@BipolarBlogger’s #MadCovidDiaries 4.11.2020
TW: Suicide and Suicidal thoughts
Risk versus suffering
Recently I was in crisis. I went through a period of low mood, which was followed by a period of semi-psychotic persecutory thoughts, and then into a terrible phase of being unable to stop obsessing about running away from home and taking my own life. My Community Psychiatric Nurse came to visit on the Monday of that week and I tried to convey to her how desperate I was feeling. I couldn’t for even a moment stop planning, planning, planning. The only break I got was when I was asleep and even so I was prone to waking in the night and having the whirling intrusive thoughts start up all over again.
My CPN (let’s call her Susie) and I discussed the possibility of hospital, but she said, “You really don’t want to go into hospital at the moment – there’s Covid on the ward.” That would be a big risk for me; my husband is awaiting heart surgery and semi-shielding as getting infected at this stage could put paid to that. And yet I did want to go to hospital. Every admission I have ever had has been beneficial – perhaps not therapeutic, it just breaks the spell of the suicidality and allows me to get on with my life post-discharge without being in constant psychic pain. Susie knows that about me and told me that she was going to “bring me up” at the Multidisciplinary Team Meeting on Thursday morning and would see where we would go from there. It would be a team decision.
As the week wore on, I felt progressively more overwhelmed and desperate. On Wednesday my husband and I went for what should have been a lovely walk, but every second of every minute my suicide plan was growing and developing and would not let me think of anything else. I phoned Susie from the coastal path and told her that I really couldn’t cope, and that “if the team recommended hospital, I would not be averse to it.” What I meant was, please, please offer me a hospital bed because I am not safe in the community. I immediately felt better. I thought that she would probably put my case forward at the MDT and it would be agreed that I could have a crisis admission. I starting thinking through all the things I would need, the usual list of items I take with me when I go into hospital to make my stay more comfortable.
On Thursday morning I was nervous, thinking about a team of people from varied professions, only one of whom I actually knew, sitting round and discussing me. Then Susie rang to tell me that the outcome of the MDT was that I should persevere with a medication increase in the community. I was gutted. I felt misunderstood and abandoned. My suicide planning increased and I began to buy items to implement my ideas. I had everything in place to do the deed on the Friday but then my husband asked me a direct question about my plan and I found myself unable to lie to his face (this a weakness of mine – I struggle to lie). After that I felt I had missed my window of opportunity and would have to wait until he was off his guard again.
Over the next couple of weeks my sense of sadness, loneliness and abandonment festered. I began to feel quite resentful that the Community Mental Health Team had not come through for me when I needed them. I began, in fact, to feel that they – including Susie – disliked me, because why else would they withhold something that could have put an end to my suffering, without me doing that myself in a very drastic way?
Well, here’s the rub. The CMHT aren’t interested in suffering. Mental health services in general aren’t interested in our suffering. Not because individuals in the system don’t care; I really do believe that Susie cares about me. But resources are so thin on the ground that risk will win out over suffering every time. I don’t feel that I was assessed correctly, as my planning was very detailed, but I was not seen as risky enough to warrant a bed, so the only reason to have given me one would have been to reduce my suffering.
Mental health wards are full of people who don’t want to be there, because they don’t believe that they should be, and they are only there because somebody has made a decision about risk. And why would they want to be there? Wards are boring and restrictive, and many people have had their liberty to decline admission taken away from them. But I also know from my association with other service users that I am by no means the only person for whom a short hospital stay is beneficial and who has been refused a bed when they desperately needed a bit of respite (as did their families).
I keep seeing things on Twitter from the great and the good of the mental health world saying that beds are not what we need anyway, that services should be delivered in the community and that the “least restrictive option” should always be found. The least restrictive option for managing risk, is what they mean. I’m tired of “least restrictive”. I want “most helpful” to be considered the gold standard.
I have talked to Susie now about my sense of resentment and she does acknowledge that I had legitimate reason to feel abandoned. She said that she found the phone call to tell me that I had to hang on in community a difficult one to make, but again reiterated that it had been a “team decision”. Reading between the lines, I don’t think it was a decision she agreed with, but of course she could never say that to me and there are hierarchies of power at play. We talked a lot about how to try and avert the next crisis, and how to handle it differently if and when it does occur. It seemed like the penny finally dropped and she understood how desperate I had been for a respite from myself.
I don’t want to be a nuisance. And I don’t want to tie up a bed that could be used for someone felt to be at higher risk. I just don’t want to suffer needlessly. And I think we all deserve a health service that is funded well enough to care about both.
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