Connecting the Dots: Counselling Session 8

(TW: Abortion discussion)

This session, I told my counsellor how I'd been feeling very overwhelmed with everything. She asked me to embellish, and I said how a lot of it was due to triggering news and discussions, as well as bad political news items. I read up on this because I'm interested in it, but it does get me down; especially when it seems that a lot is going wrong in the country or the world. I've also found it hard to reply to private messages from friends, due to being so overwhelmed. As much as I love talking to friends, it can be a draining process when there's lots of messages, and/or long messages. I think about what I need to do in order to reply. It includes:

1. Reading the message
2. Processing each point made
3. Thinking about what to reply with
4. Writing it out, while re reading parts of the message received so I don't miss anything out
5. Reading through my reply to make sure I've written it properly and the tone is alright
6. Sending the message
7. Waiting for a reply
8. Go back to step 1 and repeat

Eventually, I have to distract myself from messages and reply again in a day or two (or a week or two if I forget!). I feel bad for ignoring my friends, but I literally don't have the energy for long conversations anymore. 

As for the triggering news, a lot of it was about abortion, and a certain politician's views on it. I just can't seem to cope with other people's opinions on this topic. Whenever there's a negative view towards it, I take it so personally, and it brings me right back to my own traumatic experience. It took a while for me to realise this was a trauma for me, and I haven't processed what happened, and my feelings about it properly. The way I was treated was in a cold, uncaring, judgmental way. I didn't feel supported by the medical professionals I was under the care of. I was not offered the counselling I so desperately needed after it was over. I just had to get on with life at university as if nothing had happened. I remember feeling so numb sometimes, and so low other times. I would spend time with my then partner (the one who turned out to be abusive) in silence. I know it affected him too, even though he wasn't the father. Nowadays, discussion (or even mention) of abortion makes me panic, feel scared (as if I'm in danger), very low, guilty, I have graphic mental images of the abortion itself, I can even feel the physical pain I was in. I think I do actually have flashbacks now.

I certainly wasn't as fluent in talking about the abortion face to face, as I am, writing it now. I can sort of disconnect when I'm the one talking about it. It's almost as if I'm talking about a character in a book; not myself. Face to face, talking it through with another person, and hearing their views on my experiences, is different though. As I tried my best to talk through what happened and how I felt, as well as the feelings and mental images I have when experiencing flashbacks, I began to feel breathless and panicky. I also became dizzy and struggled to pronounce words. Every time I said a long word, I kept repeating it, and saying to the counsellor that I wasn't sure if I'd pronounced it properly. It was all very weird. I felt very weird, and it took a little while for me to get to a point where I could talk about other things.

The bad news around the country and the world fed into my low mood. I felt as if everything was going wrong. I catastrophised things and felt hopeless about it all. I wanted to help people, but with situations in the country being so bad, I didn't know if I would be able to do it. 

After listening to all of this, my counsellor said we should do an exercise. She handed me a sheet of paper, and asked me to write "Low Mood" in the middle of it. I was then asked to draw a spider diagram; writing the things that related to this feeling, or happened to lead to it etc. The things I wrote included the following:

• Abortion - Not processing what happened properly. Feeling trauma, panic, shame, guilt and loss. Complex thoughts around the foetus; thanks to pro life/anti choice opinions. Worrying about this being a loss, and I might never have a chance to have a baby again
• Low self esteem 
• Bullying
• Frustration with myself - not being able to fully control my mental health
• Feeling I'm lacking a sense of purpose
• Using therapeutic techniques, but them not working
• Wanting to control things, e.g. my own mental health

I explained each of these things, as I wrote them down. A running theme seemed to be wanting to control things. We then went onto another exercise. This time, I would draw a sort of timeline, with the word "Control" in the middle, things that fed into or led to the need for control, along the left hand side of the timeline, and pros and cons of having control, on the right hand side. 

Left Hand Side:

• My early beliefs about the world, and people. I'd been taught that if I was nice to people, they'd be nice back. If I helped people, they would do the same for me. 
• When I was bullied, I found that the bullies acted in a way that I didn't expect, so this threw me off. I wasn't prepared for this, so I had no idea how to respond.
• After a long time being bullied, I began to wonder if I even deserved to feel good and have people being nice to me. After all, these people had been horrible, so surely they wouldn't do that if I didn't deserve it? (Remember, these were my early views, I know the world doesn't work like this now)
• Because of all this, I began to want to know what would happen next, in situations, conversations, people bullying me etc.
• I wanted to predict the future, and read people's minds, so I knew how to respond.
• I felt helpless, weak, useless, like a failure, like I would humiliate myself
• So in order to fix this, I needed to gain control.

Right Hand Side:

• Control would lead to reassurance, certainty, feeling strong, knowing how to respond to situations and people. 

As for the negative side to gaining control, this will be discussed in my next session. My counsellor told me that there were only 4 sessions left, so to be aware of that. We discussed what I wanted to do next. I said that counselling is helping me progress, but I need something more intense and specialist in order to focus on and hopefully process properly, the traumatic abortion that I had. I felt I needed some sort of trauma therapy or EMDR. I asked my counsellor what was available. She told me that under this mental health team, the only therapy they offer for trauma is CBT. This is something I've had before, for Depression and Generalised Anxiety Disorder. I didn't find it helpful, so I didn't feel very sure that it would help my trauma either. I told her that I'd give it another go, but only because it was that or nothing, so I'm not sure if I'm in the right frame of mind to be having it at all. 

My only other option is to consider private trauma therapy. I've looked up what's available in my area, and the prices start from around £80 for an hour's session. My only regular income is from ESA and PIP, so there is no way I could afford this, on top of all my other bills. I recently decided to set up a Ko-Fi page, which asks donors to buy "coffees" for the person whose page it is. You click on the amount of "coffees" you want to buy, and that goes directly to the person's Paypal account. I have had one donor so far, who I am so grateful to. I need to raise around £800 though, so I can get enough sessions of trauma therapy. The button that links to my page is on my blog, but I've placed the link again here in case anyone would be kind enough to donate and/or share.

Resources

Counselling for trauma and PTSD: https://www.bacp.co.uk/about-therapy/trauma-and-ptsd/

What is EMDR?: https://www.emdr.com/what-is-emdr/

Cognitive Behavioural Therapy: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

"It's a Process" : Counselling Session 7

(TW: Suicide mention, sexual assault details)

I've been extremely depressed this week, to the point of having suicidal thoughts again. Usually, the Sertraline helps calm these thoughts and urges (I'm on the highest dose, so it should be bloody doing something!), but recently, they have managed to break through. I know that there is about a 90% chance I won't actually attempt, but that's because my cat, Billie, is my safety net. He sees me as his mother, and he relies on me all of the time, so I need to be around to take care of him. In that sense, it doesn't matter how much I want to end my life, that option is not available to me.

As well as this, I told my counsellor about what happened at the pharmacy. (You can read about that here , if you want to.)

I told her how the feelings and thoughts, as well as the reactions I had were almost identical to the time I was sexually assaulted at the bus station. It was as if I was having a flashback. I knew that I was in the pharmacy, but I was taken right back to the bus station; having all the alarm-bells-ringing thoughts and feeling like everyone could see what was going on, but no one was doing anything. I felt like I was completely alone and cornered by this strange man. I felt like he could do whatever he wanted to me and I couldn't do anything about it, because I didn't feel strong enough to shout at him etc. All I could do was freeze, or flinch away, and hope the whole thing ended ASAP.

My counsellor wondered whether I could link my reactions etc to the abusive relationship I was in. After some thinking, I said I probably could. The sort of running theme was being connected with a man who felt he had some sort of ownership over my body. The abusive partner was a virgin before he met me, and he basically said that I was obligated to do things for him that he'd never experienced before. As if I was less of a person, and more of an object to fulfil his desires and need to learn about different sexual experiences. When a man treats me in this way, it makes me feel less like a person; as if my identity is either non-existent or doesn't matter to anyone (least of all, him).

I wonder whether my counsellor feels I have PTSD, as I have had traumatic things happen in my life, and the hypervigilance and flashbacks I have are very similar symptoms to what a person with PTSD would have. She asked me to talk more about the hypervigilance and flashbacks too. She seemed interested in learning more about my experiences. In our first session, she did say what I went through sounded like Post Traumatic Stress as well. Whether I pursue the diagnosis or not, I'm just not sure. Unless I can get NHS funded treatment, just having the label doesn't seem that helpful.

We then got onto the topic of identity, and how my mental health and disability blogging and advocacy, had become part of my identity. That isn't a problem in itself, it's just that my online identity, where most of my friends are, only tends to show part of me and my interests. I have occasionally let my friends and followers know about the other interests I have (gaming, cross stitch, singing, keyboard, guitar, flute, metal music, rare nights out, gigs etc) but I don't make them very apparent. I do find myself wondering how well my online friends know me as a whole person. I often see conversations between friends, about their favourite band, film, TV show, game etc and I wonder whether they know mine? I do mention things like Sims 3 (my favourite game), or share posts to do with cute animals or gothic clothing. I told my counsellor that I feel there's a lot to me, just like everyone else, but it's like I've not given myself the opportunity to express other parts of my personality, interests, and hobbies. I worry about losing part of my identity, and I am desperate to grab opportunities to express those parts. Blogging and advocacy are very important to me, but my other interests have their place too. If I spent all my time focusing on the lack of access for disabled people, in many areas of life, and the discrimination faced by people with disabilities, mental health problems etc, I don't think I would ever be happy. Regardless, I still think I don't advocate for my fellow disabled and mentally ill people enough. I want to be stronger, more assertive, more resilient against critical/abusive comments online.

I told my counsellor that I struggled to move forward in life, because of my mental and physical illnesses. I doubt myself, and I struggle to believe in my own abilities and talents. I never say "I play guitar", I say "I play guitar very badly". I still do need to improve my playing a hell of a lot, but I am still able to play, and I shouldn't put a negative spin on things.

I guess that's what Depression and Anxiety particularly do. They make you doubt yourself as a person, as well as the things you do. They enhance your perception of your faults, and minimise your perception of your abilities. It's very hard to fight against all the negative thoughts that tell you that you're failing, or not being good enough.

I'm so fed up of myself and my situation, and I want to do everything in my control to improve.

I asked my counsellor how I could move forward. I told her I was stuck, analysing my problems to a certain degree but not knowing what to do next. I told her what I tended to do in therapy, counselling etc is give the therapist as much information about me as possible, in the hopes they can take that, analyse it, and tell me what steps I need to take to feel better. My counsellor and I agreed that it's not as simple as that. She said that if she did that, and the steps I took didn't work, I'd never be able to trust her again, and the therapeutic relationship would break down.

She told me that therapy/counselling is a process. Throughout the sessions we do what we can to recognise my problems, link them to other things that've happened in my life, make connections, and then hopefully I will go away and think about these things, then come up with ideas for ways I feel ready to move forward. In a nutshell, the counsellor can't give me all the answers and steps to take, all she can do is help me to help myself.

I think these counselling sessions are making me think about the whole process in a different way. I know I'm still searching for answers, but I can't expect the counsellor/therapist/CPN/whoever to find them for me. I need to be patient with myself, and focus on my progress as well as my struggles. I can only be guided.

I'm still not entirely sure how to move forward (apart from joining a choir, or other class relevant to my interests) but I'm gathering information about myself, with the help of my counsellor. I did feel a little better when I came out of my counselling session though. I may not be able to completely control my health, but maybe I can shift my focus or include my interests a bit more, in order to improve my quality of life? I think my counsellor wants me to live in the moment, rather than worrying about the future (whether I'll get married, have children, work again etc) all the time.

My next session is in a couple of weeks, but I will try to write a different post in the meantime, so watch this space!

(I've also set up a Ko-fi page, as I'm needing money for disability based things. One big thing I need is private trauma therapy. If you like my writing and want to read more, please consider donating and I will try to write more often)

Resources

Counselling Session 6: https://www.amysmysteryillness.co.uk/2019/06/judgement-and-entitlement-counselling.html

Symptoms of PTSD:  https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#.XQgaQLxKiM8

Amy's Ko-fi page ko-fi.com/amysmysill

Society's Influences and Stigma: Counselling Session 5

(TRIGGER WARNING: Mentions of self harm and sexual assault)

Leading up to this latest session, I'd been very low, anxious, and lacking motivation. My physical health isn't great (which affects my functioning enough already) but my mental health is quite poor at the moment, and the lack of motivation that forms part of my Depression, really affects my ability to do daily tasks.

I managed to wash and dress, as well as feed myself, but this exhausts me enough. I want to be able to do more, more often, but I'm not on sufficient medication for my pain, so it becomes quite debilitating. I feel like I'm constantly having to balance looking after my mental and physical health.

Anyway, back to the counselling session. My Anxiety and Depression scores were high again, and I told my counsellor that the main things bothering me at the moment were my lack of motivation and worrying about my mum's mental health. I won't go into detail about mum, as it is her business to tell who she needs/wants to. I just want her to get the help she needs to make her life easier to cope with.

We ended up talking about all sorts of things, including how certain things that have happened affect my moods at the moment.

We did an exercise where I had to write down the big events that I think have affected my mental health. These were the termination, the bullying at school, and the abusive relationship at university. Underneath, I put the moods that have resulted from these things. Finally, I wrote down the behaviours that these things have led to. Here is what I wrote:

Termination:
       Moods: Panic, Guilt, Shame, Low Mood, Anxiety
       Behaviours: Avoidance, Releasing anger by venting online, self harm to punish myself, making myself read/watch triggering things, as I feel I deserve to feel that way.

Bullying at school:
       Moods: Identity Problems, Low Mood, Low Self Esteem, Anxiety, Paranoia, Loneliness, Feeling useless.
       Behaviours: Seeking Reassurance, Avoiding Group Conversations, Self Harm when I feel myself acting like I used to, Lacking Motivation

Abusive Relationship: 
       Moods: Low Mood, Low Self Esteem, Anxiety/Panic
       Behaviours: Seeking Validation, Second Guessing Myself, Hyper-awareness, Being Suspicious of Men, Being Promiscuous in the past - seeking comfort, but with risky behaviour

The moods and behaviour from the termination are very complex and contradictory. I either avoid everything, or flood myself with everything. I show self-destructive behaviour; where I am constantly punishing myself, whether that's physically or mentally.

I'm the same with the bullying and the abusive relationship. All the comments and judgments made about me have formed part of my identity and made me feel suspicious of some people. I worry that people have ulterior motives and don't really like me/just as a friend.

I remember a time a friend of mine and I were thinking about meeting up. He'd been quite flirty and I had my guard up, so I kept putting him off. One day, when my parents were on holiday, he turned up out of the blue. Suddenly my safe place (i.e. my flat) didn't feel as safe. I let him in as I wasn't sure how he'd react if I didn't. We watched a movie together, but then he started playing with my hair. I felt like alarm bells were going in my head. I thought he'd try to have sex with me, without my explicit consent. I also worried I'd just let him because I wasn't sure what he'd do if I rejected him. As far as I was aware, he never did anything violent, but my mind instantly thought he might.

I've been sexually abused (by a stranger in a bus station) in the past, when I was a teenager. I didn't discuss this with the counsellor, but thinking back, I think this also fueled my suspicion of men who are flirty with me. If I'm not attracted to them, I find it very hard to reject them and I end up feeling violated, and disgusted in myself if anything happens.

We didn't have time to go through everything, but from what I explained to my counsellor, she spotted a pattern. I was very influenced by society's views, as well as possibly wanting to influence society with my own views. She said this was very interesting and important. This is something she wants us to discuss and unpick in subsequent sessions.

Although my moods have still been pretty awful, I'm at least feeling like I have a good therapeutic relationship with my counsellor, and it helps to talk about how I've been feeling. She gets me to explain certain things I say, gives her view when appropriate, and helps me to understand and pick up on things. I do feel positive about these sessions and I'm hoping in time I will be able to talk more freely about the things I've been through.

There's no "homework" as such, for the next session, but I am continuing my journal and at the very least, it is helping me monitor my moods and fill in the PHQ etc questionnaires.

What Influences Me? : Counselling Session 4

(mention of cancer, suicide method, and death)

At the start of this session, I wasn't sure what to talk about. Not much had happened, mental health-wise, in the last week.

I was still thinking about my old school-friend, who died recently. Although I knew we'd drifted apart, I still blamed myself for not making enough effort. I miss her to be honest. She was a good person.

I'd also had a GP appointment recently, where I was told to taper off my pain medication (Tramadol, slow release) as well as stop my anti-sickness medication. I have struggled with my pain, since lessening my dose of Tramadol, and I'm trying to live with it, but it is affecting my functioning. I want to function better but I can't keep pushing myself to my absolute limits.

As well as this, I'd had some pains around my stomach, hips, and back. The pains were like cramps and were getting to the point where I was doubled over and sweating. The GP seemed concerned about this, and suggested I might have an ovarian cyst. This played on my mind, and I got a bit of a shock when I was handed the blood form and found they were testing for cancer (I reckon ovarian cancer, but I'm not sure if they test for antibodies or something like that.) They say it's around 1 in 2 people who get cancer now, and my parents haven't had it so far, so maybe I won't be so lucky? I'm trying not to think this way, but I can't help worrying this may be a possibility. Even if it's not cancer, any kind of problems with my ovaries makes me scared that my fertility would be affected.

I'm nearly 30 and running out of time where my fertility is at its optimum levels. I feel as if I am running out of time to meet someone, get married, and have children. Life seems to pass by so quickly, and with the death of my friend, it seems to be getting shorter and shorter.

The counsellor seemed very sad that I was thinking this way. She asked me why I thought I wouldn't meet someone.

I said that I just don't see myself having that life, and I'm scared that nothing will change unless I change parts of myself. But how? Where do I start?

I became upset as I told her that I never felt as if I was "enough". With romantic relationships specifically, I always felt as if I was second best, last choice, or just completely unimportant, so I felt like that about myself. I wanted to feel loved, attractive, and respected. She asked me why I felt this was so important?

I said that I wanted to make some sort of difference in the world. I wanted to feel as if my life was worth something, that I was worth something. I don't want to leave this world without doing some good. She also asked me if there were people I looked up to, who had made these kinds of differences in the world. I told her that I had some friends who were very vocal about mental health, and did their best to write in order to tell the truth about mental health services these days, as well as raising awareness and breaking down stigma. They wrote for online magazines and newspapers. They had thousands of followers. I'm not too bothered about having lots of followers, but I do want my opinion to be heard, respected, and understood. I want my words to mean something to someone. I want to do something good, however I can. I wish I had the confidence to do this. I feel I'm wasting my life otherwise.

I admitted that I had done some good. I've been over the phone/text/twitter to someone who was taking an overdose. I have talked someone out of killing themself. According to some friends, my blogging has helped them, and I've helped them by being there for them when they needed it most. I just felt like I could do more, make more of a difference. Even here, I feel like I'm not doing enough, and that I myself am not enough.

After this, my counsellor suggested doing an exercise. She did suggest talking about the future, but I refused, as I was feeling so scared and down about it, that I couldn't bring myself to focus on it right now. Instead, we did more identity work.

She gave me a sheet of paper, and asked me to put myself in the middle. I drew a stick man, and wrote "me" above it. My art skills aren't great...

She then asked me to write the traits I thought I had, around the figure of myself. I struggled a bit, but managed to put things such as "stubborn, determined, wanting to control things, perfectionist, kind, friendly, a good friend, ambitious, impressionable".

We spoke about the traits I had, and I told her that control was a big part of my personality. I'm diagnosed with OCD, although I believe my symptoms are quite mild now, but I am still a real perfectionist who hates to be out of control. We also talked about my stubbornness. My counsellor asked why I thought I was stubborn. I struggled to explain, and couldn't give any specific examples, but I did tell her that when I set my mind to something, I would usually do it. I would listen to advice from others, but it was ultimately me who would make the decision.

Possibly contradictory to the stubbornness, I also felt that I was quite impressionable. If I looked up to someone, I would try to take on parts of their personality. I would also follow their advice. In the past, I would do whatever someone wanted me to do, without question. Maybe I was worried about the consequences, if I did question them? I have a feeling this is how the bullying started anyway.

Lastly, the counsellor asked me to write down people who gave or influenced these personality traits in me. I won't say specific names, but these included friends, parents, and grandparents. I could link certain things to certain people. I also found myself digressing when I talked about some of them. One was a friend of mine who hasn't spoken to me in a long time. He was someone I had a lot of history with, and still thought about recently. I believed I got my determination and ambition from him, at least in some way. I resented how he hadn't been there for me for ages, when I really needed him. I wish we hadn't complicated our friendship, but at the same time, I still have thoughts about being with him again. I wish I could switch off those feelings, but I had a dream about him recently that brought it all back. I hate how influential my dreams are.

My counsellor and I discussed how it is interesting that people can pass certain traits onto people, without intending to. It certainly made me wonder just how impressionable I am.

There was only a few minutes left of the session by that time. My counsellor summed it all up, and said that she felt I was very lonely, unsure of myself, not really feeling like myself anymore. I want to go back to how things were with some friends, and my own traits (confidence, feeling attractive etc). I doubt myself and dread the future. She asked me what I'd like to do between sessions, in order to make some sort of change in myself. I asked what I could do, but she wanted me to come up with my own suggestions, as this wasn't rigidly structured (like CBT). Eventually, she said journalling would be useful for me. I could put what's important to me, the traits I have/inherit, how I'm feeling etc.

This session brought up a lot of difficult things that I have to face. I cried as I explained how lonely I'd been feeling. It's played on my mind ever since, so found it hard to put everything down on paper.

I will probably post about how the journalling is going, so might have posts every few days. It depends on how I feel. If I don't, then the next post will be about my next ENT appointment, where I undergo Vestibular tests for dizziness and balance problems. After that, I will post about my next counselling session.

Am I Ready?

(TW: Mentions of Self Harm and Overdosing)

Recently I've been thinking about where I'm going in life. There's a lot I want to do, but my health either won't allow it, or causes me to struggle to do it. If this is the first post you've read by me then here are my diagnoses:

Fibromyalgia
Joint Hypermobility Syndrome
Overactive Bladder Syndrome
Irritable Bowel Syndrome
Borderline Personality Disorder
Obsessive Compulsive Disorder (although I'd say this is very mild these days)
Depression
Generalised Anxiety Disorder
Agoraphobia

Some of these illnesses aren't as bad nowadays, but others can be unpredictable. After trying different medication, I've come to accept that this is probably the best my health will be for the foreseeable future. So, what do I do with my life?

I've always been an ambitious person, and I do put a lot of pressure on myself to achieve things. This means I tend to do too much at once, or throw myself into things without considering pacing myself. I want more out of life than I'm getting right now though.

I've considered studying again, but doing it with the Open University so I don't need to travel. I looked into a Masters in Psychology. I meet the entry requirements, and I could get the finance I need, but the only thing I can't do is afford the £2000ish required upfront before the loans are paid in. I want to save up for this somehow, but I don't see how I can save much at all while on benefits (they do not stretch far!)

I've considered working again. It should mean more income, and I could hopefully keep my PIP (if the assessment goes well, as I'd have to report a change in circumstances). Could I manage working though? Even the most basic-sounding office job requires sitting up for hours on end (I often have to lie down), remembering a lot of information, possibly walking to different departments, answering/making telephone calls (I'm not as bad now, but still have phone anxiety), bending and reaching shelves (which I can do, but it's very painful) etc. Even part time, I'd be doing this about 5 days a week. Is it worth compromising my health? How many times would I have bad days, and need to call in sick? What about the days when my anxiety disorders give me panic attacks, my depression causes me to need naps throughout the day, or my BPD causes me to feel such self hatred that all I want to do is harm myself? It's a constant battle, and with the (lack of) support I have available for both physical and mental illnesses, I don't see much changing. The more realistic option would be a home based job, but there's not a lot around that offer regular work that would pay enough for me to live on.

I want to move out before I turn 30 (I'm 28 right now), but I don't know how I will manage on my own. Last time I planned moving out, the stress put me into crisis, I overdosed twice, and even now I still have urges. There's also finances to consider, how I would physically cope with running a house by myself, and how my benefits would be affected because of me having to cope by myself. I can't live with my parents forever though.

I went to a family wedding very recently, and one of the usual questions came up from a certain family member; "so, what are you doing these days?". I mentioned that I blog and I vlog sometimes, but of course what they wanted to know was if I was working yet. The disappointment in their eyes when I said "no" was quite hurtful. I quickly followed this up by explaining I'd been thinking about studying or working. They didn't seem satisfied though. Apparently Psychology isn't the right path to go down for work or study. I should be doing Computer Science instead.

As well as working *and* studying, they expected me to take up driving lessons again (I did learn 10 years ago, but failed my test and couldn't afford it/lost my confidence afterwards). They also wanted me to travel to see them more.

It was very hard to explain why I couldn't do some, let alone all of these things. I also felt I wasn't being listened to, I was just being told what I *should* be doing. The thing is, this family member knows at least some of the illnesses I have, yet they don't seem to realise that chronic means lifelong, and that these illnesses affect my daily life significantly.

This has been playing on my mind a lot recently, and I feel like I'm achieving nothing in my life right now. I spoke to a few friends about how I'd been feeling and got some great advice for testing how I'd manage with the workload of a job, as well as some advice about driving. To my surprise, a lot of people my age and older don't/can't drive. The only reason I might take up driving again is if I have children in the future. Apparently, I may have to check with DVLA as to whether (with my conditions) I'm actually allowed to. Honestly, I don't want to drive. It makes me panic, I don't feel safe or in control, and I don't think it's worth feeling this way. I always felt like I had to learn though, for my family if not myself. To be told by a friend that I don't ever have to drive if I don't want to, was really helpful though.

Right now, I can't say I've decided on anything. I'm looking at job vacancies, but I'm also considering whether I'm ready or not. Studying will have to wait, unless I do some free short courses. Driving is something I don't want to think about right now, and I guess moving out will just have to wait until I'm financially more secure (whenever that will be).

In the meantime, I have to look at the little achievements, one of which will be finishing this blog post!

Do you have a Chronic illness (physical and/or mental) and struggle to work/can't work? What parts of your job do you struggle most with? What are your thoughts?

The Big Meeting

A couple of weeks ago, a meeting was set up to discuss concerns about my nan, and the needs that she has. Nan insisted on being present at that meeting.

Myself, my parents, and some of my uncles were also present. Luckily, we had time to cover one topic out of earshot of my nan. This topic was her mental health and capacity.

Over the past year or so, some family members and I have started to notice some changes in Nan's personality, memory, mood, and ability to process things. She seems very depressed as well as argumentative and verbally aggressive at times. She is finding it hard to follow conversations and often forgets things or mixes things up. She has trouble organising her medication. She does not cope well with bright lights or any kind of noise, and often complains of her head thumping. She doesn't seem to realise how much help she needs either. There's probably more that I can't think of right now, but these signs and symptoms are definitely worsening.

I explained all of this to the staff present (namely a doctor, an occupational therapist, a social worker, and a discharge nurse) and the doctor said he would arrange for Nan to have a cognitive assessment. I think the nurses involved in her care had noticed certain things themselves.

Straight after this, my nan came into the room. She basically lectured us on speaking about her behind her back. I wasn't sure what to say to this as I feel conflicted about it. I don't like to speak about people behind their back, but there are important things to be said that might not have been put across properly if Nan had been there. She tends to speak over people and doesn't allow them to finish what they say, especially if she disagrees with it. We needed to be able to voice some of our concerns in a way that would allow the hospital staff to understand.

Once Nan had (finally) sat down, other concerns were voiced by the present members of family. These included her struggles with sleeping in bed (she sleeps in her recliner chair as she cannot lift her legs to get into bed), as well as struggles organising medication, needing night visits from carers (but these not being available), problems with incontinence, problems controlling her type 2 diabetes, the help she needs to shower, and other help she may need since having a major operation (a full hip replacement).

Naturally, my nan disputed a lot of things and we had to explain to her why we had these concerns. The discharge nurse, occupational therapist, and social worker tried their best to explain too. The occupational therapist had a list of equipment she could order to make Nan's life a little easier. This included a shower chair with a back, a commode in her bedroom, a grabber (as she is not allowed to bend from the hip more than 90 degrees), a perching stool, a key safe, and equipment to help her lift her legs. Nan rejected a lot of this equipment, saying she didn't need it, but she did agree to the shower chair, perching stool for the kitchen, and key safe.

The next topic was help with care. The occupational therapist explained that Nan would have visits 4 times a day, for up to 6 weeks, from the Enablement Team. This is a team of carers who would observe and encourage Nan to do what she can for herself, and help her with things she cannot do. This help is free, and is designed to rehabilitate Nan so that she is able (with the help of carers) to look after herself in the community. Nan didn't see the point in this, as she believed the carers at her care home would do everything whenever she asked. This is not the case however, as the care home she lives in is vastly understaffed, and does not provide night visits. The Enablement Team unfortunately do not offer night care either, so would see my nan first in the morning.

Once everything had been agreed and clarified, the meeting came to an end. The family were left for a few minutes, to discuss things amongst ourselves, and this included explaining things to Nan again. She seemed to accept what was going to happen, if reluctantly.

--------------------------------

Yesterday, Nan was discharged from hospital, and brought home by hospital transport. We were told the transport would arrive at 12, and it'd be around 12.30 that she would be home. What actually happened was the transport arrived at 1, and dropped Nan home around 3! My dad was left waiting 3 hours to let the transport staff (and my nan) in the flat. Luckily, she'd had lunch before being discharged, so didn't complain about that. The Enablement Team arrived a couple of hours after that. I am waiting to hear how she is getting on with this team, so I will keep you posted!

Self Care New Year's Resolutions

The end of a year can be very difficult for many people; bringing up mixed emotions and placing expectations on us to think over the past year and make resolutions for the new year.

I find resolutions difficult to make/stick to, and the guilt and failure I feel when I don't stick to those resolutions can be very damaging for my mental health. Mental health problems, such as Depression include symptoms such as guilt and feeling like a failure, so another dose of that is definitely not welcome! I have general aims I'd like to meet, but no strict resolutions. I decided to put them here, in case they may be helpful for you. Of course, you can tailor them to your abilities/what you feel able to cope with!

1. Be kinder to myself.  Specifically, I want to try not to say such horrible things about myself and focus on the more positive things I can find. I can't be all bad, right?!

2. Do my best to set boundaries. If I am not comfortable with something, it's ok to say no! If I am finding a friendship is becoming toxic, it is ok to step away and even end that friendship if I feel able to.

3. Stay connected to loved ones. I am terrible at starting conversations. I know I expect people to talk to me first, and I feel very alone if no one does even for just a day. I want to take that step and say hello to someone first.

4. Let friends/family know if things aren't going well. I don't need to bottle up my physical or mental health problems. If I'm in pain, it's ok to say! If I'm feeling down, it's also ok to say! That bit of support I hopefully get in return can really help my mood.

5. Take time for myself. Although I shouldn't isolate, it's ok to take some time out for myself. Being round people can be exhausting and overwhelming, so it is a good idea to have that time and space for myself.

6. Do a nice thing for myself every day. This could be watching a movie I like, playing a game, treating myself to a favourite snack, or putting on makeup and taking a few selfies! Whatever I consider a positive, mood lifting thing counts.

7. Stay hydrated! I know I don't drink enough water, so I often try to aim to remedy that. Apart from other drinks, I manage half to a whole 500ml bottle a day. I want to double that.

8. Try not to put too much pressure on myself. There's quite a few resolutions here, but I need to remember that these aren't set in stone. They are just guidelines, suggestions even. If I only manage one or two next year, that's fine! I'm not a failure if I can't manage to meet all of the above.

Are you setting any resolutions for 2018? Comment below with your suggestions!

Whatever you do, I hope next year is the best year so far for you. See you then!

Another CMHT Assessment

TRIGGER WARNING: mentions of overdose

To catch up on my experiences with mental health services, please watch my playlist on Youtube.

After another sharp decline in my mental health, and a small overdose, I decided to call the Community Mental Health team (secondary services). It'd been just over 3 months since I'd been discharged back to my GP. I was feeling confused, panicky, lost, and honestly unsafe.

Some things had contributed to my mental ill health; one of them being a PIP reassessment. I knew there was the possibility of having a face to face one, but being given just two days' notice was a real shock. I felt like I wasn't able to properly prepare, and I didn't have time to arrange a recording of my assessment. I vented about this, how I'd felt, and what I'd done, on Twitter, and some close friends persuaded me to contact mental health services.

Doing this wasn't easy. I doubted myself, and wondered if I really was ill enough for their help. I took a deep breath and called though. The person I spoke to was lovely. She said I'd done the right thing and booked me an appointment for an assessment with a CPN (community psychiatric nurse).

The assessment itself was thorough. It wasn't with my old CPN unfortunately, but this one was just as kind. We went through my problems right now, things in the past, things in the present, possible triggers, my meds, what therapy I've had before, whether I'd been with secondary services before etc. She wrote a lot of notes, and I hoped she could do something for me.

Her decision however, was to advise me to try mindfulness at home, and wait for the CBT (cognitive behavioural therapy) sessions with the Primary Care team. I did ask about DBT (Dialectical Behaviour Therapy), as I'd been diagnosed with BPD (Borderline Personality Disorder) but she said things had changed with the mental health team, and I may not fit the criteria for that type of therapy. I was emotionally and physically exhausted, so I just accepted this, and said goodbye.

I'm not sure how I feel about this assessment. I think I feel listened to, and I guess I wasn't expecting much in the way of help, but last time I was assessed, I felt pretty much the same and was offered some help from secondary services. In all honesty, I feel I've been abandoned since my BPD diagnosis, even though there are therapies suggested for it. Why am I not getting access to these, when they could help me a lot? Is the diagnosis just not enough anymore?

Resources

My Mental Health Vlogs:  https://www.youtube.com/watch?v=0kX521jdPAU&list=PLLVKOK6LyfuspXXsZ0xdiKCW_Z6SYjTzO

CPN definition: https://en.wikipedia.org/wiki/Community_psychiatric_nurse

CBT definition: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

DBT definition: https://www.mind.org.uk/information-support/drugs-and-treatments/dialectical-behaviour-therapy-dbt/#.WiGLcUq6-M8

BPD definition: https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/#.WiGLtkq6-M8

Going Abroad with Chronic Physical and Mental Illnesses

Last month, I went on holiday to Gran Canaria, with my parents. As a person with multiple mental health, physical health, and mobility problems, the thought of travelling abroad can be quite daunting and nerve wracking. Will I remember everything I need to pack? How would I be able to get across a large airport, when I can't walk far at the best of times? How will I keep myself calm? Will there be toilets available nearby? How can I plan my holiday to make sure I'm not overdoing it every day? These were just a few worries that I had. Below, I explain how I eased or solved these problems.

Packing:

About a week before I was set to go, I made lists of things to pack. I wanted to ensure I would be able to keep as cool and comfortable as possible.

• I picked clothes that could mostly be slipped on, with no fiddly fastenings to deal with.
• I made sure I packed extra medication (including extra pain medication) so that I definitely had enough for the holiday.
• To keep myself cool (as well as for easily removing makeup!), I packed a full pack of face wipes. 
• I packed travel size bottles of shampoo, shower gel, moisturiser etc. These are useful for keeping the luggage weight below the allowance, but also are easier on achy arms. There will be days where washing/showering is a struggle, so light products are helpful.
• Dry shampoo! I usually try to shower every other day, but sometimes I have to miss a few days, so dry shampoo is absolutely wonderful for ensuring my hair stays relatively fresh and clean.

At the Airport:

There are various things to consider, when at the airport, especially when you are chronically ill (physically or mentally). 

• It is important to book special assistance at least 48 hours before you are due to travel. 
• As soon as you arrive at the airport, find OCS for special assistance. They can help with getting across the airport and through security, as well as boarding the plane and even getting you to your seat (using an aisle wheelchair) if needs be. You can use your own wheelchair, if you have one, or one will be provided for you. There may also be mobility scooters available if you'd prefer to use those. I flew from Birmingham airport and found OCS opposite the Spar shop in departures. Make sure you have your passport and boarding ticket to hand, to show when asked. 
• This link will give you more information about special assistance at Birmingham Airport specifically. For any other airports, there should be information about disabled facilities and special assistance on their website.

On the Plane:

• Ask for assistance, if you need help with putting your hand luggage in the overhead locker. Airline staff are there to help!
• I find it's helpful to have anything you need for the flight to hand (maybe in a handbag if it fits) so that you won't need to get to the overhead locker and search for your bag amongst the others.

Arriving at your destination's airport:

• It's likely that passengers will need to alight the plane via the stairs (unless you're lucky and a tunnel is ready!) An ambilift will be available, however, for passengers needing special assistance.
• You will need to wait until everyone (not needing special assistance) has left the plane, before assistance and the ambilift will be available. This may take a little while, so it's best to remain seated until you see special assistance staff.
• If you have checked in your own wheelchair, it may be the case that it will arrive on a different carousel to your suitcase/s. At Las Palma Airport, the wheelchair arrived on the last carousel to the right. We weren't made aware of this beforehand, so had a bit of a panic before a member of staff advised us!

Transfers from the airport to your destination.

• Coaches can be a nightmare to get onto; with large steps and rarely any toilets. The amount of stops they make can increase the journey time by a lot as well. I would suggest booking a taxi. It pretty much halves the journey time!

At your destination

• I know it's tempting to plan to do a lot on holiday (especially if there's lots to do/explore!) but consider what makes you flare up. As you would at home (when having plans for days/nights out), rest up as much as you can, before doing anything potentially flare-inducing. Most hotels have areas near reception where you can relax, so keep that in mind if the cleaner needs to access your room. 

Are there any other tips you would give for fellow spoonies? Comment below!

Resources

https://www.birminghamairport.co.uk/at-the-airport/terminal-facilities/special-assistance/

How it Feels to be Numb

I'm having a numb day today. I have these a lot. If I've recently had days with intense mood swings, this can be a relief, but other times, it makes me feel as if I'm broken.

It can be hard to tell if I'm thinking or feeling these things, but when I'm numb, it's like I'm not even human. I'm just some thing that exists with no real purpose. Sometimes self hatred will creep in and I'll become very depressed, but mostly, I don't feel anything.

I want to be "normal" and act like a human being. I want to know what kind of person I am. I want to know what my personality is, and why I should even exist. I want to interact like a "normal" person, but it's as if I've forgotten how. I feel like/think I am an imposter who has to perform reactions and guess how I should respond to things such as someone talking to me. I feel as if I'm doing everything wrong though, and others will notice, and think I'm either weird or rude.

Most of the time, when I feel numb, I dissociate too. Nothing feels real, and I struggle to "ground" myself. I try to focus on things I can see, smell, touch etc but it can be very difficult to convince myself that these things mean that I am real, and I am here.

Eventually, I will come out of this numb feeling and hopefully not straight back into intense mood swings. At the time though, it's as if I will never come out of it.

Do you experience numbness? How does it feel to you?

After CMHT Discharge

On 26th June, I was discharged from the Community Mental Health Team (CMHT). I was told I'd be sent my care plan in the post, so I'd know what to do depending on how well/ill I feel. At the time, I was having a fairly ok day and, although I felt anxious about being discharged, I accepted it and thought that maybe this was a good time for me to try coping just with self help and my support network of friends and family.

It was about 4 weeks before I eventually received my care plan, and in that time I was feeling more unwell, and really needed to be reminded of what to do. I rang the mental health team, to ask for my care plan, and also with the hope of being able to talk about how I'd been feeling. The line was bad unfortunately, and there was a lot of background noise. I had to repeat myself a lot, and couldn't face talking through how I felt in the end.

When my care plan arrived, I had a look through it and saw that there'd been some errors. On the front page was the Summary/Formulation of Need. It said:

Amy has been seen in primary care, however did not complete her therapy. There has been a history of bullying in school and emotional distress after a traumatic life decision. Amy feels that she has a diagnosis of Borderline Personality Disorder after comparing her symptoms to others and would like an OPA with a consultant psychiatrist in order to obtain a formal diagnosis. She is currently not working due to chronic pain caused by ME and hypermobility. She has agreed to have a short piece of work in regards to self compassion and anxiety management prior to her discharge from services.

26/6/17: Discharged from CMHT to continue her recovery independently in the community

As you may know, I have been formally diagnosed with Emotionally Unstable Personality Disorder (also known as Borderline Personality Disorder), but this was not confirmed in the Summary/Formulation of Need. When talking about my chronic pain conditions, it's written that I have ME and hypermobility. I actually have Fibromyalgia and Joint Hypermobility Syndrome.

The next page gives information on how I will be cared for in the community. In this, it mentions my GP is to provide future care and support. It also mentions my mental health medication (Aripriprazole 10mg and Sertraline 200mg) and that I can self refer to primary care if I need more support with anxiety.

The last few pages advise on what I would notice and what I should do when feeling relatively well (this is coded as GREEN), when I'm feeling that things are building up (AMBER) and when I am at crisis point (RED).

For GREEN, I would notice that I'm feeling more loved, less anxious, more motivated and impulsive etc. While I feel like this, I should continue with distraction techniques, self refer to Primary care if I feel able to tackle anxiety issues, and remind myself of positive comments I've received.

For AMBER, I would notice that I'm feeling low, that there's no point to anything, I'm being more argumentative, panicking, and having urges to self harm. While I feel like this, I should contact CMHT or out of hours and try to use coping strategies.

For RED, I would notice that I am having suicidal thoughts, dissociating a lot, becoming paranoid and isolating myself. While I feel like this I should contact CMHT and I may be reallocated to CPN and/or have an emergency OPA or medication review.

Although this care plan sounds pretty comprehensive, I've been finding it hard to concentrate on it and follow the advice. I've been feeling that I am between the Amber and Red stages, so should really contact CMHT but I'm put off by my experience when calling to ask for my care plan. I'm wondering about whether there's any point to asking for help from them. My mental health conditions are ongoing and what I need is ongoing care from mental health services. I remember my CPN saying that, due to funding cuts, they were only able to offer short term help. Should I call anyway? Will I be able to talk to someone or will there be lots of background noise again? I may need to talk about some difficult/private things and I worry others will hear me.

What I really want/need is ongoing contact with a CPN (preferably the one I was with before). It takes me a while to really open up and let go. I can sound positive if I don't know the person I'm talking to. I find it hard to really say how bad things are, so I may seem ok. Unfortunately, it looks as if I wouldn't be able to get a CPN on more than a short term basis.

I've been trying to use my support network as well; most of them being online. Thanks to social media algorithms, however, the status' etc that I post aren't always seen. I had a time very recently when I was feeling particularly low/paranoid/panicky and posted a status basically asking for friends to check in on me and notice when I'm spiralling. The first time I posted it, no one commented. I posted it again, and one person commented. Although I was of course grateful for one person noticing, I felt upset and angry that no one else had. I felt that surely out of 80ish friends, more would notice. I thought I was being ignored, or that I'd been muted/unfollowed by people I thought cared about me. I felt so awful and I guess I was getting to the RED stage of my care plan. I was too engulfed in my own horrible thoughts/feelings though, so could not motivate myself to read it and follow it.

The next day, I decided to take a break to see if anyone would notice I wasn't online. That only lasted a couple of days because I was so desperate to talk to friends, so no one noticed.

A few days after, I posted another status and was surprised to get a fair amount of comments of support. It definitely made me feel a bit better, although I knew that I still wasn't feeling well. Since then, I've had times where I'm numb, times when I'm emotional, and times where I have self harmed and felt suicidal. These feelings have been changing so rapidly though, I haven't been sure of what I should do. What if I feel really ill and decide to ring CMHT, but then I sound ok when I get through to them? What if they decide I should just rely on myself and then I'm left feeling awful again? Having rapidly changing moods is so hard when it comes to accessing help. Just because I may seem ok at one point (and may be feeling ok/numb as well) doesn't mean I'll feel like that for the rest of the day even!

The self compassion work did help me a bit, and I started to feel less paranoid if a friend didn't reply to me. I could consider that maybe they were just busy or not feeling well enough to talk. A support worker helped me with self compassion. Having that support from her did help me feel a bit better, but now it's not there, I've been feeling awful, alone, and paranoid about friends again.

The distraction techniques help as long as I'm not too unwell. I find it hard to catch myself before I get too ill though. My motivation to use the distraction techniques tends to be quite low as well.

I feel useless when it comes to looking after myself!

What Dissociation Feels Like to Me

This is something I vlogged about a couple of days ago (see below). I've been wondering what to blog/vlog about recently, and a friend suggested I write/speak about Dissociation and how I would describe my experience of it.

(source: https://www.youtube.com/watch?v=2zsYBghCOVc)

According to the Merriam-Webster website, dissociation is "the separation of whole segments of the personality (as in multiple personality disorder) or of discrete mental processes (as in the schizophrenias (sic)) from the mainstream of consciousness or of behaviour"¹

You do not have to have schizophrenia or multiple personality disorder to experience dissociation, as it is "one way the mind copes with too much stress, such as during a traumatic event"². Anyone can have short experiences of dissociation, but it is when it becomes long term that a dissociative disorder may be considered. 

The kinds of things you can experience when you dissociate may include:

• " having gaps in your life where you can't remember anything that happened
• feeling as though the world around you is unreal
• feeling as though you are watching yourself in a film or looking at yourself from the outside
• feeling as if you are just observing your emotions
• your identity shifting and changing" ³

There are many other things you can experience, as part of dissociation, so no two people will experience this in exactly the same way. As shown on the Mind website, there are clinical terms for each type of dissociative symptom (for example, derealisation) also. 

For me, dissociation is a symptom of the disorder I have; Borderline Personality Disorder ⁴. The kinds of things I experience include feeling as if I'm not real, or the world around me isn't real. I can also feel as if I'm watching myself speaking or moving, and I do not feel completely in control. I may feel disconnected from my emotions, or I may start panicking (usually because of not feeling in control). Sometimes, I will look in the mirror and not recognise the person looking back at me. 

I dissociate quite often, and it can be very hard to "ground" myself. Grounding ⁵ is "a technique that helps keep someone in the present. They help reorient a person to the here-and-now and in reality". There are various techniques for grounding yourself, and they usually involve focusing on stimulating your five senses. One particular example ⁶ asks you to try the following: 

"Look around you. Identify and name:

5 things you see

4 things you feel

3 things you hear

2 things you smell

1 thing you taste "

Of course different techniques will work for different people.Have you found any techniques particularly helpful, if you experience dissociation? Please comment below. 

Resources

¹ https://www.merriam-webster.com/dictionary/dissociation

² and ³ https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/#.WVtwcYgrKM8

⁴ https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/#.WVty8IgrKM9

⁵ http://www.peirsac.org/peirsacui/er/educational_resources10.pdf

⁶ https://uk.pinterest.com/pin/38632509284472245/

Dear Distant Friend

I'm writing this whilst feeling very low and forgotten. I know I shouldn't dwell on the past, but it's hard to let go of old friends when they drift away. It's hard because the memories don't go, especially the memories of times you've been there for each other through some really difficult stuff. I can't just forget you, as if you never mattered. Because you really really did.

There could be many reasons why we drifted away, but please don't let it be because I got ill. All I wanted was to be believed and supported. I can't expect you to fully understand (although I really would appreciate you trying to) but when I cancelled plans, please believe me when I say it's because I wasn't well enough to meet up. I would never cancel because I can't be bothered. I loved the times we spent together and I get frustrated with myself for being ill (even though I know it's not my fault).

I miss the closeness we had. I miss how we'd confide in each other and be there for each other, through good times and bad. I wish I could switch off my feelings, because they are so painful, but I can't

One day, I hope I'm able to let you go if we're never close again.

Mental Health Questions Asked at Work Capability Assessments

(TW: Suicide)

Since my first Work Capability Assessment, my mental health has definitely declined. Throughout the process for claiming Employment and Support Allowance, claimants are treated as if they are faking/embellishing their disabilities. Letters from GPs, specialists, therapists etc are given little or no consideration in deciding whether someone is "fit for work", "fit for work related activity" or not fit for either.

There's a lot of pressure from filling in lengthy forms, gathering evidence (in the hope it will be considered), sending sick notes in on time, sending assessment forms in on time, being able to explain your disabilities to an assessor & hope they will not twist or completely disregard your words. This is all before a decision has been given, and already it is not surprising that someone's mental health will suffer.

A particular issue with Work Capability Assessments is how the assessor asks mental health-based questions; primarily suicide-based ones. Claimants are asked questions such as; "Have you ever tried to harm yourself or take your own life or needed to go to hospital?"¹, "do you have any intentions or plans to hurt yourself currently?"², and "what is it that stops you from acting on the thoughts that you have?"³ These questions are asked in a hostile environment; where the claimant is observed right from the moment they arrive in the car park of the assessment centre. To be asked such personal questions in that context is extremely distressing and has led to worsening of people's health conditions.

At my first Work Capability Assessment, I was asked if I have had thoughts of suicide, why I had those thoughts, whether I had attempted suicide, and what stopped me from attempting. It took a while for me to really open up about my suicidal thoughts to my own therapist, so being asked those questions so brazenly, by a stranger no less, was very distressing. I found it very hard to answer, and I burst into tears as I was made to think about my darkest times. The assessor was barely sympathetic, and was more interested in getting me to answer these questions.

Maximus has been criticised for the types of suicide-based questions they ask claimants, but their response has been that "Every healthcare professional we employ is trained to ask people with a mental health condition a series of clinical questions to assess how their condition affects their daily lives."

A spokesperson for the Department for Work and Pensions (DWP) said "If an individual has mental health issues or there is an indication of suicidal thoughts or intentions, this will be given careful and sensitive exploration to establish the circumstances"

According to a Freedom of Information request in 2014 (I haven't been able to find anything more recent unfortunately), WCA assessors get approximately 17 days' training if they are nurses or physiotherapists, and less than 17 days if they are doctors. I've looked through the PDFs released as part of the response to the request, & it appears that actual mental health training is only covered in just over 4 of those days for nurses, 7 days (including overviews of some mental health conditions) for physiotherapists, and just 2 days for doctors.

The British Association for Counselling and Psychotherapy (BACP) have ethical frameworks for working with suicidal clients. According to this, factors such as the following determine the best way of approaching the topic of suicide and what action to take:

• The context in which therapy is taking place
• The relationship with the client
• The boundaries of confidentiality agreed
• The confidence of the practitioner to explore the meaning of suicide

In the Risk Factors section of the BACP ethical framework document, it is stated that "Practitioners need to be aware of factors that might suggest their client is in a high-risk category" (for acting on suicidal thoughts). This doesn't mean that those in statistically non-high risk categories are unlikely to carry out any plans, but gives a guideline that can determine "the dialogue that then needs to take place with the client". Sources of information on high-risk category clients can also provide vital tools that support risk assessments. 

When exploring how to word questions based around suicidal thoughts & plans, the ethical framework document says "The wording of such questions is important and needs to be treated sensitively. Much will depend upon the setting in which the therapy takes place, the age, understanding, or emotional capacity of the client, and the individual approach of the practitioner" "It is important for practitioners to think about how they might ask a client about suicide. However, best practice suggests asking clearly, openly, and empathically"

This document goes on to explain that it is also important to explore protective factors with the client, and encourage them to use those support networks etc. If the client is at high risk of attempting suicide then specialist mental health services may need to be involved. 

And this is all within a therapeutic setting. A work capability assessment is by no means a therapeutic setting, & the vital resources for dealing with suicide risk are not there; which makes approaching the topic of suicide with the claimant potentially very risky. This could quite easily lead to the worsening of suicidal thoughts and even plans. As for the discussion of protective factors, this is only very briefly touched upon in Work Capability Assessments, so is very unlikely to counteract the impact of asking a claimant (for e.g.) if they have considered suicide, and what methods they would use/have used. If risk of suicide needs to be explored, as part of someone's assessment, surely the healthcare professionals involved in the monitoring/treatment of their mental health (therapists, psychiatrists, GPs even) should be contacted? This could also determine whether a face to face assessment would be necessary, or whether it would be likely to cause a significant deterioration in the claimant's mental health. 

Resources:

¹, ², ³ DNS Article - "Maximus 'admits' using brutal and dangerous suicide questions": http://www.disabilitynewsservice.com/maximus-admits-using-brutal-and-dangerous-suicide-questions/

Article in the Independent - "DWP's fit-to-work tests 'cause permanent damage to mental health' study finds": http://www.independent.co.uk/news/uk/politics/fit-to-work-wca-tests-mental-health-dwp-work-capability-assessment-benefits-esa-pip-a7623686.html

Freedom of Information Request: https://www.disabilityrightsuk.org/news/2014/september/wca-assessors-how-much-training

Nurses' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/nurses.pdf (see pages 6-7)

Physiotherapists' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/physiotherapists.pdf (see pages 7-9)

Doctors' training documents: https://www.disabilityrightsuk.org/sites/default/files/pdf/doctors.pdf (see page 8)

BACP "Working with Suicidal Clients" - Introduction: http://www.bacp.co.uk/ethical_framework/documents/GPiA042.pdf (see page 6)

BACP "Working with Suicidal Clients" - Risk factors: http://www.bacp.co.uk/ethical_framework/documents/GPiA042.pdf (see page 8)

My Mental Health Timeline

Childhood: When I think back to my childhood, I believe I had some mild mental health problems back then; which were probably brought on by the bullying I experienced. I have always had a low self-image, and been critical of myself. I've always had anxiety in some form or another as well. I'd feel anxious about eating in front of people, being in busy places, and catching the bus. I still managed to do all of these things, but I constantly worried about embarrassing myself, seeing one of my bullies, or having a panic attack. I self harmed fairly frequently as a way of releasing my emotions, and as a way of punishing myself for not dealing with things as well as I thought I should.

As I moved onto secondary school and the bullying continued, I became very self conscious & blamed myself for anything that went wrong. I started carrying out certain routines (praying 3 times, exactly at midnight) and carrying "lucky charms" in specific pockets. I truly believed that, if I did this, the bullying would lessen or I'd cope with it better. If I didn't carry out the routines, or forgot to bring certain "lucky charms" with me, I believed my day would be awful & that I wouldn't be able to cope with anything. If I did have a bad day, I believed it was because I hadn't done my routine properly or at the right time. I started to have violent intrusive thoughts, that led to violent dreams. I worried that I'd carry out those violent acts and that I was a terrible, evil person.


University: When I finished school, I decided to go to a university where it was unlikely I'd know anyone. I needed a fresh start, and felt I was a bit happier and confident enough to make new friends. I think this was one of the best decisions I made. I was independent, popular, enjoying life! I was also very impulsive and a bit of a risk taker when it came to certain impulses.

In my second year of university, the physical health problems started and I think this is what led to the anxiety relapse and depression. It certainly didn't help that I was in an abusive relationship at the time, and lost friends thanks to my fluctuating physical illness. I blamed myself for everything again and felt I had to explain why I was well enough to go out some days, and not others. I felt very trapped and isolated by my illness, as well as by my partner at the time. We broke up, but I still felt isolated & I struggled with making plans. As well as feeling too physically ill to attend most lectures, I became very anxious with being in busy lecture halls. I spent more time in my room & became fairly paranoid about friends. I wondered what they thought of me, whether they believed me, whether I was losing them.


Work: After university, I had my first full time job. I was in a relationship at the time, and was fairly happy. It was lovely to come home from work to my partner. He made me feel wanted, and encouraged me to be more sociable. Although not as good as university, I became a little more sociable; catching up with old friends. When it came to work, I often felt as if I wasn't good enough. I struggled with phone-calls, as I worried that the customer wouldn't think I was competent. I still had anxiety with busy situations, and found meetings made me panicky. Whenever I could, I would avoid meetings.  Eventually, my physical health had worsened so much that I had to give up working. My anxiety had worsened a lot too.


Breaking Up: The paranoia I had, the anxiety, and the fact that I wasn't well enough to go out much, I think led to my partner breaking up with me. I struggled with being single, and felt completely worthless and broken. Finding out that he'd met someone else just two days later didn't help either. Was I that easily replaceable? I'd moved back to my parents' flat and away from old friends. Most of my social interactions were online, and so I didn't go out much. I lost more friends, and ended up breaking ties with the rest of one friendship group, before they broke ties with me. It hurt a lot, and I still have times where I dwell on it now.



Unemployment: Once I'd moved back home, I had to decide whether to force myself to work again , or to try claiming Employment and Support Allowance. I was really worried that I'd be thought of as "faking it" or just not being ill enough to qualify. After a horrible assessment, I was accepted for ESA. Stories in the tabloids of "fakers", "scroungers" etc made me paranoid that maybe I'd be accused of this if I was seen outside, or walking one step further than I should be. If I saw a strange car or van outside, or if someone looked at me for longer than normal, I instantly thought they worked for the government.


Starting Therapy: I noticed my moods had been so low, and finally decided to open up to my GP about this. (You can find my blog post about this here). I was given the number to self refer for Cognitive Behavioural Therapy. My first lot of CBT was at a low intensity level, and I saw my therapist every fortnight. We talked about my home situation, physical health (and how that had an impact on my mental health) as well as things that'd happened recently and how to re-examine my thoughts. I liked the therapist, but wasn't finding therapy very beneficial. It seemed too simplistic, and I wasn't sure I really fit the boxes that come with mental health questionnaires etc. I didn't know how to explain it so thought that maybe I just wasn't trying hard enough. I started to have very strong suicidal urges, and was soon in crisis. My therapist at the time contacted crisis team, and I had assessments but nothing else could be offered for the diagnoses I had (Generalised Anxiety Disorder, & Depression). I got very panicky at my last low intensity therapy session, and was then referred on to high intensity CBT. I was also prescribed Amitriptyline by my GP, to see if this would help my moods.

I didn't seem to have such a good rapport with my second therapist. I felt she was repeating a lot of what I'd already learnt about CBT, and I wasn't given much opportunity to talk through how I felt. It seemed more about going through worksheets. If my suicidal thoughts were more frequent, my therapist would instantly go to contacting crisis team. In the end, I told her not to, and I began to hide my darkest feelings and just comply with the worksheets. I ended up finishing this lot of CBT early, partly because I couldn't get transport there any more (and was too anxious to use taxis/buses), partly because it just wasn't helping me.

My third lot of CBT (again at high intensity level) was carried out at home. I was far too anxious to travel, and had then been diagnosed with Agoraphobia, which helped a lot with getting a therapist to come to my house. I got on well with this therapist, and was opening up a bit more. I still didn't find much benefit from the worksheets, and found that I was just going through the motions with homework. It seemed I wanted the therapist to think they'd helped me a lot. I felt like I was failing otherwise. Apart from this, I found a bit of benefit from having the odd walk outside, with the therapist. She wanted me to get a bit more confident outside, and I liked how we didn't have to always be indoors for therapy. I knew I needed help for my agoraphobia, and having someone accompany me outside and build up to me being a bit more independent, would be a good idea. Unfortunately the sessions came to an end before I could make any noticeable progress.

As well as going through therapy, my latest crisis also led to some appointments with a psychiatrist. They changed my medication to Sertraline (with Diazepam as a short emergency prescription). They also suggested I have Psychodynamic therapy, as CBT didn't seem to be suiting me. Unfortunately, I was not given that therapy. I'm not sure any available therapists were trained to carry it out. My third CBT therapist did say, however, that due to the trauma I'd experienced in the past, she may be able to offer me EMDR, as she was training in it. She wanted me to have a break from therapy for a few months first though.

Moving: My parents and I moved house quite quickly, a couple of months after the third lot of therapy. Unfortunately the area we moved to was not under the same mental health team, so I was discharged and told to approach my GP and get referred to the team in my new area. I struggled to get up the courage for quite a while, and took longer to phone the self referral number. I wanted to avoid mental health services altogether, and be left alone. I felt that I wouldn't be reliable and would be discharged for cancelling so many appointments; due to (physical) ill health. When I did eventually call the number, and soon after got my telephone assessment, I found myself rambling a lot to the therapist on the phone. I wasn't sure where to start, and was already very nervous. It felt as if they listened though.

Interpersonal Therapy: I was very pleased to be offered a type of therapy that wasn't Cognitive Behavioural Therapy. I needed to talk about things in the past, and how I formed/maintained relationships, so Interpersonal Therapy seemed like a more suitable one for my issues. At my most recent session, however, I lost trust in my therapist after they dismissed my concerns about my self harming getting worse, as well as a diagnosis I thought I might have. This condition is Borderline Personality Disorder. I explained some of the reasons why I thought I had it, but I didn't feel listened to. The therapist just told me that BPD was something that psychiatrists diagnose you with, if they don't know what's wrong with you. This made me really angry, as I know this condition is real. I couldn't listen to what he said for the rest of the session, and spent most of it wondering whether to just walk out. It was a good job I stayed until the end though, as he suggested I get referred to Secondary Care services (CMHT). I went to my GP the next day, who contacted my therapist to confirm this referral was right for me. After a quick phonecall with the therapist, later that day, I was referred. I was contacted the following day by CMHT; who gave me an appointment for 3rd February.

Community Mental Health Team (Secondary Care): On Friday, 3rd February, I went to my appointment. In the room there was a Community Psychiatric Nurse (CPN). and psychology assistant observing. The CPN explained about my referral and gave me a Wellbeing questionnaire to fill in rather than the usual Depression (PHQ9) and Anxiety (GAD) ones. This questionnaire included questions about coping, making decisions, whether I've felt close to people etc. I've found this questionnaire, with similar questions. I was ticking rarely or none of the time for a lot of them; so I'm guessing my "wellbeing" isn't great!

The CPN then went on to asking why I think I've been referred to the Secondary Care Team, what my main struggles are, and what sort of help I think I need. I spoke about mood swings, the intensity of my moods, how I would be full of emotion (to the point where I feel I'll burst) or feeling nothing at all. I told him how I found it hard to cope with how quickly/extremely my moods can change. I mentioned the numerous crises I've had, suicidal thoughts (which became plans at one point) and frequent self harming that's getting worse. I said I was feeling less in control when it came to my moods and self harming. I can get very irritable and angry, but tend to turn this anger on myself. I also mentioned the times where I've been hypomanic, quite impulsive, agitated etc and how I find that strange; given my diagnosis.

I spoke about the many years of psychological bullying I experienced, as well as an abortion I had at 19, and a controlling, abusive relationship I had, not long after.

Finally, I spoke about my last therapy session, where I felt I could now open up about how, for over a year, I've wondered if I have Borderline Personality Disorder.  I can relate to pretty much all the criteria, although some were more prominent when I was a teenager/ very early 20s. The CPN didn't confirm or deny a BPD diagnosis, but did say that (looking over what I'd told him) he believed I had a long-standing trauma related disorder. He wasn't entirely sure if secondary or primary care would be more suitable for me, but he would have a word with my therapist and give me a call next week.

So this is where I'm at now. I'm not entirely sure what to think about the CMHT appointment. It was a shorter appointment than I expected, and not quite as thorough either. The CPN did ask some specific questions, but it was mainly left to me to explain how I'd been feeling. There were things I forgot to mention to him (and he has given me contact numbers to ring if I do need to talk about them) but I think he got a fairly good picture of my problems. I guess I'll just have to wait and see!