Mental Health Crisis – A rough survival guide for supporting.

What follows is an email I wrote earlier this year to a group of friends and activists following a serious suicide attempt that lead to an admission to an acute psychiatric ward. Apart from names and places I’ve keep the email as it is because although it speaks about specifics I hope it also speaks generally about such experiences.

I’ve decided to publish this advice as I was often getting requests for it to be passed onto others dealing with crisis, so thought it better to have it as an online resource. A more complete guide from different perspectives is in the pipeline.

But for now I hope it helps.

(If you know whom this emails was for, please don’t be a dick and put their name in the comments or on social media, or anywhere.)

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Hi All,

Sorry about the length of this email, but I’ve tried to cover as much as possible.

This email isn’t intended to scare you, but I’ve tried to be realistic, and it’s better to know the potential things that could happen. Supporting Daniel could be very hard, so it’s important you think through your capacity.

Get a cup of tea and get cosy.

I’ve given some subheadings to what I’d like to share. Something’s may seem obvious, but I’m not intending to patronise anyone, just trying to give some reassuring thoughts and experience.

(For those that don’t know me, hi! i developed different mental illnesses about 14 years ago and have lived with it since, sometimes its not been a problem, sometimes its nearly killed me, I’ve had a lot of contact with NHS mental health services whilst also trying to find radical alternatives… and i helped get Daniel into hospital on Friday night… sigh).

A bit about mental illness.

Mental illness is an illness like any other, so people experiencing mental illness are not to blame, they are ill. Being mentally ill also means that the person’s behaviour can be affected, which is why looking after someone who is mentally ill can be hard. It can feel like the person has changed, but they haven’t, they are just experiencing the world in a different way, sadly that can be painful, but it can also be amazing.

Why do people get mentally ill? I think to be honest, we don’t know. Things that can contribute are the way your brain is wired, how you were raised, our interpersonal relationships, the environment you live in, the society we live in, the capitalist system that oppresses us. I think it’s a combination of all these things and more.

How do you treat someone who is mental ill? This is the hard part, as things stand, and from my experience the tools we have can feel blunt and painful to use. But there is hope! Going mad isn’t a bad thing, many radical peeps have exploded the wonderful value of being mad, of seeing the world in a unique way, but it has the double bind of being a painful experience. So what becomes important is helping people manage the pain (I use the word pain intentionally, cause being depressed, confused, suicidal is very very painful and traumatic). As people who may wish to support Daniel, this is where we can really help. Mainly cause we have hope for and with Daniel and can share that, but I’ll come to the details later.

Some things to help understand what feeling suicidal is like:

http://www.metanoia.org/suicide/

–       I love this one, always my first port of call

“Suicide is not chosen; it happens when pain exceeds resources for coping with pain. That’s all it’s about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn’t even mean that you really want to die – it only means that you have more pain than you can cope with right now.”

Dealing with suicidal feelings factsheet

nhs psychiatric process during admission and discharge.

Firstly, the hospital have a duty of care for Daniel, they will do everything they can to keep him alive, that may sound dramatic but it’s the reality. Something’s may feel harsh and blunt, and in many respects they are, but, they will keep him alive, and in the moment that is his and our priority.

Daniel will be assessed by a psychiatrist at some point from tomorrow, they only have crisis doctors on the weekend. Based on his/her assessment and the notes taken by the nurses on the ward and from his admission on Friday, it is likely s/he will recommend medication. Daniel is not under section, so he has the right to deny meds, get a second opinion, or try to delay taking them (maybe the best option i.e saying ‘I’m open to taking medication but would like not to rush into it, I’ll like to get all the facts etc’, or take them (which isn’t a totally bad idea, it will depend on the specific meds, and dosage. Him taking some sleeping pills and some form of valium – in the short term will do him no harm. Anti-depressants, anti-phycotics and mood stabilises are more complicated, getting those working is often a trial and error process, which can take years and isn’t guaranteed to work, but some people (me included) feel that they actually help, even with the side effects, and that it’s worth the pain of finding the right one, cause it’s better in the long run. But as much a possible keep your options open whilst not being bullied onto the first thing the doctors suggest.

At some point in the coming week he will have a ward round. This is a meeting with him and will include his consultant psychiatrist, lead nurse, social worker, and some others. He is allowed to have someone with him, I imagine the hospital will allow 2 people, so a family member and friend would be ideal. Find out when this is, check how many people can come, tell Daniel who is going to be there and if he okay with that. (Again don’t give him to many options, he’s feeling confused so thinking through options can be hard).

After this the care team will create a CPA (care plan approach), which Daniel and the people in the meeting with him should give as much input into as possible, the outcome may involve Daniel staying in hospital a bit longer, or being discharged.

Food! – food in most nhs hospitals is crap, so take him in fresh organic fruit and veg, nice salads, nuts and seeds, eating well will really really help, a few nice cakes will be good too! (maybe that’s just me…)

Exercise – You may not be able to take Daniel off the ward, don’t kick up a fuss about this, cause that may effect how the hospital see Daniel’s social situation or cause Daniel stress. But do ask if you could take Daniel out for a walk around the grounds of the hospital or even down the corridor, if there is a games room, play on the Wii or see if you can go to the art therapy space, get him moving and feeling his body, even if it’s for 60 secs, if he is on any meds they can make you feel disconnected from your body. If you wish (and are allowed) to take him off the ward for a short time, explain to the nurse’s that you will hold Daniel’s hand the whole time (which you need to do) and that you’ll bring him back straight away if things get difficult (which you should do). But that fresh air and stretch of the legs can feel so wonderful. But again, don’t take any risks.

Make his bedroom nice (most wards now a days you get your own room!!!!) – pictures, poems, cards, flowers. herbs, bring colour into his life!

Also – if not yet sorted, clean clothes, toothbrush etc. phone charger. nice bed clothes, good but simple books. Tobacco, rizla etc. bit of money so he can get the nurse to buy him treats. Other everyday things he didn’t have on admission.

Don’t take anything in that it would be easy for him to harm himself with, even if he asks you to. (It will make you feel bad if he uses it, trust me, I’ve made that mistake). Also things get nicked a lot on wards, so don’t lend anything you really really want back.

Before I talk about the discharge process, just a word about sectioning.

Daniel is current a volunteer in-patient, if he is going to be in hospital, it’s A LOT better this way, he has way more rights and it will be viewed that he is being proactive in getting help. If Daniel wants to leave, he will have to be assessed by a psychiatrist first, he has the right to ask for this, however what can happen is the nurse or doctor saying ‘if you try to leave, it’s likely that you’ll get sectioned’. So it’s important that any wish to leave by him and those supporting him is done in a calm and open manner. Anyway, to cut a long story short, it’s better we support him through a volunteer admission than a sectioned one. Even if that means supporting him through a volunteer admission that could last weeks, worst case months.

More here

– Detention under the Mental Health Act Factsheet

– http://www.rethink.org/living_with_mental_illness/rights_and_laws/index.html

on discharge.

To get discharged Daniel will have to agree to the Care Plan Appraoch. Don’t worry that won’t be anything to bad about that.

He could be put on a Community Treatment Order, but I don’t think that is very likely, but again if you hear word of that let me know asap.

However there is a small tricky bit here.

On his discharge it will mostly like mean being transferred to the community mental health team. Make contact with his GP, and agree to keep in contact with the care team, it’s worth supporting him in this, sometimes if you disappear off care teams radar they panic, which we don’t want – they tend to call the cops.

At first this could be nurse’s visiting him at home once a day, maybe twice, seeing a psychiatrist maybe once every 3 weeks. As he gets better they will withdraw support.

However here is the problem, mental health care is postcode specific, so if you move around a lot, you’re not going to get consistent care. So because Daniel’s GP is in Fake Place, I imagine the hospital will want him to stay there, so they can keep an eye on him. In the short term this maybe the sensible thing to do, it doesn’t mean he can’t visit social context xxx and other people, and work towards returning.

more general thoughts on NHS service.

Most people who work for NHS psychiatric services are amazing people, the nurse Daniel and I spoke with on friday was a lovely man, who really listened carefully to Daniel pour his heart out, and spent a long time reassuring him what he was experiencing wasn’t his fault.  However there are a few pricks, people on power trips, people who think it’s all chemical. Best thing if you encounter people like that is stay calm and ask to talk to someone else, explain that their approach is distressing Daniel, they’ll find it hard to argue with you, again as much as possible stay calm.

If fact always stay calm, mentally ill people pick up of your energy very fast, so if you’re frantic or aggressive they will pick up on it.

future support.

Okay, so, Daniel is really ill, and like any other illness, he needs professional help, however much you love him, that alone isn’t enough. That doesn’t mean NHS only, but also it’s worth helping him find the services that are worth using and avoiding the ones that aren’t. For example, I get on with my psychiatrist very well, he is very open minded and understands that I may be mad, but I’m not an idiot. However some centre’s and approaches reduce me to the tears, so I avoid them. But the service is so over worked, opting out of options is easy once you’re not under crisis services.

I’d recommend he applies for ESA and DLA benefits, having a bit of money is helpful, being ill can be expensive, getting taxi’s, eating organic food, alternative therapies, the social worker at the hospital will be able to fill in the forms, so it’s worth asking for that help, and the doctors will give supporting evidence, meaning it’s much more likely to go through hassle free at the DWP.

Non nhs treatment options

In a crisis – the maytree http://www.maytree.org.uk/ – i’ve been there, it’s amazing, watch this video – http://www.guardian.co.uk/society/video/2011/jul/22/suicide-taboo-subject-remains-video

The Philadelphia association run radical community houses – http://www.philadelphia-association.co.uk/community-houses.html

And therapy – http://www.philadelphia-association.co.uk/therapy.html – you can get a trainee therapist very cheap, i have one, she is ace.

The Cassel Hospital  – http://www.wlmht.nhs.uk/cs/cassel-hospital-services/ – i went here when I was XX, it’s the radical end of the NHS, again would require local health authority funding, but i think it is a good model of care. Very compassionate, and they have a massive garden.

Friend Support Do’s and Don’t

Spend time with Daniel, but don’t try and make him happy. If he is sad, this is okay, just give him love in the ways you know how.

Make promises, and keep them. On Friday night i promised Daniel i would fight for his life, but only if he would. We made a promise; it’s a good thing to refer back to. ‘Remember we promised we’d do this for each other’

Make time for Daniel, but don’t try and save him. We can support him in his fight, but he needs to fight his illness, not be saved from it – think of it like freedom, you fight for it, it’s not given. (and I think he’s a fighter and part of him wants to, this is a really hopeful thing).

Break the cycle of feeling bad, for a moment. Being depressed and with out hope is shit. But when it last days, and those days are long, it’s important to have moments of hope, to experience something other than despair. So doing little things, going for a walk together, watching a film, riding a bike, simple things that can just briefly lift your spirit. Those bits are really important, it reminds you that it isn’t always going to be hard, it may mostly be hard, but not always.

Think about what you can do, and be realistic, then don’t beat yourself up if you feel it’s not enough. You’re only any use to Daniel if you are okay. Supporting him is going to be hard, so you need to be aware of how much it’s impacting on you and not pushing yourself into a place where you’ll get ill as well. It’s okay to have emotional limits, even if you’re an anarchist.

Help create peaceful and consistence spaces. Being in a safe space, where you trust those around you, where you don’t feel judged, where you can cry and not care, where you can say ‘I want to die’ and people will not question you but listen, and help you find hope, this will help massively. Also a lot of new faces and people who you don’t know, whose responses you can’t predict can be hard.

Be patient. Daniel will test you, he’s not doing it to be nasty, it’s just a bad side effect of being in pain and being confused. Don’t let him been mean to you, but don’t get angry with him, stay firm but fair.

Listen. You may think Daniel is talking in a paranoid/psychotic way, but for him it isn’t, it’s what he’s experiencing, so don’t dismiss it. Listen and help him make some sense of the confusion, even if he get’s confused again very quickly.

Don’t be afraid. He’s still the same amazing person. Treat him like normal, just with a heightened sense of how he is feeling. And if something scary happens don’t be afraid of being forceful. It’s not easy or pleasant, but in some situations in the future you won’t be able to have many options, so act with conviction and remember, it’s better to over react than him dying or seriously harming himself. If you need to hold him, explain why you are doing it, tell him you need to hold onto him cause you love him. He may get angry with you, tell you he hates you, call you a cunt. It will hurt, but it won’t be that way forever.

Give him space. This can be hard, but it’s also hard for him to be around people all the time when he is feeling vulnerable. If you feel he is in a safer headspace, give him space if he wants it, but also tell him, if it becomes too much he can ask for help.

It’s a sign of strength to ask for help. Keep telling him this, and keep reminding yourself. Talk to each other about how you feel.  

** Note on this point below. It’s here because a lot of people use drugs to cope, I not advocating people take drugs to cope, but just want to make people aware of my experience.

Try and keep him away from strong drugs. A small bit of grass, a glass of wine, pint of beer, all these are not going to do any major damage. Acid, Skunk, or drugs that effect your mood (mdma, pills etc) no nos during a crisis point – you don’t know what my happen, and in my experience sometimes it’s really ugly. When you get better, you can get back on it…

Help him find his own path. There isn’t a right or wrong way for him to break through/recover, unless he dies. Some people find talking therapy good, some people find pharma drugs helpful, some people find herbs helpful, some people find art etc etc. What’s important is you support him in what works for him, that doesn’t mean you can’t ask critical questions, but also don’t allow your own thoughts on how people should live dictate how you response to his journey. It’s also important to ask yourself, do I really really know what I’m talking about?

Watch your language. Using words like mental, crazy and bonkers to describe things can be really painful, cause your hearing someone use your condition as a cuss. So check yourself and each other, doesn’t need to aggressive, just mindful.

Feeling suicidal is traumatic. Feeling suicidal or attempting it can in of itself be really painful. It’s okay to talk to Daniel about suicide, it’s not a taboo if you’re thinking about it a lot, so talk about it in an open and honest way, don’t be afraid, the more we talk about it, the less scary it is, like all taboos.

It’s okay to ask for help. If you find yourself in a situation that you are worried about it’s okay to phone around and ask for advice/get help.

I guess there’s lots more I could write, but I think we’re all going to have to be a bit flexible and response to what happens over the coming week.

He can get through this, and so can you. Straight up, no bullshit.

james x