Crisis

This post follows on from the one entitled Last Night

(Trigger Warning: Details of Self Harm and mention of Suicide)

Tuesday

I still felt really awful on the Tuesday, but thankfully not so bad that I would need to contact Crisis Team ¹. The stomach pains were still there, but I was trying to take things easy and only have simple meals in small portions. I felt as if I knew what to do, if I did go into crisis, so I guess this reassured me. After all, I was "in the system" so they'd have to help, right?


Wednesday

Wednesday, things got much worse. I'd been feeling so down that day, and I couldn't concentrate on a thing. I had barely eaten anything either. Doing ANYTHING seemed completely pointless. All I could think about was ending my life. I did the right thing, and told mum how I was feeling. To be honest, she'd noticed something was wrong with me, so I don't think she'd have let me hide it. I was starting to talk about making plans, so mum decided to call Crisis Team.

They wanted to speak to me, so I thought that they'd finally do something to help! I explained (well, rambled) to the woman (possibly a CPN ²) that I thought I might be in crisis, I couldn't think of anything but suicide and I'd started making plans. I told her that in my last Therapy Contract ³, with the last therapist I saw, I had agreed that I would contact Crisis Team if I felt like this, and that I could be dealt with by them directly. From that information, I'd always thought that because I was "in the system" I could then self-refer. It turns out this information was wrong. The woman told me that I couldn't self-refer and would have to either go to my GP (closed by that time), go to the walk in centre (all the way across town, and would be closed by the time I got there) or A&E (they have a very poor reputation for dealing with mental illness). I choked out a "thank you, bye" before hanging up. So that was it. There was NOTHING I could do when I'm in crisis. Nowhere I could go where someone would be able to help. This made me feel even worse, so I decided to go to my room, pick up a pen and notepad, and write down my bank details, passwords etc. I hid this and told mum that I'd done this, in case anything happened. I wanted her to have that bit of money if she needed, and to have my online details so she could let friends know what had happened. It seemed to make sense to me to do these things. There was a plan I wanted to follow (which I won't detail here, as it could be very triggering) but mum wouldn't let me out of her sight. If I'd been on my own, I don't have any doubt that I would've followed through with it. So I was stuck. I couldn't do what I WANTED to do (suicide), or what I SHOULD do (get professional help). I still felt incredibly low, I still had the very strong urges, but all I could do was exist. I still had very bad pains, and wanted to escape from things, so I decided to start my Tramacet ⁴. I knew the side effects involved things like drowsiness, feeling spaced out etc. That sounded like the only thing I could do for myself at that time. It started to work, and even helped the pain,which I was so glad of. I thought I could just wait out these feelings, and that the Tramacet would help me escape them for a while. In the end, they made me very sick though. Clearly I should've eaten more, and just taken the one tablet instead of the prescribed 2. I had to throw up about 5 times, and the pain and exhaustion this caused, brought all the strong suicidal urges back.

Twitter was my outlet that day; more so than usual. I felt incredibly guilty for talking through everything, being so negative and moody. I am so sorry for worrying so many people. I wanted to let people know what was going on, but I think my tweets were getting pretty scary.

Mum decided to call NHS Direct (111?) around 11.30pm to see if there was anything they could suggest. I wasn't sure exactly what was going on (I was starting to dissociate ⁵) but she told me that a nurse wanted to speak to me. I tried my best to explain what had happened, how I was feeling etc. The nurse was very nice and said that I would be speaking to a doctor next, and that they may send a doctor out to me. I then explained everything I could do the doctor. I can't remember everything they said (I was very confused) but I remember them saying that an out of hours GP would be sent out & that it may be a few hours. When they hung up, all I wanted to do was go to sleep. I kept telling mum to cancel and (lied) that I would be fine. She didn't believe me though.

The GP arrived much sooner than expected (around 1am?). I didn't like that he asked so many questions that made me even more upset, but in hindsight he needed to get an idea of my medical history, childhood, family life etc. He asked me if I'd been abused, had I ever been sexually assaulted (this is something that happened when I was about 17. I've not spoken about it on this blog, but I may do at some point soon), how my relationship with family was, what my childhood was like (I rambled about bullying then, and the times I used to bite and scratch my hands), what I'm diagnosed with etc. We also spoke about the suicidal thoughts. He didn't exactly help, with the things he was saying. He spoke about consequences, and how I'm luckier than some people because I have a family etc. I thought he'd understand that Depression doesn't discriminate! I could be a millionaire and still be depressed. Granted, more contacts and money helps, but no one is immune from mental illness, just like no one is immune from a lot of physical illnesses. Sometimes these things just *happen*.

Once I'd answered all his questions, we discussed meds. I told him about all the antidepressants I'd tried, what I'm on at the moment, whether it helped (it didn't) and why the GP hadn't changed my meds. I told him that she was reluctant to try me on anything else at that point, because I was at a huge risk of suicide. He advised me to see my GP the next day, and ask to be referred directly to a Psychiatrist. I knew no better, so thought that she could do this (especially if I was having severe symptoms). He also gave me 2 Diazepam (2mg x 2) to get me through the night. I didn't think he'd be able to help further (why didn't they send someone trained in mental health??) so I gladly took the meds, and his advice. The Diazepam did calm me down a lot, stopped me throwing up, and helped me sleep.


Thursday

The Thursday I was really exhausted and felt fairly calm, so decided not to contact the GP yet. That could be done the next day. I just wanted to have a quiet day, where I was kind to myself. I did worry that if I didn't get further treatment, however, that I'd go back to being in crisis.


Friday

I managed to get a home visit with the GP on Friday. I told her everything that had happened on the Wednesday night, as well as what the out of hours GP had said about the psychiatry referral. She told me that she didn't have authority to refer me directly to a Psychiatrist. Everything went through the Referral team (RAS), or Crisis team. She told me that she would refer me to Crisis Team for an assessment, and that she would prescribe me a "rescue course" of Diazepam, to take on my worst days. Apparently it's a strong and addictive drug, so shouldn't be taken every day. She asked me if I'd been in contact with Healthy Minds. I'd told her that I had, and that they had put me on the (8 week) waiting list for High Intensity therapy (for one more go at CBT) and told me to ask my therapist to put me on the (9 month) waiting list to see the Wellbeing team. My GP was shocked that I hadn't already been referred to both, so said that I could ask the Crisis Team to refer me to the Wellbeing team and see if I could be seen by them, sooner. She said that the Wellbeing team consisted of CPNs, Support Workers (or something similar) and that they had a Psychiatrist; who I could hopefully see. It sounded as if there was more support there for me, so I was satisfied with the information I'd been given. I even felt hopeful that this assessment would open doors for more support for me. Surely this would be the turning point for me, so I wouldn't keep getting the same old generic CBT?

Later that day I received a phonecall from one of the CPNs in the Crisis Team. She made an appointment for me to see her on the Saturday morning, at the psychiatric hospital near me, where they are based.


Saturday

Dad drove me to the hospital in good time for my appointment. The CPN who greeted me, was the same one I had spoken to on the phone the previous day. She sounded very approachable and compassionate, which set my mind at ease slightly.

She asked a fair amount of questions, such as my medical history, what family life was like, childhood etc. I spoke about the self harm, the bullying, what I think made me worse etc. I know I wasn't being very fluent, but she did make a lot of notes. I also mentioned the dissociation. As far as I was aware, this wasn't a symptom of Generalised Anxiety Disorder or Depression. Not at the frequency I experienced it anyway. I told her what seemed to trigger it, when I started getting it and how I felt during. She seemed very interested to know more. I also spoke about the Agoraphobia and  the paranoia that came with it. She also wanted to know more about the suspected Obsessive Compulsive Disorder. I said I'd been reluctant to self-diagnose because of the information I had about it. Also the fact that I thought I only had obsessions and compulsions with one particular thing. She asked me whether I ever had any particular routines when I was younger. I had to think a bit but I realised that actually, I did. When I was a young teenager, and being badly bullied, I used to keep certain "lucky charms" in the pockets of my school blazer. I always kept certain objects in certain pockets. I also checked all of them a lot of times, to make sure they were still there. I told her that I knew it was ridiculous, but I thought that if I didn't make sure they were there, or if I forgot them, that I would have a really bad day.

I'd started learning about Paganism at that age too. I didn't mention this to her, but I used to say certain blessings the night before school. I felt that I had to say these blessings, otherwise something awful would happen the next day. The "awful" thing being the bullying getting really bad, or me being humiliated. I never spoke to anyone about this. It was a very private routine.

After hearing what I had to say, she made more notes and told me this did sound like OCD, but of course a therapist would have to confirm this.

She also told me that I couldn't be referred for High Intensity therapy as well as seeing the Wellbeing team. It was either/or. She didn't say why, but I gathered that this may be due to cutbacks to mental health services. The only other thing she said she would've signposted me to, was a group service for young adults with similar mental health problems. Unfortunately, it involved travelling into town to meet the group (not possible because of my Agoraphobia) and the service was only for people up to the age of 25 (I turn 25 next month) so they'd be unlikely to accept me anyway.

We then spoke about medication. She told me that I wouldn't be able to see the Psychiatrist, but she would speak to him to see if he could suggest a different medication to the Amitriptyline. In the meantime, I was to keep taking it. Another thing she said (which I found very interesting!) was that I could take the Diazepam every day if I needed to. Also that I was on a low dose, so that could be increased if needs be. Our session ended after this, and she asked me to wait at Reception while she looked for/spoke to the Psychiatrist. Unfortunately he was in the middle of an assessment, so she took my number and said she'd call me later with his verdict.

She kept her promise, and later that day I received the call from her. The Psychiatrist said that I was to stay on the Amitriptyline for now (as I'd only very recently had the dose increased) and to take the Diazepam as needed (so, not every day). If I still found the Amitriptyline unhelpful, then I could ask my GP to refer me to the Psychiatrist for a one off appointment, to review my medication. The CPN also said that if I felt I was at risk again, then I could call the Crisis Team, but I would only receive telephone support.

I'm glad that they are trying to give me a bit of extra support, but it doesn't feel as if this is nearly enough. A lot could happen in the 8 weeks I'm waiting to receive a High Intensity therapy appointment. Sure, I could ring the Crisis Team but, unless I have my crisis at a 'convenient' time, how on earth can I receive any actual support from them? I've been told so much conflicting information that I'm not sure what I can do if I go into crisis again (apart from take Diazepam and hope it knocks me out). I feel as if there has been a massive breakdown in communication between GPs and Mental Health Services. It's hard to know what the truth is, but from what I can gather, the referral team are the gatekeepers to extra support, and they appear to be keeping those gates firmly shut.

I'm lucky that I have my family and friends to support me in those times, and contact services when I refused to, but what if I lived alone? What if I'd alienated all of my friends and had no one to turn to? It doesn't bear thinking about.


Sources

1. Crisis Team - http://www.bcpft.nhs.uk/services/for-adults/83-community-services/14-crisis-resolution-and-home-treatment-team

2. CPN (Community Psychiatric Nurse) 
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/mentalhealthinthecommunity.aspx

3. Therapy Contract - http://www.privatepracticehub.co.uk/therapy-contract.php 

4. Tramacet - http://www.netdoctor.co.uk/aches-and-pains/medicines/tramacet.html

5."Dissociation (psychology)" - http://en.wikipedia.org/wiki/Dissociation_(psychology)