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:

Northumberland and North Tyneside Psychiatric Liaison Team - CNTW153 - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

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:

Crisis Resolution and Home Treatment Team - Northumberland and North Tyneside - CNTW118 - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

More details on my local Initial Response Team can be found here:

Initial Response Team - Northumberland - CNTW119 - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

More details on my local Universal Crisis Team can be found here:

Universal Crisis Team - Northumberland and North Tyneside - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (cntw.nhs.uk)

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:

Newcastle and Gateshead Step up Hub - CNTW206 - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

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

CNTW (@CNTWNHS) • Twitter

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (facebook.com)

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