Off the back of my most recent self-harm I was put under the care of the Crisis Team and when I had the assessment with them to decide whether they were going to put me on their caseload, one of the staff said something to me that inspired this post. She said; I know you look very put together, but I know that you’re good at doing that when you’re actually really struggling inside.” It was really reassuring to discover that they knew this because it’s something that, I think, it’s something about me that takes a little while to learn and it’s something that’s kind of essential when supporting me with my mental health. I told them that my CPN (Community Psychiatric Nurse) always says I’m like a duck because they look calm above the surface but underneath, they’re paddling furiously to stay afloat. That’s me. It’s so challenging to be this way because I feel as though mental health professionals are looking at me thinking ‘if you can laugh and joke then you can’t be suicidal.’ And the hardest part is, I understand why they’d think that way and honestly? If I hadn’t gone through what I have, I would’ve thought the same of another person. I think that I cope this way because while the abuse was happening, and I had all of the reasons that stopped me from telling someone, I felt like I had to put on a ‘brave face.’ And coping like that for so long – I didn’t report the abuse for two years – has meant that it’s sort of become ingrained in me. Like a habit. Or a knee-jerk reaction.

Assuming that someone feeling suicidal should have a particular appearance?! I mean, does anyone even know what suicidal looks like?! Do you have to have to be crying? Do you need to be actively trying to kill yourself? What exactly do people expect someone who is feeling suicidal to look like? Personally, I think that in expecting someone to look suicidal, you’re underestimating the feeling. It’s like when you hear of someone committing suicide and everyone that was close to them is saying that they didn’t expect it because the person never seemed depressed. Firstly, depression and suicidal are completely different feelings – you can definitely have one without the other. Secondly, having others unable to guess someone is feeling suicidal is sort of the whole point of the feeling; if someone wants to die then a part of them will be wanting to hide that in order for them to carry out the act.

Another underestimation in mental health comes with risk. Risk to self and risk to others. I, personally, have only ever been violent towards someone once when I was on a PICU (Psychiatric Intensive Care Unit) and a Nurse told me that I was to blame for the abuse and that I should go ahead and kill myself to give them all a break. I’m not proud to talk about how I reacted but it’s important not to underestimate the potential that such words can have on a person. It’s also equally important to take responsibility for your actions and not to blame them on what someone has said. Then there’s also the regular media stories about escaped or newly discharged psychiatric inpatients having violent outbursts and killing people… I can’t speak for any of these people but for myself, and my own actions, I’d say that it has taught me not to underestimate the power mental health has over you. How it can completely change who you are. Who you were.

Risk to self is another regularly underestimated factor of mental health. I think that even the most docile and quiet people have the thoughts and feelings they express questioned as to whether they are being dramatic or exaggerated. It’s an example of people not being able to possibly understand how someone else feels. You can make assumptions. You can even – as lots of mental health professionals do – form an opinion on what that person is telling you they’re feeling; form your own beliefs on their mental state. Sometimes, this is the complete opposite of what the person is telling you. There’s been instances where I’ve voiced to professionals that I felt suicidal or was having thoughts to self-harm and they would either underestimate the power those thoughts and feelings had over me, or they would disbelieve that I was even experiencing them. Either way, I’d sometimes be left to my own devices – whether that mean being discharged from hospital or not being admitted to hospital – and nine times out of ten I’d follow through on either self-harming or attempting suicide. Those situations were difficult because they resulted in me thinking I was worthless; I thought that professionals mustn’t think I was worthy of help and that they didn’t think my life was worth being saved. I think that some people look on a person discussing the risk to themselves as a ‘cry for help.’ They think ‘if that person really wanted to self-harm or commit suicide then they would just do it.’ I can understand that thought process but for myself, in the beginning I did want help; so, I’d be honest in telling them the difficulties I was having in keeping myself safe. But then, after a while, I discovered that they weren’t going to do anything about so I might as well tell them the dark and ugly things going on in my head!

The final underestimated aspect of mental health that I wanted to talk about is treatment and medication. A while ago I made the difficult decision to ask my Psychiatrist for an increase in my anti-psychotic medication and was faced with a bit of a debate. She spoke about studies that showed medication doesn’t help people with my diagnosis of Borderline Personality Disorder (now named Emotionally Unstable Personality Disorder) and argued that if I needed an increase then maybe it actually wasn’t benefiting me. But I reminded her of what had happened when I wasn’t taking medication and she gave me the increase. And it worked. Another treatment underestimated is therapy; trauma therapy, Dialectical Behaviour Therapy (DBT), Cognitive Behaviour Therapy (CBT)… I really feel like people don’t appreciate the impact these therapies can have on a person with mental health problems. I’d say that professionals refer people for these therapies more often that they prescribe medication but they make the referral without the knowledge of whether it will work and – potentially – save a person’s life.
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