Tag Archives: assessment

They’re Not All Bad

I realise I’m quite often pretty scathing about mental health professionals but some of them are OK. Some do an amazing job and are let down by their colleagues. Quite often our bad experiences overshadow the good and we get into a negative view of all professionals, which is understandable.

I’ve had a few good experiences with different professionals. The negatives with these professionals only come when they are let down by the system they work within, otherwise they are amazing and make all the difference. When someone is caring and takes time with you it makes you feel valued and has a positive effect.

The first professional I found that was great was my art therapist. This was the first major mental health professional I worked with. At the time she was part of the young person’s service which was part of CAMHS (Child and Adolescent Mental Health Services) and worked with those aged 16-25. I was 20 when I started working with her. She treated me on a level with her. I was training to be a teacher and she treated me like a professional as well as a patient. She didn’t patronise me and went at my pace. Her main work was to get me to communicate and she did well with this but at my pace. She made herself available between sessions if I needed to leave a message or write a letter to help with the next session. She’d talk me through situations. She tried to teach me it wasn’t all my fault and at times I almost believed her. The main thing that sticks with me though is that the young person’s service was disbanded so all over 18 were to be taken on by adult services meaning I’d lose my therapy. However she fought for me and told them it ws totally the wrong time to take it away from me and that she needed to continue her work with me. This led to me having a further 18 months with her. Leaving her was hard and I miss her a lot. I still have the card she gave me at the end of therapy.

Another mental health professional that gave a good impression was a psychiatrist I had in adult services. She is the one that diagnosed me with BPD (Borderline Personality Disorder). She always valued my opinion and explained things when asked. She wasn’t perfect in that she didn’t discuss my diagnosis with me before it appeared on my notes but she was happy to go through it after. She was also a consistent presence for nearly a year before she moved on. This makes a difference.

The next professional who I had a good relationship was a care coordinator of mine, L. L was very proactive in my care and worked hard to get things sorted for me, not only with my mental health but my physical health too, even spending ages on the phone to a hospital trying to sort an appointment for me. She didn’t make me feel like our time was limited, it was always as long as I needed to talk. She took an active role. It was sad when she moved on.

My current care coordinator is also great. She’s not been involved in my care for long but has already shown me how great she is in that she gave me direct contact details for her and allows me to text rather than talk on the phone. She doesn’t mind me messaging between sessions and is quick to reply even if it is to tell me she’ll get back to me properly later. She’s also always on time or early for appointments which makes all the difference. I’ve kind of thrown her in at the deep end with my crisis but she hasn’t made me feel bad about it. I hope we can work together for a while.

Unfortunately these professionals are the exception rather than the rule. It shows as these are four out of many professionals that I have encountered. Hopefully things will improve and we will get more professionals that want to help rather than make us feel like an inconvenience or stigmatise us more. If we can be part of the education of professionals I think it would help them to be more empathetic and understand us more.

Have you had any good experiences? Feel free to share in the comments or on Twitter, Facebook or Instagram.

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Screwing Up

This is a personal piece. Please be aware some of the content may be triggering.

I have screwed up majorly. I have pushed people away and withdrawn from others. I didn’t mean to. I just am either too much or not enough. There is no balance. I warn people and they say they can’t see it and then when it happens they recoil in horror. I tell them they need to tell me as I’m not skilled at picking up social cues but they don’t and just ignore me. I know it’s my fault but it hurts.

All that is going through my head is how much I must of hurt these people. I hate myself for it. I’m not excusing my behaviour but I don’t always realise when I’m doing or saying something wrong. If people let me know I could try and talk to them and make things right but I don’t always get the chance. I understand that maybe they get too hurt by it but when they just ignore me without telling me I’ve hurt them I feel worse. I know that’s selfish as it’s not really about me but it would help others too as I could learn what I’m doing wrong instead of just guessing. Also I really want them to know how sorry I am and I dont get the opportunity to let them know.

People say I’m being paranoid. That I need to understand that people might be busy or not well. I understand this I do but I can’t help going through everything I’ve said and done to the point I make myself sick. It makes me push away further if they do come back. It also makes me try to not get too close to new people. Though I fail at this massively. I get caught up in it all too quickly. My feelings for people go to an extreme and I’m desperate to talk to them and help them. It all becomes too much again and again people ignore and hate me.

I want to ask what is wrong with me but we all know. I’m just not cut out for friendship. I deserve to be alone.

It’s not just friendships I screw up though. It seems I destroy my support systems and the help I’m being provided. I reach crisis point and they say its too much. They can’t help me. I trust them and ask for help and it backfires. I’m pushed further away when what I need is reassurance. They wonder why people don’t talk when they’re suicidal but what other option is there when you’re scared you’ll lose everything anyway. Why try to make yourself better? For people that say they are good at working with people with BPD they seem to forget the fear of abandonment part that can cause further crisis. It feels like they’ve helped me hit self destruct again. But then at the end of the day it is my fault. I should never of asked for help instead of acting on the thoughts I was having.

So there you have it. Why I’m a screw up. Don’t worry I hate myself more than anyone else.

For further comments please use the comments, Twitter, Facebook or Instagram.

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Self Harm Etiquette For The Medical Profession

This is a blog post for anyone working in the medical profession. This includes Doctors, GPs, Nurses, Healthcare Assistants, Paramedics, Support Workers, Psychiatrists, Care Coordinators, Psychologists, Pharmacists, Admin staff and Receptionists. Basically anyone who comes into contact with a person who may have self harmed (therefore could also be useful for police officers too).

It has come to my attention that some of the people we want to help us deal with self harm can be some of the least useful with their comments and actions regarding dealing with self harm. Therefore I thought I’d put some tips together specifically for them and any professional that needs to help with self harm.

1. Don’t comment on it in front of other patients

This may sound really obvious. Patient confidentiality is key. Bringing it up in front of other patients without permission is wrong and can cause harm to the person who is self harming, the relationship between patient and professional and possibly even the other patient/s who could hear about it. You never know where this information will go. Unfortunately I know it happens. I’ve seen it happen.

2. Don’t guilt trip us

I’ve had this happen with a former GP. I was told I obviously didn’t love my parents over my self harm. It was awful. I didn’t return for treatment until two years later after a suicide attempt. This isn’t the only impact it can have. Self harm is not a selfish act. It’s a way of trying to keep going. It’s a way of coping. Most people who self harm probably already think about the perceived damage they do to others. To be guilt tripped by a professional is more likely to make the situation worse and even cause the patient to withdraw from seeking help, maybe until it is too late.

3. Don’t mimick self harm behaviour

Again this is something I have encountered and not just with one professional but many. It seems some can’t bear to say the words “self harm” and so use actions like using their hand to mimick cutting across an arm. Not only is this not clear communication, it can be triggering. It is a difficult topic but it is one that needs to be dealt with sensitively and professionally. Yes you do need to ask, but please use words rather than miming actions.

4. Be careful with what you say

Most professionals are careful with what they say. They think before they speak and take into account the individuals situation. That’s great if they know the patient. However without continuity of care, which is heavily missing in places, you may not know details or you may just be someone that only encounters someone briefly so has no background information to draw on. This means being careful with what you say. I’ve heard things that concern me. They may be useful for some but I can also see them as potentially inflammatory to the wrong person. I’ve heard “you’re scars look cool”, “just use your faith” and “what would your family think?” as common phrases among others. Let’s work backwards, the last comment can easily be seen as a possible guilt trip but it can also cause some negative emotions to surface, particularly if there is friction within the family. The middle comment is also dangerous as some people don’t have a faith and this may be because of trauma or abuse. It can also suggest unless you have a relationship with a god, you can’t be helped. The first statement may be the most troubling though. You’re reinforcing the behaviour. Yes self harm shouldn’t be something people feel ashamed of, but it shouldn’t be highly celebrated either.

5. Don’t judge or use stereotypes

Some professionals have a preexisting picture of what a person who self harms is. They may see them as frustrating and a drain on resources. They may see it as attention seeking. These stereotypes tend to grow over time within a staff member. I can see how hard it must be to treat someone who seems to be causing their own suffering. But it is a symptom of an illness. It is like an addiction. It is hard once you have started to stop. It can feel like all you have in the world at that time. It is a sign of distress. Being compassionate, non judgemental and just kind to the patient goes a long way. It can help the person to keep accessing help. Doing the opposite could push people away and leave them in dangerous situations.

6. Don’t compare us to other patients who have self harmed

Every person is going through their own unique experience with mental illness and self harm. Self harm is self harm. So it may not be as deep or as “bad” as someone else you have treated, but to that person the pain they feel inside is probably just as intense and unbearable. Hearing that we aren’t as serious as someone else because it doesn’t reach a certain level is heartbreaking and can have a negative impact. It can cause us to try and do more damage. It makes us think we aren’t good enough or that we don’t deserve help. Everyone, whatever level of self harm they present with, deserves support and compassion.

7. Don’t use the terms “superficial” or “attention seeking”

I hate the term superficial when it’s used to describe my self harm. It makes me feel like a rubbish self harmer and that I need to harm worse or more. It can encourage the behaviour and make things worse. The same can be said about the term attention seeking as it can drive the behaviour underground and prevent people getting help.

Those are just a few helpful hints for medical professionals. It might not be a regular thing you encounter but it is always useful to know how to help someone who self harms.

If you have any tips you wish professionals knew then feel free to use the comments or Twitter, Facebook or Instagram.

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Shutting Out The World

This is a personal piece. Please be aware some of the content may be triggering.

Things at the moment aren’t great. I’m not in the best place. My head is a mess and I’m not tolerating the world very well. Therefore I’ve been shutting it out.

I know this is not the best course of action but at the moment it’s what I can cope with. The world feels overwhelming. People feel overwhelming. Life feels overwhelming.

I don’t know what has caused this decline. I have theories. It could just be a depressive episode. It could be the disjointed care. It could be turning 30. It could be a number of individual things or all of them combined. I don’t know. And I guess it doesn’t really matter.

Shutting out the world means avoiding Facebook interaction. It means not messaging friends. It means not asking for help. Instead I have replaced it with self harm and thinking of suicide. I have spent my time dwelling on the fact that everyone would be better if I was no longer here and have been on a mission to prove it to everyone.

I’ve also been experiencing physical symptoms. My body aches. My head is thumping. And I feel sick. I either sleep too little or too much. I either have no appetite or binge on food. It adds to the mental difficulties.

I hate myself for the way I’m coping. I hate myself for doing what I logically know is the wrong thing. I see it as protecting myself but realistically I need people and I need help. What help they can offer I don’t know. I guess I won’t if I don’t ask. The thing is I’m put off asking at the moment by the fact I have no stable care. I feel a burden to everyone, including those paid to care for me. I know I’m just another caseload that they could do without.

So what would my advice be for anyone else feeling this way? I guess it would be to do what feels like the hardest thing, ask for help. You deserve it. You are worth it. Now I just have to try and believe it for myself.

If you are struggling the Samaritans are available 24/7 in the UK. If you are outside the UK then please check out the crisis help page which can be accessed via the menu. To follow my experiences you can do so on Twitter, Facebook or Instagram.

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CMHT Fail

This was not the post I planned on sharing today but I needed to get this out.

Today I had a psychiatrist appointment. It was with a new psychiatrist and my latest care coordinator. Except it wasn’t. While in the waiting area I received a phone call telling me my care coordinator had left on Friday and trying to arrange an appointment with my interim care coordinator. When I told her I was waiting for my appointment that was already running ten minutes late they rushed down. Remember they don’t even know me.

In the appointment the psychiatrist had no access to my notes as he had been blocked from the system. Thanks to the interim care coordinator he was able to access the last letter but couldnt read in detail.

He asked me how I was and when I mentioned my mood was low a lot and unstable, he asked more questions about my concentration, appetite, memory and sleep. He asked me to rate my mood which I put at two at best. I mentioned I was having suicidal thoughts and that the voice I hear is worse. He said I didn’t have plans to end my life, he actually didn’t ask.

The psychiatrist then wanted to refer me to a service that has refused to take me on. When I explained this he said he understood and offered no alternative. He did not want to change my medication despite my obvious deterioration. I managed to persuade him to up my mood stabiliser but he did it by the smallest margin possible.

I tried to bring up some other concerns but by that point he was already wrapping up the consultation and urging me out the door with the words “I’ll see you in two months”.

Everything felt like it was too much effort for them. This is from a trust that is rated as outstanding. A trust that can’t seem to retain staff or offer support. It is currently a postcode lottery within this Trust as to what treatment you can access (I am aware that this is actually down to the CCG).

When did continuity of care in mental health services become unimportant? Especially with people with BPD where fear of abandonment is a major symptom. When did it become acceptable not to fully risk assess people?

Unfortunately this seems to be the way it goes for many service users of mental health services. It isn’t often I cry in an appointment and straight after in the street but today’s fiasco made me feel awful and worthless. (Thanks to the psychiatrist who actually sked if I felt worthless).

To keep up to date with my mental health experience, follow me on Twitter, Facebook or Instagram or use these and the comments to share your experiences.

Losing A Mental Health Professional

This piece contains my personal opinions and some of the content may be triggering.

Sometimes in life we can’t control what is happening around us. People come and go in our lives whether we want them to or not. This can be hard to deal with. One big change can be when we lose a mental health professional who has been involved in our care for a long time. We may have come to rely on their help and support. We may have built up a good relationship with them. And then it ends.

As someone with Borderline Personality Disorder (BPD) endings can be particularly tough. Having a fear of abandonment means that when someone does actually leave our lives it is like a self fulfilling prophecy. Our worst fears are happening. This may lead to us getting involved in risky behaviours or rejecting the person before they are out of our lives in a way we believe will protect us.

Recently I was given the news that my care coordinator was moving on and I was going to have to say goodbye. It was difficult news to take as we had a good relationship and she was a great and supportive care coordinator. Getting the news made me feel like I was being abandoned as at the time there was no replacement on the horizon and no idea when one would be recruited. I was close to tears. Many thoughts went through my head including “was this my fault?”.

As I came to accept that this was going to happen I started to pull away from my care coordinator. This is what often happens with people who have a BPD diagnosis. It’s a way of protecting ourselves from a perceived abandonment even when it is not a true abandonment.

What helped though was the way my care coordinator rounded up our sessions together. She made sure my care plan was updated before everything ended so the next person would know what I needed help with and what I was working on already. Also in the end a new locum care coordinator was appointed so my old care coordinator could introduce me to the new one. This allowed her to inform the new person as to how often we met, what my major issues are and what needs to be brought up at my next psychiatrist appointment. It also helped to make a plan with the new care coordinator as to how our meetings would work.

What should a mental health professional remember to do when leaving a therapeutic relationship?

  1. Let the person know your leaving face to face
  2. Answer any questions about the change that the service user/patient has about the change
  3. If possible introduce your replacement to the service user/patient
  4. If unable to introduce your replacement, leave notes for your successor
  5. Tie up all loose ends

What can I do if I’m losing a mental health professional?

  1. Talk about any issues you feel need to be taken into account with a member of your mental health team
  2. Make sure you have numbers of people you can contact if you need help
  3. Create a support network (if possible) away from the mental health team
  4. Be open to a new mental health professional, remember just because they are new doesn’t mean they’ll be awful

Those are a few pieces of advice that I have but if you have more then feel free to use the comments or Twitter, Facebook or Instagram.

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The Lesser Known Symptom Of BPD

As some of you may know there is a criteria of 9 symptoms which are considered when diagnosing BPD (Borderline Personality Disorder or Emotionally Unstable Personality Disorder (EUPD)). To gain a diagnosis of BPD you need to meet at least 5 of the 9 criteria but each criteria can be met to different degrees. This means there are many different combinations of the criteria and therefore everyone who has the diagnosis is unique.

One of the lesser known criteria is hallucinations and psychosis in times of stress. This has been described below as mentioned on the NHS website.

“Brief episodes of strange experiences – such as hearing voices outside your head for minutes at a time. These may often feel like instructions to harm yourself or others. You may or may not be certain whether these are real.” (NHS website)

This lesser known symptom of BPD can be devastating but it is often overlooked by others. Most people focus on the difficulty with relationships and self harm. These of course are very serious symptoms of BPD but so is psychosis.

Often when you tell someone you hear a voice people will assume you have schizophrenia but it can be a part of many different illnesses, BPD being one of them. It means that an already stigmatised diagnosis (BPD) is even more stigmatised. This can be from others with the same diagnosis as well as mental health professionals.

It took a long time for me to tell my mental health team about the voice I hear. I thought that they would write me off as crazy and didnt realise it was part of my BPD diagnosis. I wasn’t informed that it was a part of BPD until years later, as different mental health professionals didn’t inform me that it was.

In fact I came up against stigma from some. They didn’t seem to take my symptoms seriously and dismissed me to begin with because I knew that the voice was in my head. They made out that it wasn’t a big deal even though it was still distressing. It took some time to persuade them to give me treatment. In fact one professional told me that because the psychosis was part of BPD I would never be able to get help with it. This was untrue as my current psychiatrist believes it can be helped by medication and I just haven’t found the right one yet that doesn’t cause me side effects.

Of course not everyone who has a BPD diagnosis experiences psychosis but it is part of the criteria so many who have it will suffer. How many suffer in silence? I want to talk about this lesser known symptom and end the stigma.

Have you had an experience of psychosis because of BPD? Feel free to share in the comments or on Twitter, Facebook or Instagram.

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