January blues: Crisis Teams

 

Ok it's technically not January anymore but I've been working on this post for a while and it follows on from my last post on accessing urgent help. Actually I have a few more mental health posts in various draughts but I am planning to publish them in May now, as part of mental health awareness month. As I want to start a new mini series for this month (details coming soon.)

I think the fear with having a mental health crisis (as defined in my previous post) is that you will end up locked away and sectioned under the mental health act. And while some people will, the shortage of beds and the advance of more community based care means there are more options available. The decision to section a patient is a serious one and there are strict procedures in place to do so. And in act the majority of patients at inpatient facilities for mental illnesses are not sectioned and are there voluntarily. And likewise with people in eating disorder units only some will be sectioned.

However in most cases there are other options available. In this post I'm going to be talking about an option that is available for care and treatment for those more severely affected by their mental health.

If you have sought support through you're GP or seen a psychiatrist following a trip to A&E in a crisis then they may make a referral for a community or crisis team.

Crisis teams or home treatment teams as they are also called (there are also other names depending on your area) are designed to help patients in crisis without them being admitted to a psychiatric unit. They often refer to themselves as a ward within the community. And offer treatment to patients within their own home. Meaning that patients can live in their own comfortable and familiar surroundings (where it is safe for them to do so) but still receive all the benefits of regular contact and treatment. This can be daily or every other day or even once a week depending on the level of support you need. Every area should have a crisis team or home treatment team. And they can be accessed through referral by your GP or hospital after an assessment. Or you may be referred to them as part of your intergration after being in a mental health unit.

Following an assessment by the crisis team you will be allocated a mental health nurse or team who will be familiar with your case. On your first visit, or on other visits, you may also be seen by a psychiatrist, especially for medication reviews or to be prescribed any new medication.

Together with the team you will develop a care plan to help you overcome your crisis; in which you identify the key areas in which you need help in order to function more normally again and manage your day to day life. This can include medication, relaxation techniques, CBT, distraction techniques, ways of controlling anxiety and self harm. As well as who to contact if you are in desperate need of help.

Depending on your situation they can also help with more specific problems that have arisen due to your mental health and help you to access services that could be beneficial. These could be help for mental health problems as a result of alcholism or drug abuse. But also more basic needs too. MIND have produced the following list of examples:

managing money, such as budgeting or paying the bills

housework, such as cleaning, cooking or shopping

using local services, such as peer support groups, employment services, or day centres

transport, such as using a taxi, minibus or bus pass to attend appointments or services

managing relationships, such as relationships with friends, family or neighbours

aids and adaptations to your home or help with mobility issues

personal care, such as washing or dressing

benefits and housing, such as help with applications, attending appointments or getting advice or information

accessing or staying in training, education or employment

support from a specialist social worker or support worker

For cases of social anxiety your team can help you intergrate and manage social situations. This may be through exposure therapy; taking you out and helping you to put into practice coping stratergies you develop with your team, whilst having the safety of a team to help you through it.

At times with this care you have to be prepared to put in a lot of effort and hard work in order to help yourself to get better. And it can be frustrating. However it is an investment in your health and wellbeing and you deserve to find that peace. For more information about crisis teams and the role they play visit MIND's dedicated page. You can also find out what services are available in your area through your GP, council website or local MIND service.

I hope that this series of posts has been beneficial to either yourself or someone that you care about and if not now, then perhaps it will in the future. Mental illness can be a very lonely place, and one that it can be very hard to recognise that you need help, or even to physically form the words to ask for it and try and put the whirlwind of thoughts into logical sentences. Recognising that you need help is a huge step forward, and one that can be difficult to take. However in doing so you are opening yourself up to the world of help that is out there. Help that you probably didn't know about. Take it, use it and regain yourself in the process. 

Like I said I will be reposting more mental health related posts in May. If you have any suggestions for posts you would like to see, or would like to share your story through a guest blog post then please get in touch.

Take care everyone

Sian

January Blues: I need help now!

 

So far this series has looked at identifying depression and anxiety, knowing where to get help and the types of help that are available. Mainly concentrating on depression or anxiety in relation to a life changing event and depression that you may struggle to identify a cause for. Most of the information has been in relation to the onset of the illness and relatively mild to moderate in severity.

Today I want to talk about mental health crisises. How to recognise that you are in crisis; and where you can access help.

 

How to recognise that you are in crisis:

A crisis can occur whether you have previously been diagnosed with depression or other mental illness such as bipolar, schitzophrenia or obsessive compulsive disorder. Or it may well come out of the blue and you were otherwise previously healthy as the first episode of a mental illness.

MIND the charity says that Mental health crises include:

 

suicidal behaviour or intention

 

panic attacks/extreme anxiety

 

psychotic episodes (loss of sense of reality, hallucinations, hearing voices)

 

other behaviour that seems out of control or irrational and that is likely to endanger yourself or others.

 

In a mental health crisis help is needed more urgently. However where as the majority of us know what to do in a physical emergency most of us wouldn't know where to get help if we or someone else is in serious mental distress. And the NHS infographics, such as the one below, don't cover mental health either.

 

Please note the above photo mentions NHS Direct which has since been replaced by 111. You can read more about this new service below.

 

Helplines

 

I know I have mentioned helplines in most of the posts in this series but that's because they have a real role to play and are recommended by doctors and mental health charities. If the crisis is a part of an ongoing problem you may already be receiving care from a crisis team (which I will talk more about in my next post) and have numbers to ring for those directly responsible for your care. However if it falls out of those contact hours or you do not currently recieve crisis care the best helpline and one that is manned 24/7 is The Samaritans. Contact them on 08457 90 90 90 

 

Your GP or Out of Hours

 

During the day you may be able to contact your GP surgery for an emergency appointment or phone call consultation. However this might not be guaranteed and you might have to wait longer than you feel you can. In which case the receptionist might be able to advise you where to go.

Outside of surgery hours you can contact your nearest out of hours service for an appointment.

I would say both above situations might be most beneficial in slightly less of a crisis, where you are worried but can wait longer. For example you might have self harmed and feeling a bit calmer but still want to report it and get extra help. As long as you can stop any bleeding. If however it is more severe or you have a more serious injury or burns then seek more immediate help, such as those listed below.

 

Dial 111

 

111 is the new service that replaced NHS Direct. It is to be used in more urgent circumstances where you cannot access your GP but where the situation is not presumed life threatening. In which case of course you would ring 999. They can also inform you of what action to take and where you can access the level of help that you need based on the information that you present them with. Whether it be for yourself or if you need to take action on behalf of someone else. From there they can  make direct appointments for you or put you through to more specialist services such as A&E, out-of-hours doctors (and others depending on the case.) In some cases they can also send for an ambulance.

 

Ring 999

 

If you have seriously harmed (bleeding profusely or severe burns) yourself through self harm, injury or overdose or come across someone that is unconscious or unresponsive as a result of their actions then dial for an ambulance.

 

Go to A&E

 

Going back to those NHS info graphics they are designed to help stop unnecessary use of accident and emergency services because there are too many patients attending that could have been treated elsewhere, which in turn reduces waiting times and how quickly those in real need get treated. However like I mentioned they only cover physical health. Just like you would a physical emergency going to A&E if you are experiencing a mental health crisis is a real option and Accident and Emergency units do have policies and procedures in place for patients that present with the symptoms of a mental health crisis. In some cases if you have previously sought help from a doctor or NHS 111 they might even have told you to go to A&E. Go to A&E if you are also in need of physical treatment as a result of your mental state, such as deep self harm, injury or overdose.

 

There they will assess you and sometimes check for any infections that might be causing any symptoms (such as hallucinations) through a blood test and urine test. As well as treating any physical symptoms if you have any. If you're symptoms are beinv made worse by the waiting room environment (which are never easy to cope with anyway) ask if you can wait somewhere quieter. In some cases they will do this automatically. They will also keep a note of your clothing and physical description for security purposes. Should anyone in severe crisis leave the department. You should also be assessed by the psychiatrist on call, alongside a mental health nurse. Unfortunately crisis care at A&E can vary. Sometimes depending on how busy they are. I always used the same one but the experience differed on each ocassion. Ideally you should be treated as stated above. Put in a safe place and treated with compassion and understanding. You can be waiting a long time too to see a psychistrist depending on the time of day and how much other work they have with inpatients etc. But know that you are entitled to be assessed by a psychiatrist and that you have every right to be there. Even if you have no physical injury. Knowing your rights and where to get the help you need is really important

 

I remember during the times that I was in crisis and although the thoughts to do harm were overwhelming, on most occasions there was also a real fear. I was just so scared of these feelings. Personally, I saw that fear as a ray of hope, which might sound strange, but I kept telling myself that as long as that fear was there it meant that a part of me was fighting back; saying get yourself some help, get yourself 'somewhere' safe. However I also know that that fear also escalated those feelings of anxiety making my symptoms even worse. Panicking that I would totally lose control. But I am glad that through that I could say "I need help, now!" In hindsight I can see that the really scary times were those of total clarity and intention. The actual planning of 'I am going to harm myself.'

 

If you ever feel like that or come across someone that does then I hope this post has helped inform you of what you can do.

 

In my next post I'll talk about what care options are available for more severe cases.

 

Sian

January Blues: Where can I get help?

 

Firstly I want to say a very big thank you for all the comments and support I've received so far about this mini series. I'm glad many of you have appreciated it. This post is going to be a point of reference of sorts, should you ever need the information. Actually the post was getting so long I've had to split it into a few posts. One that's more general (which is this post) and another for more of a crisis situation (which hopefully will be published soon) and a post on what treatment options are available.

 

When you are battling with your mental health the hardest thing it can seem to do is to ask for help. Because it can be really difficult to actually admit that there is something wrong. Especially bad enough for you to need help. And of course the thought of needing help can also fill you with fear. Thinking that if you actually told someone what you are feeling then they may think you're crazy, mental or those horrible names nutjob or psycho. And consequently that you will be locked away and sectioned under the mental health act. However in reality this is very rarely the case.And what you are experiencing is something many others are also going through. 1 in 4 people will experience some kind mental health problem at any one time. So try to reassure your self that you will not be locked away.

 

However when you feel like that asking for help is the biggest step you can take. You may have had people telling you that you need help for some time. And perhaps you dismissed them. However deciding to get help needs to be very much your own want and recognition that you need that help. If you are concerned about a friend or family member there is a specific page on the MIND website for advise http://www.mind.org.uk/information-support/helping-someone-else/

 

But where do you turn to when you want help? Would you know? Would you know how to help someone else that is suffering or in crisis? Below I have shared some options of where to get help in the early stages.

 

Talk to someone- firstly you might just want to talk to a friend or family member. Think who will understand and will listen without judgement. If there have been people who have been wanting you to seek help then they might be a good place to start. As long as you feel that they will listen and genuinely care about you. It may be that that is all the support you need. Just getting things off your chest and maybe thinking up solutions with a friend can be a big help.

 

Talk to your GP - when you have a mental/ emotional problem you may think that going to the GP is a waste of time. That they can only help for physical problems. However, in truth GP's see a large number of people with mental health issues each day. One GP once told me (after I had said that I felt that I was wasting his time) that it was actually about 80% of his job. That being said you need the right GP. One that you feel comfortable with and one who you feel actually really listens to you. Those 2 factors are very important. So if you feel uncomfortable with a certain GP or that they haven't treated you with compassion then ask to see another GP in your surgery. Do not let a bad experience affect your right to be listened to and to get the help that you need. And if you burst out crying in there don't worry about it. They should get you to complete a questionnaire that they can use to assess how you're mental health is, you can find an online copy of it here http://www.nhs.uk/Tools/Pages/depression.aspx Fill it out honestly. That way they can help you on a course of treatment that is right for you. I am preparing a separate post on what help and treatments are available.

 

Counselling- Counselling is one of the course of treatments that could be suggested for you. But as it is not exclusive to needing to see your GP first I wanted to mention it in this post. Counselling on the NHS can have long waiting lists due to the high amount of people that need it. The NHS are trying to put more counsellors into GP surgeries to reduce waiting times for this much needed service but wait times can still be long. Especially for a service where the sooner the better. However if you feel you cannot wait that long then there are other options available.

If you are employed then your employer may be able to get you a counsellor through occupational health. And this in no way should affect your standing at work or make you feel less employable. It is a service they can provide to look after the wellbeing of their staff. So if you are experiencing any problems, even ones that are not work related, then ask your boss if an appointment can be made for you. You don't have to tell them the reason either unless you feel you want to.

If you wish to see a private counsellor then you will need to pay.As with most service providers nowadays a simple search on Google can tell you where there are local counsellor's in your area. Along with a pinpoint to their location and contact details. I simply typed in "where can I find a counsellor?" and a list of local places came up on my phone.

 

The following site also has a list of directories that you can use:

http://www.nhs.uk/conditions/stress-anxiety-depression/pages/free-therapy-or-counselling.aspx

 

And there is also:
Www.counselling-directory.org.uk

 

Charities

 

Mental health charities do such a fantastic job for raising awareness of mental health issues and also offering services to help sufferers.

 

MIND

 

MIND is a mental health charity that not only is an organization that fights for the rights of those with mental illness but also has thousands of branches across the UK. Each branch offers a number of services available to each community. On the link below you can see what services they offer in your area. Some even offer free counselling, which can sometimes be accessed sooner than through your GP surgury.

http://www.mind.org.uk/information-support/local-minds/

 

Other services include:

 

supported housing
crisis helplines
drop-in centres
employment and training schemes befriending

 

You can seek lots of information about different conditions and issues surrounding mental health on their website www.mind.org.uk or their infoline 0300 123 3393 or text 86463 or email info@mind.org.uk 

 

Other charities and organizations that offer specific help for different issues or clearer groups of society are:

 

Calm (Campaign against living miserabley)

 

Free support and information for young men in the UK between the ages of 15-35
0800 585858
www.thecalmzone.net

 

Women's Aid

 

Is a charity for women and children experiencing domestic abuse.
0808 2000 247
www.womensaid.org.uk

 

Cruse Bereavement Care

 

Offers specific support to anyone following the death of a loved one.
0844 477 9400
www.cruse.org.uk

 

B-eat (Beating Eating Disorders)

 

Offers advise and information on eating disorders.
0845 6341414
Youth line 0845 6347650
www.b-eat.co.uk

 

Headway

 

Offers support and advise to anyone affected by brain injury.
0808 800 2244
www.headway.org.uk

 

Relate

 

For advise and counselling for any type of relationship and the problems that can occur within them. They have centres around the country. Visit their website for all services they offer.
0300 100 1234
www.relate.org.uk

 

Helplines and other contacts

 

When you are in distress phoning a helpline can be useful. Your GP or your local MIND centre will have access to local helplines. However these might have limited hours. If you are in a more desperate need to talk to someone, then The Samaritans is a 24/7 service. Their helpline is 08457 90 90 90 or if you don't feel up to using the phone you can also email them jo@samaritans.org More information can also be found on their website www.samaritans.org 

 

In my next post I will be talking about what types of treatments are available for moderate depression and anxiety. Then a post on where to get help in more of a crisis situation.

 

Sian

January Blues (a mini series)

I have said it a few times in posts but I'm going to say it again I'M HAPPY! In spite of being chronically ill I really am. But there was a time when I wasn't. Really wasn't infact. At the time what was hard to comprehend was the fact that it was a time where I should have been really happy. And there are times when I fear I'll go back there.

To start off this series of posts on mental health issues I thought where better to begin than my own story. I have posted a few times about my past struggles with depression, anxiety, panic attacks and self harm but I want to reitterate some of it for the purposes of this series, to show that this topic actually means a lot to me. It's something that I will carry around with me for the rest of my life. And I'm not the only one. Mental illness of some kind affects 1 in 4 people at any time. Yet how often is it talked about? So let's start talking...

Look at the photo above. What do you see? A young woman on her graduation day. One of the biggest achievements of her life. Well sometimes photographs can be deceiving. I really wasn't sure at the time if I could even attend the gradution ceremony. Wasn't sure I wanted to. Because behind that photo was a woman who was fighting a battle against her own head. A scared shadow of myself and all that that photo should represent. Take off the layers of concealer and you'll see eyes puffy from constant tears. Look at that hair, only clean because my Mum had to wash it for me as I shook so much. Peel back those sleaves and you'll see the fresh cuts and the healing scabs that begged to be itched and scratched. The bare legs that my Mum helped do with an electric razor to stop my brain from feeling temptation.

So no I've not always been happy. I've suffered a few bouts of depression and anxiety since the age of 14. However the period after I left university and graduating was certainly the worst. It's a place I never want to be again. Sometimes I feel that I am running scared from mental illness hoping it will never catch me again. Unfortunately I can't guarantee that. However I'm extremely grateful for every day I have where I'm not battling my own mind. I'm lucky I learnt to control it. Luckily the physical scars are not too visible but the emotional ones will last far longer. I will never forget that time. 

I try to use that experience as a way to try and remain positive now, to be more grateful for what having a healthy mind means. Sometimes I even say to myself that if I can get through that then I can get through anything. Within reason of course. That has been tested a few times during turbulent flights. And of course regularly gets tested during particularly bad health flares or relapses. What's more I've learnt that mental health needs to be talked about more. That it's all too taboo and hush hush, which considering how common it is is ridiculous. And so I try to talk about it when I can in a bid to raise awareness. 

To go back to the graduation photograph to the outside world no one would have guessed what was going on in my head. And it's the same for millions of people. Sometimes though it's important to see behind those masks. To say actually my mental health problem is more real than what my photograph documents. And if I can help just one other person by blogging about my personal experiences and by doing this January Blues series then that's something positive.

If you have any suggestions for topics or conditions that you would like to see covered in this blog series then please do leave a comment. Likewise if you would like to share your story through a guest blog post. To any of you that are suffering or if you know someone that is then I hope this series will help somewhat. 

Sian 

I salute you BBC 3

I have to say that I am impressed with the coverage that mental health is getting on the television lately. BBC 3 inparticular have been very active in showing a range of documentaries that show the range of people that mental health can effect. From celebrities to teenagers. Mental illness like any physical illness can affect anyone no matter what their circumstances. And yet it is still so taboo, so misunderstood. It's a dirty secret that gets swept under the carpet because it doesn't comply with the image of being 'capable.' But like with chronic illness how can anyone begin to understand it or understand someone that suffers from any form of mental health issue if it is ignored? I hasten to use the words to see mental illness in a good light because mental illness is a dark dark place. Perhaps what I mean is that these documentaries and the accounts of people that have suffered from a mental illness show the strong people behind these conditions. They show that they are 'normal'. That they are people not an illness and that through all the horrors that they face from the condition or in getting help they are strong and determined.

Recently I spoke to another ME and Fibromyalgia sufferer about how people often forget that we are more than an illness. We are still people. People with interests and passions, curiosities and complexities. We don't just suddenly stop being a person once we become ill and just become a hospital number. If anything we need things to hold onto even more. We certainly don't want to be sick, we want to relinquish the lives we had before or try to forge new memories and achievements.

And this is exactly the same for those with a mental illness. Only the biggest battle is with your own head. Part of you can say yes I'm going to live my life whilst the other slams that thought down at every opportunity. Telling you not to be so stupid that YOU could never do that. It is a betrayal by your own mind. It can be particularly difficult when there is nothing physically wrong. You have the 'ability' to live life but your head says no you can't. With a physical illness people will understand somewhat. Especially where medical evidence is obvious (ahem so not ME/CFS or fibro). But with a mental illness unless you know the signs it's hard to detect by others and the lack of comprehension, taboo and even disgust surrounding it drives it even more undercover.

Not long ago I watch a series on BBC 3 called 'Don't call me crazy' that filmed the daily goings on in a teenage mental health unit and yesterday I watched I watched a documentary called 'failed by the nhs.' The latter was presented by a young man, Jonny Benjamin, who had schiztophobia, a combination of schitzophrenia and depression. Before being diagnosed he had been to his GP and A&E a few times in a manic state and attempted suicide. He had gone there to desperately seek help. Scared that he didn't know what he was going to do. But he never got help. Only tranquilizers. On one occassion luckily his friends took him to A&E but they were asked whether he was simply being 'dramatic' or 'putting it on.' Which lets face it is shocking. Who would want to pretend to want to end their lives?

Unfortunately, Jonny found many more similar cases. It is stated that anyone presenting at A&E with a mental health issue should recieve a psychic evaluation. However many people don't. Even when they have been treated for the physical signs of mental distress such as self harm and even ligature marks. Others have been put straight onto anti depressants without any warning of the potential (and please note that word because different drugs work for different people) side effects. One man was put straight onto 60mg of fluoxitine or prozac as it is also known and the massive chemical overhaul in his body made him even worse. I have had good and bad experiences with fluoxitine. In my late teens it worked well but when I tried it again a few years ago I shook so much I thought I was having a fit. Luckily I knew that something just wasn't right and I was able to see a doctor who changed them and gave me tranquilizers to help me counteract the madness they were causing my body. Consider me lucky or unfortunately knowledgeable about these things.

Luckily any time I went to A&E with massive panic attacks I was able to see a psychiatrist. Although the wait was always long and distressing. A&E units are scary, noisy and manic places. You see you have to wait for a psychiatrist and a psychiatric nurse to become available from the psychiatric ward or unit. But understand this as in all wards at night there is only basic cover. Don't quote me on this but I'm sure there is only one psychiatrist on night shift, that is at the hospital I was at. So as you can imagine you can be in for a long wait, in which time your anxiety levels can rocket even more. I too have had doctors at an out of hours service dissmiss me as 'a tablet seeker' or 'young and has no need to be in distress.' Neglecting to even put the visit onto my record as it was 'of no concern.' It makes me angry just thinking about it. It was very very lucky that I knew better despite my added anxiety.

The stories presented in this documentary were shocking. They had basically had to rely on their own resilience to get them through and to find something within themselves that could stand the fight to want to get better. It is truly sad. You go and beg and beg for help because you are at your lowest ebb and often will not recieve it. If you went to A&E with a broken leg, it would be x-rayed and plastered and you would recieve crutches and advice to help you. But there is still such a quandry surrounding mental health (and chronic illness of course, don't worry not forgotten) despite it affecting 1 in 4 people.

Luckily a new act has been passed the health and social care act 2013, which lays out that mental health should be treated as equal to physical health and therefore hopefully it can recieve much more funding. This also gives me hope for chronic illness too. That more can be done to help understand illnesses such as ME/ CFS and Fibromyalgia. A cause. A cure would be bloody lovely.

I understand that so far I may have painted a poor picture of mental health services but there are positives. Like I said fortunately I did get to see a psychiatrist when I went to A&E. I've had some great GP's who actually knew the art of listening. All of which I've laid out in my post "ME and mental health". There are also some great charities who work tirelessly to advocate mental health in a positive light such as MIND and time to talk. When I was first diagnosed with ME I thought I'd really struggle mentally so I went to a local drop in ran by MIND and saw someone straight away. Just talking and expressing my fears was relieving. Unfortunately I never made it back there as sleep took over my life but I'm really grateful to them. So there is help out there. It's just a shame that what we would automatically assume is our first port of call to get help can sometimes be not very helpful at all and unless you know about other services then you can feel completely cut adrift. So spread the word folks. And BBC 3 I salute you.

Www.mind.org.uk here
Www.time-to-change.org.ukhere