Today, I was discharged from the crisis and home resolution treatment team; an emergency outpatient mental health service. The first moment of recovery, I suppose. I have a lot on my mind. As a little mandatory note, all names I mention here have been changed, so I don't get in any trouble.
This does feel like my first recovery win. Not that I'm someone who thinks recovery (whatever that means) is paramount - but, hey, it is quite nice to no longer be suicidal enough to have constant psychiatric involvement in my days. My referral came about when I presented to A&E quite desperately suicidal. I hadn't exactly made a plan, and I didn't quite have intent, but I had this palpable urge that I couldn't get out of my head. I couldn't feel safe without going somewhere and doing something about this, even if I really didn't want to do what I did. I spoke to a questionable man there, who had some not-so-nice things to say to me. One good example is that I might be burdening my friends because I asked them for help, another is that I might only be trans because I'm autistic. Great! I would rate the A&E experience a 4/10. It wasn't all bad; I got a referral to the crisis team.
I have my reservations with crisis teams. When I was sixteen, a crisis team in another area of the country refused to see my dad, and he later that day died by suicide. It was probably preventable, I'm coming to accept. So, when I was referred to a crisis team, I had real doubts. I also had real doubts on the grounds of antipsychiatry - was I just going to be medicalised? Was I going to, someday, have my freedoms taken away by this team of people? I would come to be quite pleasantly surprised. Well, as pleasantly surprised as an antipsychiatrist could probably realistically be.
My first encounter with the crisis team was the afternoon after my night in A&E. It was at the local psychiatric day hospital, a place I know well from psychiatrist visits. It's an alright place, in a nice neighbourhood opposite the rugby field, with its unthrowable tables and chairs, its psych-ward-grey walls, its slightly wilted tree planted in a corner by the TV. It does have photos of the town on the walls, though, which would just feel quite cruel if this place had inpatients. Anyway, for my first encounter, a friend accompanied me, just as back-up and support in case they tried to section me under the Mental Health Act. I had a cup of water, and soon, two crisis nurses came to take me to a counselling room. I remember it well - it was cool in there, with muddy pink walls, 4 chairs all arranged in a circle, and the lights were dimmed. We did the basic questioning, the one you've had a million times over if you've ever had any psychiatric involvement. What landed you in A&E, are suicidal thoughts normal for you, how do you self harm, what feelings are behind all of this, what medications are you on, what do you think we can do to help you best...
The visit ended uneventfully, thankfully. I was safe to go home, but I had to return every other day for follow-up visits.
My next session would take from DBT. Distress tolerance techniques; they're actually quite good, you know? I met an assistant psychologist I'd see a few more times during this appointment, I'll call her Emma. I could never quite get over the awkwardness of being therapised by someone your own age that you can just tell you'd be friends with if you'd never ended up in their care. Regardless, her sessions were always nice. Our first session focused on distress tolerance and what works best for me - turns out, it's sensory input. We came to the conclusion that when I'm distressed I need to change one thing about each of my senses, even if just for something to do, a momentary distraction. This session is also where I learnt an absolutely insane coping mechanism, but one that surprisingly works. Fill a rubber glove up with water, freeze it, and then you can squeeze it for the effect of holding an ice cube, or, if you want something more aggressive, snap its fucking fingers. Just break them. Break its fingers. Cool.
Then, I met a new pair of crisis nurses for a check-in. I don't remember much of this dull appointment, really. It was your average "are you going to kill yourself" intervention. I'll leave it at that.
Back to Emma for a session on formulations. If you're not sure, formulations are an exercise in different types of therapy where you identify basic things about yourself like your interests, values, and hobbies, and then things about your past, things that trigger you, and the horrible feelings that come from those feelings. Then, you pick a horrible feeling, and you follow it from birth to death. I'll explain a formulation I did with Emma that relates to me feeling overwhelmingly sad. First, something triggers me, usually something grief related. Then, I sit and wallow in the feeling, and it gets so big that I feel stuck in it. That leaves me sitting around overwhelmingly sad. Next, I need to get that feeling out, and there's one of two ways that can go - healthy or unhealthy. I get that feeling out somehow, then go to bed, and wake up feeling a little bit better. Me and Emma, in that session, worked on identifying that cycle and discussing at what point in it I need to use coping skills to break the cycle. It was surprisingly helpful to see my vicious cycle scribbled down on a worksheet by someone else. In this session was the first time I'd been made to feel truly human by a psychiatric worker. We discussed a mutual hobby, crochet, in quite a lot of depth. I make hats, she makes frogs in dungarees. We also talked about building a crisis kit - a bag of things near me at all times that reminds me that this is all worth it. About putting things I love in there, things that make me happy - it was nice to have it recognised that I am a person with hobbies, friends, loved ones, interests, things that make me happy, that I'm more than my illness. Being made to feel human and not like some subject really warmed me up to engaging more with the service and taking it more seriously.
That happened again in my next appointment, actually. I met a nurse I'll call Harry, a London boy through and through, who talked to me about F1 while sat on the sofas on the empty ward with a cuppa. Sorry, Harry, for almost spoiling Miami GP to you. This was another check-in appointment, so nothing much to say here. I was, again, safe to go home.
Now, onto my last appointment, again with Emma. She had obviously picked up on how helpful other DBT activities had been for me, and presented me with two options for today's appointment. Unhelpful thinking patterns, or emotional regulations. I chose the latter, so the latter we did. Having not slept too well, I dissociated through a lot of this appointment. What I do remember, though, is "coping ahead." Putting measures in place before a situation that might upset you happens (for me, we chose going to my mum's house, where my dad passed away), so that when it inevitably happens, you don't have to climb around trying to pull your plan and resources together. They're already in place. So, tonight I'll be making a note in my phone of a few bullet points to go through whenever I'm at my mum's house and feelings of grief pop up and I can't squeeze them back into the little recess they came from.
After that, I was deemed safe to be discharged. Yay! I spoke to a nice lady from the crisis team who really hated my "village idiot" hat because "you shouldn't wear negative things on your head." She does have a point, I suppose. Anyway, she deemed me safe to go home and not return anytime soon, with any hope. She told me that, although she hopes to not see me again, they'll always be there if I do need them, and that they'd not be happy to see me again, but that they "all think I'm very entertaining." Girl, whatever that means. The psych ward's little jester.
I guess that's me, then. The jester of the psych ward. Do I still have my reservations about crisis teams, and about mental health care for suicidal people in general? Of course I do. It'd be silly and against my entire personal belief system to write off systemic criticism in the name of "well I had a good experience!" But that I did have. I was given recaps of skills I'd long forgotten that may help me, I felt seen, and I was made to feel human here and there. I'll take "human here and there."
Comments
Post a Comment