What happens if I don’t qualify for an inpatient OCD treatment?

Trigger Warning: This post contains feelings and thoughts about self-harm.

I really don’t want this to happen.

The last time it felt like support was unavailable when I was discharged from local CMHT (community mental health team) and it turned out that the referral for primary care had gotten lost, a couple of years ago. life seemed hopeless and I seriously self-harmed.

My parents have mentioned moving on with life and getting a job if the admission falls through. When asking my CPN what would happen if I didn’t qualify for the mental health inpatient admission it is that I’d have to do “something”, which could include getting a job (mentioned) or something else (left vague) and find a way to deal with my OCD in the community.

I don’t want that to be the case, as if its possible to manage my anxiety with a community intervention (and not an admission) it means that I am currently useless for not having managed it yet.

I’m scared of being in an environment with big deadlines when I can’t cope with them. I never want to feel that the only “exit strategy” is self-harm again. At the moment the promise of treatment feels like it makes self-harm unnecessary to coping as there’s always the promise of treatment and I have ongoing support.

There are bad memories of flunking out of university in the second year. This came from feeling unable to engage in academic work and deadlines, with an crippling anxiety about doing the “wrong thing”. Frustratingly I finished my first year with a score of approximately 80% – I can’t explain what then went so badly wrong that the second year ended with me not even passing.

Minor deadlines can leave me feeling too anxious to do the stuff necessary to complete them. I make slow progress – doing stuff intensively feels like way too much.

I don’t want to self-harm, but can’t help feeling worried that it could trigger in the future.

Discussing self-harm as a risk if I don’t get access to treatment feels too close to threatening to self-harm so I don’t want to bring it up with the CMHT. I’ve never been accused of threatening self-harm, however I am paranoid about being perceived to threaten self-harm. Second guessing people’s perception of how I’m behaving feels like an inhibitor to open discussion when my anxiety spikes.

All this risk could be resolved if I have a coping strategy that doesn’t revolve around the safety blanket of ongoing support. I don’t know how to build a better method yet; I’ll figure it out.

I’m feeling agitated this evening, so I’ve taken a sedative (lorezepam, 1mg, prescribed to me as PRN). I’ll shoud feel better tomorrow, as sleep usually helps.

It’s a training issue…

Met a a CPN (community psychiatric nurse) (lets call him Mark, not his real name) on Tuesday for an assessment. He had training in handling difficult behaviour.

It’s not what you think, his training focussed on understanding why someone would do something, and how to work with them.

So his first response to me self-harming is why did it happen, not how to deter or stop it. Although how to avoid it happening does come later, and the procedure is based on understanding the person.

He did understand that a lot of staff didn’t really want to focus on the triggers, just avoiding the problem of self-harm, especially when they are the triggers. Obviously 99% of staff don’t have the behavioural training, I really wish they did.

Oh, and as a double-plus I found out that my current social worker definitely subscribes to the same view as Mark, I’d suspected that beforehand though, as her behaviour towards me indicated that.

This gives me a bit of hope that the CMHT might be able to help me.

P.S. I’m an unusual case for Mark, usually he’s called in to deal with aggressive/uncooperative behaviour, that isn’t me, but he was still the best option. For me it was that stuff triggered me to self-harm, but most staff had (some?) trouble figuring out how to help and reduce incidents.

P.P.S I’m not sure just giving all staff behavioural training would work, as some have been on the job for long enough that their mindset that “the patient is always the one at fault, not the system they’re in, and definitely not any staff”. I’m not sure what would be required to fix that, other than making sure that new staff don’t develop the mindset so that eventually it’ll disappear as staff retire.

Almost, but not quite 😁

So tonight I almost burnt myself, but pulled back at the last minute.

Unfortunately I did spent more than 75 minutes procuring the means to burn myself, and I cut (superficially) earlier.

I’m gonna call this this a victory. I still have the means, but I haven’t used them.

What got me distracted? Had a new phone which had all the wrong ringtones, so I had to copy them from my old phone onto the new one, and pick the right ones. It was a mundane task, but having my new phone just the way I like it made me feel better (the old phone probably stopped charging because the charging port had too much water/cleaning damage).

I did call the local crisis team as well, just had a quick chat with them about what I would be doing tomorrow and later in the evening, when they asked for details, not much time spent on the self-harm. Not sure how helpful it was, but I didn’t harm myself afterwards, so it can’t have been all bad…

I don’t know about tomorrow, or the day after, but for tonight, I’m good.

P.S. Was assessed by the occupational therapist on the local CMHT on Tuesday. She was really nice, and somehow made me feel safe describing a lot of the rituals that I go through as part of my OCD. Guess the confidence is a psychology staff thing, only seems to really exist around them. Just to be clear, safety exists with other staff, but psychology staff get to the “safe zone” a lot faster somehow (ie. not after lots and lots of meetings).

My worst psych ward experience: “Finish the job” … and “stop wasting [our] time”

Warning: If you are affected by self-harm or suicidal thoughts, or have experienced mistreatment by psychiatric staff this post may be triggering

This ward admission happened in August 2018 last year, so 12 months ago now.

I had overdosed, for the third time in 3 weeks, and was being assessed by a member of the local crisis team after being treated in A&E for the overdose.

She asked me the usual questions, was very nice, and explained that my care coordinator (mental health social worker) and my community psychiatrist had written emails to her asking her to admit me to a ward while they figured out how to avoid another incident. Spoiler: They changed nothing about my care, so this ward admission was entirely pointless.

She said that it was up to me, going into a ward I hadn’t been to before, or being followed (with phone calls) by the local home treatment team.

I’d been followed by the home treatment team before, and discharged from them, and was in A&E just hours later, with a broken heel (my mind went a bit crazy and I went out a first floor window)… So I wasn’t anxious to repeat that, and had no confidence they could help me.

Being offered a different ward was a surprise. Had it been the ward I’d been in before, I would have answered no – had a bad experience there.

I wasn’t keen on the idea, but as care co and community psych had recommended it, and I wanted to be as “not difficult” as possible, so I agreed to it.

I’ve never been accused of being difficult my my care co, psychiatrist, or any therapy staff I’d interacted with. Some ward staff on the ward I’d been on before this one had viewed by OCD behaviour as being deliberately troublesome though…

Arriving at the ward, a new environment was unpleasant, but insignificant compared to letting a psychiatric nurse search through my stuff, mixing up all the contaminated and non-contaminated objects. I just pretended it didn’t happen in order to cope, despite the fact I was standing there, watching it happen!!! It was still very awful though.

So far, mostly OK, nothing abnormally bad. Maybe I need to get a new definition of bad, but escaping all the stuff that’s bad beyond a “normal” perception would mean getting rid my my mental health condition, which (as of August 2019), really hasn’t gone away, yet…

The following day I was assessed by the consultant psychiatrist, who told me I was wasting everyone’s time with the repeated self-harm harm, and I should either finish the job, or stop trying.

She also suggested that morphine would be a far more effective drug to take (it would take effect in minutes, not days, which I already knew). My verbal response to here was “If it didn’t kill me, I’d be left with brain damage, and I wouldn’t know how to get hold of it anyway”. She didn’t respond to that.

Her knowledge of the effects of the medication I had been treated for before coming to her ward was a bit sketchy, she seemed to assume I’d have to take it multiple times in a week for it take effect, which I guess appears the same as taking it once, and waiting a few days for it to take effect.

After she had finished asking questions, she said she wanted to discharge me immediately. My reaction (internally): I let all my stuff get contaminated, and watched it, for nothing!! I asked her to telephone my care co first, and my care co persuaded her to keep me for another 24 hours. Technically I still hadn’t been forced to do anything at this point.

I guess this is the part where my actions triggered a reaction, I took several photos of people free areas of the ward, and no anyone’s room but mine. I did accidentally take a photo of all the patients names on the “meals orders” sheet, that’s my mistake.

After the assessment had completed, and I was back in my room in the ward the psych knocked on the door, which 3/4 nursing staff behind here.

I was then accused of recording the assessment, because I had my phone in hand, by the psych and I was told to hand over my phone and laptop.

My phone was in hand as I didn’t want to leave it anywhere, for fear of getting it contaminated by the surface it hit, and no, I didn’t record the meeting, kinda wish I did – I didn’t realise how unpleasant it would be.

I called my care co to ask her about my options, which came down to “it’s her ward, I can’t do anything”. I asked “could I leave the ward”, she said I could, as I was voluntary, she didn’t attempt to persuade me to stay. It seems the psychiatrist called my care co before approaching me about any issues, and told them she had evidence of my photographing staff!!!!

Strangely enough, that wasn’t mentioned on my discharge papers, as they wasn’t any evidence – I hadn’t taken any, the other photos were!

In my mind I took my care co not trying to persuade me to stay, as an indication it would no longer make me look “difficult” if I just got discharged.

I let them take my laptop and phone, and then asked to be discharged.

As I walked away from the hospital building (which contained the ward) my mind focussed on jumping in front of a train. I was angry, frustrated, and just wanted to stop feeling so awful.

Fortunately my care co called me just moments later, as she had been told by the ward they’d discharged me, and calmed me down just by letting me explain the events I had been subjected to, and how I felt.

Conclusion: I am NOT agreeing to go in another ward, ever again! I was in there less than 24 hours, but it left an outsized mark on my mind, even a year later, so many of the details of the incident are still in my mind. The overdosing taking a background position.

Fortunately no-one has advised me going in a ward again, even though I have overdosed twice since then, and burned myself multiple times.

The knowledge that I react badly to wards, and wards react badly to me, has persuaded my care staff that its counterproductive to admit me.

P.S. Ongoing CMHT assessment (August, this year) update, got a new care coordinator, the old one from my last time under the CMHT is going on maternity leave shortly. Discussed some stuff, apparently the extended assessment is for the CMHT to review me, and identify whether my problems are as “intractable” (their words, not mine) as they appear, and is there anything they can do that will help.

P.P.S. My only diagnosis is “Severe OCD”. I have been considered for other things, but that’s the only label which stuck.

A good day, for me…

In the last 24 hours I’ve

  • Tidied up the rubbish in my bathroom and taken it out
  • Cleaned my shower (as I put stuff in there while tidying the rest of the bathroom)
  • Changed, not, cleaned the shower curtain
  • Had a shower
  • Gone out of my flat
  • Got food
  • Got back

Six months ago that would have been a bad day, so I’ve deteriorated quite a bit.

Tidying my bathroom is hard, not just because its a bathroom, but because every time something hits my skin, clothing, whatever, the only way to adequately clean it is with bleach, for skin that means putting bleach on, and quickly washing it off before my skin starts to sting too much.

Onto the next day, fingers crossed, it’ll be better – at least because the first 3 items won’t take up any time, as they’ve been done 😉

P.S. CMHT have decided to do a six week extended assessment to try and get me “better” before deciding whether to put me on the books.

Another assessment, another pointless exercise

I had an assessment for CMHT support today, the conclusion being (pending review by the full CMHT staff) that I’m not at sufficient risk to be followed. And that the status-quo is OK, they can leave it for other services to eventually catch up and follow me.

Leaving whether that’s true or OK to the side.

What I want is specialist support for my OCD, especially a professional who has significant experience with it. I don’t know how to get that, and I’m stuck, in the same place as usual, asking other professionals “what support is there?” and “can you find out what is available?”.

Fingers crossed I’ll eventually get there, but I really don’t feel hopeful about it at the moment.

Bye for now.

P. S. I also feel abandoned by the services supposed to support me, on the grounds that “there isn’t anything” 😕

Trusting professionals

Lately I’ve been experiencing a large number of thoughts around self-harm. This has started my thinking about who do I trust to tell about them. The answer is, very few people, and just two professionals.

Trusting professionals is the subject of this post.

When I’m in crisis I’m advised to call the local CRHT (crisis resolution and home treatment) team. I don’t, ever. I am too terrified that I’ll call and be accused of threatening to self-harm. I don’t trust the CRHT to help me, and I have too many friends who have been dismissed by the CRHT as not at risk.

Comments made about me by professionals express that I’m too high functioning to need continued access to support, with the same arguments for removing me from the ward now being used to justify discharge from the CMHT (community mental health team). The reasoning being, that they don’t appear to do anything for me.

Then there is the incredibly common expression by psychriatric staff “it’s your choice to [self-harm/kill yourself/…]”. It doesn’t help, at all, it just works as a way to absolve the staff member of any responsibility to help you. This isn’t personal, it is just how they always respond, with the idea being that this will provide you with the willpower to not hurt yourself. It does not consider the case where you actually want to hurt yourself as it doesn’t feel like there is another option – they don’t explicitly provide another option. This also gives the staff grounds to disregard whatever you do to yourself as “your choice”, “your responsibility” and ignore the emotions and distress that led to the action. When seeing a psychologist this doesn’t happen, they understand that this method is extremely unhelpful and acknowledge your distress. Unfortunately staff are trained that reacting to your distress or expressed thoughts is a bad idea on the grounds that it encourages you to express yourself that way for attention. I’ve found it really doesn’t matter how little attention they issue, it doesn’t put me off self-harming, as the goal is internal and for me only, how they react isn’t relevant.

From my point of view that means I might as well self-harm without telling them, then they can’t accuse me of being attention seeking or say anything at all; at that point all that’s left to do is patch up and prevent any serious damage and send me out into the real world again (as stated by my care plan).

The staff reaction isn’t all bad. When I encounter A&E staff who are trained in treating physical problems I have found them sympathetic, supportive and worried. In a way I’m lucky, my diagnosis is OCD. If it was BPD there is a significant chance it might be the other way around.

Onto my two professionals, a psychologist, with whom my time is coming to a close. I did get more than the maximum allocated 20 sessions, which I am glad of – just 20 wouldn’t have been enough. The other is a social worker who has helped me navigate the benefits system and access a psychiatrist when necessary.

However I am going to lose both of them shortly, as I haven’t had any serious incidents since September (barring attempting to burn myself earlier this week). As such I am no longer view as appropriate for the CMHT to follow me.

The part that puzzles me is the remark that “my crisis plan will remain in place, with some follow up by CRHT”. It feels like it won’t matter how bad I get, I will not ever be brought back onto CMHT support. I do not like that. It feels that if I’m going to be at risk of hurting myself, I should still be on the CMHT, not the treat any phsyical problems, then discharge ASAP from A&E plan.

I have to admit this post isn’t the most cheerful, and is very busy expressing how I feel. That last paragraph is only expressed here, hasn’t been said anywhere else, and I wish it was, hopefully I’ll find a moment with a trusted professional to express that…

I don’t find it easy to trust staff, as there are way too many of them and they all react differently, trust only comes with extended positive interactions, which are rare.

Sorry I haven’t edited the post, it was too anxiety provoking to go back through it.

Transition and recovery

This blog will cover my experiences recovering from OCD and its complications.

In the last week I have been told that I am no longer ill enough to have the local CMHT follow me.

The CMHT is the community mental health team. They work with people whose physical health is at serious risk as the result of a mental health problem. That no longer applies to me as it’s been nearly 4 months since the last incident where I was at risk.

While it’s good to have a sign of progress, I’m going to miss the members of the CMHT who keep track of me. I will lose having someone reliable to talk as they will no longer be available.

The road ahead is unlikely to be smooth, but, fingers crossed, I’ll do more than just survive.