From One Extreme to the Other in Mental Health Care

Yesterday. I honestly don’t know where to start with yesterday.

Having had a peculiar and confusing appointment with the crisis team made at the last minute the day before, my mind was whirring and my anxieties were peaked to the extent that I didn’t get an iota of sleep. I was a mess all morning, but at least my care coordinator was due at 12:30…and, after all, I told myself, this was likely me overreacting and catastrophising about the crisis team situation.

My wonderful care coordinator turns up and we have an incredibly therapeutic 2 hour talk – thankfully she totally understands me and so we manage to go over all the things buzzing round my head…hence the extra hour (which she certainly doesn’t have to spare) that she spends with me. We spend time talking about how things are, noting that the risk levels are higher than ever before with me, working out what might be heightening risk, learning that plans for the therapeutic community are progressing nicely, thinking of new ways to work, planning consultations with specialist colleagues, and working out that – although not ideal – how I’m managing to stay alive right now is living from crisis team visit to crisis team visit, with their support over the phone in between (support which we are both very grateful for). That brought us on to my fears: what on earth the unusual visit with crisis would be about that afternoon and that – with past experience – crisis would almost certainly decide that, no matter the risks, because of my diagnosis and fears of me ‘becoming reliant’ it was time to discharge me. My care coordinator reassured me that she had checked the system and there was no record of this visit and that she hadn’t been made aware/invited to attend it – so, it could not be a discharge planning meeting, and must be just to discuss more intensive psychological intervention (it was with the team’s psychologist and a nurse). She also said that with my current presentation, with the identification of my need for 24 hour intensive and psychological support within a therapeutic community, and with the clear need and impact of the crisis team, there is no way that there was any justification for my discharge from them. We also discussed the complete peculiarity of this past justification for ending support by crisis – that, in fact, I do absolutely everything within my power to not rely on anyone or anything, which is how I have ended up in this ridiculous and dangerous position in which I currently find myself…my long-term care team have been fighting hard for the past 11 months to try to get me to rely on them even a small amount, and so it would actually be undoing their work for crisis to use this argument. Excellent! It must just be my brain going haywire, nothing more.

My care coordinator spots the time, realises how long she’s been here, and leaves me much calmer than I had been before her visit. The crisis team psychologist (who I’d met once, perhaps 8 months ago, but at the point when I was unable to speak to 99% of mental health professionals) and nurse (who I had worked well with in the past but who hadn’t seen me for perhaps 6 months) turn up soon after. As the psychologist sits down she says “So, your discharge plan, we want to hear what you think of the team’s decision…people with your diagnosis…reliance…” PANIC. It’s late Friday afternoon. This visit was arranged at the last minute – in stark contrast with plans known to me and my care team – with no details made known to any of us, other than that the psychologist would be coming, and with no possibility of anyone attending; this triggered my PTSD from abuse by a mental health professional last year, where he would spring meetings on me without the knowledge of anyone else, and take that time to cause immense and lasting harm to me through what he has now admitted to be intentional cruelty and punishment.

Outright panic.

Alone.

No protection.

Brain not functioning.

Sobbing.

Shaking all over.

Can’t breathe.

I AM GOING TO BE HURT AND I HAVE NO WAY OUT OF THIS SITUATION.

Having been clinging on to life with my very fingertips, the crisis team has now sent in this giant, de-stabilising hurricane and my grip is loosening further – I lose grip entirely for a moment. I’m close to losing grip forever.

The world is imploding.

I do not understand anything that is happening around me or within me.

In under 2 minutes the world had ended.

Eventually the crisis team members realise that they also had been incorrectly informed, believing that everyone had been properly informed and prepared for the situation. They realise and apologise for the negative impact that they have had on me, then do their best to attempt to calm me down and reassure me. They are kind but the damage has been done (though I now see that they were not party to whatever had led to this behind the scenes and were shocked, too). I calm very, very slightly (that is, I breathe for a few minutes) and they realise that this is as good as it’s going to get, so they leave to try to sort out the mess.

I then EXPLODE into panicked, screaming sobbing from which I cannot think or calm down. I am trapped in past trauma and present incredibly high risk, feeling betrayed and hopeless beyond explanation. I manage to put a call request in to my care coordinator but realise she will soon be going home, not back until Wednesday. I put a quick call in to my mum and she heads up to my community mental health team office to collect my medication and try to speak to my care coordinator in person.

2 hours of non-stop hyperventilating sobbing later, my care coordinator phones – instantly concerned by the distress that she can hear has been caused within just hours of her seeing me – and she is equally upset and confused by what has happened. Managing to calm my sobs, she promises that, no matter what the crisis team tries, discharge cannot be planned without her and my consultant’s consent – which certainly had not been given – and promises that she will do her best to get hold of her managers and my consultant before they all go home (if they haven’t already, this late in the day on a Friday) so that they can fight on our behalf on Friday. I admit to my care coordinator that it had been the most horrifically difficult fight to not just give in and act impulsively on those suicidal plans that we had all been struggling to work together to stop from coming to fruition (having discussed in depth that afternoon how difficult it was even at that point), now having had the hopelessness of the situation confirmed and trauma triggered, feeling like my worst fear of history repeating itself was indeed coming true. She begs me to hang on for her.

Meanwhile, at the CMHT office, my mum is informed that – without informing us or delivering as they should have – the crisis team have taken my medication unexpectedly. Considering that I need it within 5 hours, this is a major problem. While the CMHT get hold of crisis, a member of the team talks to my mum – upon hearing about what crisis had done that afternoon, the CMHT member (who I haven’t met) informs my mum that crisis had put the request in to plan my discharge the previous day but that the consultant had not just rejected it but had made a point of making the whole team aware in their team meeting that under no circumstance was discharge from crisis safe or appropriate, that it wasn’t to even be discussed with me due to how unwell and unsafe I am. It seems that crisis had then put this last minute meeting in place, to spring it on me without consultant/care coordinator/CMHT being aware. The member of staff reinforces to my mum that there is no way this can happen without my consultant and care coordinator’s approval – and goes off to make sure that the team are all aware of the situation and ready to fight come Monday. My mum then offers to do the crisis team a favour by driving to the other side of town to pick my medication up, rather than them having to drop it out to my house. Except they don’t answer the door, even though they were expecting her and knew she was helping them out. And the control room cannot get any answer out of them – not over the office phone or any of the mobiles. After 40 minutes of waiting, ringing the bell, phoning and an already incredibly stressful day, my mum has to come home. Not only am I in a completely broken mess due to the actions of the crisis team, it now also seems that I will be without my medication due to them, further increasing my distress and risk. Eventually, 3 hours of phone calls later, the control room finally gets hold of the crisis team and they plan to drop my medication off before bedtime.

When they come out, my mind is screwed up further by their assertion that if I was still so unwell and unsafe after 3 weeks under their team, then being under them was pointless (sounding to me like they’d decided I was a hopeless case and so discharge was the only option, leaving me without support and very likely to end my life).

Complete and utter despondency.

BROKEN. Beyond repair or survival.

I manage to pluck up the courage to put a call in to crisis, knowing the potentially fatal outcome if I don’t, and a junior member of staff who has been working very well with me stays late and speaks to me for over an hour. He, thankfully, takes the time to listen to how much the day had destroyed me, to how I now felt without a doubt that the only option was death and that their actions felt like evidence to that fact. He was patient and we talked everything over, ticking further and further into his free time. I explained how confusing and contrasting all the messages from the team were (also filling him in on the contrast with the entire CMHT), with seemingly no justification, putting my life very literally on the line for no apparent reason and against all procedure. A lot of stuff – obviously – neither of us were in a position to find out, change or decide – but we discussed how it may be possible to try to start sorting things out and what would be helpful at this point. We talked and talked. Eventually we put my next steps for the evening in place, both aware of how badly wrong things could easily go if I didn’t exert the utmost strength and will, and push myself to get through no matter what. We worked on trying to make things a bit safer. He sent some emails and promised that he would do his best, which I believed, even if my trust was otherwise completely decimated, and I wasn’t sure of the extent to which he could impact this nonsensical situation. I’m grateful that he so kindly gave up his free time, right into the night, to try to help me.

I still cannot wrap my head around all of this. I don’t know what to believe and I don’t understand any of it. I feel sorry for the individuals who got caught up in this. No-one seems to understand why this has happened. What the hell did I do wrong? Is this all my fault? Is this the sign that this really is the end, time to give up once and for all? Why are they hurting me like this? Why was so much effort exerted to break protocol and go against my consultant and care coordinator? Why me? Why do I cause nothing but chaos, pain and darkness? Why should I live? Can I even manage to remain alive?

Terrified. Lost. Drained. Confused. Bereft. Alone. Broken. Ashamed.

Scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared scared.

I’m sorry.

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