A letter to my psychiatrist who discharged me when I was suicidal

My psychiatrist discharged me from mental health services when I was suicidal; here’s the letter I want them to read.

I’ve been lucky with the care I’ve received from medical professionals since my diagnosis of Bipolar type 1 in 2012. The two psychiatrists charged with my care had been understanding and respectful. That was until 2019, when a new doctor took over. The first couple of appointments were fractured and awkward. I thought maybe we just needed to get to know each other and build a rapport.

Then, out of the blue, my mood plummeted. One moment I felt suicidal; the next, I was full of tense energy that made me irritable, and I lashed out. I’d hardly been sleeping. The morning before my regular appointment, I formulated plans to take my own life. Then later, at the appointment, the psychiatrist discharged me from mental health services. It was a massive shock to me and everyone I knew. I wanted them to understand how much distress they had caused. I sat at my desk and wrote that psychiatrist a letter;

This is the letter I want you to see

‘I walked into your office, but you didn’t stand up to greet me, didn’t smile, barely looked up from your computer screen. Despite this, I laid it all out. Through tears and scattered sobs, I explained how unwell I felt, how I was suicidal and not only but actively planning to end my life. I even explained how I would do it. This should have been your moment to pay attention, to take me seriously. I didn’t know where else to turn. I was beyond helping myself. I was desperate. Instead, without looking up from your screen, you passed me a box of tissues as you typed. No eye contact. No words of encouragement. No empathy. I was in shock. We sat in silence, and the only noise was the clacking of the keys on the keyboard. Eventually, you spoke. Matter of factly, you said,

“Are you taking your medication, and is it still working for you?”
If my jaw could’ve hit the floor, it would have. My honest reply was yes, I was, and yes, the medication had been working, but not recently, obviously. You made some noises of agreement. You didn’t know me very well, that I’m stubborn and opinionated, or the fact that after years of living with severe mental illness, I know I have to fight and articulate my thoughts no matter how unwell I happen to be.

So I gathered up my strength, and I was honest. I told you how appointments like this put me on edge. I dreaded them. These appointments made me deal with complicated feelings, and I found it especially tough today. I couldn’t express myself the way I wanted to. I tried to be assertive and tell you your care was not good enough, but I was too ill. Instead of providing some supportive words, you simply told me I wouldn’t have to come to the hospital anymore. You would discharge me back to my GP (General Practitioner). I was still crying, but now my body was shaking with the tension and fear I was experiencing. None of this seemed to bother you.

Empathy should be at the core of what you do, not tick boxes and reaching patient discharge targets.

I often see people celebrating when discharged from their psychiatrist or mental health team. I was not one of them. I was not ready for this change. I was shocked as you explained how long I should stay on these meds and the tapering-off process. At that moment, I was intensely vulnerable. I couldn’t challenge what you were doing.

You didn’t treat me with respect or as an equal. You made decisions for me without discussion, without once asking my opinion. I am an expert on my mental illness. I’ve lived with it every day since I was fourteen years old. I should be involved in significant changes to my care. The final decision should be mine; unless I become so unwell that I lose capacity. What you did that day was dangerous and negligent. I made an official complaint, but you denied any wrongdoing. You lied, saying that I had agreed and was willing to be discharged. You even denied that I was visibly upset or on the very edge of a crisis. I lost all trust in mental health professionals. You robbed me of the care I needed for over a year. I was let down, isolated and gaslighted by the professionals who were supposed to help me. Empathy should be at the core of what you do, not tick boxes, and not to reach patient discharge targets. You let me down, and all I can hope is the complaint made you reflect on your practice and was a catalyst for real change.’