Wednesday, 21 May 2014

This is a CPA...

note: I try to think of my blog as a way for people to gain an insight into mental health, whether it's by telling you of a disorder different to your own diagnosis or explaining things from an inpatient point of view when you have community experience. I realised that I've explained ward rounds and the processes we go through for them here so here's a post about CPAs as I have recently had one...

Care Programme's Approaches (CPAs) have to occur every six months when you're in hospital. I was looking forward to mine as I have had no incidences of self-harm since my last one and I was hoping to get more of an idea on when I can be discharged.
Everyone in your MDT (multi-disciplinary team) put together reports; here are a few snippets from some of mine:
'Ms Wilson continued to occasionally express suicidal intent "I might still have occasional thoughts but I have no intention to act on them - I don't think I'll go back to that or self-harm... I don't want to do that." She did not indicate that she planned to act upon these thoughts and recognised this as part of her progress.'
'Aimee has spoken of her low mood and been able to rationalise the thoughts much easier using the skills taught to her in psychology sessions'
'Over the past six weeks Aimee has displayed good coping strategies in regards to anniversary dates that she struggled with in the past, during this time Aimee has not displayed any self-injurious behaviours managed to cope with emotional difficulties.'
'Aimee currently displays active psychotic symptoms in the form of auditory and visual hallucinations'
'She continues to be troubled by auditory and visual hallucinations and racing thoughts, but has not acted on commands; she says that although she has suicidal thoughts she no longer wishes to die.'
'I am encouraged by Ms Wilson's commitment to treatment, study, and furthering the cause of Service Users. We would wish to support her in rebuilding her leave entitlement safely. However, in view of her fluctuating mood and ongoing suicidal thoughts, I just that for the present she should continue to be Detained in the interests of her health and safety and for the protection of other persons.'
'... and whilst in groups sometimes has inappropriate bursts of laughter. Aimee requested that her groups are on a morning as she has 'nap' time in the afternoon'

So the CPA got off to an actually really bad start; there was a report submitted late so when I got the chance to read it in the first ten minutes of the CPA, I was horrified to find that it went into explicit details about my 'trauma.' It was reminiscent of my police interview when they told me I had to use all the correct biology words when giving my statement... And that's not how I tend to talk about what happened to me. And then there was the fact my Mum was sat beside me reading it too. I was so embarrassed; it's like when you watch a film with your parents and there's sex scenes in it or something and it's really awkward. Except it was actually about me and not actors!
A while ago, if that had happened I probably would've cried, stormed out of the meeting and probably done something to warrant medical attention and five minute observations but that would have missed the point. And I'm not in that place still, mentally. So, instead, I spoke up about how disgusting it was, how irrelevant it was to put such things in the report, how embarrassing it was and how it was out of order to have just been given it right there and then. The other staff in the CPA hadn't even read the report so when they saw how Mum and I reacted they all flicked through it and it was agreed that this piece would be removed from the report and it wouldn't be read out or discussed. It was a good experience to highlight that I get the reaction and response I want/need when I go about things in the right way.
So, once that was out of the way, each of the staff said a little bit about my progress and how I'm doing and I was really happy and proud. There was a bit of discussion around how long I've been at this hospital and whether it would be a good idea to be nearer home. Of course I'd love to be nearer home but not at the cost of my recovery. I've been here for so long now; I know the staff, I know the girls... It took the staff a while to understand my behaviours and things - which is understandable but I like knowing that they know me so well. And that for the staff who know me the best, they can sometimes predict my next move. I also have the greatest Doctors that I've ever had and it was said in the CPA that with BPD, psychiatry is not the most important part but they're much more than that. I have such deep conversations with one of my Doctors and she's my greatest support at the moment. I'd be lost without her! And then there's how much I love the girls; my second family.
Anyway, we finally got onto the future plans part which is what I was looking forward to the most. They agreed I'll be out before Christmas and they're not even keeping my next CPA to six months because I should be so close to discharge by then. And they think I should be informal (discharged from my section of the Mental Health Act) by the next CPA.
So, I was really happy with the CPA, but I didn't really get a chance to properly enjoy it because I was going into the medical hospital today (21st) for a procedure for my urinary retention so I had that on my mind once the CPA was over.