AXA P-P-P-Please Please Tell Me Now, Is There Something I Should Know?

AXA PPP

Call them at around 9pm. Speak to a counsellor for an hour to let them know that I am planning my suicide and ask to be assessed for psychiatric treatment. They tell me it will take 24/48 hrs for treatment to be approved.

NHS

Blissfully unaware of ALL MY PAIN. Doing other vital work.

AXA PPP

No contact from them.

NHS

Blissfully unaware of ALL MY PAIN. Doing other vital work.

AXA PPP

I call them at around 7am. Due to an admin error, my case hasn’t been approved. I speak to a counsellor for an hour about ALL MY PAIN.

At 9:30am they call to let me know that I have been approved for psychiatric treatment. They will send me a list of “suitable psychiatrists’ within 24-48hrs. I then need to contact the psychiatrist to make an appointment.

NHS

I call the SLAM helpline at around 3pm. They tell me to go to A&E as soon as I can.

I go to A&E at King’s College hospital at 6:30pm, am assessed by a psychiatric nurse and referred to the At Home Treatment Team.

AXA PPP

I call the Claims team at 9am. They advise that I have yet to provide consent for treatment. I’m referred to their online portal to submit a claim.

The online portal advises me that psychiatric treatment is not eligible for online approval and I have to call the Claims team to obtain approval.

I’m given another number to call and my claim is approved. I should receive the psychiatrists’ names by close of business that day, I am advised.

NHS

I meet with a psychiatric nurse and a psychiatrist at the Maudsley hospital at 11am.

I am diagnosed with severe depression due to trauma and prescribed medication, which is dispensed to me before leaving the Maudsley.

A daily-contact treatment plan with the AHTT is agreed. I am signed off work for a week, but I’m advised that I’m likely to be off long-term. Months, not weeks.

AXA PPP

At 12.04pm, I receive a list of 3 psychiatrists from the Fast Track Appointments service

Of the 3 names:

1. Dr Mervi Pitkanen’s secretary tells me that I will need a referral letter before Mervi will accept me as a patient. I don’t have one of these.
   
2. Dr Paul Shotbolt’s secretary’s voicemail advises that Dr Shotbolt is not currently accepting new referrals. Great.
   
3. Dr Khalinda Ismail (whose area of specialisation is diabetes and mental health conditions resulting from diabetes) has no contact details listed in the email that I have received.

I call AXA PPP and discuss the following:

1. How do I get a referral letter?
   
   They tell me they’ll send me through the assessment done on Sunday 18th.
   
   They assure me they will send it through asap. I receive it digitally on 26th Oct at 4.20pm. Yes, 4 ‘real’ days and 2 working days is the time it takes them to upload it to their portal.
   
2. Why am I being sent Drs with specialisms in diabetes? Shouldn’t any referrals be skewed towards specialisms in suicide and depression? Also, Dr Shotbolt isn’t taking new referrals. And Dr Ismail has no contact details. Shouldn’t a minimum level of checking be performed by the Fast Track team?
   
   I’m advised that the Fast Track team don’t check specialisms or availability. I can contact Dr Ismail via her hospital’s contact details – which have not been provided. And hospital switchboards are, of course, famously easy to navigate.

The person I’m speaking to is my assigned Psychiatric Case Manager. That’s her official title. So, in theory, she isn’t a random call centre drone. AXA PPP have evidently recognised that cases such as mine, involving mental illness, require a separate case-handling process. And yet, everything is so slow, generic and frustrating.

I give up for the day. In terms of Reasons To Stay Alive, dealing with AXA PPP doesn’t figure high on the list.

NHS

The AHTT come and visit my flat. They ask how I am. I tell them that I still want to kill myself. They tell me that the meds will take a while to work and to just hang in there.

AXA PPP

Tina calls back and gives me 2 more names:

Dr Lade Smith (per my post-call Google search: specialist in Black Womens’ mental health)

Dr Stefanos Maltezos (per Google: specialist in autism and ADHD)

NHS

Still taking meds. Still receiving visits from AHTT.

AXA PPP

When ‘Know You Can’ becomes: Know You Can Wait Until Monday, Because We Give Zero Fucks.

NHS

Meds, AHTT, repeat.

AXA PPP

No contact. Obvs.

NHS

AHTT come to the flat for a visit. Unload ALL MY PAIN on yet another 2 benevolent souls.

Register online for a GP surgery that’s a 5 minute walk from my flat. At LDNGBFF Ben and Mark’s urging, I plan to go in person the following day, to be seen as a ‘crisis’ patient.

AXA

I receive the psychiatric assessment document from 18th Oct, having requested it the previous Thursday.

I duly send this and my referral letter back to Dr Mervi Pitkanen’s secretary, as requested.

I call King’s Hospital and am eventually routed to Dr Ismail (of diabetes fame)’s secretary. She doesn’t manage Dr Ismail’s private calendar. No, she doesn’t know who does. No, she can’t do any more to help.

I email Dr Smith and Dr Maltezos’ secretaries, including both the AXA and GP notes.

Dr Smith’s comes back to me almost immediately and with the most human response from anyone in AXA-world so far: unfortunately, Dr Smith is a trustee at the Maudsley, so seeing her would be a conflict of interest with the current AHTT arrangement.

NHS

The GP surgery around the corner complete my registration manually to reduce delays.

I have a phone consultation with a GP from that clinic by 10am.

By noon, there is a GP referral letter available for collection from the surgery, confirming that I am at high risk of suicide and requesting an urgent psychiatric review.

I’m going to be staying with my friend Bee next week, so I let AHTT know. They say they will consider this nearer the time, but I’ll likely stay under their care, but contact will be by phone. The other option is for me to temporarily transfer to Wiltshire, where I’ll be, but that’s a lot of admin, so is not their preferred option, given that I’m gone for a short amount of time.

AXA PPP

Dr Mervi Pitkanen’s secretary sends me an email:

Dr Pitkanen is currently on annual leave.

Please can you speak with AXA PPP to refer you to a different consultant?

JESUS FUCKING CHRIST.

If Dr Pitkanen was about to go on annual leave and would be therefore indisposed, why did you make me go to the trouble of obtaining and sending the referral letter???

Do you, Patient Reader, now understand the magnitude of the bullshit that I am having to endure JUST TO TRY TO GET BETTER??? I came into this process suicidal, but I’m pretty sure I’d want to end it all even if I’d started in high spirits. Just finding a psychiatrist to speak to feels utterly hopeless, let alone recovering my fractured psyche.

NHS

Another uneventful day of the NHS doing its thing. The At Home Team come around. As ever, it’s 2 new faces and, as ever, they will exclaim at how nice my flat is and fret about whether to remove their shoes or not.

I tell them to do whatever makes them most comfortable. I try not to think too much about the other homes they’re going into. The homes in which the ‘deserving’ sick live. Not frustrated little princesses like me, who’ve lost the will to live because nothing is as easy as it once was.

I try not to think about it, but it gnaws away at me. How I’m taking resources from an ever-shrinking pot and how little sympathy I deserve. On and on it goes, around my head…

Yet again, I have to tell 2 kind strangers how I am. How I am is: suicidal, thanks for asking. I will, again, receive reassurances that this will get better. That there is much to live for.

Instead, my daily task of explaining to 2 kind strangers that, no, I really do want to kill myself, is only reinforcing the thought in my mind. The NHS are doing a sterling job compared to AXA, but the lack of consistency is starting to be a real strain.

AXA PPP

I contact The Priory directly, to ask if I can be assessed by an AXA PPP psychiatrist, with a view to being admitted. The reply is prompt and the secretary says this will be possible, but The Priory has a COVID outbreak and is therefore not accepting new patients. At time of writing, this is still the case. And they stress that a reduced range of services are available because of Lockdown.

Another door closes.

NHS

I go to the Maudsley for another session with 2 strangers.

I remind them that I’m shortly leaving for Wiltshire and they’ve still not confirmed I’m I’m sticking with Southwark by phone or transferring to Wiltshire. Nearer the time, they say. We’ll figure this out nearer the time.

I also remind them that I’m signed off from work, but my note is about to expire. Someone will sort this out, they say.

I also have to give blood and am duty-bound to let you know that the phlebotomist at the Maudsley is a fucking ninja. She has 4 vials out of me without me feeling a thing. All hail that woman.

AXA PPP

No contact. No real surprises here. Nadiya and Kim let me know that they are raising hell behind the scenes at the Massive Conglomerate at which I work in an effort to stimulate some kind of activity from the Know You Can Massive.

NHS

Another day, another 2 kind strangers. I’m so sick of this. I ask them about Wiltshire and my expiring sick note. They will make a note, they say.

AXA PPP

Still no signs of activity.

NHS

I go into the Maudsley. It’s not a fun day.

I see a woman called Annie and her sidekick. I am asked, yet again, how I am and I say, yet again, that my mood and intent are unchanged. Annie wangs on for a bit about how depression is tough and that in these dark days, I may have “fleeting thoughts” of suicide. I interrupt her flow and ask her if she’s read my notes. Discomfited, she says that she’s only been back at work for 2 hours and hasn’t had time to.

For the umpteenth time, I explain that my suicidal ideation is near-constant, that I am resolved to die and that the only reason that I’m still here is because there isn’t anything on the certainty/agony matrix that I can will myself to do. And that resolving this preoccupies any waking thoughts that aren’t wasted on Thinking About The Guy.

She shifts and, yet again, I watch a person’s features rearrange into horror as she realises that I Am Not Fucking Around.

She mutters some platitudes, but I’ve had enough. All I want to sort out are 3 things:

1. The meds that I’m here to collect
2. The doctor’s note that everyone keeps telling me I will definitely receive
3. What is happening about my treatment whilst I’m in Wiltshire

They don’t have my meds. An oversight. She should be able to give me everything I need from the dispensary.

There is still a doctor on duty who can write me a note.

I will transfer to Wiltshire for the duration of my stay there. Southwark can’t treat me if I’m not in Southwark. I don’t really give a fuck at this point, but it’s contrary to all advice I’ve received so far and it’s disorientating.

I have to walk with Annie for 10 minutes to go to AHTT HQ. This is why it’s always such a wait when I go into the Maudsley in-person. Once there, she tells me I can’t go in, because patients aren’t allowed over the threshold. So I wait, outside, in the dark, in the rain, for 10 minutes. Today is shaping up to be a real doozy.

She comes back out, wielding a doctor’s note and my meds. The dose of anti-anxiety tablets has been halved. I query this. Annie says that this is normal, but given that the printed dosage has been struck through in biro and overwritten by hand, I suspect they just didn’t have enough to give me.

She tells me there’s a doctor that I can discuss this with and I am, after all, ushered through the front door. The doctor isn’t Dr Charlie, but someone younger, who looks like he’s had an even harder day than I have and is almost too bored to function.

The very fact that I’m querying the dose suggests to him that I’m becoming too dependent and that I should continue with this reduced quantity. This is for my own good.

Fuck all of this. I just want out. I leave with the meds, the note and a reduced faith in humanity.

AXA PPP

NHS

Emily from AHTT calls me mid-manicure (I did say I was keeping up appearances). She asks how I am and I tell her how frustrated I’m becoming with the constantly changing faces and my continual need to repeat my litany of woes in a way that’s starting to feel almost scripted. I was bored of ALL MY PAIN weeks ago, it’s so far beyond that now that I feel I’m creeping ever-closer to getting comfortable with some agony if it means my death will be certain and all of this can just fucking stop.

Emily listens. Really listens. Then she talks about her own struggles with depression and the days where she felt hopeless that then made her so grateful when she got out on the other side. We talk about road trips and she makes me laugh. I miss laughing. I used to do it all the time, but it has a hollow ring nowadays. Not this time though. Emily makes me actually, really, laugh. Without cynicism. Thanks Emily.

AXA PPP

It’s now been 2 weeks since that first Crisis-stricken call to AXA PPP for psychiatric assessment and I’m still no closer to a psychiatrist. Two weeks. TWO WEEKS.

NHS

Guess who? Yep, AHTT. They confirm that I’ll be handed over to the North Wiltshire crisis team in the morning. They leave the contact details with me and tell me to give them a quick call on arrival, just to let Wilts know that I’m absolutely, positively there. We’ll see… I anticipate an admin catastrophe.

AXA PPP

Well. Someone, somewhere has obviously done SOMETHING. At around 2pm, I get a phone call from a chap at AXA PPP who has heard that I am not satisfied with the way that my claim has been handled so far.

I confirm that, yes, I am extremely unsatisfied. That I have been waiting over 2 weeks to be referred to a psychiatrist who:

1. Is taking new referrals
2. Has experience of patients with depression and suicidal ideation
3. Is available
4. Will/can treat me

He starts to tell me that he will get the Fast Track Appointments team to send me some more names.

I See White. This is like seeing red, but with a blistering clarity and sharpened tongue. You do not want to fuck with me when I see white.

With absolute calm, but absolute righteous fury, I tell him the following:

1. No, he’s not going to ask the FTAT to send me some names
2. All AXA PPP have done is to send me slow drips of names for weeks
3. Someone at AXA, I don’t mind who, needs to find me a psychiatrist who is available and able to treat me asap, and call me back with that psychiatrist’s name and the time of the appointment.

I can actually feel him tremble down the phone. The power of Seeing White is quite something. I wish I could channel it, but it comes when it comes.

He agrees that he’ll get someone on this asap.

Within 2 hours, the FTAT call me to ask my permission to schedule an appointment on 8am that Thursday. I can do it in person, or via Zoom. I explain that I’m in Wiltshire, so Zoom is the only option for now.

I receive email confirmation of the appointment 5 minutes later.

Amazing what you can do when you try, eh AXA?

However, today, I also receive an email from Dr Maltezos’ (remember him? Me neither. I messaged him on 26th October) secretary. Dr Maltezos is not registered with AXA PPP, she says.

NHS

Southwark call me on the way to Wiltshire. Am I there yet?

No, I’ll call Southwark when I am. I’ll call Wiltshire too. EVERYBODY will hear from me when I grace Wiltshire’s borders, I assure them.

When I call the Wiltshirel team later that afternoon, I give my name and start to explain who I am, but the lady cuts me off:

“Anne-Marie! Hi!”

After being one of 40,000 patients in Southwark, this sudden familiarity is both cheering and unsettling. Am I the only suicidal person in Wiltshire, I wonder? If so, there really is something to be said for all that country air.

It transpires that calling me is on the cheery lady’s to-do list, hence her immediate recognition. She lets me know that I’m all set with them and will get daily contact. They’ll call me later, if that’s ok?

Steven does call me later on. We actually have a good chat. He is forced to concede that yes, I do make a compelling case for killing myself (I get this a lot. I should have been a lawyer). He’s a bit flummoxed, but rallies and we talk about the nature of trauma and how, from it, new beginnings can sprout. I’ll only speak to him once, but he’s a good egg.

AXA PPP

So. The psychiatrist. Nearly 3 weeks, I’ve waited to speak to an AXA PPP-recognised psychiatrist. Finally, I can make steps towards moving to private healthcare.

The session does not go well. This is a miracle of understatement.

I’m going to bullet this because we’ve all already been here a long time.

• The psychiatrist, we’ll call her Dr F to spare her blushes, has not been sent my note by AXA PPP. Dr F does not tell me this until the end of the session.
• When Dr F had seen my employer’s name on the referral sheet – which is apparently all she got, along with my name and address, from AXA PPP – she assumed this was a workplace anxiety case. Which it actually is, just with quite a dramatic conclusion.
• To start things off, she told me we’d do 40 mins of her asking me questions, then we’d do 20 minutes to plan treatment.

So, she asked me to tell her how things were at work. This is virtually the only question she will ask for the next hour.

• Assuming that she’d READ MY NOTES, I started back in 2015 to detail the work stress that had occurred since then and brought her bang up to date. (I’m not going to cover this stuff here, it’s for another time).
• I then went on to describe, as you know from my time with the lovely Bola, the lockdown depression, the operation, the heartbreak, the decision to kill myself, my Greatest Hits, if you will. This took 55 minutes and she didn’t interrupt or ask questions, just scribbled frantically.
• After 75 minutes, she said that in the space of an hour she didn’t feel she knew anything about me and that there had been really bad wifi delay the whole way through.

• She could not treat me as an outpatient, such was the severity of my case. If we were to work together, I would be an inpatient under her care at The Nightingale hospital.
• She made a point of letting me know that AXA PPP would only pay for 4 weeks there and that she would take steps if I tried to leave before she felt I was well – even if I had admitted myself voluntarily.
• I asked her to confirm that she meant sectioning. She did.

NHS

I call Wiltshire and Southwark to let them know that I’m staying a couple of extra days. This means that I will run out of meds before I leave. Wiltshire have to order them in. I must be on some fancy London Meds that aren’t distributed outside of the Metropolitan elite.

The meds will arrive without further incident, although we will have to drive for 30 minutes to collect them. Not so much “At Home’ doorstep service in the countryside. Even getting a pizza is Big News out here, so it’s not a massive surprise.

When I come back to London, Wiltshire will even find time to write and post me a letter letting me know that they’ve transferred my care and that they “wish me well for the future”.