New Country – New Healthcare System – New Psychiatrist

Finally, after seven months of moving-house-related chaos, including various insurance SNAFUs, I now have a new psychiatrist.

As most of you already know, I moved from the US to The Netherlands last summer. After all the hubbub in the US media last year about the supposedly poor quality of the healthcare system in the UK, I am the first one to admit I was very nervous about having to find a psychiatrist in my new country. Yes, I know The Netherlands and the UK are miles/kilometers (and a sea or two) apart, but the US media does make it sound as if all European healthcare was spawned from Beelzebub himself. I am very happy to say that in The Netherlands, for me, this just isn’t so.

Unlike in the US, there is not a shortage of psychiatrists where I now live. After seeing my GP, I was given an appointment at GGZ to see a psychiatric intake nurse almost immediately, and the appointment lasted for a full hour. The next appointment, a mere 3 days later, was an intake with the psychiatrist. Imagine my surprise when that session lasted 1.5 hours (with my last two American psychiatrists, each spent only half an hour with me during our first appointment). Within the first week I spent a total of almost three hours with my new team, had thoroughly (and I mean thoroughly) reviewed my history, had my present concerns carefully addressed and left my appointment with a battle plan to manage my Bipolar.

This efficiency frightened me to the point I almost needed a Xanax.

Now, you can’t spend all of this time with nurses and psychiatrists without a few new items emerging. One thing that did change was my diagnosis, from BP II to BP I, and I am comfortable with that. Especially after all the care and attention that was paid in documenting my history. I have long suspected this to be the case, and even wrote a post questioning my BP II diagnosis last October [Hypomania or Mania – Which Was it?] Another reason I respect the change is at no point did I relay my original diagnosis nor did the nurse or psychiatrist ask, “Which flavor of bipolar are you?” Instead they allowed the history itself to reveal the diagnosis.

It also seems that my new Dr and I are on the same page, thank goodness, when it comes to antidepressants. My weight gain is out of control due to the Wellbutrin and with diabetes running in the family, I thought I’d give it the old college try to dodge that bullet a little while longer. I came away from my appointment with the elimination of Wellbutrin in very gradual stages (it has always caused me to gain weight) and a minor adjustment to the very low dose of Abilify I am already on (which never made me gain one pound). So, with that said, I am going to indulge myself with a bit of whining. Because coming off an antidepressant is like wallowing in the fifth circle of hell. All of the withdrawal symptoms make me extremely angry that I ever had to go on the stuff in the first place. I can’t wait for the nausea, stuttering vision and inevitable migraines! Ah, just talking about what I have to look forward to…I can feel my blood beginning to boil with fifth circle rage already.

So, in the spirit of a right and proper free-for-all, I open the floor to all of you. Share your horror stories about the nightmares involved when trying to find a new psychiatrist – about going off of antidepressants. Or, what the heck! Let’s talk about the unpleasantness of titer-ing down / going off of any psychiatric drug.

Your experience so far (with finding a new psychiatrist) sounds like the exact opposite of every journey to find one I’ve ever had! I hope the new team continues to be as awesome for you, you sure as heck deserve a little doctor TLC!

I am *so* thrilled that you’ve found the support and medical attention we all yearn for! What an incredible gift. Really, I’m just so pleased.

As for going off the Wellbutrin—sister, it is what it is. You know how horrible it will be/is so you can plan for it and be gentle with yourself while you go through it. Think about the end game, how this will help you lose weight and be a healthier person all the way around. This is a positive step, even though it’s a hard process to go through.

I love the idea of the European Healthcare System, and I’m all for it. Another topic for another time.

With your diagnosis changing, it seems that you might be getting more suitable care. How do you feel about it?

And, I am astounded that you gained weight on Wellbutrin! It’s practically unheard of!

I hope you are well. You sound well.

I did the same thing – well, similar – as you: I moved from the US to the UK one year after diagnosis. And it has been an extraordinarily different healthcare experience!

When I was in the United States, I had very regular and excellent weekly treatment and was prescribed a range of medications. Every meeting was prompt, and the psychiatrist or psychologist that were treating me were always available by phone if I needed them, and could see me the next day if anything urgent came up. I managed to even shop around for the best psychologist I could find for me on my insurance plan: interviewing several before making a decision on someone that I felt I could trust and open up to best. Every moment of my U.S. healthcare experience was gold-standard and very supportive, but I understand very well that I had a great health insurance provider through my corporate employer. The problems lay in the price: each psychiatrist appointment was $160 co-pay, each weekly psychologist appt $25 co-pay; and the prescription meds were $35 co-pay each, with Abilify (as a name brand) was $80 a month. Therefore my healthcare bills — on insurance — were $445 a month. I realised very early on that everyone involved with my healthcare were making a lot of money out of this.

Moving to the UK was a polarising shock to the system. I wouldn’t say that every horror story you hear about the NHS is true: they do use tax payer money wisely to offer equal treatment to all and you can see that they are trying their best in the resources available. When I moved to London, I immediately enrolled at the local doctor’s office and made an appointment to see a GP. This is the easy part as the GP is basically the ‘gatekeeper’ to every medical treatment. I told them that I had bipolar disorder and was given a questionnaire to fill in for the psychiatrist’s office (called a Central Mental Health Trust or CMHT). I then waited about three weeks before a nurse called from the CMHT for a telephone screening process. I must have passed that with flying colours as a week or so later I received a letter in the mail with an appointment date to see a psychiatrist (the NHS loves to send mailed letters, the telephone and email revolutions have mainly passed them by. Every correspondence happens by mail). So within about two months of moving to my new home, I went to meet with a psychiatrist. It was an hour long meeting, where she tried to go over much of my history and current state. An increase in dosage was agreed – in line with NHS drug guidelines, everything is done ‘by the book’ – the British National Formulary to be precise. I was then put on the register to receive regular weekly psychotherapy appointments – two years later and I am still waiting on the list. I do get a appointment notice in the mail every two months or so, so I feel like I am in the system, but in comparison to the dedicated care I received in the US, the NHS feels very piecemeal. Honestly, since I have mainly been in remission the system of care has worked alright for me so far, but I do have concerns for those who are less stable, and how much the NHS might fail these people.

In terms of therapists themselves, I have seen about eight different people over the course of my life, and the quality varies considerably. Bad experiences do linger: My first ever therapist never asked any of the tough questions, so I never felt like I should tell him what was really going on. The current person that I have seen at the CMHT (can change each session) is a behavourist, who insists on dwelling on dream analysis and examining subconscious decisions(!). Each new therapist is like hitting a ‘reset’ button on your treatment, you have to spend a number of sessions filling them in on what has happened to you in both your life, and in your treatment and psychotherapy journey. I find that frustrating. No therapist is perfect, and as a bipolar person you may end up especially critical of them as I am. But it sounds as though you’ve found a good place in the Netherlands so that is really great. Best of luck to you in your new life!

Hi, Sarah: I just responded to your comment on the “Sometimes Less is Not Better” post, so glad to see you’re still poking around the blog. 🙂 Sounds like we do have similar relocation stories! Thanks for recanting your experience in the UK. My husband was actually offered a position there as well, so I’ve always wondered what the healthcare experience there would have been like. I did a small amount of research before we knew we would wind up in The Netherlands and your story matches pretty closely with others I was able to find. At least you are seeing therapists. Although I love my Drs, I am still not in therapy. They want to get me to a point where I am more stable before they send me into a situation that could potentially dig up something disturbing. Which suits me just fine. It *is* frustrating having to start at the beginning with new therapists, I completely understand what you’re saying. I’m honestly dreading having to begin again. Do you feel like you’re taking a few steps backwards when this happens? Do you still feel like the therapy is worth it, even with the constant resets?


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