Tag Archives: inpatient

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.

A long journey

On the 2nd May 2015, I was sat in a car park, on the way to work, and I had cut my wrists. I had phoned my mum, terrified I was going to run into traffic. As soon as I had hung up, I realised I didn’t want to be saved.

I cant remember much of the next 18 months. I know that I was desperate, that my sole intention was to kill myself when I could get the chance. And there were times I nearly succeeded. I stopped eating and drinking and was taken in and out of hospital for glucose and fluids. I remember fighting that, I didn’t want them to help me. I couldn’t understand why the staff didn’t just give up on me. I spent hours head banging, trying to escape myself. I still have two ridges in my forehead and I spent a long time with an open split on my head where I had gone too hard.

My mental health story started long before that. Aged 14 I was being bullied at school. It wasn’t just name calling, I was pushed over a wall, slammed in a door. There were comments made on a bebo page- one of which stuck with me. That I was better off dead. That was the first time suicide entered my head. By the end of year 9, I was self harming and bulimic. I felt so alone.

I moved schools for sixth form and found my  feet, still suffering from an eating disorder and self harm, but I was feeling happier. I had a group of friends. For the first time in a long time I felt like people liked me.

The same came when I started university. For the first term, I loved it. My eating improved, I mostly stopped self harming. I was feeling well. But then I was raped and my world fell apart. Almost immediately my eating disorder took over. My depression clouded me. By second year I was anorexic. I’ve never felt so isolated. We lived in a horrible flat. I remember sitting there trying to persuade myself that I could cope. I managed to finish second year with a 2:1 but I didn’t feel any sense of achievement. I was completely in the grips of failing mental health.

In December of third year I was admitted to an Eating Disorders Unit where I spen ten months. I came out still struggling anorexia but then months later I suddenly flipped back to bulimia. Horrendous bulimia. I was binge purging on 1000s and 1000s of calories. Once my bank even rang me as there had been so much use of my card. I was falling apart and was admitted to an acute unit, twice. I came home, relapsed and that started this admission.

I’ve spent too much time in hospital. I’m tired of living by a regime. I want to be able to wake up when I want. I want to work.

And suddenly I’m getting there! This Wednesday I had my section lifted! It’s been the best part of two years since I was free. There is no better feeling that sitting out in the park knowing I can sit in the park enjoying the sun and not being limited to 1 hour. I can walk as far as I want. It’s such a weight off. I’ve worked so hard to get this far and I’m going to keep working.  I have the most incredible family, friends and boyfriend, even when I’ve felt alone, I haven’t been. They’ve been there, every step of the way. I have a 2:1 degree in microbiology and I’m going to use it.

My mental health story doesn’t end here, it keep going but changing course. Two years ago, I was desperate to die. Now? I’m desperate to live.

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.

Acute services with an eating disorder

Inpatient wards are never nice places to be; they can be frightening, frustrating, dictative  wards. Anything other than specialist eating disorder units where the service is designed to support and treat the eating disorder service users are suffering with can make acute or other specialised support all the more difficult.

My first inpatient experience was to an eating disorder unit. I remember sitting in costa after being told I was going to have to start inpatient treatment for anorexia nervosa the next day and phoning to mum to break the news and then having to tell my university that I would have to defer absolutely terrifying. I had only been involved with the eating disorder outpatient service 4 weeks and still hadn’t accepted my diagnosis, it all felt rushed and I was resistant to being classed as an anorexia sufferer. I can’t remember my first month or so but slowly came around to being in treatment and it was refreshing to find others like me who had the same thoughts and experiences with anorexia. The groups were all designed directly to focus on anorexia and drive the sufferer forward in their recovery. There was the medical side of it which never stopped being utterly traumatic in my ten months there and I resisted the weight gain side of treatment and at discharge I barely made any head weigh with the weight side of things but I also left with a whole set of skills and a group of friends who truly got it.

Maybe my experience having first been such a safety net and so understanding has made me biased but I’ve never been able to recreate the experience in acute wards. All my admissions since the EDU have been to acute wards and suddenly I was thrown into the world of adult mental health. Each time I have been hospitalised I’ve relapsed to anorexia, maybe not in weight although in some cases lost a significant amount of weight but in behaviours. Every time it’s reached the level where I stop eating and drinking completely. It’s hard on an acute ward to cater to account for all service users difficulties where the funding is low and the supply so demanding. It means though that eating disorder patients can easily slip through the net and only picked up upon when crisis level has been reached. I’ve found that as I’ve moved through services my ability to sustain a low weight and lack of nutrition has deteriorated and in this admission found myself in general hospital for IV fluids. It’s come to the point now that everyone accepts I won’t eat meals and instead have ensure drinks. It can be quite isolating not finding myself able to eat meals in the dining room and I find myself wondering how have I found myself in this position, again.

Acute wards are all about survival and crisis management but this is often to the detriment where specialist services are called in. The level of support and guidance an eating disorder patient is simply not available and in an ideal world that wouldn’t be the case. But for now it’s not and that needs to change.

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.

2015: a round up

When I think back on 2015 it’s with very mixed emotions. The year started off wobbly, I had just found out I had been successful in getting a job which sounded perfect- a reablement assistant post helping people get back into their own homes after hospital. The snag was it was felt by occupational health that I wasn’t fit enough to work a full time job in such a stressful environment. I was gutted but soon rallied and applied for jobs at Waitrose where I’d  worked before. I was successful and started to work there 22hours a week as a petrol station supermarket assistant. A job far more stressful than it sounds. Manning the tills, authorising fuel, safety checks, bakery checks, customer service and refilling the stock. But I initially really enjoyed it and the team. Very early on full time and management contracts were starting to be mentioned although this pressure led to the eventual decline in my health. 

Before working I spent two weeks in the Oxford day hospital as my suicidal thoughts had returned full blast. The admission worked and I left feeling better than I had in a while. Then mum and I spent a magical 3 days in Iceland where we were hoping to see the northern lights but they never showed up and to go whale watching but the sea was too stormy. But we did manage to fit in our Goldern Circle tour and the city itself was stunning. So much snow and we had lobster soup in a fisherman shack and the best fish and chips I’ve ever had. And it was wonderful spending time with my lovely mum.  

 March and April were spent working and trying to find my feet at work. I liked my co workers but didn’t find it easy to make good friends. 

As the pressure increased at work, demands from an unwell friend piled up and my mood dropped faster and faster. Until on the 1st may in my way to work I got to the park and ride and knew if I got out the car I would run into the traffic. I phoned my mum and then panicked and smashed a bottle I had in my car and cut my wrist. Deep but not deep enough. I was sent home from a&e but the next day my CPN called a meeting with me and my mum and it was agreed I would go inpatient voluntarily. There no beds in the trust so the next day I found myself at the priory roehampton.

The priory was good, I found the groups  really helpful although it saw the beginning of my anorexia creeping back in. About three weeks later I was transferred back to the ward at home. 

This was where things really crashed. I went from being on a planned 10 day admission to te ward to prepare for discharge to ligaturing and self harm so often I was placed in a anti ligature suit and my discharge was cancelled. I was placed on 1:1 and haven’t been off it since. Around the same time I completely stopped eating and drinking only tiny amounts. On the 16th June I tried to leave the ward and was put on a section 5(2) of the mental Health Act.  Later that day I was assessed and put straight on a section 3. 

Throughout June and July my eating remained non existent and my fluid intake was minimal. I was taken to hospital twice for dehydration and malnutrition needing IV fluid and vitamin infusions. Then in August it was decided that as my self harm, suicide attempts and mood weren’t improving ECT was the only option and that way I could receive fluids under sedation without having to go  to hospital. ECT was stopped early though as I tried to abscond on my way to it with staff. 

In September I was finally persuaded to start eating and drinking again with the support of my wonderful mum who came to ward round and told the ward they needed to get a handle on my eating disorder. I started off entirely on ensures but I’m slowly coming off them. 

At the end of September I had my tribunal which was not pleasant. I was prepared that my section wouldn’t be lifted but it hit home when the said no. They did however make a recommendation that I be transferred to a specialist unit. Which has very slowly been worked towards by the ward and I had an assessment the other day. 

The other day I was allowed to see my dogs which was lovely even if it was in the hospital. 

   I wasn’t allowed to go home for Christmas but I got an hour with my family where mum made it feel like Christmas by going to so much effort- non alcoholic champagne, a table cloth, mini Christmas tree and presents. It was the best part of my day.  

 The support and care I’ve received from family and friends this year has been amazing and I couldn’t thank people eniugh. 

The other absolutely massive part of my life this year has been meeting my boyfriend chris who I love to pieces and has been an absolute star, visiting every night. He’s more than I could ever ask for. 

And that’s been my 2015. A mixed bag and 2016 will probably still be spent in hospital but I hope it’s a better yesr. Happy new year all! 

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.