time... Diagnosis, part II
And soon: Beginning Treatment; Treatment Update; and Masking.