Tag Archives: care coordinator

Ashamed

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

Today I had a melt down. Not just a little one but a major, uncontrollable show of emotion. I was in the DBT peer support group that I’ve started attending and I got triggered and that was it. My mind started turning over everything. Memories came back with full force. The voice started. It was overwhelming. I started by sitting quietly with tears going down my face. We were doing an exercise and everyone was focused and I just couldn’t ask for help. Then someone noticed me. They asked if I was OK and I got asked if I wanted to take a moment. That’s when things just nose dived.

I practically ran out the room. I wanted to slam the door behind me but couldn’t do it. This infuriated me and I hit the wall and ran to the stairs. At that point I just sobbed and emotion overtook me. There were so much emotion that I have no idea what it was I was feeling. All I know is it was horrible. In that moment I wanted to die. Everything was so intense. It felt unmanageable. I felt nothing was going to be OK again.

Luckily the peer support facilitator followed me. She was amazing. She got down to my level. I think she grabbed my arms. It’s a little hazy. I can’t remember what she said. All I know is she got someone else to go in with the group and took me somewhere quiet.

When we got in the office I just wanted to curl up small and hurt myself. I hated my reaction as well as still feeling the heightened emotions. Also everything was still going through my head. I couldn’t look at her. I was so ashamed of myself for so many reasons. For my reaction. For my feelings. For the thoughts of what had happened in the past. For what the voice was telling me. I started to hit myself as I was asked to stop. I hadn’t even realised I was. Things were hazy. It was like being in two different places.

The facilitator started talking to me. The conversation is a little bit of a blur. But it started to calm me. She got me to focus on my breathing to bring me back to the moment. She then had to leave me to go back to the group but someone else sat with me. They talked to me about nothing in particular but it helped. I started to be able to respond and the tears seemed to stop. The intensity of the emotions slowly eased.

When the facilitator came back we decided to have another talk. I opened up about a lot of things from my past. It all kind of blurted out. There were things I had never really spoken about. It just felt, well not easy but, OK to talk about. I felt listened to. I felt understood. I felt I mattered. But this was also contradicted by other feelings of shame (of what had happened in the past and of needing to ask for help), of being selfish, of guilt. I hated myself. As much as I was told it was OK I couldn’t believe it. I was (and am) an awful person. I couldn’t stop apologising.

Eventually I left, apologising as I went and promising to email her and contact my care coordinator. I decided to text my friend. She was the only one I wanted. I explained to some extent what had happened and she was concerned about me. Immediately guilt started to escalate again. But I kept talking (still apologising). She kept me calm. She was great. I’m so grateful for her. I’m so grateful for the facilitator too.

When I got home I got into trouble for being home late. It started as soon as I walked in. Immediately all the negative emotions started to rise again. I tried to explain I had a melt down and the questions started. They were things I found difficult to discuss but they wouldn’t leave it alone. Even when out walking with mum she brought it up and told me I just need to get over it. Maybe she is right but it added to how bad I’m feeling. Shame came forward again.

Since then things have been hard. My mind has been going over things. The voice has played its role. I’m trying hard to stay afloat. But its tough. I hate myself.

If you have any suggestions on dealing with shame feel free to share in the comments or on 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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Mental Health Professionals

This is a post about the different professionals involved in my mental health care. I aim to discuss a bit about what each of them do and my relationships and experiences with them. There are many different professions in mental health care and it can be confusing to know what they do.

1. My GP – I thought I would cover this role first as its normally the first port of call for anyone struggling with their mental health. They can offer advice and medication, as well as referring you on to get help from other professionals. My GPs have on the whole been great. I see two who deal with everything and have been really supportive in getting me the right care. Sometimes it takes a while to find a good GP in the practice; the ones I see now were not the first I approached about my mental health, but keep trying as there are great GPs out there who can act as your advocate.

2. Psychiatrist – This is a doctor of the mind. Mine is involved in prescribing medication and referring me for other treatments and services, such as therapy. I have seen many different psychiatrists over the years, some great, some appalling. Getting one who listens to you and respects your opinion is amazing and can make all the difference. I currently see a different one each time I go which makes continuity of care hard.

3. Care coordinator – A care coordinator can be any mental health professional and is usually the main point of contact for support. They also sort out your care plan under the care plan approach (CPA). I’m on my second care coordinator after my first left. Neither of mine has actually really made the time to sit down with me yet and discuss my care plan. I hope this changes as I feel I need their support.

4. Support worker – These are people who support you in different ways, from being a point of contact with services to getting you involved in activities. Me and my support worker don’t always see eye to eye but she has been my regular contact with the mental health team and sees me on a weekly basis (usually, she is currently off sick) to check in with how I am doing and to trouble shoot any problems.

5. Psychologist – A psychologist is different to a psychiatrist. A psychologist offers talking therapies in order to treat mental illnesses. They have nothing to do with medication. I am currently going through the process of getting an assessment and hopefully starting therapy, and it will be my psychologist who facilitates this all. In the past when I had art therapy I had a great psychologist who really understood me and respected the way I work. I hope this will be the case again.

6. Crisis team – A crisis team is there to support you when you are particularly unwell and treat you outside of hospital. They will often see you every day for a short period of time. Although they are not currently involved in my care I thought it was important to include them as they do play an important role in keeping people safe in crisis times. I have seen them a number of times with varying responses, unfortunately not all good. Some people find them frustrating.

So there you have the professionals that are, or have been, involved in my mental health care. There are other professionals that work in mental health but I haven’t had contact with them. Please feel free to share your experiences of different professionals in the comments. It may also be different if you live outside the UK. For more information on mental health professionals check out the Mind website.

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Relapse

This is a personal piece. Please be trigger aware when reading.

This post is a post I hoped I never would have to write but I think this is an important post for me to write. As you may have guessed from the title things have not been going well for me and I have relapsed into a deep depression.

The reason I think this is an important post is because it is an honest view of how recovery works. It’s not all high flying and going forwards. There are quite often bumps in the road that tip you into a hole of despair. And that is exactly what has happened to me.

I’m no longer able to say that I am a year free from self harm. In fact I can barely say that I am a day free at the moment. But part of me is hopeful things will change and I will get there again. I hope I will be able to cope without it again.

This whole relapse has led me to seeing the crisis team for extra support which did not work out very well. I was told I wasn’t ill enough for their support which led to a further drop in my mood. But on the positive side I am going to get more support in the form of a care coordinator.

This relapse has shown me how amazing my friends are. Even when I was withdrawing from the world they were there supporting me. I am truly grateful to them for that.

This was just a short post to explain my absence from the blog and show the true nature of recovery. I might not be able to see a way forward at the moment but my friends keep telling me this is just a glitch. I hope if you are having a relapse you can see a way forward and know that this is not permanent.