Having gone through a minor crisis this weekend, has led me to think about the state of our mental health crisis support, out of hours care and the general disparity between mental health services and physical care.
I felt a bit rough the whole day on Sunday, so I decided to head to bed early and take my medication. I was really focused on staying in the moment and not losing time; as can happen with a dissociative disorder. But try as I might and no matter how tired I was, different alters clearly had other ideas, and we just couldn’t get to sleep.
Sleep is often an issue for us so we utilised all our normal strategies, reading, relaxing, grounding techniques, distraction… you name it we tried it, but nothing was working.
I watched the clock moving forward hour by hour and still desperately wanted to sleep. I use a journal to help us, so I began to draw, and then write in the hope this would help. Then suddenly without any warning I found myself in floods of tears, tears that seemed impossible to stop and tears for which I had no apparent reason.
By now it was gone 3am and my sobbing was so loud that I woke my son who lives with me, he couldn’t help and try as he might I knew we needed more help and yet I didn’t know who to seek it from.
I messaged my daughter who lives close by, in the faint hope she’d wake up and be able to help; but of course at gone 3am she was like most people fast asleep.
Now like many people with a mental health issue I have a formal care plan, and it has a list of things I can access in such times. But no one ever asks if I can use them easily or am able to actually make use of them.
So in such times as this, when I am clearly at a point of crisis, I can no longer deal with the distress or difficulty myself I am meant to access the local ‘CRISIS TEAM’.
Crisis support is only available by telephone, now If I could call then they might not be there, I’d get an machine to leave a message on, not in my opinion much use in a crisis. I actually find making calls difficult even on a good day, so at times of crisis calling a number and speaking to a stranger is impossible. I can’t even call the Samaritans and I have had to utilise their text service before now, when I felt like self harming or worse.
So contacting Crisis is always going to be a huge hurdle for us, and the reality is that like many service users, I know that this service is only ever able to offer a limited response even if I got through to them. You see the services are so stretched that basically all they can offer at night is a voice, who will ask questions like have you tried distraction, having a hot drink, what’s worrying you, and the like. I knew I had done everything they were going to ask or offer as a suggestion and I had no idea why I was so distressed, absolutely no idea.
I also knew that they’d ask did I feel like harming, had I harmed, and had I misused or taken my medication inappropriately.. and this was worrying me. I didn’t feel like harming, and I hadn’t harmed, but I hadn’t taken my medication appropriately. I’d missed them at least twice in the last 24 hours by mistake and I knew that they’d see this as a worrying sign. They don’t tend to understand dissociation or dissociative disorders, so wouldn’t understand that I had missed my medication because of my losing time and dissociating.
Failure to comply with medication or treatment doesn’t go down well and it raises more than an eyebrow. I also knew my state of distress which was bad wasn’t going to look good either, and together these things would set off alarm bells at the crisis team. The staff can’t come out to you in the middle of the night nor can they leave you if they think your vulnerable. So as I have been told on many occasions the only option left if they feel you are vulnerable or at risk, is to seek external help.
Now external help, basically means asking the police to undertake a safe and well check, and I have been told that the police have the power to then detain under a section 136 if they are concerned for my mental well being. I know utilising a section 136 is in fact illegal within my own home, but my care team clearly still can’t grasp this factor.
So at nearing 4am I had to make a decision, and with tears and sobs controlling me and feeling so so sad and down, I knew I wasn’t getting better I was worsening and before I started to lose any sense of rationality I had to act.
TO CALL OR NOT TO CALL….THAT IS THE QUESTION!
In my case I made a decision, the call itself would take so much effort, I knew I could predict the outcome, in my case a safe and well check… so as I knew that the Police had far better things to do with their time, and I didn’t need to deal with the hassle of all a visit would involve, not just the actual visit which I couldn’t predict the outcome of, but the village gossip later which in my head was going to be huge, I made a decision not to call. Now I know the police are very good and kind, this isn’t a criticism of them, more a realisation that I was saving us all time and in their case valuable resources.
Yet I needed to do something, nothing wasn’t an option…I decided that the least worst thing to do was to take extra medication to help settle me, well at least see if it worked. Now I don’t have any PRN meds prescribed but I knew I had missed some of the medication that I would need to use in this case and my dissociative episode in the previous 36 hours meant I had some spare.
So in the end I did take medication, out of line with my prescribed dose, to help me sleep and on this one occasion it helped. It’s not something I advocate others doing, and It is not something I would normally do myself. But circumstances gave me an option and I used that option. I did settle for about 3 hours which was never going to be enough but it got me through to the next morning when I could access help and support.
But the reality is that in a crisis the NHS seems to assume that all service users can access a phone.. that’s simply wrong. If you felt suicidal could you call and leave a voicemail and wait for a call back?
The Crisis service in most areas do not undertake visits in the evening or night time, instead relying on the police to do the job via safe and well checks. Now I know that the police are over-stretched and underfunded, and they don’t need to become the dumping ground for other services, but this kind of thinking does just that. It places a health matter, a medical issue into the criminal justice arena. Does anyone else think that is daft?
Crisis services and NHS staff who believe wrongly that section 136 can be used at home to detain someone, are again just passing the buck, and in the process they attempt to criminalise those who are mentally unwell. It’s the same scenario of course if there is no place of safety and the mentally unwell end up staying in a police station cell instead of a hospital bed. Would you like any of your close relatives who were unwell put in a cell instead of a hospital?
Yet the current system does place vulnerable people in cells time and time again. Even young children are placed in cells as places of safety – have we really gone bonkers. Is this called progress?
If the powers that be in central government and the NHS, actually want to bring about effective change in how we treat those with mental health issues it needs more than just hollow words or platitudes.
It is going require resources of NHS community services, a shift change in attitudes amongst staff and management. It needs more hospital beds not less, yes you heard MORE BEDS!!!
It requires more frequent visits from CMHT staff to vulnerable people in their care. I have had 2 visits since July, and its nearly December. Is that enough, the answer is simple, NO. Minimum standards of care should be established, that have to be adhered to and resourced.
The harsh reality is the Mental health services delivered by the NHS are failing, they are in crisis and until we tackle these issues people like me will either slip through the net, end up in a cell or take matters into their own hands and that may not always have positive results.
The police need to get on with policing, that’s what they are good at and yes of course there is an interface between the services at times around mental health but it should be a rare occurrence not a regular feature of every single police shift in the UK.
The crucial point here is this is a medical issue, and people should be treated by medical services, police cells are not fit to be places of safety. So central Government needs to change the law, prevent it happening. That is something we can all lobby our politicians to tackle, demand they bring about change.
In 21st Century Britain its time we delivered a mental health service that is fit for purpose, and treated those with mental health issues on an equal parity with those with physical issues. There are waiting times for physical issues, if I had to wait more than a year to access a routine treatment for Cancer, Arthritis, Epilepsy, there would be an outcry.
Why isn’t there an outcry over the waiting times for talking therapies, WHY?
Let’s stop this injustice, yes it time to talk mental health, its’ time we talked and saw action on equality, fairness, correct treatment, funding, adequate services, resources and a parity with physical health.
People like me deserve better, we deserve to be treated with care, with the aim being on getting us well, giving us back hope and a future not just writing us off.
I know so many people with Dissociative disorders who have to scrimp and save to pay for their talking therapy, there are organisations out there who because of their frustration advise of the pitfalls of the NHS and suggest paying privately.
If we do that, go private, we allow the NHS to get away without providing the right care and treatment for us, I know I am one of many who simply could not afford to pay privately, I have to battle the NHS system to get my treatment, I have no choice.
I will continue to battle for parity and for treatment and care, not just for me, but for others too, will you?