Tag Archives: mental health act

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.

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A letter (Trigger: rape)

Dear X,

I don’t really know where to start this letter. I think you probably know what it’s going to be about though. Or maybe not? Do you even remember that night? Or has it faded into the background of your life like any other normal day to you?

Maybe I’ll start by telling you what I was like before that night. I was bubbly; not just cheerful but joyous. I loved to laugh and spend time with everyone. Every morning at 10am I’d go to the library cafe with the biology girls intending to work and every morning work would fall by the wayside in favour of lattes, cake and funny YouTube videos. I would laugh until my sides hurt. Yes I had bulimia and self harmed but I felt like a young woman whose life was just opening up for her. I loved to wear nice clothes and dressed to flatter my body. I dressed up for nights out, wore heels I couldn’t walk in, got drunk and danced with my friends until I could barely stand! I was young and relatively carefree. My whole future was ahead of me. I wanted to study graduate entry medicine and specialise in tropical disease. I enjoyed time with my family and days out pretending to be tourists. I loved to sing and play violin, I was part of the the choir and ICSE, I loved concerts and the sheer joy of making music in beautiful venues.

Now let me tell you who I became after. I withdrew, nights out became fraught with fear. I felt tainted and dirty and any male attention sent me into a panic. I drank to numb rather than enjoy. My eating changed, suddenly my stomach was too full of poison for food and I began to obsessively restrict and lose weight. As my body became smaller, more angular, more protected by anorexia the safer I felt. And then there were the binge purges where I desperately filled and emptied trying to squash the poison down. By the middle of third year, the week of Christmas, I was admitted to an eating disorders unit with a BMI in the critical range. I spent ten months there, I had to defer uni, I lost the trust of friends and family. My mood crashed and the badness I’d always felt was inside of me intensified and the only way I could get it out was by cutting, deeper and deeper. Landing myself in A&E more times than I can count, arms covered in scars. In January 2014 my anorexia morphed suddenly and violently back into bulimia. I remember walking the streets at all hours- day and night- to the supermarkets multiple times a day, stuffing it all in and making myself sick up to 20 times a day. The sheer desperation I felt. I remember multiple overdoses, rarely seeking help, hoping this time it’d work. I remember losing my music, I still can’t play the violin or sing without feeling panic. Then there were the admissions, 2 to a general psychiatric unit in 2014, one under section, day hospital after that and another day hospital admission earlier this year. And then this admission, sectioned, on my 5th month in hospital, into my fourth month on 1:1, feeling hopeless I’ll ever get my life back. Too scared to move forward in case I fall even further. I should be starting an MSc, I have a place, but here I am, not even able to shower or piss in private.

I have flashbacks to that night you know. I can feel you on top of and inside me and how much it hurt. I don’t remember most of what happened but I have flashes and they are too traumatic to verbalise here. I remember the sickly, dirty, unclean fear the next morning and the way it’s stayed with me ever since. I haven’t felt clean since, no matter how hard I try to wash you away.  I should hate you, but I feel tremendous guilt for letting you do that to me. I feel it’s all my fault. And yet at the same time you ruined my life. You took everything that was good about me, everything I valued and everything I wanted from my life and ruined it, spoiled it, made it twisted and negative. You’ve turned me from someone who had hope to someone who feels the only way out is suicide. I hate that I let you win. You took my virginity, my dignity and my future and made a joke out of my life. And there you are; making a living, building a life for yourself, laughing, happy and ultimately victorious. I don’t know what you wanted to achieve that night but I feel you killed off the Becca I used to be. I’m not dead but I might as well be because I can feel your poison running through my veins and it’s destroying me. I can’t even enjoy the time I have with my partner because every time he touches me I feel you doing the same and the clutch of panic and disgust inside me is so real and overpowering.

Youve put a millstone of guilt around my neck and it’s dragging me down. To quote Stevie Smith ‘I’m not waving but drowning.’ I’m drowning in guilt and fear and disgust. I feel completely detached from my body, I punish it by cutting, burning and my ED. I tried to starve and overdose and ligature it away but none of it’s worked and I’m stuck in a body which let me down so badly, which you invaded. It’s an object which you used and I now need to punish.

Youve got a life and I’m not going to take it away from you, but know that on January 18th 2011 you took my life and made a failure and laughing stock out of it and I can never get the Becca I was before back. And I hate you for that.

Becca

Being assessed under the mental health act- my first time

I’ve been assessed under the Mental Health Act three times now. Whilst my first time did not lead to my being sectioned- I agreed last minute to an admission- it was probably the scariest time.

I had presented to Chelsea and Westminster A&E the night before having self harmed. I remember filling out the form for reception and writing, under the question asking why I had attended, ‘self harm. Sorry.’ I hated attending A&E and always felt I was wasting time. Usually I had to wait in the waiting room for a while but this time I was taken straight through to the mental health cubical- a room furnished in such a way you could cause yourself no harm whilst in there. The on call psych liaison nurse was called to sit with me whilst I waited to be seen. I was seen quickly and stitched by an incredibly kind doctor who treated me with the most respect I’ve ever been treated. Then things started to go wrong. The psych team were called to assess me and they decided a psychiatrist evaluation was required. It was midnight by this time and it was decided I needed to stay the night and be assessed in the morning. There were no beds available though and after a lot of persuasion I agreed to spend the night in A&E.
My night was spent attempting and failing to sleep curled up on a chair being watched by the psych nurse.

In the morning I was told that if I tried to leave I would be sectioned whilst they attempted to contact the home treatment team. As it turned out my postcode meant I was under the WLMHT crisis team instead of the CNWL team (which my ED service was under). I was escorted and transferred to Hammersmith and Fulham mental health unit.

There I was assessed by a doctor and a nurse from the crisis team. At this point I was told I was to be admitted to the unit and I fell apart completely. Sobbing and distressed I completely refused. No way. The crisis team decided to discuss with the whole team and I was told if I left the unit the police would be called. Half an hour later I was told as I had refused voluntary admission I was to be assessed under the MHA.

I was taken through to the section 136 suit which is little more than a police cell with a toilet and a mattress and left in the care of a nurse from the ward. I was terrified and distressed. I didn’t know what was happening or why I was being locked in what was essentially a cell. I did eventually curl up and sleep, utterly exhausted and freezing cold- there were no blankets and I was wearing the same clothes as the night before.

I was woken up when two doctors and an approved social worker entered. I don’t remember them introducing themselves. I sat in the corner, the cold of the concrete seeing into my back, utterly terrified. They questioned me for half an hour- I felt like a criminal, I hadn’t done anything wrong but I felt a thick coat of shame and guilt enveloping me. At one point one of the doctors asked me why I was so distracted, that it felt like I wasn’t in the room with them. Truth be, I was so frightened that I had detached myself from the situation- appearing distant and vacant. I answered their questions like a robot- yes I had thought of killing myself, yes I had plans, no of course I wasn’t going to tell them what they were, yes I had stopped taking my medication, no I would not accept an admission. At the end of half an hour they left to discuss between themselves and once again I was left in the room/ cell terrified out of my mind. When they came back in I was told I was to be sectioned under the MHA. At that point my survival instincts kicked in and I agreed, sobbing, to be admitted, voluntarily. I was escorted to the ward where I spent the next week. I couldn’t stop crying and spent most of my first day stood in a corner refusing food and drink, too terrified to sit down on the sofas.

That first assessment under the MHA was utterly terrifying. I’d never experienced that side of mental health services before and being sat in the 136 suit I truly thought I was being arrested for a crime I didn’t commit. It was probably the worst place I could be in my mental state, my overwhelming memory of that room is concrete grey walls and a blue plastic covered mattress and being freezing cold and frightened. No one explaining to me what was going on and only knowing that I couldn’t leave without being brought back by the police. Already feeling confused and vulnerable my mental state only deteriorated further being kept in that situation.

Losing my freedom

I never thought I would be sectioned. I always thought I would have the insight to know when I needed hospital, that I would never get that unwell. That I knew myself better.

I was wrong.

5 months ago on Monday I was sectioned under the Mental Health Act.

That day started like any normal day. I didn’t wake up feeling suddenly out of touch with reality or a danger to myself. In fact I had a job interview that day. I travelled out to Watford and attended my interview. I bought a coffee from AMT on my way home and tried to ignore how fat I felt, how the feeling of my thighs rubbing together made my skin crawl.

As had become my every day, I found myself stuck in a binge purge spiral as soon as I got home. Desperately wandering the local supermarkets, dodging from shop to shop spending £5 here and £5 there, scouring the reduced aisle. Then going back to my living room and stuffing it all in whilst hating myself more and more each mouthful but being unable to stop myself. Standing over the toilet clawing my own throat and stomach in an attempt to get rid of the calories. Head spinning and ears ringing, smelling of my own vomit but being compelled to keep going. The crisis team were visiting me daily and they would be at my flat in an hour but the thought of the calories I’d consumed and the fact that in about 8 weeks I’d gained 15kg and gone from anorexic to bulimic tormented me and I reacted in the only way I knew how. I self harmed. Badly. But I didn’t feel I deserved to look after it so I simply changed cardigans and left it.

When the crisis team arrived it was the same lady, S, who had taken me to A&E a week earlier after an overdose and another man. I was skittish and nervous around them, never sure how much I should say and usually desperate for the visit to be over.

This visit didn’t go as usual. Whilst talking to them my cut bled through my sleeve and I was told I needed to go to hospital. At which point I immediately refused. They were kind and talked to me about why not but insisted that if I didn’t go with them then they would have to call an ambulance. I remember sitting sobbing with my head in my hands curled up in the arm chair that I always staked claim to. I remember not really understanding why I was reacting as I was, just that I knew I could not go to hospital. At this point they told me they’d have to ring for an ambulance and I ran. I didn’t make it out the house though and was stopped at the front door by the male crisis team member assuring me that they wouldn’t phone 999 if I came back in. I was bare foot and for some reason I trusted him. I agreed to go and sit back in the lounge and talk to them. I remember being so concious tht my stash of 200 paracetamol was sat on the desk next to me and wondering how I could hide it from them without them seeing. I was sobbing and shaking and unable to take anything in so didn’t think twice when the man went outside to put money on their car. I lived in Fulham and parking was expensive and they’d already been with me an hour, I assumed they honestly did need to top it up. I don’t remember much more until I was sitting in the lounge with the two of them again and suddenly there were sirens outside- but I lived on a main road and there were always sirens. Then our doorbell went off, again and again and someone was hammering on the door trying to get in. But our neighbours were always having noisy house guests so I went down to answer the door and tell them they’d got the wrong flat. I should have known when the man came with me, but I didn’t.

Next thing I new there were four police officers coming into the flat and a paramedic. I turned around screaming and sobbing trying to get to my room, the living room, the bathroom, anywhere I could barricade myself but S had blocked my way. She said ‘It’s for the best, we’re trying to help you.’ But by that point  I was too upset and desperate. I bolted into the kitchen but there were now 7 people in the flat trying to stop me from running. I remember standing by the oven sobbing and saying over and over to leave me alone, to please leave me alone and go away. That I was fine. The female police officer tried to talk to me and eventually got me to sit on a chair whilst the paramedic took my vitals and said I needed to go to hospital. I refused again and a police officer asked the crisis team if I was under section, ”not yet”, By this point my flatmate had come out of his room to find the flat full of police and medical professionals. The crisis team were talking to him, explaining the situation as finally I realised I had no choice but to go.

I was followed round the house whilst I got my stuff together but could only think to put flipflops on and grab my bag and phone. I didn’t think I’d be there much longer than a few hours. Outside there were two police cars and a rapid response paramedic car parked up with their lights flashing and people watching as I was taken sobbing and shaking to one of the police cars, accompanied by two police officers and S and driven away. With the exception of one half hour visit a month later that was the last time I was in my flat.

At A&E I was taken straight through to the little room where mental health patients are treated and then left with S and hospital security stood outside the door. No way out. My phone battery was dying and I hadn’t brought my charger and I needed to stop mum worrying when I didn’t send my usual email. My wounds were seen by the doctor but I was too stressed to really notice and then three mental health professionals entered. I’d been assessed under the MHA a month earlier but had last minute decided to go in voluntarily, so I knew what this was even though no one told me. But I wasn’t able to agree that I needed to be in hospital. My suicide date was set for the 6th June, that day was the 2nd June. I had everything I needed to carry it out and I was determined noone would stop me. As it turns out they did- the assessment didn’t take very long and then I was left on my own again, for the first time that evening. I texted my mum telling her I was in hospital but not why or how and remember wanting desperately to pace the room, I’d been sat down too long and wasn’t burning enough calories off. It seemed like ages but thinking back it can’t of been until the approved social worker came back in and told me very matter of factly that I had been deemed a risk to myself and detained under Section 2 of the Mental Health Act. It was about midnight at this point and I’d completely shut down, I didn’t fight as the social worker and four security officers took me through A&E and over to the Mental Health Unit. I was met by staff who I’d met only a month previously and searched, then shown my room whilst the social worker rang my mum.

I’ll write more about my time on the unit another time, but that night was one of the most frightening and traumatic of my life. I’ve only spoken to that flatmate once since and am too embarrassed to try to change that. I remember just standing in my room on the unit once everyone had left and sobbing whilst thinking ‘what the fuck?’ I hadn’t realised at that point that I would not be able to carry out my intended suicide on the 6th June, or that I’d spend much of my two month admission on arms length 1:1 observation. I shut down completely.

hospital room