Out of the blue …..

Just a short blog to put down in words how hard it is when what I might refer to as ‘Early Warning Signs’ or difficult feelings/symptoms hit me out of the blue.  

Today I had to stay in my car and was unable to drive off as totally overcome by emotion, just cried for no apparent reason and this was hugely unsettling. When I am depressed this is sometimes expected but when I am feeling quite well it hits me hard and seems to knock me for six.

Earlier today I also had a mild panic attack which I could probably put down to having 3 meetings in a row at work and feeling under pressure (or thinking I was under pressure) but I wasn’t expecting it.  

Subsequently I now feel very fragile, like I am walking a tightrope and not sure whether I might fall off or not. I am sure this is just a small wobble but what I do know tonight and trying to hang on to is that I am feeling positive enough to have quite a bit of hope which is good.

So for the rest of this Mental Health Awareness week (#MHAW15) and in the weeks to come (as awareness us good all the time!) I am hoping that I can continue to raise awareness, have positive conversations and not experience too many more days like today! 

Fighting the #Stigma battle

Maybe triggering – please take care…

Last night saw the inspirational, sensitive and excellent documentary aired on Channel 4 – ‘Stranger on the Bridge’. It told the story of how Jonny Benjamin, after a huge hunt found the stranger who helped him on Waterloo Bridge one morning when he planned to take his own life.  

I would recommend people watching this if they haven’t already as it was brilliantly put together and as someone who has lost a friend to suicide and have been suicidal myself I found it very helpful.  It was though very moving and could also be hugely triggering so please take care if you are fragile at present.

I thought that the whole story gave a very powerful message in the fight against Mental Health Stigma.  This is something that is very close to my heart and when I am well I do my best to talk about mental health and try and break down some of the misconceptions and challenge stigma that I come across in my day to day life.  Normally the stigma which I challenge is amongst people I have met before and more about helping people to realise that talking about mental health is ok and can be so positive for all concerned.  

One thing I have tried not to do is challenge the huge ‘celebrity’ (I use this term loosely) voices that seem to take great delight in doing whatever they can to damage those with mental health illnesses further.  I am acutely aware that these people thrive and feed on publicity of any kind and probably sadly make their money by causing hurt and upset to many vulnerable people. I was though angered by a certain tweet regarding the ‘Stranger on the Bridge’ programme and felt I needed to challenge this.  

I decided to tweet a reply but to an employer of the person concerned and whilst this hasn’t had a huge impact an online paper did write an article on the subject and quoted my tweet in their article.  This made me sit up and think and remind me that we do have a voice even when others seem to do what they can to destroy this. 

So today I have talked to others about suicidal thoughts, explained what this is like for me and let more people in to some quite difficult experiences from my past.  In return I have felt comforted by the responses I received and buoyed by people’s understanding and in some cases a change of view point.  

It also made me realise that the simplest of acts can sometimes have the biggest impact – just like the stranger on that bridge……

Online Counselling – My story

Nearly two months ago I was pretty desperate and had been waiting 3 weeks for an appointment with the community mental health team (CMHT) after my GP had urgently referred me but I had heard nothing. I was very unwell and felt that my thoughts and feelings were building up like a pressure cooker waiting to explode. I really didn’t know where or who to turn to.  I am lucky as I have very supportive family and friends but it isn’t always easy to tell them my darkest thoughts and when I am in the depths of depression feeling a burden to them is always uppermost in my mind.

I was getting to the point where I knew I needed to get some professional help myself as not only did I need an outlet for my thoughts whilst in this crisis I also wanted to build on my ‘Wellness Toolbook’ for the future. I am lucky that through Twitter and my blog I have met some amazing people who not only offer empathy and support but also have a vast amount of knowledge at their disposal. One such person asked if I had heard of Online Counselling and recommended an organisation to me.  I was immediately interested and went about finding out more information.

The first thing that sprung to mind was the accreditation it had and whether the site was reputable and so I was pleased to see that it carried the logo for the British Association of Counselling and Psychotherapy. I spoke with my family and friends who were sceptical at first but after I spoke to my GP who was very positive I decided to give it a go.  I was impressed by the website, security features and also the options available for counselling which include Skype and Instant Messaging. 

I went about carefully choosing a counsellor and then had an introductory session which was very useful.  I opted for Instant Messaging mainly because the anonymity that it provided at a time when I was hugely anxious was reassuring. I was also very frightened of seeing someone face to face as was feeling completely let down by mental health services and worried that the anxiety caused by meeting a new professional for the first time might be too much for me so this sounded a good option. 

I didn’t want this to replace the CMHT appointment that I think I need and am entitled to ( I am still waiting nearly 3 months on) but I also couldn’t sit back and do nothing when I am so determined to help myself where I can. I wonder whether for some people ( and I realise this wouldn’t be a viable option for everyone) this could be offered on the NHS? I don’t for one moment suggest that it should replace services already on offer but with waiting lists so long this could be a huge lifeline to some people experiencing mental health problems. 

I would also add that I am paying for this treatment myself and well aware that I am in a fortunate position to be able to do so.  Many others I’m sure, would like to pay for treatment themselves due to the lack of NHS services and the long waiting lists but obviously could not afford to. 

This is my first blog on the subject and I hope to be able to help raise the profile of online counselling and the huge benefits for people like myself. 

A very positive few days…..but

After returning to work full time this week I knew that it would be a sort of test for me to see how I really was coping and feeling. I have been feeling much better for a week or so and after 2 months of pretty desperate times it has been a huge relief. The last couple of weeks I have had quite a bit of annual leave and also not been working full days so I knew this week was a different challenge of sorts. 

Work has gone well this week and I have coped ok with quite a busy time and also managed to get the balance right so that I am taking things gently when I can. I feel back in control, able to make decisions and even have snippets of feeling positive about my own abilities! I can’t say that I haven’t once felt depressed or that the anxiety hasn’t at times felt like it was taking over but these feelings are no way near what they were.

Tonight though I experienced the dreaded feelings of worrying about getting ill again.  They sort of came in a huge wave of emotion and made me realise just how fragile I am and also how frightened I am of feeling how I did just 2 weeks ago.  It is hard for me to separate what is ‘normal’ emotion about a very sad situation and when I should be concerned that I might be getting ill.  Before I know where I am I feel anxious, very upset and just want to hide away and stay in bed. Ok this didn’t last long but I am left with the worry that wasn’t there this morning and hoping it will be better when I wake in the morning. 

Revisiting my #WRAP 

I have wanted to revisit my Wellness Recovery Action Plan (WRAP) for a while but as I have spent the best part of the last 2 months being quite unwell it wasn’t really a good time. I wonder if now is even too soon as I have only had 4 better days and maybe it is too early to look at how I can do my best to stay well in the future but I feel I need to do this.  

I use a fairly standard WRAP format and one which I have worked hard with my GP to put together. This WRAP includes both depressive and hypomanic symptoms due to my Bipolar diagnosis.

To start with I looked at my ‘Wellness Tools’ (Activities I enjoy or that help me feel better) which include:

Spending time with husband & family, Talking to Friends/Socialising, Mindfulness, Going to Church, Keeping a routine including going to work, Using my light box, Reading, Singing, Watching things on TV I enjoy, Listening to radio and music, Doing things I know I can do, Write a blog, Chat on Twitter, Online Counselling, Taking small amounts of medication to help anxiety symptoms, Monitor my sleep & use small PRN if needed even when well.

Closely linked to these is the ‘Daily Maintenance’ (Things I should try and do everyday) which include:

Keeping a routine, Eating 3 meals a day, Getting some rest, Taking regular breaks at work, Resting at home everyday, Reading for 1/2 hour everyday, Have a shower, Do something I enjoy, Keep my mind active, Mindfulness, Get out of bed everyday 

It is then important to identify ‘Triggers’ which for me are:

Tiredness, Emotional events, Seeing people that may of caused me distress in the past, Skipping meals, Too much stress at work, Spending too much time alone. 

I also need to remind myself that sometimes I can become unwell without experiencing any of these triggers. 

If any of these triggers occur and do affect me negatively or I think they might I try and implement a ‘Triggers Action Plan’ which is:

To try and stick to my daily maintenance plan, Call someone on my support list, Practice mindfulness, Remembering it is ok to care for myself.

‘Early Warning Signs’ are probably fairly crucial for me as it is knowing when to recognise them but not to panic about them before they arrive. For me these are:

Not sleeping more than about 4 hours per night, Slight paranoia, Anxiety in certain situations, Becoming very low, Spending too much money, Racing thoughts, Slight Hypomania, Not enjoying things.

If I notice these signs I then try and implement an action plan based on these which is now going to include calling my GP at this stage.  

I did call my GP when I became unwell in February and noticed the Early warning signs. This did help me feel more supported and also enabled my GP to refer me to CMHT – the fact I am still waiting for an appointment 2 months on is awful but if CMHT can get their act together GP intervention at this point is crucial. The other important things in the Early Warning Action Plan are asking for some help from support list to implement daily maintenance plan, Ask people for help and support, Try to have company where possible, Start using PRN – probably promethazine, Talking worries through with people.

When things are getting worse I will often notice some or all of the following symptoms:

Experiencing Depression all of the time instead of it coming and going, Wanting to sleep all day but not able to sleep at night, Anxiety getting worse & shaking some of the time, Not eating at all without prompting, Having thoughts of suicide, Hearing or seeing things that others can’t, Paranoia so bad that I can’t leave the house easily.

If these signs are present then again I try and implement an action plan: 

Call GP and update her that I am in crisis, Try and ensure I am not on my own, Talk with people who are able to offer support, Think about taking Diazepam to control symptoms, Talk to work about implementing flexible working and other reasonable adjustments, Discuss with someone about attending A&E as a last resort but ask for help from support network to do so,  Ask for support in monitoring PRN so that I am safe, Identifying where on the scale my suicidal thoughts are. 

This is obviously my own plan and is what works for me. I find it helpful to carry my WRAP & care plan from the GP with me to show to other professionals I might meet. This WRAP helps me to feel more in control which I find really important. I constantly re-visit this WRAP and share its contents with those involved in my care. It has also proved useful at work to ensure I am supported correctly.

When I do finally receive a CMHT appointment I will ensure that this WRAP is my starting point for discussions with them. I need their input to work with this plan so that hopefully earlier intervention can lessen the time I am unwell and the need to attend A&E. 

Received a letter confirming CMHT Appointment – wished I’d never opened it!

As promised I received a letter from the CMHT today confirming my appointment that had been given to me over the phone for 27th March.  This is nearly 2 months after my GP referred me urgently as part of the crisis plan I currently have.

The first thing that I read is that I have an appointment to see the ‘Liason Intake Team (LIT) Duty Worker’.  I have never received a letter with an appointment that doesn’t name the professional I am seeing.  I find this hugely anxiety provoking and in the many years I have received mental health services they know I need to have appointments with females but yet on many occasions I will be given an appointment with a male either in writing or with the crisis team which always delays treatment further.  Not knowing the gender or name just adds to my distress. 

Action number 1 tomorrow is to clarify who I will be seeing and ensure that they recognise I need to see a female duty worker.

The second issue is the location of the appointment. Under the trust’s policy I know that patients can request to be seen at the nearest mental health centre to them.  This is because the trust made a decision to move services around and therefore the staff have to travel. When I was first refered I made it clear that the appointment needed to be at my nearest centre as I am unable to travel by public transport and there is no parking at the other centre.  Yet again I have been ignored and the appointment is not in the correct place.

Action number 2 tomorrow is to ask again for the appointment to be held at my local centre as requested.

The letter itself comes with a leaflet outlining the services that the LIT team offer. The leaflet makes it clear that this is an assessment. As I have said previously I really don’t feel that an assessment is the most suitable solution for me or in fact anyone with a long term mental health condition who requires ongoing support.

Action number 3 tomorrow is to explain again that I know what support I need and what would be helpful to me. 

The leaflet also talks about ‘developing an initial care plan’. I already have a very comprehensive care and crisis plan which I work hard to follow.  Part of the care plan was to contact services via my GP if I felt I needed them – the delay in getting the required help has had a huge impact but doesn’t mean my care plan needs re-writing.  

Action number 4 is to ask them to read my care & crisis plan which is on my notes before I attend any appointment.

The whole process is completely unsatisfactory and has made me so anxious at what is already a very difficult time. The LIT team should not be used for people with long term mental health needs that need some extra support in addition to the GP support every once in a while. I was promised when discharged from services that if I needed support in the future that it would be quick to access and relevant to my needs.  I am struggling to see this promise in action. 

I am seeing my GP tomorrow morning and hoping she can advise me what to do and help restore a little faith in the health service I am faced with.

What does the future hold for me with bipolar? Will my Symptoms get worse?

Not a question I often ask myself and probably not one I should be spending time thinking about when I am not in a great place. However my head is playing tricks with me, putting the worst case scenario at the forefront of my mind and maybe writing this will help in some way.
Tonight I am truly frustrated. I had been seeing a tiny bit of hope and glimmer of light in the darkness. Things were difficult but I had been getting slightly better nights, hadn’t had so many desperate thoughts and was able to enjoy more than I had done in a while. I wasn’t as hopelessly terrified as I had been either.
This seemed very short lived as my panic attacks have increased and I have taken what seems the compulsory 3 steps backwards after 2 going in the right direction.
Thoughts keep coming to the forefront of my mind where I find myself never getting any rest from the illness, not having the long periods of wellness that I have been used to and the possibility that maybe someday I will have to contend with continuous symptoms of some degree without any rest or wellness. This is absolutely terrifying me and whilst it is probably not productive to be thinking of this right now I have always tried to be realistic and so feel I need to think things through.
I worry that I will have to rely more on people and I find this hard as feel a burden as it is. I like to be able to help others and get concerned that this won’t be possible in the future.
I currently manage to work full time, I enjoy working and don’t want to have to give up and with that comes the prospect of having to take more medication – regular medication is something I don’t use due to the fact I want to continue to work. I have such poor tolerance to medication and bad side effects that it makes it impossible for me to work and take it. Therefore I use meds only when absolutely necessary and am lucky enough to have reasonable adjustments in place to manage this when it occurs.
I know that at the moment I am coping as well as I can do and I hope that the CMHT referral might give me an opportunity to discuss these fears. I am trying to hold on to the moment right now, keep as positive as I can and not look too far ahead – if only my head would try and remember that too!

Referred back to CMHT …. Here we go again

Saw my GP today and she suggested that a referral back to the CMHT would be a good idea. I am not sure what to make of this – in one way I know I need more support however this referral is no guarantee of getting any.
I can’t really describe how I am feeling but what I do know is that I feel like my head is currently unable to counteract any of the negative thoughts that I have battled so hard to overcome.
I am trying to stay positive even though I feel quite a failure for having to agree to the referral. I am not terribly depressed but worried that I am heading that way and so today was probably something I needed to do sooner rather than later.
I have though decided that I cannot place all my hope in the system. I know how it works. I might not get a assessment for weeks and then there is a chance they may refer me straight back to the GP. I also realise that by continuing to function, work, keep busy it will be even harder to explain how I really feel and that communicating is probably an important key to getting the right kind of support.
I also need to remember to keep communicating with the people around me – that includes my GP as she has said she will be in touch especially whilst I am waiting for the CMHT to call.
I realise that the faster care access option is accident and emergency but that is completely out of the question for me and whilst this may seem the wrong decision to some people I have to keep some element of control as my head certainly isn’t helping me to feel in control at all.
I am hoping that even though I can’t write exactly what is happening inside my head I know and can hold onto the fact that lots of people care and I am so grateful for that – it is keeping me going.

The Blame Game

TW – talks about feelings of desperation, please be careful if you are likely to be triggered by this.

About a week or so ago after a great couple of weeks I started to feel the waves of anxiety again, the desperation was mounting as I fought the feelings and thoughts that I was becoming unwell again. I had been so well during the early part of January, work was great again, I have so many lovely family events coming up – things were looking good, I was enjoying life.
I keep going over and over in my head what had changed – what had I done wrong? All I knew is that I wasn’t depressed as such, just horribly frightened and anxious and what was scary was that I didn’t want to be around to find out if I was getting ill again.
I am aware of my feelings so much more than in the past – I am not sure whether this is always a positive thing or not! It means I can put my crisis plan in place much more quickly, start taking useful medication etc… However it also means I tend to worry more and maybe overthink my feelings and the anxiety has been quite a factor in this recent episode.
As the anxiety has increased I have also become quite low, I haven’t experienced the very painful depression that I did at the end of last year but I have been very low indeed.
I am also so angry, angry with the mental health system as what I need most is some consistent support so that I can talk to someone that knows me well without going into a massive long history. I am feeling so guilty for worrying family and friends that I bottle things up and if I had a mental health professional to talk things through to this would definitely help. Yes my GP is supportive but 10 minutes every 2-4 weeks and maybe 5 minutes on the phone in an emergency is not ideal. My GP is also reluctant to refer me to services as the system is so stretched and I have had such negative experiences in the past and my GP is doing what she can to keep me well.
A and E is also my crisis option however there is no way that this will be an option I would choose as just too frightening a prospect – it makes me so cross that the options available to me are in fact likely to make me worse.
I recently visited some amazing examples of mental health care within the trust where I am a governor and whilst being such a positive experience this also made me sad as I so badly need just a small amount of support like this.
I am also very angry with myself and blaming myself for feeling like this. More recently I have been able to be angry at the illness or even the system, but being angry and blaming myself seems like a huge step backwards.
I am angry that I have let myself look into the future too much and not concentrating just on the next day or even hour. And yes I am angry with myself for having destructive thoughts, ones which have frightened me so much.
I am trying this evening to concentrate more on the positives and take things a little more slowly and remember that I have felt like this before and changed – it is just so hard and scary especially when I am doing all I can to stay well.

A Rising Panic …

After 2 weeks off work which have contained a lot of good times and also given me a chance to really rest, I am tonight panicking about returning to work on Monday. Not only have I had 2 whole weeks off but I am going back full time after over a month on reduced hours due to a depressive episode.
I am therefore trying to do the following things to try and stop the panic, as one thing I do know for sure is that going in on Monday having got myself in to a state won’t help me in anyway at all.
1. I have reminded myself that I can do my job! The situation has been horrendous at work but it is improving and slowly more support is in place.
2. I am reminding myself that I am in a much better place mentally than I was even 2 weeks ago. The break has certainly done me good in that respect.
3. I can be reassured that I am on hardly any PRN medication now so therefore it will be easier for me to work longer hours and concentrate better.
4. I have double checked that I have a doctors appointment in place so that if I need more support or need to look at my hours again I have that safety net setup already.
5. I have organised a lot of home things so that I am up to date with household and other jobs so that I can rest when I get home from work more as I will be tired.
6. I have been setting a alarm for the last few mornings to slowly prepare for Monday. Mornings have been very difficult for me recently and the depression has often been unbearable first thing and so being unprepared for next week isn’t sensible.
7. Most importantly I have to keep reminding myself to just take a day at a time – in order to be well on Monday I need to stay well today – that is what I am trying to hold on to.