Sunday, 24 January 2021

EVERYTHING YOU NEED TO KNOW ABOUT TIMING IN MENTAL HEALTH



THE POST’S INSPIRATION

A little while ago, when I was putting the Christmas wrapping paper away, I heard a clicking noise in my thumb and it swelled right up pretty damn fast! So, I called the Plastic Surgery department in one of my local hospitals because since my EPL tendon (one of the two tendons in your thumb) snapped on Boxing Day 2019 and I needed surgery to repair it, I’ve been under their care. They asked me to come straight in but on examination, decided nothing needed to be done urgently and I was referred for an ultrasound. At the ultrasound (yesterday) they found that my EPL tendon has misplaced, which I didn’t know could even happen!) and I have to see a surgeon in February.

The reason this inspired the post is that this isn’t the only physical health difficulty I’m going through right now… Since separating the AC Joint in my shoulder in September, it has properly dislocated three or four times and is now at the point where I need a specialist MRI (they’re going to inject a contrast dye directly into the joint – which sounds so painful, but I get a local anaesthetic first – and then scan it) of the joint to determine the exact extent of the damage and to create a treatment plan based on whatever they find.

So, having these two – sort of big – issues right now with my physical health, it’s really made me think about timing and the importance of it for a person’s mental health. I mean, since I have these two things going on at the same time, it has made me realise that it’d be harder to deal with if my mental health was also unstable. And knowing just how much I can struggle when my mental and physical health are poorly at the same time, I’m actually relieved at the timing of the two physical problems!

 

PHYSICAL AILMENTS

In the past, when my mental health had been unstable and I’ve been unsafe, if I became poorly physically too, I turned it into more motivation to hurt myself. I’d think ‘why bother working so hard to get my mental health better if I can’t control my physical health?’

Then, since the abuse I experienced left me feeling completely robbed me of being in control, in any and every sense of the word, it has meant I really appreciate having control in my life. So, where that physical problem involved pain, I would think ‘at least if I self-harm I’m in control of the pain.’

Since I very quickly began comparing mental and physical health, I guess it’s understandable that I’ve very often considered the timing of them and determining which was in some ways ‘better’ – or at least not as challenging, as the other. When I’ve been in physical pain – no matter how bad it has been – I have always remained grateful that it wasn’t any sort of struggle within my mental health. I have two reasons for this:

1.      Physical pain or illness is so much easier to understand even where a person hasn’t experienced the exact same ailment as another. In mental health, I feel that almost everyone is very aware and cautious of never saying that you know how another person feels. I think this is mainly because the potential impact that statement can have on a person’s mental health is fairly common knowledge. Saying something similar to a person in physical pain, though, seems somewhat more acceptable. In fact, if anything, it can become a matter of competition with someone telling the story of their worst pain or injury of some sort.

2.      Physical ailments tend to be treated so much easier. I mean, when it’s come to my mental health, I’ve swung between two places; the first was when I was an inpatient in the specialist psychiatric hospital and literally every inpatient was on medication. I think that it meant I was much more easily prescribed psychiatric medication. The second stance with my medication was when I’ve had to fight to be on it, against the few professionals who are of the conviction that absolutely everyone with my diagnosis of Borderline Personality Disorder (BPD) should be treat the same. It took me being off all of my medication and ending up in Intensive Care for a suicide attempt for those professionals to sit up and think ‘oh! She does need it!’ It was so dangerous because I actually could have lost my life just because they were wrong. The other issue with psychiatric medication compared to physical is the length of time each takes to have an impact on your health. Ironic, that where an antidepressant is needed to reduce a person’s risk to themselves, it takes weeks. But you can find some relief from a simple cold with something you can just buy over the counter! When it comes to physical health, it’s occasionally still a mixed bag with some Doctors being reluctant to issue a particular drug that another one doesn’t blink twice when prescribing. But I think it’s safe to say that professionals are more willing to prescribe medication for physical symptoms as opposed to mental health difficulties.

 

EDUCATION

Having been at High School during the abuse I experienced, I’ve had an incredibly difficult relationship with education in the traditional sense.

For many reasons, I felt that I couldn’t tell anyone that I was being abused but, in some roundabout ways, I tried to show people that something was going on. The main behaviour changes I made were whilst I was at School and yet not a single teacher questioned the sudden change in me. When interviewed by the Police though, each of them made a comment along the lines of ‘I didn’t see anything, but I did suspect it.’ For a long time, I lived with something that felt even more powerful than anger, with the thought that they’d supposedly been wondering whether someone was hurting me but hadn’t done a single thing about it! After years of therapy, I learnt that whilst I was more than entitled to my fury and hatred toward them, it wasn’t going to change something that had already happened.

During those years of anger though, I still attempted to continue my education in a classroom setting. In High School, we had been taught that you do your GCSEs, your A Levels, attend University and get a job. No one mentioned Apprenticeships and Internships or online/distance learning. We were led to believe there was only one route to getting a job and unless you took it upon yourself to doubt this and do your own research, you would feel like a failure if you ever fell of that path. Doing my GCSE’s during the abuse was obviously difficult but also a big distraction. Whereas my A Levels were the aftermath of the abuse and it was the time when what had happened to me was really starting to sink in and that meant I really struggled to do well at the subjects I’d chosen. I remember telling one of my teachers that I’d ‘ruined everything’ purely because I’d found one exam difficult; but I think it’s hard to put things into perspective when you’re younger and particularly where you’ve just been through a trauma.

It didn’t occur to me that perhaps it just wasn’t the best time to be doing homework and spending hours revising for exams when I had something really big inside of me that I had no idea how to cope with. However, even after being sectioned under the 1983 Mental Health Act, I still wanted to try my hand at education and over the years I attempted courses in Childcare, Law, and Fashion. I think that not really having a clear career in mind also made the timing poor and now that I have my blog and all the opportunities that have come from it and which have really proven the industry I’d like to work in, I’m almost grateful that I didn’t make much progress in any other field!

Whilst I was in the specialist psychiatric hospital, I began taking distance courses with the local College because being sectioned meant I needed permission and staff escorts if I were to attend an actual class. I think that was good though, because it showed me that I could continue my education through distance learning. And this is something I still do through websites like FutureLearn and Centre of Excellence.

 

SELF HARMING &/OR ATTEMPTING SUICIDE

There might be readers out there who will see this and wonder ‘if you can ‘time’ your self-harm or suicide, surely you can just not do it?’ That isn’t what this part is about. It’s about how the timing of when you do something like this, can impact the response you receive.

When I first thought about this part, I thought of how Accident and Emergency (A&E) staff, Paramedics, and Police have often commented to me that their busiest time in so far as mental health related situations, is when it’s a full moon. I have no idea whether there is a connection there (in the same way that there’s a connection between the seasons of the year and mental health), but I don’t think it should be remarked upon in front of the person in crisis. It can come across as dismissive and patronizing as though a person is only struggling because of the moon. As though their reasoning for the crisis means nothing because it must just be the size of the moon.

The other timing issue with self-harm or a suicide attempt can be the day or the time. I think that I’m not the only person who has interacted with the previously mentioned professionals and can confirm that those professionals can treat a person differently depending upon how busy their service is – and how stressed they are because of that. The ironic thing is, I can understand that. No doubt, when I’ve been really busy, I’ve felt irritated and snapped at someone for no good reason. The important difference though, is that my irritation won’t have the same impact as one of those professionals. When I trained some of the new recruits of my local Police force, I have always told them this metaphor for them to be aware that when they attend a mental health crisis call-out, their response has the potential to influence whether a person jumps or whether they step back from the edge.

The final timing aspect of self-harm or a suicide attempt, is the timing in your life that it takes place. I think that those who do one of these things will get a different response depending upon their age. To a degree, this is necessary; a younger person might have a different understanding of mental health and their experiences in general… I was fifteen when the abuse first started, and I was so naïve and had very little education that would allow me to understand exactly what was happening to me. This also illustrates the fact that an age difference can likely mean different experiences that have led to the person doing this… The additional point of this, is that people of different age groups will mostly require different responses to their actions. I think that the most understandable aspect of this is that there are different mental health services available for different age groups and sometimes, there are fewer inpatient beds for one age to another – even if they both require one. This factor can impact a person’s hope for recovery.

 

EMPLOYMENT

Out of everything I say on I’m NOT Disordered, one of the most embarrassing statements to make is to say that yes, I’ve had numerous voluntary jobs and an internship, but I’ve only ever had two paid jobs (and one was a newspaper round so I don’t know if that counts…?). I hope that the voluntary jobs illustrate the fact that I haven’t just sat on my bum and that I do as much as I’m able to.

I was raised by my Mum who had an amazing work ethic; she put in all of her time and energy into her job and was always fully dedicated to it. So, I think – or at least, I hope – I’ve inherited some of that, and whilst it isn’t necessarily true for me having paid work, it’s definitely the case with my blog and voluntary roles.

The paid job I had when I was younger was at a retail store and unfortunately, the auditory hallucinations started at the end of a shift during my employment there. Obviously, I didn’t tell anyone about the voices so when my Supervisor told me I was going to be trained to be in charge of the ground floor changing rooms, I couldn’t tell that I was worried it’d be more stressful than my current role on the tills and the shop floor. I was right about the stress of it because I was very quickly left alone on what was a three-person job, and not having a bell to call for help, I regularly struggled with angry customers for simply telling them they couldn’t try on accessories in the fitting rooms!

In the end, the voices got so loud that even when I had screaming customers in my face, their shouts seemed somewhat muted and dull than they might have been, had I not also had the additional noise. So, I walked out in the middle of my shift! Looking back, even though it was stressful, I don’t think I would have walked out or quit if I hadn’t had the voices too. I think I would’ve just continued to moan about the stress but have the ability to tolerate and cope with it.

I guess that’s why, whenever my mental health was doing well; I would take on some sort of employment role. Mostly that meant working in the retail sector of charities. It wasn’t until I started blogging whilst a psychiatric inpatient, that I started to realise I really didn’t want to work in retail. Learning that I wanted to work in the communications/marketing/social media industry meant that I could start homing in my search for a role I felt able to do whilst my mental health was in whatever state it was at that time.

                                            

PETS

I think this part will be the shortest because it’s fairly obviously based on the fact that you should only add pets to your family where the timing is right; and this mostly means that your mental health should either be in a good state, or at least be in a state where pets will be of benefit to it.

My first cat; Dolly, had been a recovery goal for over a year whilst I was a psychiatric inpatient and had a kitten collar hanging from a photo frame (the glass had been removed) in my hospital room. So, I think a huge essence of the timing in getting her, was that it was the first time in years where I could say I had the ability to take on an additional responsibility and not be worried the stress of doing so, would deteriorate my mental health.

Three years after getting Dolly, my visual hallucinations of rabbits came back, but my fear of being hospitalised again led to me being reluctant to tell anyone in case they’d think I’d relapsed. Then, I was in my local Pets at Home store looking at their rabbits – actual rabbits – when I came to the very random and abrupt conclusion that holding one of them might help. When I asked to hold the fluffiest one with the lop ears, I burst into tears and told my Mum the hallucinations had come back. So, straight from Day One, Pixie has been therapeutic and helpful for my mental health. One thing I will say about getting her though – and I would never wish I hadn’t gotten her! – is that I wish I’d done some research on having a house bunny so that I could have been more prepared for the challenges that have come with her.

After Dolly died – just one year into having Pixie – the home wasn’t the same without a cat and Pixie would follow me everywhere and constantly wanted to snuggle. So, I adopted Emmy within just a week of losing Dolly. So many people told me it was too soon and that I hadn’t had time to grieve, but I was 100% convinced that it was the right thing to do for me and Pixie. And I turned out to be right! She was instantly happier having a little friend to play with and chase. And I felt slightly more complete.

Then, whenever my mental health did dip to the point where I was suicidal, I would think about Emmy and Pixie. I’d think about how it would affect them. How they wouldn’t want me to be gone. And mostly, I thought about how they’d probably be separated to be rehomed.

The final aspect of pets and the timing with mental health is the possibility of your pet becoming poorly and having an idea as to how you would cope with that. When Dolly passed away, I was off my psychiatric medication so it was a huge knock to my mental health, and I was honestly scared that I would never come out of the very dark tunnel I had found myself in. Fortunately, Pixie was there so it felt as though I wasn’t completely alone in knowing how it felt to live with Dolly, and how it felt without her in our home. Though sometimes, it made the sadness a bit worse to think that Pixie was going through some level of grief too.

Since losing Dolly, both Emmy and Pixie have been poorly (obviously with different conditions – an infection for Emmy, and Gut Stasis for Pixie) and I think the main reason I’ve coped has been my medication. Though, I will acknowledge that all my hard work in therapy hasn’t gone to waste and I use my Mindfulness, distraction, and self-soothe skills in these situations too.

 

RELATIONSHIPS

I’ve had one long-term relationship in my life, and it lasted almost ten years. I met my Ex just months before the hallucinations started and before I made my first suicide attempt, so he was literally there from the very beginning. I think that part of the reason why we were together for so long was a bit out of habit. I mean, I was almost eighteen when we first met so it was almost as though I didn’t know any different. All I knew was him and the relationship we had.

Of course, just because it’s ended, it doesn’t mean I don’t recognize the good times and when people say they weren’t in love because their relationship ended; I don’t believe I should dismiss the feelings I had for all those years just because we split up. I want to have more respect and appreciation for the relationship since, even the bad moments, were worthwhile because they’ve taught me what I want and what I don’t want from someone.

I do, however, think that a big ‘fault’ in our relationship was that it wasn’t at the best time. I mean, he saw some very unwell moments and I think the fact he stayed with me through them all, made me almost settle for poor qualities in him because I was so grateful for his presence. As though I felt that leaving him – even for completely justifiable reasons – wasn’t fair because he’d been there for me for so long and through so much.

Unfortunately, it was a case of the-straw-that-broke-the-camels-back in that it took something big and serious for me to almost see sense and find the strength to walk away. I surprised myself in all honesty because my mental health was actually really poor when we split so I’d have thought that was me at my most vulnerable, and at a time when I didn’t want to be alone. I guess it just illustrates how bad things were that I was able to end it regardless of my mental state.

It isn’t just about romantic relationships though; a key relationship to impact your mental health due to the timings of it, is that of one between you and a mental health professional – or any professional who becomes involved in your mental health or in one crisis in particular. The timing of their involvement will obviously shape the relationship you have with them, so it can range between feeling full of tension and spite or full of gratitude and respect!

One of the hardest elements of this part, is the lack of consistency. This is mainly because in the case of a crisis, there’s no real regularity to the staffing of all those professionals who could potentially become involved. This means you don’t have the opportunity to build any sort of bond with one of them, in the way that you can as an inpatient.

 

PSYCHIATRIC HOSPITAL ADMISSIONS

I thought that I’d sort of transition from that little bit about the difference in relationships with professionals depending on the timing that they enter your journey and talk about the timing of psychiatric hospital admissions; including being sectioned and undergoing therapy…

When I was first detained under section 2 of the 1983 Mental Health Act, the main reason for it was because I refused to tell anyone why I had made a suicide attempt and was refusing to have the potentially lifesaving antidote treatment. Having had no prior contact with mental health services and with everyone being completely at a loss as to why I had done what I had, I think with that timing in mind, it’s understandable that the professionals felt backed into a corner in their discussions and debates to section me.

After that my third sectioning, I was finally given my BPD diagnosis; and that definitely changed things. One of the professionals who argued against the diagnosis said it was because BPD was a death sentence. She said that once you had that label, services wouldn’t want to work with you, you’d get no help, and would end up committing suicide. She was (almost) right. From having the diagnosis, any suicide attempt or self-harm was treated completely differently. It was like a whole other world from the one I’d experienced in the beginning of my mental illness.

Whilst professionals probably thought coming to a decision on a diagnosis was the best first step, I wonder if things would have even gotten to the point of me being on life support from a suicide attempt? I mean, before the label, I did actually feel helped and supported. Granted, it might not have seemed to make much difference, I wonder if it would have done given more time…

Being admitted to a psychiatric hospital actually became a whole lot scarier when the professionals weren’t doing it every single time I was in crisis. It meant that often, I thought I knew just how honest I could be in talking about my thoughts, feelings, and experiences without them sectioning me. Some might say it was manipulating the system, but I think that’s more about when someone is saying particular things – or even telling full-on lies – because they want to be hospitalised. Anyway! My point is that when I thought I knew something; they would snatch the rug from under me and section me for something which I regarded as lesser than an occasion I was allowed home. I began to believe that the response and whether I was admitted to a psychiatric hospital could come down to who you happen to be assessed by. Timing.

Another element where timing is important in being an inpatient, is when the professionals determine – or occasionally the inpatient requests – that therapy starts. I think that it’s quite rare to have therapy as an inpatient because most hospitalisations are about timing. They’re about getting some well enough so that they can leave, and it leaves the actual time and effort to be supported in achieving recovery, to the community teams. However, I can completely see the argument for someone having therapy whilst an inpatient because the sessions are likely to take their toll on someone and could trigger a relapse. Something which is much safer to happen as an inpatient. Although, as someone who complex trauma therapy has been recommended, I can also understand the issue of timing in engaging in therapy as an outpatient. The argument there is that it’s best someone begin therapy when they’re stable enough to manage any thoughts and feelings that manifest from the sessions, by themselves.

 

ACHIEVEMENTS IN GENERAL

This part can very obviously include an enormous variety of achievements that could range from winning an award for horseback riding, learning to swim, going a period of time without alcohol or smoking, or – in my case (most of the time) – reaching a milestone or securing a collaboration or opportunity for I’m NOT Disordered.

I think the first instance in my life that I’d label as a real achievement was when I was sixteen and I passed all of my GCSE exams. This felt huge because my abuser had actually tried to interrupt and sabotage some of my exams, so it was almost as though it was an actual win against him personally.

I had little achievements – which sometimes felt big at the time, but in perspective they really aren’t – over the years but I would say my next biggest one wasn’t until I reached 100,000 readers on, I’m NOT Disordered in 2015. Celebrating that achievement with a huge party that I ended up labelling the greatest night of my entire life, really encouraged me to make the most of every achievement and I think it helped me to find what I had previously deemed the ‘small’ achievements, as more important.

The timing of such moments is almost always spot-on. I mean, if I were struggling with my mental health and achieved something, it very obviously really cheered me up; and if I were doing well, it was extra encouragement to enjoy that feeling.

 

TIPS ON COPING WITH BAD TIMING:

1.      Research different education options before dedicating to one

2.      Use Mindfulness to recognize the situation you’re in and accept what you can change

3.      Research the pet you want before committing to owning it

4.      Don’t be afraid to celebrate your achievements – no matter how ‘small’

5.      Recognise that sometimes a response you receive isn’t always personal

6.      Be practical and aware of the reasons for any inconsistency

7.      Resist wearing rose-tinted sunglasses

8.      Don’t be pressured into a relationship

9.      Consider a person’s motives when they act against your wishes

10.  Never avoid taking responsibility where appropriate