What I wish I knew BEFORE I was admitted to a psychiatric hospital

What I wish I knew BEFORE I was admitted to a psychiatric hospital

Having been known to child and adolescent mental health services (CAMHS) for years before I was admitted for the first time, I was fed a lot of absolute bullsh*t by professionals, other people my age, and the internet, about what a psychiatric ward was ‘really’ like. I’m not sure how much was exaggeration, how much was trying to scare me, or how much was just outdated or irrelevant information. But what I encountered was nothing like I had been told to expect, or what I had been so scared of ending up in. Going into hospital has been terrifying, but completely surprising.

Staff are busy. Like, all the time. If you’re expecting an admission to be a constant 1:1 session, then you’re wrong. Even on a PICU ward there might only be one staff member on top of the staff on ‘observations’. You might only see the consultant once a week, twice if you’re lucky. For ’round the clock care’, you spend a lot of time alone. Unless you are on observations, and then it’s the complete opposite. You literally cannot get away from the person on your observations. They’re following you around, watching what you’re doing like a hawk. And believe me it’s tiring to sit there trying to keep yourself distracted when a HCA is butting in every few minutes with ‘Wow! You’re so talented’ ‘Why don’t you show me more of what you’ve done?’ when you’re barely keeping the colours between the lines. It’s even more hideous when you’re being ‘observed’ in the bathroom, or when you’re trying to explain to a male HCA why you need to swap onto a female so that you can ask her for a freaking sanitary towel without being humiliated.

Some patients are friendlier than others. Every time I’ve gone onto a new ward, I’ve felt like the odd one out. Everybody else already knows each other. There are usually little groups of people who ‘hang out’, even on the adult wards. People do look you up and down when you first walk in. Everyone wants to know what’s up with you, how you wound up here. Other patients take guesses for what you’re in for. Usually my self-harm is a complete give away. So, it can also be really, really lonely. And even when you do ‘make friends’, you still feel completely alone. You’re rarely able to talk to another patient without a staff member also being present. You’re not really allowed to talk about anything ‘triggering’ or ‘upsetting’ (which in a psychiatric ward is pretty much anything), but there’s not really much else that anyone has in common. You can’t have physical contact with anyone, you can’t whisper. But you still wake up in the middle of the night to the alarms ringing and your friends screaming for staff to ‘get off me and just let me die’ and have to roll over and go back to sleep because it happens almost every night, there’s nothing you can do, and sometimes that person screaming and struggling is you.

Avoid being on a section. OK, this sounds really obvious, but hear me out. I’ve been admitted to hospital when I wasn’t on a section, but I was never explained to the section process. I was never told about being on a section or why I would need to be on a section, or even that I was having an assessment for a section until I was sat in front of the same two Doctors and a social worker I had spoken to casually before and told that I was being detained under the Mental Health Act. The reason why I was detained was because I had asked a Nurse if I could leave. Or rather, I had said that I was going to leave because nothing was keeping me here. It’s just not a good idea to tell anyone you want to leave or insist on leaving. You can talk to your Doctor about why you feel like being inpatient isn’t helpful, but if you go around threatening to walk out, they’re going to section your sorry ass faster than you can get out the air lock.

Bring your essentials. Roll on deodorant. A comfort blanket. A teddy. A few books that you really want to read and are going to be easy to read, and aren’t just for your English course. Paper. Pens. Lots of pyjamas and joggers. Ear plugs. Pictures of your family and friends. Stress toys. Slippers. Shower gel and shampoo. A towel from home. Your hairbrush. Make up and a nice outfit for when you’re allowed on leave. A list of important contact numbers in case you’re not allowed to use your own phone.

You’re going to see some weird shit, but psychiatric wards are mostly just full of very sad, lost people. I would be lying if I said that I hadn’t been scared or shocked by other patients on the psychiatric wards that I’ve been on. I’ve seen some really, really horrible things and I have been frightened by other patients. I’ve seen some things happen that don’t seem harmful to them or to anyone else, but are just downright weird and socially unacceptable. But what I’ve learnt is that these people aren’t to blame for the way that their illnesses are manifested. They’ve been through some horrible, horrible things, things that people in the community might not even be able to imagine going through. And they’re still alive, still fighting. On the ward we’re all sort of sad and broken in our own ways, but mental illness doesn’t affect people in one same way. There are many ways that people can be affected.

Staff members can be so, so rude. There have been staff members I’ve been looked after by and treated by who have made me wonder ‘Why the fuck have you got a job in the mental health sector if you are absolutely void of compassion for the mentally ill?’. It must be such a stressful job, but sometimes staff would just snap at me, or at other people, and it would really upset me. The environment is so intense in there that little things can be blown up, and bigger things make the whole situation seem unbearable. I remember one time I had been given kitchen access on the ward, so I was able to toast my bagels at night (it’s the small things). However, the Nurse on one night shift wasn’t aware of this so when she saw me outside the kitchen door she absolutely screamed at me and told me to ‘get lost’. Slightly unnecessary. Other times I would just watch staff members clearly taunting distressed patients, or doing absolute fuck all when a patient was clearly upset and needing help.

It’s not forever, and you’ll get there in the end. I was six months into my first admission when the thought first came to me that I could never get out of hospital. I was making no progress, still on 1:1, and was being referred for a long-term (years) stay at a specialist unit. I just felt so hopeless and out of control. I felt like I was never, ever going to be free, that I was either going to live the rest of my life in the clinical walls of a psychiatric unit, or die trying to free myself one way or the other. Other patients on the ward felt the same. But I came to realise that this mentality wasn’t helping me no matter what happened. Every time I slipped I pulled myself up to my feet and tried again. It took me a long time, and it’s still something I’m working on now in the community, but I got there.

I’m not ashamed of my time spent in psychiatric hospitals. I’m not the same person I was then but that Rosie has made me the strong, resilient and overall happy individual that I am now, and her hard work within the walls of a unit has meant that I now have a wonderful life. I still have bad depression days, but I am really, really, quite free. I just hope that I can use my experiences to help other people who are still going through shit and can’t see the light at the end of the tunnel.

What self destruction takes away from you

What self destruction takes away from you

Over the past few months, I’ve been opening up more and more to professionals about my experiences and my emotions. Despite the fact that I’ve been in services for over 6 years (!), I have always been deemed as ‘difficult’ and ‘resistant to therapeutic engagement’. The reason for this isn’t that I’m rude, or that I’m lacking social skills (well, to an extent anyway), but because the emotional overflow that comes with articulating traumatic events and painful feelings is often all too much. This is one of the biggest problems with BPD: you have to talk about things to get better, but it hurts so very much to talk about it in the first instance.

I guess I’m growing up. Time is a fantastic healer, and as I’m moving further away from things that happened when I was younger, I’ve found that I’m coming to a point where I’m more ready to talk about where all these confusing emotions are coming from, and how that can help me to remain emotionally stable now. Even more so, I’ve realised that nobody is going to force me to get better. Nobody can. If I become determined in my own mind that I don’t want help from services, then I have the right to that decision no matter how costly it is to me, with the exception of being sectioned of course. But even still, nobody can force me to talk and nobody can dig up painful, razor-sharp memories for me. It’s got to come from me.

So, thank goodness, I am finally making some kind of ‘therapeutic’ progress which feels amazing. I’m getting on well with my psychiatric nurse which is a first, and we are going over more DBT (Dialectal Behavioural Therapy) skills, whilst I wait to have a place with a psychologist for more specialist and specific treatment tailored to my individual needs. And I feel better. Just by telling her things and working on them together, I’ve realised that nope, I’m not alone. These things aren’t ridiculous and they are not my fault.

The first thing that we have looked at, and I’ve considered on my own, is the cost of self-harm and other ‘coping strategies’ that actually make issues that I have a lot worse. Of course, I know that self-harm is pretty awful for you, but I had never thought about it in such a systematic way. Although difficult to talk about, it’s important to not reinforce these behaviours positively, and hence to be able to shift away from them.

I am going to discuss the generic self-destructive ‘coping strategies’ associated with BPD. Some of these things may, as you know or may be able to guess, be applicable to me, but others won’t. I want to be able to help other people with their journey with BPD as I go through mine, but also preserve my own privacy to an extent. I want this blog to be about helping and supporting other people.

Self-destructive behaviours associated with BPD:

  • Dwelling over mistakes

COST = Lack of productivity, missing out on future opportunities, spiralling into depression, focussing on the problem rather than the solution, blaming yourself or others, twisting the problem out of proportion

IDEAS FOR SOLUTION = Accepting mistakes as part of the past and trying to learn from them in a productive way, apologising to others, taking time to practise self-care and look after yourself, making a plan to avoid this from happening again and to deal with any consequential problems

  • Isolating yourself from others to avoid distressing situations

COST = Missing out on precious memories and happy times with family or friends, a monotonous life, reinforcing the distressing situation and thus making anxiety/panic worse, becoming more depressed as more time spent alone

IDEAS FOR SOLUTION = Dissecting why the situation is so ‘distressing’, using friends or family to support you into the situation, practising rational thinking and radical acceptance, using anxiety medication as a short term solution, not permanently writing off the situation, remaining hopeful and optimistic

  • Dependency on alcohol or drugs 

COSTS = Financial problems, issues with relationships and domestic problems, risk of mental health deteriorating further, addiction, violence, health problems, contracting transmitted diseases, accidents and injuries, poisoning

IDEAS FOR SOLUTION = Seeking professional help for alcohol or substance abuse, talking about the issue with family or friends, surrounding yourself with other people, turning to more ‘positive’ coping strategies such as exercise or self-care

  • Becoming excessively angry at others

COSTS = Temporarily or permanently ruining relationships with other people, self-hatred, violence which could lead to problems with the police, unemployment, loneliness

IDEAS FOR SOLUTION = Removing self from the situation when you feel your emotions becoming overwhelming, explain to those around you that you struggle with anger and that sometimes you just need Time Out, using breathing techniques, exercise, rational thinking skills

  • Dangerous, physically self-harming behaviour 

COSTS = Life changing injuries, scars, risk of infection, disfigurement, risk of death, hospitalisation, serious and long-term physical health problems

IDEAS FOR SOLUTION = Caring for your body by practising self-care, minimising the severity of self-harm, using digression techniques to lessen the urge to hurt yourself, seek medical advice for any injuries, keep wounds clean to avoid infection, keep professionals updated on any resultant problems, using distraction techniques

  • Unsafe sexual activity 

COSTS = Unwanted pregnancy, infections, physical health problems, deterioration in mental health, unhealthy perception of relationships, potential violence, self-hatred

IDEAS FOR SOLUTION = Contraception, regular medical checks, discussing issues with mental health professionals, avoiding states where this is more likely to happen e.g. being intoxicated, try to practise healthy and balanced relationships

  • Using food to punish or control

COSTS = Significant weight loss or gain, anemia, heart problems, chronic pain, hair loss, malnutrition, risk of early death, organ damage, dehydration, low self-esteem, loneliness, depression

IDEAS FOR SOLUTION = Reward yourself for achievement rather than punishing for failure, maintaining a balanced diet, using light exercise, avoiding counting calories, discussing why you feel the need to punish yourself

  • Attempting suicide 

COSTS = Death, hospitalisation, severe ongoing physical health problems, physical pain, emotional distress from family and friends, Mental Health Act Assessment, feelings of failure and continued hopelessness

IDEAS FOR SOLUTION = Don’t let it get to that point. Take your medication, attend sessions with professionals. Talk to your family, friends and the people around you. Keep them in the know. Write down how you’re feeling if you can’t tell them. Write down why you want to disappear so much, and try to rationalise it. Write down happy memories. Call a suicide hotline number. Text a friend. Get dressed in the morning. Spend time outside. Try and make plans for the future.

So, what next? 

Of course, there are many other self-destructive factors that people with BPD suffer with. Every individual is different and suffer in a different way. But it’s so easy to resign yourself to a miserable and painful existence because of the fact that you may be struggling with these things, and that’s not alright. You shouldn’t have to live in misery. All too often these behaviours become comfortable. They become what we know and what we accept. They become normal. We forget the incredible long-term damage we are doing not only physically, but to relationships with others.

Recovery is a long path, but from the moment you accept that these ‘coping strategies’ are actually the enemy, the things actually hurting you, you have made incredible progress.

Hopefully I will be writing more blog posts as I go along with my BPD journey and try and make sense of DBT skills. I hope this is useful not only for those also cursed with such a problematic personality disorder, but those who struggle with emotional intolerance of any kind, or know somebody else who does.


Mental health at university

Mental health at university

I have survived my first year at university. Despite my ever-precarious mental health, I’ve done it. It’s done.

I want to talk about my experiences of mental health at university in order to enlighten other sufferers that might be starting university in September, or perhaps going back into their second or third year. So many people suffer in silence, and so many people are unaware of services that are available. Although I attend the University of Nottingham (woo), I’ve tried to write this in a general way in line with how mental health services work across the country.

DO try to set up help before you arrive. You can do this through several means. You can contact the university mental health service, the university counselling service, disability and academic support services, the disability liaison officer in your school or your hall warden. By making people aware of your mental health issues, they will be able to work out how to support you the best. If you had a Community Care Team in your home area, put yourself on the transfer waiting list immediately, because this can take a long time.

DO find out where the local GP, walk in centre and emergency department is. Have basic First Aid equipment in your room. Have crisis numbers to hand. Use the taxi firms approved as ‘safe’ by the university. Write down important numbers and put them in your purse. Know the university night line number. Find out about free counselling services in the local area. For example, Harmless and Let’s Talk in Nottingham provide many free, useful services for people struggling with mental health.

DO bring relevant paperwork about any mental health conditions. This might be needed in order to access certain levels of support, to apply for funding to help you with specialist equipment (Disabled Students Allowance often allows for support workers, recording devices or other equipment), and to allow for special circumstances in exams or with coursework. For example, you could be entitled to have a exam room on your own, or to have rest breaks.

DO arrange to see your new GP as soon as you have registered with the university health service. My GP has become a great point of contact for other services, and it’s really useful to have a Doctor that knows you and can help you specifically. Even if you only check in with this Doctor every few months, it can be beneficial to have someone else in the ‘know’.

DO find safe and quiet places where you can come to when you’re feeling anxious or low. For me, this is in one of the small gardens around the university, or in the Disability/Chaplaincy office where a cup of tea and a chat is always available for those who need it. Having found these spaces means that I always have somewhere I know to go when I’m on campus and feeling like I’m about to blow a fuse.

DO make your own room also into a safe and positive space. In my room I have positive postcards and notes all over the walls, photos of my family and friends, posters, reminders stuck on the mirror and wardrobe, lots of fluffy blankets, and of course, teddies. Whether I’m studying, relaxing or even pre-drinking with my friends in my room, I’m constantly reminded of the power of POSITIVE THINKING. Cheesy, I know. But it helps. It’s my space.

DO approach members of academic staff if you have missed something or feel like you have fallen behind because of your mental health issues. This isn’t sixth form anymore and tutors are unlikely to contact you first. But, if you approach them, they will be more than happy to help you. You don’t have to be on your own, and your illness doesn’t have to stop you from achieving. Don’t lose your passion for your subject.

DO continue to take your medication. One of the biggest mistakes I made in my first semester was stopping my anti-depressant medication. With the buzz of Freshers and a new start, I felt like I didn’t need it anymore and that this energy would drive me through. Wrong. It’s incredibly dangerous to just stop taking medication, and it’s usually a bad idea anyhow. Anti-depressants work for depressed people for a reason.

DO get involved with things. Of course the whole ‘you don’t have to drink to have fun’ is a bit of a boring trope because let’s face it, the majority of people drink at university. But it’s not the only thing and although I love a good night out, I have so many precious memories of events and activities that didn’t involve excessive alcohol consumption, and were possibly much better for my mental health. Join societies, join the gym, go to events, make friends. Expand your circle, expand your horizons.

DO understand that universities are extremely accommodating of mental health conditions, just as they are of physical illnesses. The university will do its best to ensure that you can continue your studies, but it is an option for students to resit years or take gap years in order to give them time to get back to health. There are safety nets at university that possibly weren’t so much an option at school. It’s fair.

DO ignore people who are rude to you, or make you feel awkward or out of place. Over the past year I think I have toughened up considerably in terms of dealing with abusive comments related to my scars, but at the start of the year I was very sensitive and found it really difficult. It’s really important to just keep your head up high and ignore these people. They are a minority of d*ckheads. Be confident, be yourself.

DON’T feel like you have to tell everybody immediately about your mental illnesses. You are not your illness, and sometimes it takes a while to build up trust. You have nothing to be ashamed of, and you should be able to talk to new friends when you feel the most comfortable. Some people may be less used to talking openly about mental health. Some people might find it uncomfortable because they’re ignorant (yes, there are people like that at university too), others maybe because it’s close to home. Be open-minded.

DON’T expect to get on with everyone, or for everyone to understand you. Like I said, some people sadly don’t understand, and some people don’t know to act. This isn’t your problem! I have found plenty of kind and caring people at university who, whether they suffer from mental health conditions or not, accept me for who I am and are always there to help me.

DON’T be disappointed if you’re not doing as well as you thought you might. University is a whole different ball game, and the workload can be very heavy at times. The grade boundaries are a lot lower than what students are used to at A Level, which can be disheartening at first. Just remember especially with first year that it’s a learning process.

DON’T expect everything to be perfect. There are going to be tears. They are going to be times when you don’t want to be at university, when you maybe don’t want to be anywhere. But these times will pass and you will enjoy some of the very best times of your life at university.

Cheers, The University of Nottingham. I’ve had a brilliant first year in spite of my struggles and I can’t wait to come back in September for another year of amazing memories.

Me and my best friend Victoria, who I became friends with only in January but is now one of the most important people in my life. Things don’t always work out straight away!