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This post is aimed at really highlighting the chosen theme for this year’s Mental Health Awareness Week; Anxiety and talking about how this can look different depending upon the situation and those involved e.g., my anxiety in seeing the Crisis Team can be completely different to that which I experience in speaking to inpatient/ward staff. As a result of the fact I’ll be concentrating on each of the NHS mental health services who were involved in my recent relapse/admission, I thought I’d collaborate with the Trust providing all of them: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW). And so, throughout the post there’s information on each of the services that led to differing types of anxious thoughts and then, at the end of this piece, there’s a lot of links that include some of the very helpful resources CNTW provides around Anxiety…
Anxiety with the Psychiatric Liaison Team (PLT)
The first CNTW staff to become involved in my mental health
relapse in February were the Northumberland Psychiatric Liaison Team (PLT) who
are based in my local A&E hospital: Northumbria Specialist Emergency Care
Hospital (NSECH – warning:
this post is likely to be full of acronyms!) and are basically the mental
health professionals who visit and assess hospital inpatients – both in A&E
and on the wards – no matter the reason why they’re in the hospital (though
typically it is through self-harm or a suicide attempt).
Personally, I think that the idea behind introducing and forming
the PLT was really wise and a very positive and productive move in terms of
providing patients who have a psychiatric illness but who are in a medical
setting to feel better supported, more understood, and validated. And I say
this because prior to PLT being put together, there were so many instances of
medical staff – particularly Nurses – making terrible comments around my mental
health, and I think a large part of that was due to a lack of education,
knowledge, and understanding around it. But now – having PLT in the hospital –
means that they can provide support and advice to the medical staff who may be
struggling to treat and take care of someone with a mental illness because of
their absence of appropriate and useful training.
Of course, I recognise that PLT aren’t always helpful for all the
people who they are intended to be there to support… This, however, can be a
common thread in mental health services and is typically because regardless of
whether there are so many people there for the same reason e.g., self-harm; not
everyone has the same needs or finds the same things useful. What one person
may greatly benefit from, another may find it triggering of flashbacks and
upsetting memories. Mental illness and those with it, can be that unpredictable
and that dramatically different. And so, of course my opinion and experience of
PLT may contradict or be wildly separated from that of others.
With the point of this post being about Anxiety, though, whilst I
have usually found PLT helpful in providing care and support for me when I’ve
been in NSECH, I have still found myself anxious every single time I’ve been
told that either they were coming to see me or especially when I’m told that if
I didn’t see them then I couldn’t leave the hospital. And a huge part of this
Anxiety is derived from the recognition that they have an authority and power
over what might happen to you/your mental health and general wellbeing. This
isn’t exclusive to them having the ability to refer you to see the Crisis Team
or advising the hospital staff to utilise their legal powers e.g., Deprivation
of Liberty Safeguarding (DoLS) or the Mental Capacity Act, to keep you in the
hospital and to forcibly administer medical treatment against your will. PLT
can also – not necessarily intentionally all the time – have an impact on how
the Doctors and Nurses care for you in terms of them being non-judgmental,
respectful, compassionate, and empathetic.
When I saw PLT in the beginning of my mental health relapse in
February, I had been in the medical hospital for a number of hours and after
trying to sparsely answer their questions in an assessment, they requested that
I go home to have an assessment with the Crisis Team so that I could be put on
their caseload. In all honesty, I was pretty sceptical that anything would come
from the assessment because if – in the unlikely event – they did say I should
be on caseload then I would refuse and that would most likely be that; they’d
go. So, the only real one qualm I had with PLT for this decision to refer me to
the Crisis Team, was the distinct notion that they were passing the buck in kind
of nudging me off to some other people… I think it’s important to remember,
here, that one of the most difficult ‘symptoms’ of Borderline Personality
Disorder (BPD or EUPD as it is referred to now) is ‘a fear of real or imagined
abandonment’ and so experiencing some sort of feeling that a psychiatric
professional either doesn’t want to help you or feels like they can’t, isn’t really
a positive or helpful thought to have to cope with.
Of course, the other important factor around this, is the
knowledge and recognition that when my mental health is well, I’m fully aware
of the fact that the different mental health teams can only do what is in their
realm and so it can be totally appropriate and necessary that they refer you to
another one, but; if your mental health was ok then you wouldn’t be needing to
see them in the first place! This means you’re already vulnerable in terms of
how you’ll cope with their response – no matter which way they swayed or were
leaning with their decision on the future of your care and support. And I think
that being aware of this – being aware of the fact that their actions and attitude
could, effectively, impact how safe and stable you feel within yourself – can
be reason enough to leave you feeling anxious at the thought of talking to
them.
More details
on my local PLT can be found here:
Anxiety with the Crisis Teams: Crisis Resolution & Home
Treatment Team (CRHTT), the Initial Response Team, & the Universal Crisis
Team
When my mental health first deteriorated in 2009, there was one
Crisis Team which consisted of pretty much one phone line and two staff! Now?
Now, they have a little department in my local psychiatric hospital and there’s
a few call handlers as well as a huge number of staff doing various roles with very
different and specific responsibilities (that has led to the branding of there
being a few different Teams within this sector).
When my mental health first deteriorated in 2009, there was one
Crisis Team which consisted of pretty much one phone line and two staff! Now?
Now, they have a little department in my local psychiatric department and
there’s a few call handlers so that it’s incredibly rare that you won’t get
through – the worst I’ve experienced was being ‘fourth in the queue’ for eight
minutes and then speaking to someone within, minutes of becoming ‘third!’ I
think that it’s common knowledge these days are that so many healthcare
services – particularly Ambulances, A&E departments, and mental health
services – are really being inundated with urgent calls, appointment requests,
and referrals etc. and are therefore experiencing considerable waiting times on
their phone lines, to be seen by a Doctor or Nurse, to be offered an
appointment, to receive an Ambulance, or to experience another element of their
services.
My level of patience tends to differ depending on the situation
I’m in – which is probably natural and true for a lot of people. It means that
if I’m in A&E due to an injury or accident, and the waiting time is a
number of hours to see a Doctor, I honestly don’t mind waiting that length of
time, so long as I’m not in pain or being sick while I’m sat there! Though that
changes when it’s a mental health crisis of some sort – and especially, when
it’s a crisis that has me at the point where I’m ringing the Crisis Team
because that’s not something I often do…
When I made my second suicide attempt in 2009, my Mum had rung the
Crisis Team and it was them who ended up arranging a massive Mental Health Act
assessment at my Mum’s house because I was refusing to attend hospital for the
potentially life-saving medical treatment. They then had six Police Officers carry
me from the house, into one of their vans, and take me to the medical hospital
where four psychiatric staff stayed with me through the entire duration of the twenty-four-hour
long antidote treatment. And during those days, I was incredibly… Not selfish…
I just, never took responsibility for my actions. I didn’t ever recognise that
the Crisis Team had done these things because of my actions, thoughts, and
feelings; and so, I resented them for it. I resented them for always having the
memory of all these Police literally carrying me out of the home that had – especially
during the abuse – been my safe place and seeing my Mum crying with a Social
Worker as I screamed and tried to fight back.
That absence of taking any sort of responsibility left me with a
really negative view of the Crisis Team and I became hostile and rude towards
them on a number of occasions after that second admission. And things only
improved and became more positive and productive after a third suicide attempt
landed me in Intensive Care and I underwent a two and a half year long
psychiatric hospital admission during which I was given Dialectical Behaviour
Therapy (DBT). In Therapy, I learnt the importance of recognising the role you
play in situations and how meaningful it can be to accept the consequences for
your behaviours and to take in experiences as opportunities to learn from
rather than mistakes etc. Learning these important things meant that by the
time I was finally deemed as entering ‘recovery’ and I was discharged to move
into my own home, I was actually grateful to the Crisis Team and recognised
that I likely wouldn’t have still been alive without their interferences and the
responses that I had once resented so much.
So, when my mental health relapsed in February and PLT ordered me
to have an assessment from the Crisis Team my levels of anxiety at the thought
of seeing them were kind of varied. I mean, part of me wasn’t too concerned
because I was fairly convinced that my mental health wasn’t that poorly and so I
felt sure that it wouldn’t give them cause for concern in terms of putting me
on caseload (I didn’t even for one minute worry or entertain the idea that I
might be sectioned again!). Looking back, I still find it kind of strange that the
fact that despite me being admittedly unsafe due to the fact I had begun
experiencing these ‘weird thoughts,’ I still felt myself totally sane and healthy
to the point of me not needing to be hospitalised! And this meant that when the
two Crisis Team staff offered to put me on caseload and I refused, they asked
if I would go into the psychiatric hospital and again, I refused; so, they told
me that they would be leaving to go and organise a Mental Health Act assessment
to determine whether I should be sectioned.
In all honesty, I thought they were bluffing and were just hoping
that I would change my mind and agree to work with them or to go into hospital anyway,
so I locked the door and went to bed. I had a very intermittent sleep that
ended after a few hours when I received a phone call from a Social Worker
telling me that she, another Social Worker, and two Psychiatrists would be
coming to my home at 3am to do the assessment!
More details
on my local CRHTT can be found here:
More details
on my local Initial Response Team can be found here:
More details
on my local Universal Crisis Team can be found here:
Anxiety with the Inpatient Teams
At the Mental Health Act assessment, I was – of course – sectioned
under section 2 of the 1983 Mental Health Act, but because I had self-harmed,
the Psychiatrists and Social Workers decided that I had to go to NSECH for
stitches before being properly admitted to the psychiatric hospital. In all
honesty, the wound wasn’t ‘that bad’ and after overhearing snippets of
conversation about there being a bed for me at a psychiatric hospital in
Norwich, I was convinced they were sending me to NSECH so that I had a bed
until they could find one closer to home! And when I was still in A&E
almost twelve hours later, this belief was almost proven.
Finally, though, a very softly spoken Social Worker appeared and
told me they were just waiting for a Secure Ambulance to take me to a ward I
had never been on but in a CNTW psychiatric unit in Newcastle city centre that
I had been in before. And I remember that as soon as I stepped onto the ward
through the locked doors, just bursting into tears and almost instantly feeling
like half a person – that’s how I’ve kept describing the way I felt while I was
there; it was as though being sectioned meant that anything I did or said was dismissed
and explained away as insignificant or untrustworthy and somehow related to my mental
illness.
Now that I was sectioned, you might have thought that some Anxiety
would be diminished because I was already in the hospital so what more could
happen? Except, there was still anxiety because I was well aware of the fact
that everything I did and said would be evaluated and documented to be used as support
towards the length of the admission e.g., if I seemed to be making more sense,
hallucinating less, feeling and being safer, and my mood more stable; then
perhaps I’d be discharged sooner. This meant that if I felt like I was
struggling or having thoughts around self-harm – because let’s be honest; being
in a psychiatric hospital doesn’t completely take away the ability to do that –
I kept quiet. I didn’t have a single 1:1 with any of the staff on the ward –
not just because I didn’t want one, but because I was never even offered one
either!
Being hospitalised in any type of hospital, for any reason, and
for any length of time, is always hard for me because I’m one of those people
who really likes to have their own things around them. I used to be ashamed and
embarrassed of talking about this because I thought people would brand me
superficial and materialistic. I thought it would leave people sceptical as to
just how poorly I was if they were to know that having my make-up and being
able to shave my legs is helpful for my mental health. I’ve built some
confidence around this though, and I’ve come to the conclusion and the belief
that no matter what someone finds helpful for their safety, their mood, and
their general wellbeing etc, it should be appreciated, recognised, taken
seriously, and treat as important and completely valid. It's important that it
is acknowledged that not everyone benefits from the same things for example,
some people may really find being an inpatient helpful and use it as an
opportunity to be distanced from their usual lives and to have the opportunity
and ability to have someone to speak to and take support from 24/7. But being
away from my home comforts and feeling a distinct loss of control over my
freedom, the way I was being treat, and how long I was going to be away from
those simple pleasures, wasn’t helpful for me in the long term. I say ‘long
term’ because I do 100% acknowledge that the admission saved me from succeeding
with a suicide attempt that I was on the absolute brink of, but ultimately, I
was worried it would do more harm than good and so when I eventually had the
opportunity to speak to the Psychiatrists and people who could discharge me, I
lied about absolutely everything, and after five days I was given home leave,
and then seven days later, I was finally properly discharged from the section.
More details
on the various CNTW inpatient services can be found here:
Locations | Cumbria, Northumberland, Tyne and Wear NHS Foundation
Trust (cntw.nhs.uk)
Anxiety with the Step-Up Hub/Team
Finally, upon my discharge from hospital, I was put under the care
of the Step Up Team; who explained themselves as being (because I hadn’t heard
of them before!) the office hours equivalent to the Crisis Team in that they
could see service users fairly frequently, they were more prepared and capable
of doing crisis care and support, they had similar authorities in terms of
making referrals and recommendations, but they were only operational 9am – 5pm
(the Crisis Team is 24/7).
It’s obviously been a few months now of being under their care but
things have been very up and down still so I still haven’t really had the
opportunity to build any kind of real rapport or a therapeutic relationship
with any of the three members of the team that I’ve met. But in all honesty,
even if I’d seen them twice a week since the discharge, I’m not sure things
would be a whole lot different because since the horrible admission, I’ve
remained terrified of saying anything that might have even the remotest chance
of causing any concern and leading to me being sectioned again…
More details
on CNTW’s Newcastle Step-Up Team (my local one – Northumberland – doesn’t seem
to have a page yet!) can be found here:
I hope that this post can instil a sense of validation for anyone
experiencing similar anxieties and thoughts and feelings around their mental
health services and the different teams involved in their care. And I hope that
for anyone in CNTW’s locality, it provides them with reassurance and knowledge
of the services and information available specifically around Anxiety.
CNTW’s Anxiety Resources:
I want to finish off with telling you about some of the most
useful anxiety-related resources CNTW have available (for their entire
Anxiety-related content you can type the term into the search box on their
website):
A Patient Information Leaflet on Cognitive Analytic Therapy (CAT)
which is a talking therapy that can help with difficulties around Anxiety: What is
Cognitive Analytic Therapy (CAT)? - Patient information leaflet - Cumbria,
Northumberland, Tyne and Wear NHS Foundation Trust (cntw.nhs.uk)
A page of information – including referral criteria – on using
Virtual Reality to treat situation specific Anxiety: Virtual
Reality - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
(cntw.nhs.uk)
Information on North Cumbria’s Talking Therapies that are aimed at
easing Anxiety (amongst other difficulties) and aim to leave the service user
feeling ‘more relaxed:’ North Cumbria
Talking Therapies - Patient Information Leaflet - Cumbria, Northumberland, Tyne
and Wear NHS Foundation Trust (cntw.nhs.uk)
A Self-Help Guide for someone with Health Anxiety: https://web.ntw.nhs.uk/selfhelp/#health
An information and advice leaflet specifically tailored to
Prisoners suffering from Anxiety: https://web.ntw.nhs.uk/selfhelp/#prisoner%20anxiety
A website page on Understanding Anxiety and Panic Attacks
featuring content from mental health charity; Mind: Understanding
anxiety and panic attacks - Cumbria, Northumberland, Tyne and Wear NHS
Foundation Trust (cntw.nhs.uk)
A Self-Help Guide with information and ways for someone with
Social Anxiety to understand their difficulties, what has caused them, and what
they can do to help themselves: https://web.ntw.nhs.uk/selfhelp/#social
The NHS Self-Help Guide for Anxiety which contains ways to
overcome symptoms and advice on coping strategies: https://web.ntw.nhs.uk/selfhelp/#anxiety
CNTW Links:
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
(cntw.nhs.uk)
CNTWNHS (@cntw.nhs) • Instagram photos and videos
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
(facebook.com)