The inadequacy of A&E in a mental health crisis …..

I have blogged a few times on my personal experiences when attending accident and emergency departments in a mental health crisis. Every time I have attended, the experience has been hugely unhelpful and in some cases worsened (if that was even possible) my mental health distress.

This week I have seen again many cases of people on Twitter who have been turned away at accident and emergency, spoken to people who have no knowledge of mental health or even sent away with tablets whilst being suicidal.

As I understand it not all accident and emergency departments have liaison mental health teams attached to them and there is also the added problems of different NHS Trusts operating different services in the same area. In my trust for example the accident and emergency is run by one trust and the mental health services run by another. This setup only seems to add to the poor experience and creates a culture of relinquishing responsibility by both parties involved.

I don’t really have any answers but a few things I try and do when I am out in the impossible position of having to go to accident and emergency are:

1.) Try if possible to go with someone – I do though understand that this is often not possible and so apologies that this is just another unhelpful suggestion.
2.) We have triage system at our accident and emergency – I always try and ask at this point what the mental health liaison care is and also whether there is a dedicated area to wait. It is important that the staff realise how distressing it is to wait in this environment when mental health distress is so high.
3.) I ask for a waiting time – they will know one if you went in with a broken arm so this should be no different.
4.) if possible I always take with me a copy of my crisis plan which is useful when by the time I get to see someone I am past being able to coherently manage to communicate much.
5.) During this last episode I have made the decision that I am not going to go to accident and emergency unless it is absolutely necessary so therefore my GP has referred me back to CMHT services. It is worth getting to grips with the system within your trust so that maybe some other care options can be investigated.

Sounds simple!!!!! BUT …….

The problem with all I have said above is that by the time the need for accident and emergency arises the possibility of being able to calmly put in place any or some of the above is pretty small. This therefore illustrates my point that the system as it stands isn’t right. It is putting more lives at risk, hugely endangering patient safety and going nowhere to improve parity of esteem which is supposed to be a priority.

The staff in accident and emergency often do try and do their best but don’t have the knowledge, resource or time to be able to help. With Mental Health beds being cut so drastically this situation can only get worse. Even after 4 hours or so in accident and emergency this hasn’t always led to me getting to a place of safety. In some cases even the crisis or Home treatment team I have referred to have been full and therefore I am left in a worse place than before.

I am unsure of where to go from here in drawing attention to this situation but for my sake and thousands of others something needs to be done.

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 lasting effects of an Oscar winning performance!

So Christmas is over for another year!
As I was so unwell during the month or so before Christmas I was very worried about how I would cope and whether I could even enjoy myself and build on my positive Christmas memories that I had been doing so well to create over the last 5 or so years.
As a Christian I also wanted to be able to participate in the Church Christmas programme which included singing and helping to lead the children’s Christmas Eve service which I enjoy so much but that can be so hard when I am unwell.
I also had the added difficulty of experiencing awful anxiety and panic in shops and other crowded places which means shopping and some social occasions also were out of the question.
So with a few very supportive family members and close friends and the trusty internet I prepared for Christmas practically and with the prayers, support and love of those at the Church I managed to participate fully in the Advent and Christmas services and with my amazing family I also enjoyed and have treasured memories of a lovely Christmas Day.
Yet this has also come at some cost. I have written before about an Oscar winning performance and how in some ways it is massively important for me to keep going with things, put on a brave face and to some people pretend all is well but on the other hand I have to get the balance right as the consequences can be hard to cope with if I don’t.
On Christmas Day evening about 10pm I felt this wave of panic and exhaustion. I put it down to overindulging and tiredness and I had such a lovely day that it didn’t spoil it in anyway. It did though mean I was worried and woke up a couple of times that night in a panic and when I woke on Boxing Day I wouldn’t of been able to pretend to anyone. I was depressed and every part of me felt like it weighed 20 stone. I was so relieved that I had made no plans as getting out of bed took hours and leaving the house was a no go area. I couldn’t even get dressed but I battled to do a few jobs, setup my new laptop and did cook a meal but everything took twice as long as normal but I tried to convince myself that exhaustion can have this effect.
Yesterday was not a lot better although I achieved jobs in the house but I couldn’t step outside and realised I had not got dressed since Christmas Day evening. The thought of seeing anyone apart from my husband or my mum was frightening.
This morning I knew I had to break the cycle for my own peace of mind and so I got up and went to Church where once again felt so pleased that I had done this and fought the illness in my own small way. Yes I sometimes smiled when I really wanted to cry but it gave me confidence that I thought I had lost. I even managed a trip to little Waitrose and cups of tea at Mum’s & a close friends.
I some ways the Oscar performance both before Christmas, Christmas Day itself and today meant that I came down with a crash but it also gave me a boost when I really needed it and that will probably help in the long run. I now have a week before I return to work and I hope the small positive steps continue and the depression lifts for longer each day.

One of the hardest weeks ……

After one of the hardest weeks I have had this year I thought I should blog as hopefully it might help to get things down and I haven’t blogged for ages! Last weekend I was struggling but trying to stay positive and I had got my sleeping into a sort of routine again. I had a fairly positive weekend – caught up with friends, went to Church – the depression was coming and going and my anxiety was also still causing problems. Whilst in Church I realised that music was slightly distorted and that I occasionally heard sounds that others didn’t.
On Sunday night I hardly slept at all and probably going into work at all on Monday was not a great idea. The depression was so bad it felt physically painful and my head was full of so many negative and painful thoughts that I couldn’t focus on anything.
I was only working till 3pm instead of 5pm as it is one of my reasonable adjustments when I am not well but work is also very stressful at the moment and so I knew I needed to take a break. I felt as though I couldn’t work out what was real and what wasn’t.
I am only under my GP who is brilliant and I knew that I couldn’t face A and E so therefore I put all my strategies into place and had 2 days off work which is very unusual for me. It did though mean that I could take PRN medication at night at slightly higher doses than normal without worrying about being dozy in the daytime. I did worry about being on my own during the day but I saw people and friends and family kept in touch.
I spoke to my doctor who then agreed that getting back into a routine might help so I went back on Thursday slightly more rested but with a fit note to work till 1pm until I finish for Christmas.
It has been a very dark week, one where I have wanted it all to end on many occasions but there is a bit more hope this weekend and I have shown that I am coping better with such severe symptoms and also made the right decisions as far as my care was concerned.
I am massively grateful to those who have sticked by me this week – hoping I can look forward to Christmas and a well needed rest.

Autumn Anxiety

I have not posted or even tweeted much for a while as I have been very busy with work but also dealing with increased anxiety. This is mostly because work is very stressful and I am struggling with the massive increase in pressure and uncertainty which every working day seems to bring.
I am experiencing physical symptoms like a racing heart beat, palpitations and the anxiety comes in great waves which can also catch me off guard. These symptoms along with worry and panic don’t make for very comfortable nights or for that matter days.
I am also anxious because I have been well for so long (since March/April) and this period of ‘wobblyness’ comes at what is always a difficult time of year for me. October and Autumn/Winter in general has many painful memories and often, although not always, the most likely time for a relapse. I think being scared of relapsing is one of the biggest factors in my anxiety and one that is hard to rationalise but talking about it certainly helps.
As ever I have put in place my WRAP and whilst I certainly don’t need to step into full blown crisis mode (far from it) I can be proud that I now have the coping strategies to acknowledge and deal with potential difficulties earlier than ever before.
I also have lots to look forward, starting with a holiday in France in a weeks time, a short break in November and a lovely family Christmas. Small steps are definitely in order!

Mental illness can affect anyone, anywhere, at any time …

I am sure that many people have been moved to write a blog about the very sad news of the death of Robin Williams as writing things down can definitely help people and it certainly helps me.
From a personal view point as someone who lost a very close friend to suicide less than 2 years ago it brought back many painful memories. I also know what it is like to be suicidal and have tried to take my own life during some very dark moments. The pain of depression is something I struggle to put into words but it is an illness and needs to be recognised as one much more than it is at present.
One thing though that has struck me about today’s news is the amount of people who have commented on what Robin had to be depressed about, or what a shame that he didn’t seek help earlier etc…
The truth and sad reality is that it doesn’t matter who you are, how much money you have, how famous you are, how wonderful your life seems to others – depression and other mental illness can affect anyone at anytime in their life. It might be a long hard struggle over many years, an episode as a child or young person and then nothing or it can hit someone later in life.
The other important thing to remember is that high profile stories like today’s tragic news make headlines but many people lose their lives to mental illness everyday and with on going cuts it mental health services this hasn’t got much hope of improving.
Rest in Peace Robin Williams and all those who have lost their lives from mental illness.

Haven’t blogged for ages … This is why!…..#uberbusy

I haven’t blogged for absolutely ages but I have had the most amazing month! Firstly I am well! Really well – no depression, no hypomania just steady … calm and well! Not only that I have coped with being ridiculously busy, quite a bit of stress (good stress!) and the odd panic attack in a way that I haven’t coped before.
As some of you may know I am a Christian and very involved with my local Church. I first went along when I was not even a year old and 34 years later it still plays a huge and wonderful part in my life. I am now an Elder and run the Messy Church with my sister in law amongst other things. I was married in the Church 5 years ago which was the happiest day of my life and the church has journeyed with me and supported me during every stage of my life and especially through my bipolar diagnosis and traumatic life events. This amazing fellowship and congregation of inspirational, devoted friends has just celebrated its 75th anniversary and boy have we celebrated! It has been wonderful to remember the laughter, some tears and worship that has taken place within the Church and been lovely to celebrate with the local community and members past and present. As the Church looks forward to the next 25 years or even 75 years I am also able to look forward knowing that I have the most amazing support network in place starting with my husband, family and friends and am so lucky to have the Church as a constant support as they also learn more about mental illness and as the stigma and barriers surrounding his sometimes difficult topic are broken down by friendship, fellowship and prayer.
Last weekend after the Church’s celebrations were over I joined with 47 others to celebrate the 50th Wedding Anniversary of a very special couple. Carole and Mike welcomed me into their home, family and friendship groups nearly 15 years ago after Carole was my tutor at college when I returned to re-take my a’levels at the age of 19. This followed my first hospital admission and I was so unwell. After supporting me at college Carole and I became friends and she has been there through so many difficult times and spent many hours in accident and emergency and psychiatric hospitals with me as well as providing me with somewhere to live at times. As I have slowly journeyed through recovery and got better at managing my episodes Carole has been there and helped me learn so much about myself and my illness and had been a major player in helping me get to where I am today. Last weekend 48 of us celebrated at Butlins and I am immensely proud of Carole and Mike, and their love for each other and for their family and friends is an inspiration.
The message from this blog for me is a reminder of the wonderful support I have, the people I have rooting for me and the fact that at the moment I am doing well and that taking a day at a time is the way forward for me. I am well at the moment and yes I am terrified of getting ill but I need to live in the now and I am going to try so hard to do this.
Massive thanks to all my family, friends and Church fellowship – love you all.

It’s a WRAP!

I thought I would write a blog about my Wellness Recovery Action Plan (WRAP) as this has been a great help to me and although it isn’t for everyone it might help people to read about mine! I also find that it reinforces mine to myself and than can only be a good thing.
Mine might not be the method everyone uses but it is one way:

Wellness Tools:
(Activities I enjoy or that help me feel better)

Spending time with husband & family
Talking to Friends/Socialising
Mindfulness
Going to Church
Keeping a routine
Using my light box
Reading
Singing
Watching things on TV I enjoy
Listen to music
Doing things I know I can do
Write a blog
Chat on Twitter

Daily Maintenance Plan:
(Things I should try and do everyday)

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

Triggers:
(Identifying those triggers or events that might make me feel worse)

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

If any of these triggers occur I try and implement an action plan:
I try and stick to my daily maintenance plan
Call someone on my support list
Practice mindfulness

Early Warning Signs:
(Subtle signs that I may becoming unwell)

Not sleeping more than about 4 hours
Slight paranoia
Anxiety in certain situations
Becoming very low
Spending too much money
Racing thoughts

If I notice these signs I then try and implement an action plan:
Ask 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

When things are getting worse:
(What signs I should look out for when I am feeling much worse)

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
Think about implementing crisis plan
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

Crisis Plan:
Ensure that GP is involved at this stage and in discussion with me consider contacting CMHT.
Ensure I have medication to help with symptoms
Attend A&E as a last resort but ask for help from support network.
Ask for support in monitoring PRN so that I am safe
Identifying where on the scale my suicidal thoughts are.
Carry my WRAP & care plan from GP with me to show to other professionals I might meet.

This is my WRAP that works for me and 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.