If you have experience of mental illness then you are probably aware of the charity Mind, they found that “only 14 per cent of people in crisis got all the help and support they needed.” Which is horrific. Try to imagine what would happen if for only 24 hours only 14% of people in a physical health crisis got all the help and support that they needed. It shouldn’t be any different. Mind is involved in an ongoing campaign to better crisis services and the overall treatment of people with mental illness. I will include a link to this campaign website if you are interested.
What is a mental health crisis and when does it become a crisis?
I would describe a mental health crisis as a moment no matter how fleeting when someone feels they have lost control of their mind and their mental illness. It could be triggered by an external stressor event, or medication changes or simply a worsening of a current illness that requires more care. Most of the time, you or your loved ones will be able to make the decision as to whether you are in crisis and whether you need help. For example, if you are afraid that you will self-harm and you don’t want to this would be a crisis, but each case will be personal. The danger or self-harm is not a crisis for everyone, depending on the amount of harm you are likely to cause and the frame of mind you are in at the time. Other experiences that may occur alongside a mental health crisis are psychosis, extreme anxiety or panic attacks, mania, paranoia, and feeling suicidal. When people with an existing mental health condition experience crisis it is likely that their symptoms will become more determined and persistent. If you are afraid that you will hurt yourself or someone else, or lose control of reality then this is a valid crisis and you deserve to have more support and to be helped through this.
I personally keep two lists on my person, they are written very simply as if a child will be reading them to ensure that whatever frame of mind I am in, I have the best chance to help myself through. One list is for when i’m feeling agitated, usually anxious and when I cannot relax. Oddly enough, when I am in this state I know that I am more likely to suddenly decide to attempt suicide, more so than when I’m feeling extremely low. This is when I am most impulsive and least likely to be thinking rationally. From experience I know that if I can use up some energy and distract myself I will calm down within 2 hours. My list is a numbered list, 1-10. I rate how ‘bad’ I’m feeling and start at that number, doing the exercise on the list and if that doesn’t work I move to the next one. It starts with simple activities like 10 mins of intense exercise or intensively cleaning the room, activities that I can channel my energy and obsession into that are satisfying to complete. As the list increases I tell myself to contact certain people who I know can help, and finally number 10 means I have to allow someone else to look after me by going to the emergency department or calling the crisis team. My low mood list is very similar, except it includes calming activities that allow my mind to switch of, such as colouring and taking a shower.
I really recommend that you write your own lists, it really helps to think through and plan for those moments because when you are in the middle of them, its extremely hard to think straight and know what you should do.
Who can help you in a crisis and who can’t?
When you’re experiencing a mental health crisis there are a number of options you have to reach out for support, you can pick the right one for you depending on pervious experience and how serious you feel your crisis is. Its always personal, and it is always as serious as you say it is.
The first options are phone services such as the samaritans (116 123). You might have local services that are available to you, it is a good idea to look these up and make a note of them or save them in your phone so they are easy to access. You could also call the crisis team for your area, if you haven’t been referred or if you don’t know the number of the team in your area you could call the non-emergency hospital line (111) and ask them. The crisis team are usually very good, they will talk to you on the phone and can advise you how to best keep you safe. They could also come and visit you where you are. It all depends on what you feel you need. If you tell the crisis team that you have self harmed seriously or taken something however, they will want you to go to the hospital and have the ability to send an ambulance. If your crisis is during working hours you could call your local GP and tell them that you are in crisis and would like an emergency appointment, they should try to fit you in that day but this wont always be the case, unfortunately. The last option of professionals that I will cover is going to the emergency department. This is not always the best option and in my experience can make things worse. I will cover more about emergency departments and mental health crisis support later in this post.
I find that it is helpful to have written out a ‘script’ for the possibly scenarios where you might be asking for help. This makes it less scary for me to do, especially if its over the phone. It also means that you wont miss out any crucial information.
Another route to support that you could consider is friends and family, however you should pick the people that will be able to help you, rather than be unhelpful or even unkind. Through experience I have learned not to elicit the help of people who are impatient, unkind, dramatic, weak, naive and people who don’t trust me. This final point is important because if you want to talk things through you might be going into the deepest darkest corners of your mind, however we all know when we are done and we are ready to let it go and move on. When a person doesn’t trust you they could end up making the situation worse by not believing you when you say you are ready to move on. Some people will feel comfortable to contact their therapist, some won’t. Some people will want to contact their family as I do, however some people don’t and this is all okay. Everyones inner circle is personal and you shouldn’t feel like you have to go to someone in crisis when you don’t feel comfortable doing so, just because they told you that you should.
The emergency department
The emergency department is an awful place to be, it usually involves a wait of above 3 hours surrounded by people while also being ignored. However, in some cases the care that can be provided by a hospital is the best thing for you, outlined by the number of times you read on the internet ‘go to the ED’ if you are feeling suicidal ect. but it might not be the best equipped place to provide you care.
- There are doctors that can assess you mentally and physically and they can refer you to other services that can help.
- You are in a controlled environment, which may make you feel safer.
- You might get a bed in a hospital and psychiatric treatment.
- You might be listened to and cared for.
- You will be sitting alone for a long period of time.
- Unless you have a physical injury, a ‘plan’, a suicide note or you have already taken actions to harm yourself. I have no experience of mania or psychosis but I imagine that it is the same, unless you are in acute and what they define as serious danger they will not treat you.
- It is unlikely that there will be a bed available.
- It is likely they will simply hand you a phone and tell you to talk to the crisis team (I’d advise you to always call the crisis team before you decide to go to the hospital, so that you don’t have your time wasted).
The emergency department – what will happen if you go?
To begin with this depends on your route there. If you have called an ambulance you will be assessed by the paramedics and then probably taken to wait in the ED for a psychiatric assessment, but not always. If you walk in to the ED, then the first person you will talk to is the receptionist. You will have to tell the receptionist why you are there, including your physical and mental symptoms. They will probably ask you to talk to the nurse at the end of the desk, who will then tell you to give your information including your address to the front desk. The next bit is tedious, your name is added to a list of people, and unless you have serious physical trauma, you will be lowest priority because of how mental health crisis are treated in hospitals. This means a wait of possibly 3-4 hours. It gets tricky here, because if you have told the front desk that you are suicidal or in danger to yourself, and if you get bored or frustrated or simply tired of the long wait, and you walk out, they have the right to send the police to collect you and bring you back to the hospital. Simply put, be sure that you want to be there, and that you have the time and ability to see it through. If you decide to leave the emergency room, make sure you let the receptionist know.
Once your name is called, in my experiences the first thing any doctor will tend to is a physical problem. They will usually take blood tests, and will treat you depending on what you have told them. Most of my experiences involve overdoses, which leads to someone checking your heart, sometimes you are put on a drip and sometimes you are observed. It all depends on the results of your blood tests.
If you don’t also have a physical reason to be in the emergency room, in my experience they don’t treat you seriously. In my times in EDs I have spoken to a handful of nice doctors, but ultimately none of them had any power to help me. The fact that I had asked for help before hurting myself, the fact that I hadn’t written a note, the fact that I couldn’t describe a definitive ‘plan’ meant they dismissed my struggle and sent me home. This is after a phone conversation with the crisis team. My most recent experience in the ED was awful.
I waited 4 hours, only to be dismissed as not in crisis. They handed me a phone with the crisis team on the other end and as the conversation progressed I began to feel less suicidal and more angry, for me this is not a good transition. They were not taking me seriously and had wasted my time. I was discharged. Then the doctor came back and asked if he could take some blood to test, I obliged. However, then he said the results would be ready in about 2 hours and that I should wait back in the main area. I was fuming and refused to wait on the grounds that I knew that I hadn’t taken anything and in my opinion the results were intended to put the doctors at rest, not me. The doctor got impatient and less sympathetic, he told me I could go but he wasn’t happy about it and he would call the police if there was anything abnormal in the results. This was supposed to scare me, and if I was intending on committing suicide, or if I had taken something, he basically just warned me not to go home. I could have gone anywhere.
Personally I feel that the care you receive in emergency departments is the best that they can manage at the time. Sometimes you will receive a psychiatric assessment, sometime you won’t. Sometimes you will leave feeling safer and happier, sometimes you will feel angry and belittled. I would never advise someone in crisis not to go to the hospital, I would just like to make sure that everyone is prepared for what will happen when they arrive.
All of my opinions and advise comes directly from my personal experiences. Everyones experiences will be different. If you feel like I have missed something, or miss-represented something about the crisis experience please let me know. For this post I will add in any notes I am given as I feel that is is an incredibly important topic.
Thank you for reading!
Heres the link to Minds campaign, its an interesting read; http://www.mind.org.uk/news-campaigns/campaigns/crisis-care/about-the-campaign/?ctaId=http://www.mind.org.uk/news-campaigns/campaigns/crisis-care/crisis-care-slices/we-need-excellent-crisis-care/
Borderline Bella xxx