I spent the majority of 2015 ‘in crisis’. Between May and December I experienced my most severe depressive episode in a decade. It took me right off my feet, for the most part left me entirely incapacitated, and ultimately at risk of dying. I only began to recover in the days leading up to Christmas. January saw steady improvement in my mood. I was thrilled to find myself alive, having been convinced that I wouldn’t see Christmas because I had to die. I had hope again and, for the first time in my life, reliable, consistent support – which was to prove life-changing and to allow the final pieces of my life and self recovery puzzle to begin to fall into place.
February was rather more of a roller coaster of mood. I panicked as I first felt my mood decline, terrified of the depression taking hold and fearing I would be trapped in it again for months, or even years as I once had been. Depression can be paralysing.
Late last year, on a day when I was able to harness some capacity, I arranged to visit the local crisis centre – a voluntary sector project – to obtain support to build a crisis plan. It was a helpful appointment – my plan involved strengthening my fledgling support network and reaching out to speak to a worker at the crisis centre. The latter can be contacted by text, email or call … 24/7. A follow up appointment may then also be made for the client to visit the centre over the course of the next two days or a follow up call may be made to the client the next day, if more support is needed. It’s a good service. There is only limited provision of a similar type throughout the UK, certainly nowhere near enough to meet demand. Commonly, someone experiencing a mental health crisis, certainly outside of ‘office hours’, is likely to find attending A&E, where resources are stretched and often not geared to mental health, is their only option.
I feel enormously grateful that I now have access to appropriate crisis support. I experienced a four year period of serious mental illness some years ago. There was no specialist crisis support where I lived at that time, only an out of hours GP service that was stretched and, I’m afraid, in no way sympathetic to mental health difficulties. Telephone helplines, such as those offered by the Samaritans, SANE, Breathing Space (Scotland) and Supportline, although helpful, were no substitute for the services that are now available to me in a new area. I believe everyone experiencing mental health crisis has a right to the best, free care – 24/7. We are some way from making that a reality.
So, what is a mental health crisis? If you’ve had one you’ll certainly know about it; they are far from fun. Like those who experience them, they are varied and individual. A crisis might involve psychosis. For the uninitiated, that’s not where one wields an axe and becomes a killer as media depictions might suggest, but rather where a person’s perception of reality becomes mildly, moderately or severely distorted. Read more here. I thank my lucky stars that I haven’t had to experience it and have much respect for those who do. They’re not ‘loony’, ‘psycho’ or ‘sick’, but experiencing the symptoms of illness. They are as deserving of respect and care as anyone experiencing serious illness. A crisis might involve suicidal feelings, ideation and plans. Equally a crisis might involve loneliness, despair, fear or anxiety, impeding a person’s ability to cope or function.
For me, crisis is feeling suicidal, whether those feelings progress to planning to end my life or not, I don’t want to feel suicidal. As far as humanly possible, I want to avoid slipping that far.
Crisis prevention care is as vital as in-crisis care.
The increasingly stretched NHS is, in mental health terms, generally reactive rather than preventative, as limited funds mean limited resources and so limited capacity. In-crisis care is often woefully inadequate, crisis prevention nigh on non-existent. I was only able to access the support I needed when I was deeply in crisis, even after months of crying out to my GP for help with my rapidly worsening depression and suicidal ideation. The attitude was very much one of not to worry, you’ll be fine. When I described finding myself assessing elements of my home as means to end my life, my GP said that was OK, so long as I didn’t act on those thoughts.
No support was put in place to ensure that I didn’t act on them or to help manage and indeed, reduce those thoughts. Only when a friend, sensing that a suicide attempt may well be imminent, telephoned my GP surgery insisting they take action, did appropriate mental health support begin to materialise. My friend (at the time working away from home and 500 miles from the city where we both live) was correct in her assumption and may well have saved my life by at first listening, by continuing to listen until she was able to understand, and, once she did, by taking prompt and appropriate action.
Aside from a lack of appropriate sources of support, the symptoms of mental illness may themselves impede access to support. In recent months, despite having confidence in my local crisis centre (at least my ‘logical brain’ does) and having received much encouragement to seek support from it and other sources, such as my GP and my housing support officer, I have been unable to do so while in crisis or once I begin the slide towards crisis. This is because my depression rather has its own mind and it’s not supportive of my well-being, darn thing that it is! Depression makes me believe that I’m a burden and that no one can or will help me. That’s not what you need to be thinking when you need to reach out for support to manage your illness. You see my dilemma. I don’t feel that way unless I’m in the grip of depressive illness. That at least allows me to continue to devise and revise techniques to circumvent the obstacles to support.
I have made progress.
In February, with encouragement from my housing support officer, I was able to contact the crisis centre as my mood began to rise after a frightening few days of persistent low mood – although not so low as to ignite suicidal ideation. The contact helped strengthen my capacity to recover and continue to move forward. I was able to arrange to visit the centre two days later, in order to discuss my difficulty in reaching out as a mood slide or other crisis trigger occurs. This proved to be enormously helpful. I found my own answers, but having the time and space to discuss my feelings and thoughts around the problem with a crisis worker, is what enabled me to do so.
I realised that I had not been able to engage with either my crisis plan or my crisis/comfort box, despite working so hard to establish them to support me. In conversation with the crisis centre worker, I realised that I had been treating both plan and box as pariahs.
They reminded me of being in severe crisis – a terrible place to which I never again wanted to return – and so I shunned them.
I resolved to rename my crisis plan a rather more cosy support plan and to drop the word crisis from the comfort box. I also made a new, larger box and reworked the contents – a few of which are shown below. It includes, but is not limited to, the following.
- Items for relaxation – such as a stress toy, herbal tea bags, a relaxation audio, a book and postcards to colour.
- Photo frames to fill with images of the few who stood by me last year and remind me of the hope and support they offer me.
- A soapstone heart and fluffy bunny – both tactile – to aid grounding techniques.
- Assorted toys and other items from my free and brilliant Little Box of Distractions to occupy and distract a stressed mind are also in there.
For the first time I feel confident about accessing appropriate support when I need it – in the form of contacting a supportive friend, the crisis centre or a specialist helpline, whichever is most appropriate in the circumstances. I am somewhat less confident about accessing crisis prevention or in-crisis support from the NHS because of it’s failure to support me in the past and because of the limitations I know have been forced upon it.
Last week a mood slide was triggered by the unexpected discovery of a psychiatrist’s report from more than a decade ago. It details my poor mental state in the immediate aftermath of my disclosure of the physical and psychological abuse I’d experienced in childhood and beyond. I had some horrendous experiences within the NHS in those days, the worst when I was verbally abused by a GP, who went on to admit his wrongdoing but which was subsequently covered up and I was hounded from the practice. A mental health charity backed me but said that without family, a supportive partner or friends to stand and fight with me, I had zero chance of redress.
I still fear being that vulnerable again and know I have still work to do to recover from it. My current GP who, since my friend acted, has improved her support and so has been slowly gaining my trust – the first to do so since that event 11 years ago – is leaving the practice next month. Starting anew with another GP will challenge me, but must be done.
Faced with this triggered mood slide and associated flashbacks and anxieties, I did not panic and so trigger a further slide (well, OK, I did a teensy bit). I calmly and mindfully worked to ground myself, helping to stabilise me, and reached out to friends, Twitter friends and the crisis centre to obtain the support I needed to begin to recover my mood and confidence.
How I felt when I achieved this (delighted) is described on a sticky note held within the jar pictured above. It was made for me last month by that super friend. Her intention is that the happy thoughts collected within it can also help to comfort me at more difficult times.