It is the small things that often matter …

So today was a huge first in I don’t know how many years. Yesterday afternoon I received a call from the community mental health team. The call was an acknowledgment of the referral by my GP only 36 hours before, so to say I was stunned and impressed was an understatement. 

The call yesterday was fairly brief but had a few simple aims, firstly to establish my safety, secondly to ensure I had contact numbers of support if I needed them and lastly to arrange a time to call me today for a telephone assessment.  

Today the same person (note the consistency) called to assess me.  This followed a fairly typical mental health assessment format but was so different to ones I have experienced before. It was carried out with understanding, empathy, support and also helped on a practical level as well. I have to admit I was very sceptical but then who would blame me after the last few years of one bad experience followed by yet more bad experiences. I was able to be completely honest with the person on the phone, I was able to tell them my deepest fears and even though they felt they hadn’t done much at all I was eternally grateful for this support at what seems an impossible time.  

The other thing that made such a difference was the honesty of the person I was speaking to.  Never has a mental health professional said to me: ‘I will try and call you back today after I speak to the doctor, but if I don’t it may be due to an emergency or not being able to speak to the doctor but I will call on Monday’.  A typical scenario is that they say they will call back and don’t and then deny ever saying that! 

Well he did call back (yes the same person)! He checked again I had all the numbers I needed and understood my fear of going to accident and emergency and seemed to join me in a determination to try and stop this from happening. He had spoken to the doctor and has some ideas and for the first time in years I am even willing to discuss a possible new medication. 

He is calling me on Monday and we are reassessing the situation then.  In the meantime I am so grateful for what he has done over the last couple of days to help shine a bit of light and hope in a rather bleak situation. It is very rare for the professionals to be the bearers of light and hope – this is often only generated by my amazing family and friends! 

Not only is this a first in so many years during a crisis situation but also I was properly listened to by a professional. I wasn’t judged because I work or because I could articulate what was happening to me. My distressing symptoms were acknowledged and not once was any aspect of my illness belittled. It will obviously take a while to gain my full trust, after so many years I have learnt to protect myself and to be cautious but feeling like I do, this support is hugely significant. 

So yes the small things do matter, I ensured that I told the mental health worker exactly that today. Sometimes things can get over complicated and the wrong help given as a result but today I received what some would consider a small amount of support but it made the world of difference. 

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.