*This
is Part Three of Three, you can read Part One here,
and Part Two is here!*
So, if you’re put on caseload, almost from the offset, the Team will want to try to work with you to create some sort of plan – this can refer to a regime around changes they may want to make to your medication, the number of visits they want to offer you, and even when they think they can foresee your discharge from them as being. This – the bit about discharge – can seem counterintuitive when you’ve just been put on caseload, and you can often and understandably get the feeling that they’re already trying to ‘get rid’ of you! But that’s not why they do this.
Their thought process behind planning a discharge as early as possible
is typically about two very large reasons (which could be totally different for
some people/their care):
1.
So that from the offset you both know how hard
and quickly you need to be working to achieve all that you want to achieve in
the timeframe.
2.
A ‘crisis’ is meant to be ‘short-term’ and so
care from such a Team, isn’t destined or intended to go on for weeks on end
(for example, my longest time on caseload was 35 days!)
Wondering what should be included in your Care Plan?
Here’s what I wanted to know:
1.
Medication changes
2.
Therapy input
3.
Input from other Services/Teams
4.
The plan if there was further deterioration in
my mental health
5.
Joint plans and information-sharing with
A&E etc.
6.
Support after discharge
7.
The number of visits
8.
Frequency of visits
9.
Discharge date
10.
Diagnosis changes
11.
Family involvement
12.
Number of staff visiting
13.
Length of visits
It’s incredibly important that you contribute to any sort of care plans
as much as possible because at the end of the day, the way I see it, is that
this is information and details about you which others – such as A&E staff
or your GP – may end up reading. And so, what do you want them to know? What do
you want them to think of you?
I’m actually having a current battle with my local A&E department at
the minute because a previous Community Psychiatric Nurse (CPN) who I didn’t
get along with, went ahead and created a ‘Management Plan’ about me with the
Psychiatric Liaison Team and A&E staff for any attendances I may have at
the department. And she did so without me even knowing it was being created let
alone being asked to get involved and contribute towards it! It’s felt
incredibly sly and sneaky and has left me with a lot of mistrust in those
professionals because I have no idea what has been agreed behind my back. And
occasionally things have been mentioned to me e.g. literally just the other day
an A&E Nurse said, “and in your Management Plan it says you need an
ultrasound machine to place cannulas…” and asked a question about it which I
didn’t have the answer to because I had no idea what she was talking about! And
it was something which, if I’d been included in the creation of the Plan, I
would have had the answer. And something I felt I should have known about
myself and my care too!
So, I’ve asked countless people if I can at least be shown this Plan and
I’m constantly passed from pillar to post or fobbed off with people saying
“I’ll get back to you about it...” or “I’ll just check with such-and-such…” It’s
left me feeling uneasy and reluctant to attend A&E when I need help and
treatment which really isn’t the best attitude to have. Like, that’s the sort
of mindset that works to really prevent you from actually getting help and
support and when the professionals claim that the whole point of a Management
Plan is that you feel better supported in attending A&E, well; it just
seems to really just defeat the whole point, doesn’t it?!
In creating or contributing to any sort of Care Plan and ensuring that
it turns out to be efficient and effective, it really demands a sense of trust
and a good, productive, working relationship between a service user and the
staff/professional involved. And to have this quality, it typically takes for
there to be some sort of mutual trust there. There needs to be a sense or
notion of the service user trusting in that professional to be making the right
decisions either on their behalf or in partnership with them. If you can’t
trust a person to be making the right judgment and to have a clear
understanding of your needs, how are you meant to do anything useful and
progressive with them? How are you meant to benefit from their care, help, and
support?
1. Be
As Honest As You Can
Even
if it feels uncomfortable or scary:
·
Share
what’s really going on (e.g. suicidal thoughts, psychosis, panic attacks).
·
Trust
is built when they see the full picture and can respond safely and appropriately.
Try
saying: “I’ve held back before because I was afraid of what would happen. But I
want to be honest this time.”
2. Tell
Them What Helps You (and What Doesn’t)
Let
them know how they can support you better:
·
What
calms you down
·
What
makes things worse
·
What’s
worked in the past
Try: “When
I’m overwhelmed, I shut down—so short check-ins help me more than long
conversations.”
3. Be Open About Your Fears or Past
Experiences
If
you’ve had a bad experience with mental health services before, say so gently but directly.
For
example: “In the past, I felt dismissed when I asked for help, so I’m nervous
about reaching out again.”
Being
open can help the team understand why you may seem withdrawn, upset, or
mistrustful.
4. Ask
for Consistency (Where Possible)
·
If
seeing different people each time is difficult, let them know.
·
Ask
if you can have one or two consistent staff members.
Try: “It’s
hard for me to repeat my story—can I see the same person if possible?”
5. Keep
a Record of What’s Working
·
Note
what helps during crisis visits or calls.
·
Share
it with them—it helps them help you better.
Example:
A short note or document like “My Crisis Support Preferences” can be
powerful.
6. Speak
Up If Something Doesn’t Feel Right
·
It’s
okay to respectfully challenge decisions or voice concerns.
·
Trust
is built through mutual
respect and clear boundaries, not silence.
Try: “I
know you're trying to help, but I didn’t feel heard in our last session. Can we
talk about that?”
7. Stay
Engaged (As Much As You Can)
Even
when you're struggling:
·
Keep
communication open, even if it's just texting “I’m not okay today.”
·
If
you miss a call, try to call back or leave a message.
They’re
more likely to keep you on their radar if they know you're still trying to engage, even in small
ways.
8. Acknowledge
When They Get It Right
If a
Crisis Team member listens well or supports you effectively, say thank you. This builds
goodwill—and encourages more of that kind of care.
__________________________________________________________________________________
A huge challenge to creating any sort of bond or relationship with staff
in a Crisis Team when you’re on caseload is that the Teams tend to be fairly large,
and it can be incredibly rare that you see the same member of staff on every
visit. And this level of change and variety can sometimes also have a difficult
impact on how honest and open you are about your mental health, your thoughts,
feelings, and experiences. To cope with this, I practiced Radical Acceptance –
which is a DBT skill from the Distress Tolerance module (which you can read
more about it and see the other skills from it, here!) – and you can find more information on how
to use it, and some worksheets to help you master the coping skill too, here! I used this skill because I recognised that
this is a situation and an element to the Crisis Team which I – and most other
people, to be fair – can do absolutely nothing about!
Almost inevitably, there’s bound to be members of the Crisis Team who
you – as a Service User – don’t quite gel with; or at least not as well as you
may with others. I think Radical Acceptance is a great tool here too because I
think that this – the idea of not bonding with everyone you meet – is just a
very general life lesson too. Like, it happens everywhere in life; work,
education… It’s really the joy of everyone being different and individual!
However, another few DBT skills that I think could be helpful here with
both the issues of trust and conflict, would both actually be from the
Interpersonal Effectiveness module (which you can read a really good overview
of here). Firstly, there’s advice/skills around Trust
in Relationships (which you can read about and find worksheets about, here) where you’re coached to be honest, to be
understanding and respectful, and to remain consistent. It recognises that
inconsistency in attitude, behaviours, decisions etc. can make a person appear
untrustworthy because it can seem as though they’re unpredictable and you might
feel incapable of appreciating their perspective.
Then, the other DBT skill from this Module is around Resistance and
Conflict (you can read about it and again, there are worksheets here) and this talks through different steps to managing
and resolving situations where communication has become challenging. The first
step focuses on validation (which is focused on as a separate skill, here) and the importance of respecting and
appreciating the other person’s thoughts and their point of view. The second
step is to repeat your own point of view and voice your own thoughts and
feelings in a calm but thorough and methodical way. The final step, is to ‘ask
for specifics’ which refers to when a person is being critical of you or there
is some kind of disagreement, it can be helpful to ask pointed questions such
as “what exactly is wrong about…?” This can help to really establish a root
cause for the challenging situation, and this can help to resolve it in a
quicker and more effective way.
Now, the final point I wanted to make around trust and relationships
with the Crisis Team, is to never be afraid to speak up where there are grounds
for a complaint about the service/treatment you have experienced. There is
absolutely nothing wrong with doing that. You’re entitled to voice your
concerns around poor attitude and responses, and I think a huge motivation for
that, could be the idea that others might also struggle with this and if no one
speaks up about it, it can continue. And there’s every chance that for someone,
it could reach a point where they become unsafe as a result. I always say that
a lot of professionals have been ‘lucky’ (not quite sure if that’s the right
word here, but I’m using it nonetheless!) that it’s me they’ve mistreated because
others may not have coped so safely.
Mental health NHS Services are typically ran by a local NHS Trust who
will have a specific contact number/details for their own complaints
department, but for most complaints against NHS services or professionals, this
page on the NHS website might be useful: NHS England »
Feedback and complaints about NHS services. Then, there’s also the chance
or opportunity to report a concern to the Care Quality Commission (CQC) who
regulate adult health and social care services in England. There’s a page on
their website that might be useful too: Complain about
a service or provider - Care Quality Commission.
As is common knowledge and understanding in mental health services,
there is typically no ‘quick fixes’ to mental illness and poorly psychiatric
symptoms. And so, very sadly, being put on caseload with your local Crisis Team
doesn’t mean there’s an instant improvement or that you’re suddenly going to be
safe and well; and I think this is actually a common mistake or misconception
that those on the outside of such Services hold. So many people will view being
put on caseload as a huge sign of recovery when actually, in my opinion at
least, it should be a sign of ‘hope’ in filling you with the knowledge or
awareness that help, and support is more readily available than it was before
being on caseload.
But that isn’t magic! ‘Being more available’ is a heck of a lot
different to ‘being effective and efficient.’ Being on caseload can absolutely
be whatever you make it to be. It can be unhelpful and useless if you refuse to
cooperate with the Team’s advice and directions or won’t engage in talking to
them and being honest and open about your thoughts, feelings, and experiences. So,
despite being unsafe whilst on caseload just being because they haven’t helped,
it is mostly caused by the way in which a service user interacts – or doesn’t
interact! – with the staff.
Either way, if you were to self-harm or even make a suicide attempt
whilst on caseload, it can be incredibly terrifying because you can become
filled with the worry – if not sheer, dramatic panic(!) – as to what they will
do with/to you. If you’re already on caseload and are still struggling, well
the next place after the Crisis Team is basically an inpatient admission in a
psychiatric hospital. So, of course that can leave you reluctant to tell them
things are still awful because there are rarely any assurances that if you were
to be open, they wouldn’t have you detained and sectioned under the Mental
Health Act!
It doesn’t help that recently, I’ve actually found myself in the exact
same position as I was around two years ago (I blogged about it back then
across three blog posts, you can read the first post here, the second is here, and the third: here) when it ended in being sectioned – taken an
overdose, refused treatment but deemed medically fit by A&E, seen the
Psychiatric Liaison Team (PLT) who then sent me home and referred me for an
assessment with the Crisis Team who (in the instance two years ago) then arranged
a Mental Health Act assessment and I was sectioned. As I write this part of the
blog post/Series, I got home from A&E after seeing PLT earlier today and I’m
literally now awaiting a Crisis Team assessment (they’re allowed up to 24 hours
to conduct them).
When I first went on caseload two weeks ago
for the one week (I blogged about that too, here!), the Crisis Team almost immediately
recognised that this was a relapse and determined that they thought it had been
mostly caused by the fact that for the past three weeks or so, I actually hadn’t
been taking my anti-psychotic medication (Mind have a very helpful and
informative page on their website about psychiatric medication, you can read
it: A to Z of
psychiatric drugs)
every single morning. The Pharmacy changed the
manufacturer, and it meant the tablet looked different but this wasn’t
explained to me and so my vulnerable delusional mind instantly saw it as
evidence that people were trying to poison me. It’s very quickly become a
Catch-22 situation because – as the Crisis Team summed it up at one point – the
delusion stopped me from taking the medication but if I took the medication,
the delusion would very likely go – or at the very least become bearable and a whole
lot less dangerous/life-threatening.
The Team’s conviction that the medication was the root of this entire
relapse meant that in putting me on caseload, their first actions were to have
the medication prescribed again but at a lower dose because they worried about
side effects I might experience if I were to go from barely taking it to
suddenly taking the high (I was on 20mg and the maximum is 30mg) dose I had
been on for around one year. They also explained that their greatest mission in
psychiatric medication is to always have a service user or patient on the
lowest dose possible of whatever the drug/the illness it was treating or
mitigating, was/is.
Despite all my efforts, energy, dedication, and time that I’ve put into
furiously and passionately trying to push past the delusion and start taking my
medication consistently again, I’ve really struggled to shake it off. And it
meant a bit of a run-in with the Crisis Team over the fact that I felt they
were really just throwing medication at me without tackling the actual problem.
As though it was some sort of band-aid or something! Like, how was I supposed
to overcome the delusion enough to have the ability to take the medication if
no professionals were spending any length of time talking it through, trying to
understand it, and working on proving it wrong for me.
As though in support of these thoughts and feelings about them silencing
me with medication, they also prescribed a strong sleeping tablet (Zopiclone)
and even gave me three additional ones upon my discharge from caseload so that
I have some in my possession should things go downhill again at another time
and so that it would mean I’d not need to rely having to see the Team or another
team or professional to actually prescribe it all over again!
Now, I made the statement earlier that simply being on caseload won’t
automatically mean that you’ll get better, so it’s only right to quickly talk
about the fact that you can still be unsafe, regardless of how long you’re on
caseload, how many times the Team visit you, and what medication they put you
on, you can still be/become unsafe.
Being discharged is very obviously the final part or stage to being
under the care of the Crisis Team and from recent experience, it’s something which
is often determined from Day One of going on caseload because it needs to be understood
that they’re temporary and a short-term support service. So, to finish up this
blog post, here’s some advice on coping with change:
1. Acknowledge What You’re Feeling
Change—even
positive or necessary change—can trigger grief, anxiety, or confusion. It’s
okay to feel unsettled. Don’t shame yourself for feeling this way.
2. Review the Discharge Plan (If You Got One)
Most
Crisis Teams provide a plan when they discharge you. Revisit it. It may include
safety plans, follow-up contacts, or next steps.
3. Reconnect with Ongoing Support
You
might now be under a Community Mental Health Team (CMHT), GP care, or private
therapist. Make sure you understand who is supporting you next—and how
to contact them.
4. Set a Simple Daily Structure
After
intense support, life can feel empty. A gentle routine can ground you and give
you a sense of control.
5. Prioritize Basics: Sleep, Food, and Movement
When
you're vulnerable, your brain and body need the basics even more.
6. Use Self-Soothing Techniques You Learned in Crisis
The
Crisis Team likely taught or modelled coping strategies—breathing, grounding,
distraction, safety plans. These are still relevant.
7. Reach Out Before Things Escalate
You
might feel like you “should” cope alone now—but that’s not true. If you're
dipping, contact your GP, CMHT, or helplines early.
8. Don’t Romanticize the Crisis Team
It’s
common to miss the attention and structure but remember: their role was
short-term. Discharge doesn't mean they don’t care—it means you’re ready for a
different kind of support.
9. Find Peer Support (Online or In-Person)
You’re
not the only one going through this. Peer support groups—whether via Facebook,
Mind, or local services—can be grounding and validating.
10. Set One Small, Personal Goal
It
might feel hard to think about the future but setting a tiny goal (like cooking
one meal, taking a bus ride, or texting a friend) can build confidence and help
you see progress.
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