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Help before you hit crisis
Posted Friday 25 November 2011
As part of our campaign on crisis care, Charlotte writes about what happened when she needed emergency support and considers how her crisis could have been prevented.
Trigger warning - this blog discusses thoughts of self harm and suicide.
I have already blogged about my recent adventures in insomnia. This was exacerbated by a rare side effect of the mood stabilising drug sodium valproate: visual hallucinations.
I was usually not frightened or disturbed by what I saw, although I admit that the writhing centipedes and the occasional mask or face gave me a shudder.
It seems strange to me now that I didn’t report this to my doctor right away. This was partly because the valproate also made me feel sleepy and stupid, so that I found it hard to think sensibly. I also assumed that, like most side-effects, it would wear off once my system adjusted.
I was beginning to become upset and agitated by the combination of the music in my head, the images in front of my eyes, and the mental confusion.
I spent the whole of my next clinical psychology session in great distress, so much so that my psychologist ensured that I had a crisis management plan in place before I left.
Importantly, she gave me information on how to contact the duty team if I was in crisis, something which no-one had told me before.
That evening, I tried a different tack. I reasoned that if I felt sleepy all day, taking valproate as a split dose in the morning and evening, maybe I should take the whole lot at night. Then I might get off to sleep without needing additional antipsychotics.
I am not sure at what point in the night I realised this plan had gone horribly wrong.
Being somewhat sedated, I did not consider solutions such as getting up and trying to read, listen to relaxation music or watching TV. The 'logical' solutions that came to mind were as follows:
1. Collect all the prescription meds I had in the house and swallow them at once. The intent behind this was not suicide per se, just a means of making my head SHUT UP. Dying seemed an acceptable risk.
2. Cutting myself with the nice sharp knife we bought for a picnic in France. Probably on the legs, and purely to distract myself from the hallucinations and earworms.
Eventually, some sensible vestige of me prevailed. I woke my partner and he stayed up with me trying helpful strategies like finding Radio 3 to try to counter the music in my head, and giving cuddles and reassurance.
Perturbed to find me in the same state in the morning, he took the day off work and we agreed that at 9am we would ring my consultant.
My partner spoke to the secretary and left a message for my consultant saying that we needed to speak to him urgently.
I spent the morning preoccupied with the urge to be somewhere where I could jump under a train or out of a window; I felt like my body was twitching towards such actions.
After a few hours with no word from my doctor, we called again. The number went straight to voicemail. Next I rang my trust’s medicines information line, which I had found useful in the past when worried about side-effects.
The friendly, concerned lady who took my call confirmed that the hallucinations were probably caused by the valproate, but strongly encouraged me to go to the duty team as she felt that I could not be left to continue in such a state of distress.
So we got in the car and drove to the hospital. I went to reception while my partner went to look for somewhere to park, and the receptionist gave me a form to fill in.
It was two sides long and requested a lot of information that the trust already held about me (address, next of kin, clinic attended, consultant, etc).
In my agitation, I really did not want to have to think about how to describe my religious beliefs or sexual orientation - although I understand completely how critical this information is to good care.
At the end of the form there was a free text box where I was supposed to write why I was presenting to the duty team today. I’m not sure what I wrote.
I know the handwriting looked nothing like mine. I know some of it was in capitals. I know I mentioned hallucinations and suicide.
I handed the form in just as my partner arrived. We were asked to wait in the reception area, which had only three seats, two of which were already occupied.
For some reason, the automatic doors were fixed open, so we all stood/sat in the cold the whole time.
After maybe 20 minutes, a nice-seeming nurse came out and said that having read my form, I really needed to see a doctor (well, yes) and she was going to find out whether one was available. My partner and I were both disconcerted that this appeared to be an if rather than a when.
After a further wait of 20 minutes or so the nurse appeared again. She had found the doctor, who was ready to see me in an interview room (the room was nice, but smelled strongly of 'hospital').
The doctor began to take a history. This process was continually interrupted by one or other of her mobile phones going off.
My general impression was that she was not paying attention to the details I had told her. There was very much a 'checklist approach', a feeling that she had learned a rote list of questions in a fixed order.
The questions were blunt and closed. Did I still have thoughts of harming yourself? Yes. Did I still have thoughts of taking my own life? Yes. Yes! Why did she think I was here?
The doctor then went to find my own consultant, and we were left with the nurse, who could not have been more different. Her tone and body language suggested warmth and empathy and I loved her for the fact that she found us a sofa and a glass of water while we waited again.
My consultant arrived and agreed at once that the hallucinations were a rare reaction to the valproate and I should come off it immediately.
My partner told the team that he would be around, so I was sent home with a prescription for stronger antipsychotics, urged to try to restore my sleeping pattern and continue with my regular psychology sessions.
I was reminded that the Duty Team were there at other times if I needed further support.
Was this what I wanted or what I needed? I’m not sure. I didn’t want to be admitted, but I was at continued risk all that weekend.
The antipsychotics were so sedative that I missed out on anything I might have enjoyed all weekend and my mood dropped further, while the agitation increased if anything.
I began to feel more and more convinced that my only options were being unmedicated and unable to cope with my bipolar moods, being on valproate and tripping until I was out of control, or being on antipsychotics and having no quality of life.
Looking at life this way, my suicide plans became more concrete and tangible.
Just before I hit crisis, I remember watching a toddler doze in a buggy without a care in the world, and wishing that I could be like that. I didn’t want have to take any more responsibility for trying to keep myself safe, because I was so tired of it.
In an ideal world of mental health care, what I would like would be pre-crisis care, somewhere I could check myself in so that the work of making sure I survive doesn’t fall upon my partner’s shoulders.
A short-term support package including medication, but also talking and body therapies, like massage and yoga, is one I would gratefully accept.
Charlotte
You can read a fuller version of this post at Charlotte’s blog, and follow her on Twitter @BipolarBlogger.
Excellent crisis care exists, but we need it everywhere, for everyone. Support our campaign, take action now.
6 Comments
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you poor girl xxxx if i could take it all away for you, i would. my daughter also has troubles like you xxx
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I wish there were some non-medical crisis houses [with appropriate medical input as required for medication/physical health issues] we could check in to, be that residential for a few a days or a 2-4 weeks or a few hours. Where we could to talk to people taking a less mechanistic approach, maybe just listening to whatever we wanted to talk about. As you say Charlotte access to some non-medical things would be useful. When my anxiety is high I get muscle spasms in my back, access to some massage would really help.Sometimes we just need to be in a different environment for a while, one which is comfortable, allowing time to be with someone or alone, with or without activity, and certainly more than damn 'circle groups'. What it takes to help people before or during a crisis isn't rocket science, some of it not even expensive, but will we ever see it?
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hi to all www.telford-mind.co.ukers this is my first post and thought i would say hello to you all -
regards speak again soon
g moore -
I'm sorry Mind and Time for Change - but comments on media reports of footballers deaths?
There are suicides of mental health service users who will never make headline news because of cuts to services, crisis care and welfare - all of whom did not have the considerable wealth and choices that footballer managers have despite the macho culture and pressure [it's stressful and pressured in crap low paid work too].
I don't mean to sound unsympathetic because any suicide is a terrible tragedy but please, champion those with no choices in accessing help or income. -
Odd isn't it the way we all resort at times to wanting to be 'cared for' 'looked after' a little like the toddler dozing in the pram..Or do we?..I think not. What we want is to be in control of things just a little more than our situation or circumstance allows/enables us. I do love the assumption that our 'nearest and dearest' will take care of us and do what is right for us. Really? Is that the case? Aren't they too only human and doing what for them is right?.
I'm sure my husband would never either see or understand (especially as it would not be in his interest to) how things he has done have contributed strongly to my mental demise. I am sure my parents would not have any thought on their part in it either because they both were people who recognising their own needs and wants attended to them at the loss of or to the neglect of dealing with responsibilities they should really have bourne to others.
On the one hand i can appreciate you are no good to anyone if you are no good to yourself, yet on the other hand i see this imbalance of care takers and care givers. Its like there is some assumption that some are permanently in a position of being persons with an overriding obligation to others...
I've come to this site today via a link on another regarding a course of study i were looking into for myself and two others who were considering options. I read Charlottes page and could relate to the positions of most of the main characters and for want of a better word 'roles'. We are living in a 'sick' society in the UK and i don't know if it is any better in other places or if all and the best we can do ever is always just to try and help and support those worse off than ourselves. I read Charlottes suggestions re pre-crisis help and thought brilliant so why doesn't she train to go to work in a health centre or wellbeing clinic where such things as she suggests might then be readily available to her and be extended then by her to others?. She knows the need for it -
Because Dawn - the sorts of things people generally find helpful and the very few services offering that which are user-led get their funding cut. As for training to offer it, most health & social care training and practise doesn't accommodate it
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