"a mental health service users experience in a crisis"

What I am about to tell you, you may find upsetting. But this is what has happened to me. It may not be the experience of others and if you have had a good experience in a crisis, I am sure you can share it in the workshops this afternoon. If by what I say, I may trigger you then this is not my intention please try and not judge me too harshly and please don’t tell me that I did these things just to be an attention seeker- there are better ways to get attention, I can tell you, than trying to kill yourself.

I spent my working life as a probation officer. Following an assault in Cyprus I developed post-traumatic stress disorder which then developed into a deep depression, and since then I have been diagnosed with rapid cycling bipolar disorder and borderline personality disorder. I am, what you might call, a repeat offender, in that in the last 13 years I have experienced numerous suicidal crises. I want to give you a composite of what happens if you have a mental health crisis.

So…. You may have been dealing with suicidal thoughts for some time and have tried to keep yourself safe using various means, like distraction, being around others, going to public places, taking tranquillisers and sleeping tablets. But what if all the tablets have been used up and its night and you can’t go anywhere to be safe? There may come a time when your energy to fight these thoughts is so low you don’t think you can resist acting on the thoughts anymore. In the past when I have got to this point I have started drinking alcohol with a wish to either pass out unconscious or die. Because If I can’t pass out I will not care enough to keep fighting the thoughts and can try and kill myself. As you will “let my god decide if I should live or die”, a form of Russian roulette with the fates. Some of my suicidal acts have been planned at other times impulsive. I am not proud of what I have done, as after each attempt I have felt feel humiliated, embarrassed and ashamed. I have caused pain for my friends who have felt helpless, confused, powerless, frustrated and angry.

When you try to kill yourself you are not thinking of the consequences, you just want out of life. At times, you may be aware that you are a danger to yourself. Once when I asked for help to keep me safe, my social worker asked the crisis team to come over, they said they could not come to my home until the next day at noon, I did everything I could to stay safe for those 24 hours. When the crisis team arrived I said I was not safe, I had thought of killing myself and not wanting to burden others with my cat, I said I had even thought of killing my cat. This thought scared me and I did not want to kill my beloved pet. The response I got from the man who was there was that he shouted at me that I was “selfish”. I said I was not selfish, if I was selfish, I would have just done it and not thought of the pain I would cause others.

They told me that I didn’t need to be in hospital and tried to dissuade me from asking any more, so I called my support worker, who told them I had been very depressed and would never normally ask to be hospitalised and that I needed to be in hospital, that I was NOT safe. They told her I would not be taken to hospital and besides there were no beds available anyway, but that they were planning to call the RSPCA to have my cat taken away. They were more concerned with the welfare of my cat than my welfare, how ironic!

Another time when I knew I was at risk I phoned the crisis team. I said “I am at risk and need to be in hospital” they said to take a tranquilliser and phone them back in 5 hours if it did not work. Well 5 hours is long time to wait if you’re suicidal. But I did phone them, (after all I always keep my promises) and told them I had already taken an anticoagulant and cut myself. They did nothing. They did not even call the police to do a welfare check. I did not die as you can see but only because I had not waited long enough for the anti-coagulate to work.

Another time I told my community psychiatric nurse, I needed a respite bed, somewhere to be safe, where I could talk or just be. But the only respite bed in Suffolk was booked up months in advance.

So, you’re in crisis, you’ve been fighting the thoughts of killing yourself all day and it gets to the evening. Your community psychiatric nurse has told you to phone the crisis team when you’re at substantial risk. When I have done this in the past some of their comments such as “go have a cup of tea, a bath, go for a walk, watch TV, ” have only brought me more frustration and anger. This escalates the situation. You phone the Samaritans, or you may call the crisis team again and they say “I’m sorry I only have a few minutes to talk to you as I have an assessment to do here at the hospital, so put your worries in an imaginary box and you’ll feel better”.

You may call the Samaritans again, who are really lovely people, but they can’t give you advice. You don’t want to call friends because you don’t want to burden them or worry them, besides it’s in the middle of the night. You already feel such a worthless human being, not even worthy enough to breathe another person’s air. You are desperate and so you attempt to take your life, you’ve had enough, you just want out. You may be discovered by accident, or have a rational, lucid moment and call for help, you may wake up alive, and either way… other people now know.

Your friends might try and persuade you to go to accident and emergency. If they can’t persuade you, they might call the police to do a ‘welfare check’. You might be able to persuade the police you’re safe.

Or your friend might take you to accident and emergency where you’re put in a room. Your friend can’t cope, your banging your head literally against the wall. The Sister in charge of Accident and emergency department is insisting the mental health team attend but they say to her “put her in the cells, she is drunk and only has herself to blame”. The Sister is refusing to call the police, she won’t let a mentally unwell person be put in the cells. Your friend might plead and beg for you to be sedated but you’re not. Because you need to see the crisis team first.

You might phone the crisis team and if you have already hurt yourself they may send an ambulance or tell you to get yourself to accident and emergency (I have tried this before when in a taxi and tried to jump out of it, my friend stopped me). You might even be persuaded by the Samaritans for them to call an ambulance. Your neighbour may have seen you in the street and called an ambulance, and they may wait for an hour and a half for one to arrive.

Once you get to accident and emergency you may be seen by a doctor who says “do you feel hopeless and helpless”, you say “no”, because once you get released you plan to finish the job. But you can’t go once the doctor has seen you, as you have to wait to see the mental health team, this can take hours. The longest period I had to wait was 12 hours when the mental health team “forgot” I was there, but it can take usually up to 6 hours. You are not given any tranquillising medication while you wait so your desperation and agitation increase, the stress may cause you to start hallucinating.

Someone once told me they passed out from taking an overdose and a nurse told their friend “well what did she expect she took the tablets she will wake up eventually”. You wake up - still no assessment- you have a panic attack and run away. Or your friend is told that they can go, as you will be admitted to psyche ward, and they go, and you’re on your own, waiting and waiting, you get frightened you, run away. Or you may be guarded by security staff, who get annoyed by babysitting “yet another mental health case”. You may be left in cubicles and surrounded by over stimulating beep sounds and the hustle and bustle of a busy department you can’t cope with the noise so you, run away.

You may see the mental health team after a 6 hour wait, you are stammering and can’t get the words out, they say “if you can’t speak to us properly, we won’t talk to you”- your crying, you run away. The mental health team may guilt-trip you into going home because” your cats not fed”, or they say “you self-manage so well”.

Accident and emergency staff may come up to you and berate the mental health team for taking so long. You know you’re making them frustrated. You feel guilty so you, run away.

You may be guarded by the hospital staff waiting for the mental health team, you over hear one nurse say to another “I’ve been brought down from theatre to do this stint”, you feel so guilty that you have caused this that you, run away. You might be prevented from leaving by accident and emergency staff, so you wait some more and more and more. You can’t bear it anymore, you wait for their back to be turned and you, run away.

IF you run away, the accident and emergency staff have no option but to call the police, it’s their policy. En route to your home, you may have hid in peoples gardens so that you won’t be caught. If you continue to hide in peoples gardens the police will put up a helicopter to search for you. So you go home.

The police arrive at your house and try and persuade you to open the door. Eventually they threaten to break down your door. You don’t want to upset your landlord by the damage to the door, so you let the police in. They might act kindly towards you or they may, out of frustration, start phoning randomly the contacts in your phone, telling people that you have not seen for years, that you’re suicidal. They may contact the mental health team who tell them your sister is your next of kin. If, for example, your sister doesn’t pick up the phone (after all it is 2. 30 in the morning), they will go and wake her up. She will be angry, and phone you the next day to tell you that the “police have better things to do than waste their time on you, when they could be catching criminals”, she never speaks to you again.

The police, at your home, may try to convince you to go to the hospital. They call an ambulance, all your meds are taken out of your house, your keys, phone and your cigarettes. You’re so afraid that in the ambulance you stand up to make to jump out the back. The Paramedics say, “Keep breaking sharply that will make her sit down”, they keep calling you Catherine, but your name now sounds like “cathy run”. So you manage to jump out of the moving ambulance and the police car is following. They jump on you and hand cuff you and put you back into the ambulance. You arrive in accident and emergency, in handcuffs, embarrassed, feeling like a criminal.

Or the police, at your home, may try to persuade you to walk outside your home, then carry out a section 136, (you can’t be sect 136 at home). They put you in the police car. They call the mental health team who say “if she has drunk alcohol we won’t see her till she is alcohol free” so the disgruntled police have no option but to take you to the police cells.

At the cells you get searched, have your personal items removed and put in a cell with a mattress on the floor. If the police man is a friend you went to school with, they may sit at the door of the cell talking to you kindly, telling you to ignore the voices and making conversation to distract you from the voices in your head that are telling you “you should be dead, you failed, next time hang yourself”. You will then be breathalysed repeated until free of alcohol then, 6 hours later, you are taken to the section 136 suite at the woodlands unit in the hospital.

You then have to wait again, without medication, for the assessment team. You may have headache but no one will give you Paracetamol, there is no doctor to prescribe it. You don’t get offered a drink and you are put into a brightly lit room that is over heated. No one comes to talk to you to ask you why you tried to kill yourself. You may overhear the lone nurse there, telling their colleagues on the phone, ” she is agitated but ok”. You try and keep it together, as so far you’ve been treated like a criminal and just want to get home. You ask if you can have a drink. The nurse sighs as if you’re a nuisance and gets you a drink of water, you wait for the assessment team. You ask if you can go to a low lit room because the bright lights and extreme heat are making you feel worse, so they put you in a freezing cold bedroom next door. You try and calm down, your shaking now with the cold and come out to ask for a hot drink You are tutted at by the nurse who reluctantly makes you a hot drink. Its now3. 30am. You’re exhausted, you just want to get home, get to your sedating meds. You may ask for your property as you don’t know what you have got. Cigarettes? “We can’t give you the package with your property in it” says the nurse.

The mental health assessment team arrive and ask you questions that make you angry. You try and convince them you’re safe to go home. You’re so tired and agitated. They offer you the home treatment team but they can’t explain what the home treatment team will do for you. They let you go, but you have to ask them if they can call for a taxi as you have no phone.

Sometimes if you ask for it, the taxi can be paid on account or if not offered it, you walk home. You may have to break into your home or wake your neighbour, up who has a key to the house. It’s now 4am and they are not best pleased.

You get home but they have taken all your meds, so you can’t help yourself calm down. You want to phone the hospital for your property but the number is in the mobile that you can’t find because they didn’t tell you they took it. You try and look for your cigarettes but they didn’t tell you they took them too. You might be lucky and have another phone at home and you might be lucky if the hospital security guard brings round your property at 5am, or, you might be unlucky and never get your property back.

On another occasion when taken to the 136 suite at Woodlands there were no mental health staff available. The police said as there were no staff, I needed to be taken to the cells. I begged them not to take me, so they waited with me in the 136 suite until a mental health worker was free. It took hours.

If you wake up alive on the medical assessment ward or the surgical ward, you may ask to be NFR (not for resuscitation). The Doctor will put you on 72 hour section and then you will be watched constantly by a nurse, who is very kind and will say things like “why did you try and kill yourself you have so much to live for” or, “only god should take a life”, or “what will your friends think had you succeeded, they would have been devastated”, you persuade the nurses that you were foolish, you did a stupid thing and wont to it again, you need to make THEM feel better.

You may be seen by a psychiatrist who suggests you need to go into hospital you tell him “but I have a borderline diagnosis my experience is they won’t put you in hospital”, he says “yes but you do have a bipolar diagnosis and you should be there, but the crisis team have to see you first”. They (the mental health crisis team) come and guilt trip you into going home, “well your cats not been fed for over 24hours now and you do have an appointment with your G. P. tomorrow which you should keep”. Your carer or friend may phone them and say “she is not safe, don’t discharge her”. But because you feel so guilty that the cats not been fed, and made to feel a nuisance, you tell them you will go home.

They may offer you a crisis bed but that would only be for 2 nights, that’s 30 hours, and they tell you you won’t have your treatment reviewed there. The carer is told “”well Cathy has chosen to go home and only SHE is responsible for her safety”. The carer is left feeling angry, worried and frustrated.

When you wake up alive in the surgical ward you might not have your clothes on, you’re in a hospital gown, and you don’t have any property. You can’t phone someone because you have no phone and can’t remember the numbers on it. The medical ward may say that you are medically fit to be discharged. You go home in hospital scrubs with a bag of blood clotted, cut up clothes and no shoes or socks. You call the Freephone number at the hospital for a taxi, and because you have no money on you, the taxi driver follows you into your house for his money. You have no meds, they’ve been taken by the ambulance. Your traumatised, you clean up the blood stained carpet and cry.

If you have tried to kill yourself in a public place, the police may section you. If the police have sectioned 136 you, the police may have to wait for you to be medically fit to be discharged, as the mental health team won’t see you until your medically fit to be discharged.

The police may have to change shifts 3 times for the length of time it takes for them to be able to hand your care over to the mental health services. It’s been over 14 hours now that they have had to “babysit” you. You are awake the whole time and hallucinating. They may be kind to you, but very frustrated by having to be with you. You pick up on this and feel very guilty.

At Accident and Emergency you may be placed in cubicles and only feel safe laying or kneeling on the floor, this way you can’t sink any lower. Someone passes the cubicles and remarks to the police officer sitting outside “someone should tell her meccas the other way”. The doctor arrives, you can’t get up from the floor. The police officer shouts at you to get up as the doctor is here. You can’t, only the floor is safe and cool, so she grabs the back of your collar and drags you up.

One day I phoned the access and assessment team for medication advice, and no one answered so I left a message on the answer phone. They did not phone back. After 45 minutes I called 111. It says on the poster ‘if you need urgent advice but it’s not an emergency call 111’ - Don’t phone 111 if you’re in a crisis and only need medication advice. If they ask you why you want medication advice and you say you are having suicidal thoughts and just need to know how much more anti-psychotic or tranquilliser you can take, don’t phone 111. Because they will always send an ambulance, even though you tell them you don’t want or need one. The ambulance arrives, the first responder arrives, and the police arrive. You are telling them all you just need medication advice and don’t need to go to hospital. They will tell you their job is only to get you to hospital. You go to hospital in the police car and sit in the waiting room flanked by two police officers. Everyone in the waiting room is staring at you, your stress levels have gone up to such a point you become delusional and start hallucinating. You think you have been brought to the hospital to heal the sick. The police leave. There are too many people to heal so what do I do…yeah your right. YOU RUN AWAY.

So what has helped me keep alive your probably asking.

1. The Samaritans, they will listen, and offer to phone you back in an hour or the next day. If the local office is open they will tell you that you can go down there and meet someone face to face.

2. The police, who sit with you while you wait, who want to help, but they are not social workers or doctors or mental health professionals. There are the kind ones, like my old school friend who talked to me, persuaded me to get in the ambulance, gave me a cigarette and told me that I wasn’t wasting their time.

3. My support worker, who says things like “well you can’t kill yourself you need to sign my time sheets on Monday…” and my friends who remove the knives and pills from the house.

4. My reasons to live list compiled when I am well. Those things that I have not yet done.

5. Medication. Many a time I’ve taken sleeping tablets and tranquillisers to knock me out and provide the respite from the thoughts that only sleep can bring.

6. My GP who shows care and empathy, never judges me, and wants for me to get well. Who will see me urgently and frequently, or his colleagues who will phone me when he is not there to say they are concerned about me.

BUT there are those nights when, alone, frightened and terrified that you may not resist the urge any more… there are……… those nights…