A while ago I joined the North Service User and Carer Forum (NSUCF) which is part of my local NHS Trust who provide mental health services in my locality: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW). At our most recent meeting, we had a Psychiatrist from CNTW’s Crisis Team join us and each Forum member asked questions and put forward ideas. In part of the discussion, myself and one of the Service Users came to the realisation that we really had different definitions of a mental health ‘crisis’ and it inspired me to write this blog post…
For me, I deem myself to be in a mental health crisis when I can no longer keep myself safe. Like, if I struggle and feel unsafe, but I can manage it myself and use the healthy coping skills I’ve been taught in therapy, then I wouldn’t label it a crisis or call anyone for help or support. Me calling the Crisis Team or a professional, usually means I’m unsafe and that I feel as though the hallucinations are in control. As though I have no say in whether I self-harm or attempt suicide because if I did, I wouldn’t do those things. When I’m me, and when it is my thoughts that take up the majority of my mind, I don’t want to die. I don’t want to hurt.
One difficulty in having different definitions is the worry as to whether you’re really ‘entitled’ to speak up or ask for help because there’s the concern that there’ll be people who might judge your crisis in comparison with others. And that they might come to the conclusion that it is completely minor and unworthy of any help or support. That in looking at it alongside another person’s crisis, it really shouldn’t be a big deal and it wasn’t deserving of help and support from others, particularly where this meant the use of NHS resources.
Another difficulty in believing different definitions can come from
ASKING FOR HELP
I think that living by myself (if you don’t count my cat and bunny!), I’ve become quite an independent person so I find it challenging to ask for help at the best of times, never mind when I’m struggling. I sometimes see it as though I’m admitting defeat by recognizing that there’s nothing, I can do to help myself. I almost feel useless and I worried that being incapable of coping by myself after being an inpatient and doing Dialectical Behaviour Therapy (DBT) for two and a half years, would mean I was a huge waste of everyone’s time and resources. And if all that time and therapy wasn’t enough to save me from a mental health crisis, what hope was there for me? What more could anyone do?
Another reluctance to ask for help, has been the memories of past, absolutely terrible, responses from professionals when I’ve reached out in a mental health crisis. The stigma against my diagnosis of Borderline Personality Disorder (BPD) exacerbated each occasion, with a lot of judgement and assumptions being made. I think a lot of those judgements and just downright nasty comments from professionals, were due to a lack of understanding and education.
And honestly? Some of that is my responsibility because I was incapable of explaining my experiences articulately enough for the professionals to develop a level of empathy. My inability was primarily due to the auditory hallucinations… I was so terrified when I first started to experience them and have mental health crises, that I was very reluctant to develop any sort of understanding. I didn’t want to have more knowledge. If I had – as I do now – that understanding, I would have been able to educate the professionals as to why I was self-harming or why I had attempted suicide. And perhaps then, I would have received better, kinder, more helpful, responses in my times of crisis.
There can be so many different influences for a person to fall into a period of crises with their mental health. It’s like; everyone has different buttons and even then, can have them pushed in different ways. You could find two sexual abuse survivors and one might have their abuse memories triggered by one particular word, which the other person finds completely acceptable and wouldn’t ever think otherwise.
The influences for my crises are usually acute triggers – so, it’s not where something has continuously happened or happened a long time ago and I’ve been trying to cope. It’s usually that something has happened and boom! I can’t deal with it! Even that could be different for others who might have the attitude that I’m reacting too quickly to something; a lot of people might usually see how they ‘go’ for a day or two and if they’re still struggling then they’ll treat it as a crisis. For me, I think I’m quite instinctive when it comes to my own mind now and I’ll recognize my early warning signs a lot quicker and recognize the importance of getting help for them immediately, because I’ve seen how unsafe I can be if I don’t.
My crisis triggers are primarily related to the abuse I experienced and that usually means a word has been used, I’ve seen something, or something in general has happened and it has reminded me of the abuse and left me feeling as though I’m right back in that time of my life. And I’m convinced that I can’t cope with it for a second time, so I become unsafe.
Another acute trigger for me to be in a crisis, has been the hallucinations. Sometimes it’s not even about them saying anything in particular; it’s purely just their existence that influences a crisis. I describe my auditory hallucinations as similar to listening to music through headphones in that their voices come through my ears but then seem to take up my entire head. Like, there’s no room there for me and my thoughts and what I want to do anymore; and it leaves me feeling that I have no choice but to listen to them.
FIVE TIPS FOR SUPPORTING A LOVED ONE THROUGH A MENTAL HEALTH CRISIS
1. Respect your loved one’s wishes where possible and appropriate
2. Don’t lose hope that your loved one will come through it
3. Try not to show your loved one any panic or fear you may have
4. Don’t overuse distraction and cross the line into denial
5. Listen to everything they have to say with interest, kindness, and without judgment
I initially called this ‘the stigma around it’ but thought that maybe that wasn’t the right wording… it’s more about people making assumptions on those labelled as being in a mental health crisis. It’s sort of like recently, with a celebrating making a comment that someone who was abusive was being ‘classic borderline,’ (referring to Borderline Personality Disorder) and everyone has jumped on it and is saying that having the Disorder doesn’t mean someone is inherently abusive.
I think that the assumptions regarding mental health crises are mostly around that person being unsafe. Of course, a person self-harming or about to attempt suicide is usually a time that would be labelled a crisis, but that isn’t always the case. In the past, I’ve deemed those instances to be the definition of a crisis for myself, but as I progressed through recovery, I began to understand and realise that I could be in crisis without that safety aspect. That a mental health crisis could purely be that you’re struggling to the point where you need help or support. Learning that, though, was difficult because I felt unable to access my Community Mental Health Team (CMHT) or Crisis Team if I wasn’t unsafe.
Another assumption of a mental health crisis is that someone in one could be dangerous or violent. For this, I almost feel like a hypocrite because in my most poorly days… well, I wouldn’t say I was violent or really aggressive; just totally uncooperative! And yes, sometimes that meant I needed to be restrained. Once, I was being restrained by a Police Officer and I kicked my foot out and gave him a blackeye. I felt so terrible afterwards, but he kept reassuring me that I hadn’t done it on purpose and that when I’m well, I do cooperate, and I am reasonable.
And I guess that story highlights another issue around assumptions, whilst the Police Officer in that instance didn’t do this, a whole ton of others have – assumed that what someone is like during a crisis is who they really are. Or, if you’re meeting someone for the first time, who they always are. Once, when I was really poorly, my Mum asked if I’d been about to leave the house to attempt suicide and she got poorly, what would I do. I told her I’d ring an Ambulance and leave anyway. Now, anyone who knows me will know how much I love, respect, and appreciate my Mum so for me to have made a comment like that really isn’t ‘me.’ And I recognize the importance of taking responsibility for your actions but if a person is genuinely – or believed to be – lacking capacity, that just isn’t always possible or even fair.
Ah, the ‘easy fix!’ I really don’t like that saying! I think that I totally understand what is meant by it, it’s just that my experience of medication – particularly in a crisis – impacts my thoughts and how I view it.
Firstly, it might strange, but medication isn’t always ‘easy’ to take. And I get that for some readers you might be thinking about instances where you’ve been in pain and have taken paracetamol or some other painkiller. So, it only makes sense that if there’s a medication out there that could help you, why wouldn’t you take it? But it’s not that straightforward in mental health – or, at least, it wasn’t for me.
Initially, I was very scared to start psychiatric medication because I was worried about all the side effects that the other inpatients were upset about. Then, for some time, I found that I actually ended up feeling much happier and the voices were a whole lot quieter. After a while though, it became difficult again when the auditory hallucinations became louder, more powerful, and more controlling. They began either convincing me that the medication was poisonous, or assuring me that having them in my head was actually a privilege and an honour, and that it was just spiteful and nasty to try to get rid of them. Obviously, this made me very reluctant to take the medication and for the following three years my attitude towards it frequently switched until I was finally admitted to a psychiatric hospital for two and a half years. Literally every inpatient on the ward I was on took psychiatric medication so it came as no surprise when I was prescribed an entire roster full of different drugs with the hope that they would stabilise my mental health enough so that I was in the ‘right’ frame of mind to engage in therapy sessions.
It was in the hospital that I discovered the benefits of medication in a time of crisis – because yes, you can still have a mental health crisis whilst in a psychiatric hospital. And what I learnt through that was if I was feeling unsafe or if I was struggling to cope I could just go to a member of staff – there were usually plenty of them! – and ask for ‘PRN.’ I’d swallow the little blue (Lorazepam) or white (Diazepam) pills and within the hour my head would be that bit quieter and my body so much calmer and more peaceful.
And yes, for that small amount of time, it felt as though medication was an ‘easy fix’ but then, through therapy, I learnt that in some instances, you shouldn’t rely on psychiatric medication to get you through them. Sometimes, you need to go through therapy and have psychology sessions so that you can build your own coping skills that are just as efficient and effective (sometimes, maybe even more so).
However, where medication is the best course of action in a mental health crisis, the person requiring it should never be judged for that. They shouldn’t have people saying that the person is in any way ‘weak’ for needing help to stay safe and to come through their crisis period. At the same time, there shouldn’t be others criticising the benefits of medication in arguing that it can’t have been a true crisis for it to have been resolved with the help of a pill. And there shouldn’t be judgement if the person has needed encouragement or a reminder to take the medication.
FIVE TIPS FOR PROFESSIONALS RESPONDING TO SOMEONE IN A MENTAL HEALTH CRISIS
1. Don’t allow any time constraints affect the help and support you provide someone
2. Where your training was limited or inadequate, always seek advice from others
3. Be honest and open about your role in the crisis
4. Appreciate that your response has the potential to change someone’s life
5. Don’t judge or blame whatever has influenced that person to be in the crisis
Having some sort of support system in place for when a crisis does occur can not only be helpful in the actual crisis, but it can also reduce the chance of the crisis even happening because the person has help and support in place as soon as they begin to struggle.
A support system doesn’t have to be a typical friends and family sort of thing. You can find support in so many other people in your life. There shouldn’t be a pressure to have close friends or a big, solid family as though they are the only definition or sources of support for a person’s mental health.
I come from a very small family – even if everyone was talking to one another(!) – so it’s really just my Mum and my Aunt who I find supportive. I think that if my Mum was the only person in my life, she’d be enough. Enough to help me. And, I mean, she was the one who really fought for professionals to take my suicide attempts and self-harm seriously when they began labelling me an attention seeker. I attribute my life being saved to many people and many things; but a huge amount of that gratitude and appreciation definitely goes to my Mum, for her determination, and unconditional love for me.
I’m also incredibly lucky to have the support of a few best friends too; Ellie, Lauren, Marty, and Georgie. Each of them brings something different to my life and my mental health. Each can help my mental health in a different way because each of them knows different parts of me. I also let each of them see a different level of my mental health with Marty probably seeing the hardest and most vulnerable parts.
But like I said, it’s not all about family and friends. I also have a brilliant Support Worker from Richmond Fellowship (RF) who I’m never afraid to show any side of me to. I think I’ve developed more trust, respect, and appreciation for her now too; since lockdown made it so much harder for us to have face-to-face support sessions we’ve adapted to phone calls and I’ve actually found myself speaking with her even more often than when we could meet up!
In times of crisis, I’m usually fairly reluctant to allow anyone in. To let anyone, see just how I was feeling. Mainly because my definition of a crisis is usually that I’m unsafe and so why would I want anyone to know I was struggling because it’d just mean they’d stop me – or do something to stop me – from hurting myself. And in my crisis state, that’s all I wanted to do.
FIVE ITEMS TO HELP
I considered not adding this bit in because I was worried that so many people would be thinking ‘if these items make a difference to you, how were you in a real crisis?’ But I totally believe that no one should judge another person for any safe coping skills they use to get through a difficult time. I especially think that’s true where a person’s previous coping skills were unsafe! I think that if anything, you should be grateful to that person for having a coping mechanism that is so safe!
So, I picked a few ideas for items from my favourite Dialectical Behaviour Therapy (DBT) skills: distraction and self-soothing… hopefully they’ll help you cope through, and after, a crisis:
Inspirational Colouring Book: £4.99
Stress Relief Colouring Book: £5.20
Christmas Colouring Book: £4.99
Moon Sleep Mask: £11.99
Sherpa Christmas Throw: £18.00
Fluffy Socks: £11.99
The Greatest Showman: £6.99
Pitch Perfect Boxset: £5.99
The Grinch: £6.98
Smashing It Notebook: £10.00
Marble Notebook: £12.00
Kindness Journal: £6.00
Writers Journal: £12.00
IS IT A RELAPSE?
For some, I think that one of the most difficult feelings during and after a mental health crisis is the worry that it’s going to be so much more permanent… Whenever I was in a crisis, I’d feel like I wasn’t even myself because when I’m really ‘me’ I love life and I want to take every opportunity I can and make the most of things. So, for me to say I’m feeling suicidal, or to be hurting myself, it genuinely feels like it isn’t me and it’s why I struggle to resist regretting my self-harm and suicide attempts. I mean, how can I not regret something that I felt didn’t really represent myself and who I am as a person, very well?! Although, I guess that this ends up being kind of helpful because it’s a big reason to fight against my thoughts and the commands of the hallucinations.
That feeling of not being myself meant that I was genuinely terrified it was going to last forever because I felt that I had no control over it happening, so how could I put a stop to it? Fortunately, my most recent relapses have all been due to medication in some way which has meant that the ‘solution’ to the relapse was literally just getting my psychiatric medication back in my system.
But, I have had crises that’ve literally been a sort of… ‘one-off’ occurrence. Like, when I’ve had reminders of the abuse I experienced; it’s been about my mental health deteriorating for that moment. Going into crisis because of that current situation and so, coming out of the crisis, I’ve needed to distance myself from the trigger. And a crisis being a one-off doesn’t mean it is any easier than when it leads to a full relapse. It can be just as difficult to come through and just as life-changing.
FIVE TIPS FOR SURVIVING A MENTAL HEALTH CRISIS
1. Try not to compare the nature of your crisis with someone else’s
2. Learning what helps might be a slow process but keep the faith – you’ll find something
3. Talk! To literally, anyone!
4. Find inspiration and hope that will be a positive encouragement and reassurance for you
5. Be honest but don’t panic if you’re struggling to put things into words