This post may come as a shock to some people but it’s actually something that’s been talked about behind-the-scenes for about two months now and I just hadn’t told anyone it was a topic of discussion amongst me, my Community Psychiatric Nurse (CPN), and the rest of the Community Mental Health Team (CMHT). As part of these discussions, my CPN suggested I write a blog post about discharge from mental health services; the technicalities behind it, the thoughts and feelings around it, the importance of it, and advice I’d give to others going through the process.
WHY I STILL NEED THERAPY
So, the talk about discharge actually came up when I got a new CPN; she was asking me what I thought I needed to do and what she could do for me to help me be ready to be discharged from services, and I told her that there’s still a lot to talk about around the abuse. You’d think that somewhere among all of these blog posts would have been the point where I’d worn out talking about the abuse but actually, I’m very short of that mark. And I think that’s because the most detail I’ve ever gone into it about it was to the Police; and for all their amazing work, they aren’t the best people to support someone with that. For them, it’s all about the technicalities in using the proper words – who cares about the words that make you uncomfortable or that you find triggering, you better be prepared to talk like you’re in a Biology class(!) – and naming absolutely everywhere and everyone that was even remotely involved. Now that that interview is over, all I can do publicly is say at one point in my life it happened… I can’t tell you his profession or the location of it because people will easily guess – my point with this though, is that, if you can guess from just those details then maybe that says more about him than it does about me oversharing! And there have been so many times when those details have been relevant to blog posts and I’ve just had to bite my tongue! So, having the ability to tell one person absolutely everything would be so refreshing and comforting that I feel it’s the one necessity missing for my mental health recovery. I have the support system, I have a positive attitude, I have safe coping mechanisms… all of that isn’t the answer if you haven’t worked on the root cause though.
WHY THERAPY MEANS DISCHARGE
In determining just what sort of therapy I needed (Complex Trauma Therapy), my CPN made some enquiries with Psychologists and gave them my notes to allow them to draw their own conclusion, and it transpired that I need to have been discharged six months in order to begin therapy. Initially, this seemed backwards and my Mum and I were confused because surely if you’re going to go through therapy then you need as much support as possible around you. The Psychologist’s thought process around it though, was that they don’t want to put someone through therapy if they aren’t stable enough to do it without the back-up of a CMHT. Almost as though, if you’re worried you can’t cope with therapy and are thinking that you need the support of mental health services then maybe you aren’t ready for it. I get it. It makes sense. But my discharge coming in such a round-a-bout way left me with a lot of questions…
MYTHS & BUDGET CUTS
‘Am I ready to be discharged?’ and ‘do I deserve discharge?’ were probably the main questions to whizz around my head from the moment discharge was mentioned and I think that they sum up quite a lot about the age-old reality of mental health services and what is now a myth amongst the general public… That once you either exhibit signs of a mental illness or are diagnosed with a disorder, then you will forever be under the care of mental health services. My CPN talked about this being a bit of a myth but I think that realistically, it used to be quite true and that the only reason it no longer is, is because of budget cuts in the NHS. Is this something that should make me afraid of discharge though? Should I be worried that maybe they’re only doing it to save pennies? The thing is with discharge – and the thing that I think staff realize (but I’m not saying they treat people based on it!) – is that it’s far cheaper to keep someone on caseload than it is to discharge them before they’re ready and then have to fund crisis services to support them! At a time when I’m desperate for reassurance, that thought reassured me that this wasn’t a motivation for my discharge!
WHY DISCHARGE IS A SURPRISE
I think that discharge was a surprise too because when I first started experiencing auditory hallucinations, I was so scared that telling someone would mean I’d be hospitalized and never let out, that I kept quiet about it for almost two weeks. In the end, my suicide attempt led to the professionals sectioning me under the Mental Health Act and admitting me to a psychiatric hospital where I got to see other inpatients hear voices and see things that no one else could; and I realized that I wasn’t alone. That I wasn’t the only person and that if I didn’t tell someone and get help, then maybe I would end up still sat in that psych ward in years to come. Telling a Psychiatric Nurse on the ward that I could hear voices was one of the scariest things I’ve ever done, but it’s also one of the few things that I’m most grateful I’ve done! Telling someone might have meant a longer hospital stay and more medication than if I’d kept quiet, but it also meant that I could be helped and supported for the right reasons and in the right way. I think that learning to make sense of the hallucinations and that they stemmed from when I disassociated during the abuse, actually really helped me to get to this point of discharge.
Making sense of the hallucinations has been just one necessity to my mental health recovery; with the others being more focused on my coping skills – or lack of! For me, self-harm and attempting suicide became my go-to coping mechanisms when things got even remotely difficult. I’d like to be able to say that it took a lot to get me to the point of doing those things but back then, it really didn’t. If my CPN called in sick when we were meant to have an appointment, then I’d do something. Although the reasons changed, the thoughts and feelings they had created were consistent; sometimes I felt numb and thought that self-harm would give me some sort of feeling, other times I thought I deserved the pain of the self-harm, sometimes it was about me trying to bring myself back to reality when I was hallucinating, disassociating, or felt lost in memories and flashbacks of the abuse.
Now, though, I think it’d take a lot to put me back in that place where I felt that self-harm or suicide was the only way around the way I was thinking and feeling. When it felt like either the only way to cope, or the only way to escape. I now know that if it does help then the benefits never last long, and that there are so many better, safer, healthier coping skills from Dialectical Behaviour Therapy (DBT) that actually do a better job coping with those thoughts and feelings that used to drive me to self-harm!
Another piece of progress in my mental health has been with the hallucinations. When I started hearing voices and seeing things, I was so scared that it would never end – that I’d never be free from the voices and the visual hallucinations – that I attempted suicide when they both first occurred. Everyone who hears voices experiences the hallucination in a different way and for me, they were coming through my ears, yet they seemed to fill up my entire head (almost like when you listen to music through headphones) and that made me skeptical that I’d ever find an escape from them. With the visual hallucinations, I felt I had no control over these scary things that would happen at the worst of times. For both hallucinations, my anti-psychotic medication has really – I feel – been the answer. Some might say it’s a mix of me learning DBT and growing up and seeing things differently, but all of those things are what has affected my coping of the hallucinations and not the actual existence of them. That has very simply been medication. Believe me, I know how very lucky I am to find medication so helpful; some people struggle to gain anything from it and find themselves trying numerous drugs in a desperate effort to find one that helps.
Whilst recognizing this progress – with the voices, the self-harm, feeling suicidal – I also know that there’s still room for improvement and that is where the Complex Trauma Therapy will come in because I believe that I still have a lot of the same feelings around the abuse. There’s still so much anger and hatred there and that might never go, but I think that if there’s a chance that it will, I’m not going to find it myself. I need help to work on my thoughts and feelings around the abuse and whilst I definitely believe that there’s nothing ‘wrong’ with the way I feel, it’s still something I’d like to change.
THE GENERAL IMPORTANCE OF DISCHARGE
This is something that might not really be applicable to me and my discharge but it’s something that I thought I couldn’t not talk about if I’m blogging about discharge from mental health services. It’s the chance of service users becoming institutionalized or wholly reliant on services and mental health professionals. I once had a Psychiatrist tell me that I self-harmed and attempted suicide because I saw hospital as a ‘safe-place.’ I think that he was trying to express that he thought I was institutionalized or relying on hospitals, but he worded is VERY poorly! Hospitals are supposed to be a safe-place – in fact, there’s a lot of controversy around them being designated ‘safe places’ under the 1983 Mental Health Act! And so many organizations and professionals recommend that if you’re feeling unsafe e.g. you feel suicidal or you have urges to self-harm, then you should attend an Accident & Emergency (A&E) department at your local hospital. And the whole point of sectioning people to a psychiatric hospital is to keep them safe and to provide better help and support. So, how easy is it for us (not just as a service user but as the general public too) to see these places as safe and to find them reassuring and comforting?
It’s not just about the hospitals and the wards though, it’s also about relying on professionals and this, again, is something that’s ‘easy’ to do because those professionals are meant to be the people you go to for help. They’re the ones who’ve spent so many years learning just how to help people when they can’t help themselves, so why would you even remotely hesitate when considering whether to call or make an appointment?
I think that if I’m honest, I’ve never felt institutionalized (even after being in a psychiatric hospital for two and a half years!) but there was probably a time when I relied on the professionals too much. I think that when your mental health is so poorly, you become so vulnerable that it’s very ‘easy’ to depend on others. The reason I think I relied on them was because I was suicidal for so long and I think that there was always a part of me (and sometimes it was really, really small!) that wanted to be alive, but that meant that the majority of me wanted to die. To overpower that majority, the little part would obviously have to get help. It needed back-up. Recently though, those parts of me have changed and there’s only occasionally a small part of me who’s suicidal and with my medication controlling the hallucinations, I’ve found that it’s very rare for me to need crisis support from services.
AM I ALLOWED TO GIVE DISCHARGE ADVICE YET?
I’m not sure if I should… A big pet hate of mine is people who advise others on a subject, but they don’t personally really know much about it. I’d get this feeling sometimes with professionals who seemed to be reading from textbooks or repeating word-for-word what was said in their training classes. I guess it doesn’t always take experience to be able to give good advice, but it definitely helps it to be more effective!
At this point in my discharge planning, I think that the only/best advice I can give is to be honest and speak up. If you don’t feel ready to be discharged, then don’t be ashamed to say that to those discussing it. Tell them what you’d rather do, what would really help you and why this is the case. At the end of the day, it’s like I said earlier; I’m sure services would rather not rush a discharge if it means a smaller chance of having a person fall into crisis because they feel they have no support.