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Crisis services really were there for me in my crisis

Friday, 01 July 2022 Caroline

Caroline blogs about how the home treatment team helped her re-engage in life after her mental health reached a low.

Caroline, a registered general nurse with a postgraduate degree in Mental Health Studies, has history of self-harm, depression and PTSD. Twitter: @cdacunhalewin

“I was frequently overcome by dread, guilt and shame, and I felt disconnected from myself and other people.”

Although I have worked closely with people who have serious mental health issues, when I myself began presenting with post-traumatic stress (PTSD) symptoms I was at a loss as to what was happening. I felt like I had absolutely no control over my mind or body and any sudden movement would incite panic. There were moments when I was gripped by a despair so great I would feel paralysed and fall to the floor. I became obsessive, both at work and home, and would ruminate on any ‘mistake’ I made. I was frequently overcome by dread, guilt and shame and I felt disconnected from myself and other people.

It was as though I was waiting for something terrible to happen, but I didn’t know what it could be. Later, I realised these were symptoms of hyperarousal, flashbacks (or re-experiencing), emotional dysregulation with marked changes in self-concept, consistent with post-traumatic stress disorder. These symptoms worsened over five months and although there were moments of relief, especially when I finally stopped working and began antidepressants, overall I felt an increasing hopelessness for the possibility of improvement.

I began to investigate ways I could end my life. I felt torn and frightened; I was aware of the permanency of this decision, most significantly the impact it would have on my partner and family, but desperately wanted relief. I was honest about these feelings to my therapist, who advised I contacted my GP. In turn, my GP suggested I attend A&E to be assessed by liaison psychiatry for further support.

Emergency departments are busy places so are not necessarily tailored to support individuals in extreme psychological distress. For me, however, there was some respite to be had from this experience. I was put on one-to-one observations with a mental health nurse and asked to wait in a room with her, away from any other patients or noise. At first it seemed strange and invasive to have a nurse wait with me, but in the end I was grateful for her company; it felt less isolating.

 Reflecting on what I wanted

The wait gave me a moment to step back and reflect on what it was that I wanted next and what was likely to happen; I began to feel some emergence of hope. During the assessment process, the staff were kind and validating, normalising my experience and keeping me updated as regularly as they could. The eventual decision made by the team, and discussed with me, was to be referred on to a home treatment team (HTT), a crisis service that supports patients undergoing a mental health crisis to remain at home.

The referral to the HTT came a day after I presented to A&E. The wait in between my attendance and initial assessment was challenging, but knowing that I would soon be supported more extensively helped keep my head above water.

“I was able to call the team any time I felt in need and could see a nurse twice a day.”

At my initial assessment, I spoke to a mental health nurse about my experiences and history and we made a plan: I would see a clinician once a day at the team base for a check-in and have regular contact with the team’s clinical psychologist. I was able to call the team any time I felt in need and there was an option to see a nurse twice a day if I worsened or wanted to. I also spoke to the psychiatrist for a medication review.

Being able to go into the team base everyday and speak to a nurse was an important part of my treatment. I had been on sick leave for two months when I was referred and was struggling with not working, but going to my HTT appointments gave my day structure. These appointments also allowed me an opportunity to express my feelings and explore feasible means of managing symptoms that had been overwhelming me.

I felt heard and validated during my discussions with the staff. They took an interest in me but made no judgements. They checked in with me that my partner was supportive. They clearly wanted the best for my care and treatment. And so it was with the support of the staff and clinical psychologist that I attempted to re-engage in life, develop self-soothing activities and surround myself with positive things once again.

Sense of closure

It was just over a month when discharge became feasible but the staff did not rush me into a decision. They even delayed my discharge by a week when I experienced a momentary increase in flashbacks. The process of discharge was conducted by my attending a joint review with a member of the HTT and my new named nurse in a community mental health team. This helped give me both a sense of closure and reassurance about my next steps.

Being referred to the crisis team was an excellent decision for me. That period is extremely important in  helping me understand  my mental illness better. I was filled with an inordinate amount of guilt and shame about my PTSD before being referred to the HTT. I still experience flashbacks, hyperarousal, emotional dysregulation and suicidality, but they are less intense than they were. I believe my improvement is in part due to my own determination to give life a go again, but also to the great support of that crisis team.

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