Tag Archives: hospital

Thriving or Surviving?

I’m a bit late hopping onto the Mental Health awareness week campaign. That is “Surviving or Thriving?” But I think it’s a brilliant thing to raise awareness of.

Before being in hospital I worked in a supermarket office, I volunteered as a first aider, I helped run youth mentoring programs. I loved to read, to sing, to play my violin. I was thriving.

Then I got admitted. For the last few months before I was admitted to the EDU I had lost my ability to thrive. I was cold all the time, my head was a mess of numbers, I was so hungry yet so full, everything hurt. I used to walk back from uni to my flat, an hours walk, convinced that this time I wouldn’t be able to make it. I was only just surviving. As my admission passed I was able to lift myself up again. Groups and therapy gave me the ability to survive and maybe hope toward thriving. I can’t say I ever really felt I’d achieved much but I did make friends for life. What’s lovely is seeing some of the girls I was in hospital with living life- learning to thrive.

I managed to return to my degree and I loved my time working in a laboratory. In there, running between my test tubes and the anaerobic cabinet, I was able to forget about my mental health. I could completely immerse myself. But I was not coping on the outside and I was sectioned half way through my dissertation.

This latest admission has been different to my previous. Here there is a real sense of helping us patients do more than just survive. Across the country there are talks of Recovery Colleges. At my EDU there was one being mentioned but solely as a way to learn about your condition. There is a Recovery College here which for me has helped bring me up to somewhere more than just surviving. Going to groups involving the whole hospital has helped bring my confidence up so I can speak in front of others. I went to groups which made me laugh- the smell of our bath bombs probably won’t ever leave me ( I don’t recommend chocolate essence!)! But I also learnt a lot and as my confidence improved I started writing for the newsletter and then became editor. I haven’t worked for years and this lifted me so much. I learnt to delegate, to use new programmes on the computer. I started to become confident in myself that I could achieve things. I’m learning that talking about my story isn’t a bad thing and in many ways has helped me start accepting my past. I look back at when I first went to Recovery College and compare it to now. I now have the confidence to start thinking about work, about future university study, about leaving hospital completely. I even picked up my violin last time I was home! The Recovery College has played a huge part in my recovery. Most of the places I have been have been solely about survival. There was nothing to help you achieve more than that. And that’s what’s different here, we aren’t just helped to survive, we’re also helped to learn to thrive.

DBT; a realisation.

Sat in the corner of my room, tying a ligature round my neck. Pinned to the floor and injected. Lying on a bed being wheeled through for ECT. Fainting and being sent to hospital for glucose multiple times. Being watched 24/7 for over 8 months, no privacy at all. Having a CT scan after headbanging. I came into hospital very unwell and there’s a lot I can’t remember, but I’ll never forget these things.

Thankfully I’m so much further on, the idea of tying a ligature is so far away, I never kick off. I am compliant. Those baby steps I mentioned in my last post? They’ve turned into giant leaps. I’m sat here at home on overnight leave, I’ve been out to town with mum and exercised my debit card! I’ve helped cook lunch. I’ve cleaned the kitchen. This time last year I was just starting to have home leave, escorted by a member of staff for 8 hours only. Now I’m a completely different person.

On Wednesday I completed my second and final cycle of DBT. I remember a year ago starting on the programme I was so, well, obstinate that it wouldn’t work. I didn’t understand it. I couldn’t open myself to it. Now I look back and it has helped me so much.  There were four modules; emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness. Each taught me skills I can use to live with, control and maybe even overcome my illnesses.

Through DBT I found a way to manage situations where I needed or wanted specific outcomes. I learnt how to voice my opinion and ask for my needs to be met without shutting down or disregulating. I started being able to take part in my treatment and to get my needs heard and met. Mindfulness taught me how to recognise my emotions, how to observe them and employ my most effective skills to deal with that emotion, or, simply stop and watch the emotion pass by. I learnt to use pros and cons of a specific situation or behaviour to balance out whether the urge I was having would actually be effective.  I went from feeling awful all the time and reacting immediately  to being able to stop, use my skills to recognise that I was feeling bad and instead of self harming or ligaturing I would distract myself. I would ‘radically accept’ I sometimes cannot change the situation (for instance I have to come back to hospital after time at home) but I can employ techniques to help.

I never thought I’d say thank you to DBT. I really struggled to grasp it, it didn’t really fit with my illness but with help I could use skills from DBT anyway and slowly that opened up a way for me to engage in DBT. It’s very weird thinking I won’t have anymore DBT but I’m so thankful for it. And to anyone starting DBT, stick with it. Don’t let anyone derail your recovery by telling you horror stories of DBT. It’s hard, you will probably cry with frustration, you won’t understand at times, you’ll feel stuck. But, for me, there’s almost a sudden moment when I realised, I do understand this and I am actually using the  skills. I can only say thank you to the therapy team for not giving up on me.

And so from baby steps, this is a giant leap. I’m on the home run.

An update

I realised I haven’t really updated you on where I’ve been when I disappeared for a while.

A few months ago things were starting to look brighter and I felt like the old me was there, just slightly out of reach. I remember going to my CPA armed with the fact I was the happiest I’d been in years. I had persuaded myself that I might get home overnight leave, that my section would be lifted. I remember being so angry when it became clear neither of those dreams would be happening. I couldn’t understand why they couldn’t see how happy I was.

A few weeks later I found myself spiralling again. I was spending hours looking for anything I could self harm with. I remember one leave where I spent the whole time secretly searching the ground for sharps. I catalogued every sharp I saw, planning to get them on my way back. I soon discovered I was never going to be able to pick them up. My eating slipped again and very quickly I found myself fully in the throws of my eating disorder. It took several hospital visits for me to relent and stop refusing my ensures. I still haven’t got up the courage to eat instead of using ensures and fruit. I hate ensures, but at the same time I couldn’t move onto solid food, they became my safety net. As my weight dropped so did my mood and I lost control of my hallucinations. It stayed like that for a long time. As I wasn’t eating and I was fainting around the ward I lost my leave, I lost my unsupervised shower. I felt like everyone was the enemy, that they couldn’t understand.

Then slowly again things began to pick up. There was a lot of tinkering with my medication but slowly it seemed to be helping, finally. I came into hospital taking only two psychiatric medications. Now I take a lot more. Haloperidol worked but gave me painful side effects. Respiradol might as well have been a sugar pill. But now I’m taking a different anti-psychotic and suddenly I found myself again. I started reading again, I started DBT which really helped, I was able to smile and talk to staff, I wasn’t afraid of laughing with other patients. The side effects kicked in, I’m so shaky I cant hold a cup or walk down stairs. I get verbal ticks when I’m talking. But it’s given me myself back and I’m not willing to lose that. My leave was reinstated. I got home leave and I got to see my house for the first time in over a year. I get time out with my boyfriend too and we go to the cinema. I love being surrounded by people who had no idea I am sectioned.And as the weather improved found the courage to wear t shirts that didn’t cover my scars, and no-one even blinked. Things are good. Yes I’m still very stuck in my eating disorder but otherwise I’m content. I’m starting to see a future. I have my books and time to see my family and my boyfriend outside of a visitors room. Yes I get lows but I’m getting there and that feels wonderful.

 

Chemical sedation versus verbal deescalation

This is going to be quite a personal post as I’m going to focus my writing on my own experiences of the two. It may contain triggering content for some so if it does stop reading and find someone you can speak to.

Chemical sedation

The first time I was restrained and injected was possibly the most terrifying moments of my life. I was pushed through the ward to the seclusion room and restrained by a mixed gender team and injected. There was no explanation, no attempt at verbal deescalation and no debrief. I was left half asleep in seclusion with my new key nurse watching me. This was a situation I found myself in many times. Though sometimes there was a relief in finally being knocked out and not having to face the pain anymore.

I’m not sure what I feel about chemical sedation. I think it has its place in psychiatric settings but sometimes it is used as a punishment or too quickly without any attempt at deescalating the situation.

Verbal Deescalation

This is a method that has worked really well for my sometimes and not so well others.

First I’m going to tell you about the time the didn’t inject me and tried verbal deescalation. It involved being restrained to the quiet room, me sobbing and shouting, and sat there for two hours with three members of staff trying to keep e sat down not desperately running at walls. It was the most painful night of my life. They tried to talk me down and talk me into taking the tablets but two hours later and we were all flagging. I did eventually concede that taking my medication was the only option if I didn’t want the injection.

That was a fairly negative experience of verbal deescalation. There’s been a change since I’ve moved units. Verbal deescalation is the norm and very rarely is the injection used. When I was constantly headbanging the staff unfailingly talked to me until I was grounded enough to be removed or walk away from the wall. There’s a much greater feeling of ownership for your emotions if you’ve been talked down rather than forced down on a bed.

I can’t give you an answer as to what is the better option. Both have their merits and disadvantages. But I do think verbal deescalation should always be the first line of treatment before the injection is considered.

World Mental Health Day: Dignity

This years theme for World Mental Health Day is dignity in mental health care. This is something I’m quite passionate about and have had such mixed experiences. 

Having a mental health problem makes you vulnerable. When you’re in crisis or at rock bottom it’s hard to keep yourself safe. And that means safety from poor treatment by professionals too. 

As someone who self harms I’ve had a large number of experiences in A&E, some of which left me feeling calmer and cared for, others which left me even more distressed. I’ve had some brilliant health care professionals in A&E who have gone out of their way to ensure I was treated well- the doctor who stitched my cuts so carefully and talked to me as a human being last year whilst I was in hospital, the doctor at another hospital who sat me in a side room with a 1:1 nurse and who came and persuaded me to stay the night rather than them having to call a mental health act assessment. He came after the end of his shift just to check I was okay. It was one of the most distressing nights of my life but he sticks in my head as someone who really cares about my welfare and dignity. I’ve also had some horrible A&E experiences- sent away after being told yes I needed stitches but because it was self harm I wouldn’t be stitched. Or being brought over in a wheelchair unable to walk and semi conscious after loosing too much blood only to be stitched and sent away- I remained unwell for the next few weeks before my GPs did a blood test and I was called in for a blood transfusion. Or the time they stitched me without adequate anaesthetic. 

Then there’s dignity involved in being brought into hospital. This is a tricky one because I honestly believe there is no right way of doing this other than making it as least distressing and public as possible. When I was hospitalised for the third time the crisis team were visiting my and I refused to go into hospital with them. They told me that they would have to call 999 but I tried to run so they promised they wouldn’t. Next thing I knew the were four police officers and a paramedic banging on my door and coming into my flat. They were kind but there was no dignity in screaming and crying and finally being persuaded in a state to walk to the police care and be taken to hospital where I was later sectioned. It was humiliating, my flatmates had to see me screaming at the emergency services and everyone on the street outside and in A&E got a sideshow of me being half dragged into and out of the police car. But there was also no better way they could do it, I was too unwell and my health was at risk and I guess that’s the same with many incidences of being brought into hospital. But it certainly lacked dignity. 

My biggest experience of dignity in mental health care has to be as an inpatient. I have such varied experiences. The hospital I was in last year had no concept of dignity. The ward wasn’t really designed with patient privacy in mind the beds were in a H shape with the communal area and nursing office in the middle. With the exception of wardroubd room there were no side rooms that could be used for private conversations or deescalation. At the time I was struggling with head banging and self harming but all the would simply happen would be I was restrained to the sofa with all the other patients watching and left in a crying heap with no option of talking to staff.  I remember one night I was so distressed I couldn’t sleep and spent the entire night awake in the communal area but not once did a member of staff check on me. My current ward is much better. Even when I’ve ligatured and they’ve had to pull the alarm they always ensure there’s as few people present as possible. And when I’ve been restrained and injected they’ve always tried to talk my down first before using the injection. I did have one incident where I was face down strip searched and my knickers removed as part of that which left me very distressed especially with my history but I put in a complaint and it was upheld and the policy adjusted for when to use strip searches . The other times I’ve been face down restrained and injected although highly traumatic and undignified the staff have been kind and given me the opportunity to talk after. 

Mental health is not dignified. I’ve been found in various states of undress after ligaturing with an item of clothing or vomited in front of staff when my ED was in control.I’ve  spent three months showering and toileting in front of staff. My medication causes me to suffer from hyper salivation causing me to dribble a lot. 

There’s little dignity in mental health crisis but with appropriate care and caring and supportive staff  you can be treated with dignity and respect. Something I strongly believe improves recovery, when you feel you’re being treated with dignity it goes a way towards improving your self worth and ultimately self esteem. When you’re treated with no respect and dignity it destroys your feeling of self respect and self esteem. Dignity  shouldn’t be something we’re surprised to find in mental health (and physical) care but something that is a given. But whilst it’s not we need to celebrate the staff who treat us with dignity and respect whilst educating those who don’t. 

ECT 

Tomorrow is my third session of ECT. I’m not going to lie and say it’s a treatment I feel particularly positive about or one I’m 100% dedicated to. But I’m doing it and that counts for something. I wanted to write a post about what it’s really like. 

When I was told ECT was my next line of treatment I was terrified. In my head I had images and descriptions of the type found in The Bell Jar. Descriptions of a barbaric process which is painful and undertaken fully conscious. 

The reality couldn’t be further from the truth. I do not like ECT and I am terrified before every treatment. But it is now a clinical and controlled process only used where clinically indicated. 

On ECT days I do not take any medications in the morning and am nil by mouth. A nurse or HCA takes me over to the ECT suite about 9-10amish with my thick ECT folder. We wait together in a pleasant sitting area watching TV until I am called through by one of the ECT nurses to the prep room. There I am settled into a trolley and all my observations taken. As always my pulse is high. My nurse/ HCA is with me throughout as memory tests are checked and then I am wheeled through to the ECT room. There a cannula is inserted and jelly and monitors stuck to my temples and forehead. An oxygen bag valve mask is placed over my mouth as the anaesthetic and muscle relaxant are injected. I quickly lose consciousness. The next thing I know I am waking up in recovery with a cracking headache feeling woozy. Because I am not drinking or eating I always awake to a bag of saline being pushed through. I am slowly re orientated and then taken through to the recovery sitting room where I have the option of a cuppa and something to eat. Whilst in the sitting room my obs are repeated multiple times before I’m taken back to the ward by my HCA / nurse to sleep and have my obs continued. And then that’s all repeated a few days later. 

If I’m honest, I hate ECT. I do not trust that it will work and I hate being unconscious. Then there’s the side effects- memory loss, headaches, muscle pain, disorientation and fear. But neither is it the draconian torture method so frequently projected. 

What does mental really look like?

I’m sorry for the long absence in posting, being in hospital makes every day monotonous and I’m pretty sure none of you are interested in the days I manage to get in the shower.

I wanted to post some misconceptions about inpatient treatment. When I used to use Instagram I regularly saw people wishing the could me inpatient on a ‘nice safe ward’ away from the stresses of life. I’ve been in hospital four times, some have been excellent, some awful. None of them (perhaps with the exception of the Priory) were safe little retreats. There is nothing safe or comforting about being restrained and injected to calm you down. There is an escape from real life but the ward is a world of its own, often more chaotic than your own home. Psychiatric wards are last resort places, when all else has failed to help. 

That said, neither are they places portrayed in films like Girl, Interrupted. Most have single rooms and staff monitor patients carefully. I’m on 1:1 and I can’t even sneak a hair band from the bathroom without questioning. The patients are not all obviously unwell, we all have our moments and there are some who are highly confused but most are quiet and reserved or sit in the living room watching TV and laughing, interrupted only by the call of ‘meds! ‘ yes one or two of us will be on one to one but even then you wouldn’t know we have life threatening mental illnesses. 

The staff are not the draconian strict staff of 90s psych movies but instead do their best to run a ward whilst often understaffed. They make time for 1:1 sessions with their named patient.

I am a patient currently in my 12th week of stay, half of which on section 3. I have a 2:1 in microbiology and an offer for two masters courses. I have a loving family and friends. I wear clean fashionable clothes most days and jewellery. If you saw me on the street the only sign of my battle with MH is the scars that stripe my skin. All in all I look pretty normal. And yet I’m diagnosed with severe depression with psychosis and on heavy duty psychiatric medication and on Tuesday will be starting a course of ECT. A terrifying prospect but one that everyone agrees is the right decision.

So there you go, we may be on hospital but many of us, you wouldn’t look twice at in the street.