Hi, as the thread title goes.

What happens if someone with severe agoraphobia (housebound) has tried time limited CBT on the NHS and it doesn't work?

It seems like there's nothing on the NHS after CBT and applied relaxation?

Agoraphobia - Treatment - NHS Choices

They're already on meds, also through the NHS. They can't afford a private practice pdoc or T.

[itjustis]

Originally Posted by QuietMind

Hi, as the thread title goes.

What happens if someone with severe agoraphobia (housebound) has tried time limited CBT on the NHS and it doesn't work?

It seems like there's nothing on the NHS after CBT and applied relaxation?

Agoraphobia - Treatment - NHS Choices

They're already on meds, also through the NHS. They can't afford a private practice pdoc or T.

I'm not familiar with this situation but I am from the UK! Does your friend have a support worker at all?

If not maybe he/she could reach out to the social services and maybe they could help.

Hey, thanks. She doesn't have a support worker. She said she called her current psychiatrist and will try to raise the concerns she has such as severe agoraphobia despite being on medication, and having a lot of really bad days.

British stiff upper lip and so minimising one's struggles?

I'm hoping there's something better than time-limited CBT therapy which they can offer her as she's done that and it hasn't helped.

Think it varies from local authority to local authority sadly.

When I had NHS cbt it was seemingly time limited but I had the option of extending if I wanted to. Having said that if cbt is not working for her the extending it is unlikely to help.

In some areas there are charities which run support groups/give guidance but as she is agoraphobic that is not likely to be helpful.

[itjustis]

Originally Posted by QuietMind

Hey, thanks. She doesn't have a support worker. She said she called her current psychiatrist and will try to raise the concerns she has such as severe agoraphobia despite being on medication, and having a lot of really bad days.

British stiff upper lip and so minimising one's struggles?

I'm hoping there's something better than time-limited CBT therapy which they can offer her as she's done that and it hasn't helped.

I think the best bet would be ringing their local authority so they could point your friend in the right direction hopefully.

Are there any voluntary organisations for therapy? I know there's one called Visyon but that is only up to the age of 25.

There's a helpline called Samaritans that he/she could call on - 116 123. It's free, 24 hours a day and completely confidential. Your friend could also email them if they don't want to call - jo@samaritans.org

I've used them myself and found it really helpful to just talk to someone about what I'm going through. It's not necessarily for people who are suicidal.

Hope this helps your friend.

It's very much a postcode lottery I'm afraid. They could check out what local charities offer free and low cost therapy, ask they're GP what else might be available locally, and apart from that private practice is the other option. It tends to be a lot cheaper on average than America (for example) to pay out of pocket.

[Apollite]

In my experience, NHS therapy is very limited and you're only ever offered CBT or basic counselling. If, like me, that doesn't work, you are thrown on the scrap heap. I still need help and I don't know what to do now.

What kind of area does your friend live in? I live in quite a deprived, densely populated area, which means that it can be practically impossible to access any kind of help because of the lack of resources. The quality of services may differ if someone lives in a "nicer" quieter place because there will be fewer people in need of help on the NHS as they can afford to go private.

Is there any way that your friend could pay for private therapy? There may be concessions available for people on low incomes - sometimes as little as £10 a session. I did enquire for myself but unfortunately there are no such services in my town, which means I'd have to travel too far and I can't afford the train fare on top of the cheaper therapy.

Maybe her psychiatrist can offer some solutions? If not, a support worker or CPN may be able able to visit her at home to offer some advice.

I know this post is quite negative and doesn't offer much advice, but in many ways I can relate to your friend because I have social anxiety, and I know how hard it is to get the right kind of help.

Bast of luck to her x

[ElectricManatee]

Never mind, misread the post...

[objectclient]

Some possible options to consider based on personal experience (though as others have pointed out, not necessarily available in all areas of the UK)

1. Secondary care services - CBT & Psychodynamic therapy. I'm guessing your friend only received a basic level of CBT limited to several weeks or months. Longer term and higher intensity CBT may be a possibility if they get a referral through a doctor, psychiatrist or other mental health worker to secondary care services. The same is true for Psychodynamic counselling.

2. You're friend may be able to be allocated a CPN (community psychiatric nurse) from their local CMHT (community mental health team), again by referral from doctor.

3. Their GP may also be able to refer them to a mental health facilitator. I used to see one in my local surgery.

4. They could find out about getting a support worker, as others have said.

5. There are affordable counselling services, at least where I live, where you can access counselling at a lesser rate on a longer term basis.

6. The BACP website has a directory of counsellors who offer private therapy and you can search for one in your area.

Hope that's of some help.

[objectclient]

Sorry, I missed the end part of the original post about private therapy

[satsuma]

In theory, I think, if one NHS treatment doesn't work then the person should be offered the next, it's called a stepped approach.

In practice not everyone gets referred on because of resources (lack of).

In my opinion the best thing to do is for your friend to keep on and on going back to the GP. If they can't get out of the house to the GP surgery, maybe they can keep on making phone appointments. The GP is the gateway to most NHS treatment, and even if it depends on the therapist your friend is already seeing referring them on, the GP can follow it up. I find that a kind of "polite nagging" will often - eventually - get a result!! (Had to do this myself when I needed minor surgery for something). Also we tend to understate problems sometimes but I've realised this is really not the thing to do where healthcare is concerned - it's important to be clear with the GP and other healthcare providers about just how bad the problem is.

[SoupDragon]

Might be worth contacting PALS. They may be able to advise on other pathways to NHS services.

Cool, I'll list out everyone's suggestions and talk to her when I can.

I don't want to overwhelm her but I also know next to nothing about the NHS system.

[TeaVicar?]

Don't rule out private practice. A good therapist will usually offer some low cost slots for those on low incomes... some as little as £1. It's worth looking into. If she lives in a city, she should definitely be able to find one.