Friday 15 August 2014

Asking for Help

Trigger Warning: Suicide

This post is pretty much a follow on, from my previous post, More Mental Health Rambling but also a (hopefully fluently written) collection of my thoughts after discussions on Twitter, about Mental Health services. What brought on these discussions was the very upsetting death of Robin Williams, the way the media handled reporting his suicide, and the recurring phrase "ask for help".

As I mentioned in my previous post, I recently had to cancel CBT sessions for various reasons; the main one being that I can't attend sessions on a weekly basis while I'm looking after my mum. I don't think I could've gone about it in any other way, because I was on the verge of being discharged for missing so many appointments (due to ill health) anyway. In part it is my doing (though I feel as if I had no choice) but I feel as if I'm left with no support for my mental health.

I'm still taking my Amitriptyline (50mg a night) for the Depression; although my pain specialist said I should be starting on 75mg per night. This is something I need to discuss with my GP soon. I don't know whether it is down to the pills, or because I haven't really got much time to think about how I'm feeling (I'm certainly trying to avoid thinking about it anyway), but I haven't had any really big, really scary dips in mood recently; where I get the massive suicidal urges (although I am still getting urges occasionally). I do still think about suicide on a daily basis,  but I guess this is in more of a passive way, as I have no plans and I feel sort of safe right now. I know I'm not fine in the slightest though. I don't feel like I've improved, I just feel like I'm teetering on the edge constantly, trying to just hold on not for my sake, but for my mum's.

I do need some sort of support, but I'm just not sure what to ask for or how I could access that support when I'm unable to travel by myself and no one is available to take me to appointments if they're anytime before 5pm on a weekday. Below, are the kind of things I'd like help with/like to achieve, the difficulties I have with access, need for flexibility with times etc, and the services I know of in this area. I'll try and list these things in a clear way, although I'm aware I probably don't sound clear at all in this post!

What I need support for:

  • To find a way to lessen these suicidal thoughts. They tend to be triggered when I think too much about the future, I convince myself I'll lose all my friends and don't deserve them anyway, I get too involved in political discussions or I spend too long reading about all the bad things happening in this world. It makes things feel hopeless. It makes me feel like I don't bring anything positive to anyone's life. I feel useless, guilty and then guilty again for thinking about suicide because I know there are consequences. I wouldn't want to hurt anyone, but I think I hurt people anyway, by talking about this.
  • To become more motivated & have more faith in myself. Yet again, I've failed to carry on with my CBT diploma. It's something that would be quite an achievement and yet I keep putting it aside for a day when I'm feeling well enough (physically and mentally) to concentrate for a decent amount of time. There've been times when I've wanted to write more blog posts, but I feel as if I'm a terrible writer and I won't explain myself properly. I keep stopping typing this particular post, and being tempted to delete the whole thing because it looks like a big mess of words to me. 
  • To be even more assertive. At some point, I'll have to talk to my GP again about the hypermobility, subluxations etc. It's been dismissed twice as part of the fibromyalgia, without proper assessment. I also need to make it clear that I need stronger pain medication. Finally, the catch 22 is that I need assertiveness to ask my GP for mental health support to help with (amongst all the other things) being more assertive!
  • To start travelling on my own to see friends & actually have a social life. The Fibromyalgia makes it very very difficult to travel for long anyway, and I don't feel safe on my own when I'm extremely dizzy, nauseous, weak etc, but a big reason why I don't travel alone is because it terrifies me. I get extremely self conscious and nervous just walking out my front door. If I need to get to the post box (just a few houses away on the same street) then I will wait until it's quiet, I won't look at the traffic, I won't look at anyone walking past me, I'll just try and distract myself by admiring peoples' gardens as I walk past. All the while, I'll be worried about the way I look, where I'm looking, whether I look nervous, whether I'm acting strangely, whether I walk strangely, just anything that could possibly draw attention to me, I'll worry about. And this is just a short walk to the post box of all places. 
          It's been a while since I've met up with friends (and that was with dad driving me there and back, in my own city). Being in busy areas, like the city centre, is exhausting. I worry that I'm not being chatty enough, I'm rambling too much and that I have to stop and rest too many times. But I like looking round shops, I like sitting and chatting in a coffee shop, and I love seeing my friends. I have wondered about asking them to come visit me, but it seems to much to ask of them when it requires so much travelling on their part. I need to be able to travel to see them, at least to the next town, so I'm not always expecting them to get to my town. There's nothing quite like chronic physical and mental illness to make you feel like a crap friend!
  • To access therapy to help with my wasp phobia. This one really has been put on the backburner because it just wasn't a priority, in comparison to the suicidal thoughts. It's only really something that's an actual problem in warmer weather, when the wasps are out. I'm really trying to tackle it on my own, but it is difficult. Maybe I need to write about this in a separate blog post? 
  • To be able to cope with being exposed to discussions about abortion, without being (as) triggered. This is something I go into more detail with, in a previous post entitled "Am I triggered?" The last therapist I saw, said these feelings were normal and fine though (even though I said it was a massive problem for me, and something I needed help with getting through).
  • To tackle the anxiety I have, related to my overactive bladder, and to stop my obsessive routine in the bathroom. If I'm not going anywhere, and I'm able to use the toilet whenever I need, I can pretty much 'go' as normal, although I will still get the bladder frequency. If I'm in a public toilet, or I'm about to travel anywhere, however, I have a strict routine when it comes to going to the toilet. This is quite an embarrassing thing to talk about, but I need to be honest. I have to 'go' 4 times. Each time, I have to wipe 10 times. If I'm about to travel anywhere (especially a longer journey) I then have to 'go' another 2 times, wiping 10 times each time again. To me, this sounds like a really unhealthy routine and I'm surprised I haven't damaged my bladder by now. I have tried so hard to break out of this ridiculous cycle, but when I try not to 'go' as much, or wipe as much, I spend the journey absolutely bursting for the loo and seriously worried that I won't get to a toilet in time. So I resort back to my routine. The problem is that sometimes, even when I've done this strict routine and feel that I'm ready to go out of the house, I still have a big urge to go to the toilet. I've been like this for a few years now and I hate it. 

Mental Health Services in my area:

  • Healthy Minds: A Cognitive Behavioural Therapy based Psychological Therapies service for people with common mental health problems e.g. depression, anxiety & stress. In order to access this service, you have to approach your GP first, who will give you a self referral card. You use the details on the card to contact Healthy Minds and arrange a phone assessment. The Psychological Wellbeing Practitioner who assessed you will then discuss with you, options for treatment or self help resources. If one to one therapy is appropriate, then you will either see a Psychological Wellbeing Practitioner (aka Low Intensity Therapist) or a High Intensity Therapist. In my case, I saw the Low Intensity Therapist for my first lot of CBT, on a fortnightly basis (6 sessions) and then the High Intensity Therapist for my second lot of CBT, on a weekly basis (intended to be 12 sessions, but I only completed about 6)
  • RAS team/Crisis and Home Treatment Team: This service is for people going through severe mental health crises. Either your GP or Mental Health Professional (e.g. psychotherapist) will refer you to the service if they feel you need it. I've been referred once because of the severe suicidal urges I was getting. You are supposed to be seen either on the same day you're referred, or within 48 hours of referral. Someone from the team will meet you for an assessment and then will decide if you need further care from them, if the care you're getting already is enough, or whether you need to be referred elsewhere. I'm not saying for a fact that this is the case across the country, but in my case, I had to get myself to the local psychiatric hospital (luckily dad was on afternoon shifts, so could get me there the next morning) and after assessment, the nurse decided that I didn't need further care from the crisis team, because I hadn't tried to harm myself yet. I was discharged back to my psychotherapist. After that, my therapist did ask me if I wanted to be re-referred to them, as I was no better, but I felt I'd only be wasting their time, as they couldn't actually see me unless I'd planned to harm myself, or actually attempted to/had harmed myself. I wasn't given the option of having someone meet me at home. 
  • Expert Patients Programme: This isn't strictly a mental health service, but it does involve mental health. It is a programme involving regular group sessions to help people with long term physical illnesses, to manage day to day living and wellbeing. 
  • Rethink: This mental health charity offers a Community Support Service in my area. It offers one to one support, workshops and group "coffee and chat" sessions in various places around the city. Services are available from 9-5 on weekdays. 

Problems with Accessing Services:

  • Times available: From what I've seen, the non emergency services only run from 9-5 on weekdays. There is no one available to provide transport for me between these times. I may be able to get the very occasional lift from a neighbour, but there is no way this would be possible on any sort of regular basis. 
  • Flexibility with location: I will continue to check and re-check, but as far as I've researched, if it isn't an emergency then home visits are simply not offered. You have to get yourself to the appointments and missing too many will mean discharge back to your GP. If I'm not able to get myself to these appointments, then does this mean I'm ineligible for any kind of mental health support beyond medication?
  • Types of services available: If I need a service that will take into consideration the impact that my physical health has had on my mental health, then my only option available is one that involves group sessions. This is simply not possible for me. My reaction to the surprise group induction at the Work Programme shows how well I cope with group sessions...
I think what is needed is a flexible mental health service, that someone can attend after 5pm. My GP surgery provides appointments from 8.30am-6.30pm on weekdays, with an extended hours service til 8pm on Thursdays. I wonder whether something like this could be implemented in mental healthcare? 

There also needs to be easier access to home visits for people with chronic physical illnesses and/or mental illnesses which severely impact being able to leave the home/on their own. 

Finally, it'd be really useful to have some sort of support to help me with travelling on my own, as this is clearly an issue that I need help with. 

With the severe cuts to mental health services, I don't see any of this even being considered anytime soon in this city, but it is definitely needed, not just by me, but by anyone who finds the support available just isn't flexible enough for their needs.

Friday 1 August 2014

More Mental Health Rambling

I cannot understand my moods at the moment. Well, I say "at the moment" but it's probably been for the past few months now.

I suppose this is part of the Depression, but I either seem to have a real lack of emotion (feeling numb, not sure how to respond when someone asks "how are you" because honestly? I really don't know. I just 'am'. That's it.) or I have days filled with a million different emotions, that I feel far too intensely. It won't take much to make me cry (seriously, just someone showing a little kindness will set me off!), I'll get really really angry at things (just hearing dad talk about work made me very angry. I just wanted to scream at him to shut the hell up!), the silliest jokes, comments etc will have me giggling like a teenager, I'll get really emotional over a movie (far too excited, far too upset etc). I just want to feel emotions 'normally' and feel like I have some sort of control over them.

Trigger Warning: Weight/Body image

One change I've made, is to stop taking the contraceptive pill Microgynon. When I started on it, I put on at least a stone. At the time, it was a good thing, but I hate it now. I  only stopped taking the pill about a month ago, and these moods have gone on for much longer, so I'm not sure if this is something I can blame on hormones. Besides, I've not been sexually active in over a year, I don't see it happening anytime soon, so what's the point in taking it at the moment? I'm having real self esteem issues, and I'm hating how much weight I've put on. Honestly, it's not much really, but I feel huge. I want to feel good about myself for something, but I just look at every part of me (personality as well as looks etc) and I'm not happy with what I see. I can't even just accept it. For someone who takes a lot of selfies, I sure do hate the way I look. Nothing wrong with faking a bit of self confidence though I guess.

My mum recently had a big ankle operation, and can't weight-bear for at least 4 weeks now. I'm doing what I can for her, when dad's at work, but I'm struggling A LOT. I pretty much start the morning in tears, but getting on with things. I feel constantly sick, dizzy, wobbly, uncoordinated (I'm covered in bruises because I keep walking/falling into things) and breathless. My pains are worse too, and the Naproxen is doing NOTHING. I wish the doctors would give me pain meds that are actually strong, and potentially work. I may be small, but small doses just aren't going to cut it.

I really wanted to vent earlier today, but I couldn't find the words. I'll try here. Basically, I feel like I can't look after my own health whilst I'm looking after mum. I have to push and push and push until I'm in so much pain/so exhausted/dizzy/breathless that I have no choice but to lie on the sofa. And then I only get a very short break before I have to do it all again. I've tried to explain it to mum, but have just ended up making her feel guilty (which is NOT what I intended in the slightest. I'm trying to emphasise that I CAN'T not I won't). I just wish there was someone else around who could be there for her when I'm not able to.

She had an appointment today, so my dad and I came with her. I'm going to sound ridiculously self absorbed here, but whenever she was in lots of pain, dizzy, exhausted, whatever, the nurses (and dad) were right there, seeing if she needed anything, asking how she was, trying to set her mind at ease etc. I of course wanted to do the same thing, but I was already in a real irritable, self pitying mood and honestly? I felt jealous. Not jealous of the pain she was in. I can't compare it to mine, but I know it gets very bad and causes nausea etc. I was jealous because people noticed, they cared, she wasn't invisible! Maybe it was just because this appointment was for her, not me, but I had a few times during that appointment, where I was in a lot of pain (I'm sure you could've seen it on my face) and I was stumbling about with dizziness. I also had that weird experience, of feeling like I'm not really there (dissociation?) I must've looked like I was struggling, but no one noticed. It made me realise just how invisible, my invisible illness can be sometimes.

I wonder how much pain my doctors realise I'm in, just how constant these pains are (they're not just mild aches), how much the other symptoms affect me, how much I struggle to do things and how hard I try to do them. In public, it feels socially unacceptable to show you're in pain, so I grit my teeth and bottle it up (I might end up crying out a bit, not loudly, when I have no other choice). Maybe I should just make it more obvious? But then again, I don't like causing a scene, I don't like being fussed over. I just want people (medical professionals, not the general public) to actually notice I'm in pain, without me having to explain it (with the fear of being doubted because I'm not yelling etc) and to treat me as someone who won't just be fobbed off with low dose meds.

This sounds so terrible and probably is one of those "be careful what you wish for!" things, but sometimes I wish something a bit more dramatic would happen, just so the doctors will realise this isn't just a few mild aches and pains, with a teensy bit of dizziness. If that's what it was, I'd be looking for a job/in a job by now.

I've cancelled my CBT sessions, for various reasons. I can't get transport there, I need to be in the house constantly, for mum, and I really don't think these sessions are helping. I mean, sure, there are some things I can try (mindfulness, going for a walk, monitoring my moods, trying to do nice things for myself), which I can just about achieve on better days. My lack of motivation seriously affects my ability to do these things to help myself though, even on better days. If I do (some of) these things, I may get a slight temporary increase in mood, but that's it. So I guess it's my motivation that needs tackling, but how? It takes motivation to do anything, right down to 'basic' things like getting out of bed, getting dressed, eating (even a really simple meal). It may make me sound lazy, but it's not laziness. On better days, I do far too much then end up feeling depressed again, because I've made myself flare up yet again. I get so frustrated with my own body.

I guess this could all be summed up as this; I am very fed up.