Monthly Archives: May 2013

Truncated Days

One of the things I hate most about the meds I’n on is the way it cuts my day short. I’m not human before 1030am at the earliest – getting up before then results in mindless zombie for a few hours. It takes me a while to get going in the mornings, regardless of what time I get up.

At the other end of the day, I take my meds at around 7pm, and by 830pm my mind is just not engaged any more. I can catch myself rereading the same line of text over and over again, and not taking it in at all.

I want to have my mind back, the mind that is sharp and strong and eloquent and able. I don’t like this fuzzy tired mess of me, but it’s going to take a while before I have me back.

Keeping Appointments

One of the hardest things for me to do when I’m depressed is to attend appointments. I don’t want to leave the house, I don’t want to see people, and I sure as hell don’t want to talk about how I’m doing. But of course, it’s when you’re unwell that the appointments multiply.

I remember at one point, I had something like fifteen appointments per month. It was ridiculous. And my reaction to it was very unhealthy.

When I get overwhelmed by the number of appointments, I start to shut down. I pretend that I’m well, give all the right answers, just to make everyone go away. I stop caring about getting help in order to get my peace back.

I don’t know if this is a common thing, the rapidly multiplying interventions and overwhelming desire to make them go away. But it’s happened to me, and it feels like it’s happening again. I hope I can deal with it in a more productive way this time.

Anti-Mental Health Thinking While Promoting Mental Health Services

I read an article today that told the stories of women experiencing postnatal mental health issues. I believe that the solution to much stigmatisation is to tell our stories, and keep telling them, until people realise that it can affect anyone. But this article rubbed me the wrong way.

There are three stories in the article, and each one had an instance of the way mental illness is maligned – it’s so ingrained that even people who have experienced it repeat the anti-mental illness lines.

The first piece tells of Meegan Hirst’s struggle with postnatal depression. The line that wound me up was “The medication – I only went on that because I left it so late for getting any help. There are alternatives to antidepressants, natural antidepressants”. This thinking – that getting help at the right time will prevent the need for antidepressants – devalues the experience of people that need antidepressants, even when they get help in a timely manner. It also propagates the idea that you don’t *really* need antidepressants for depression – an idea that is true for some people, and hugely damaging for others.

Meegan also says that if a mother-and-baby psych unit had been available, “I would have got over it and sorted myself out.” The idea of ‘getting over it’ is another crushing theme in mental health care – even if she’s not intending to, she’s using language that devalues the process of becoming well again.

Emma Green also suffered post-natal depression. She too was prescribed antidepressants. She says that “Because I’m not a big believer in medication [anti-depressants], I took half a tablet every two days, then one tablet every two days.” Modifying your treatment plan on your own because you don’t believe in medication is not a message that should be going out to mental health patients. Treatment plans are created by experts and tailored to your needs, using the best science available. It’s not always perfectly done, some doctors aren’t great, but doing what you want with your medication is more likely to not help you. Mental health patients are vulnerable to anti-medication ideas that can be very harmful.

Finally, there is the story of Bronwyn, who experienced post-partum psychosis. The thing that bothered me about her story is that she opted for a pseudonym, because she was afraid of the stigma around mental illness.

These stories are the personal tales of three women, and they’re only chronicling their own journeys. But each of them reflects in some way some of the problems facing mental health clients – particularly around medication, which is one of the least accepted facets of mental health treatment.

Why I Think Long-Term Mental Health Facilities Need To Return

The old psychiatric hospitals had a horrific reputation. Abuse, misdiagnosis and bad treatment was fairly common. Nonetheless, I believe that they have a place in modern psychiatric treatment.

The move toward deinstitutionalisation came in the 1980s. The new model emphasises community care, and inpatient admits only for stabilising acute cases. And it’s not working. Acute inpatient units are holding people for months, even years. There are very few inpatient beds available for acute patients. And the current acute wards are not designed for long-term residents.

The blunt truth is that some people cannot be treated in an outpatient setting. They’re a risk to themselves or their community, or they need more intensive treatment than can be provided in outpatient care.

Some people need long-term hospitalisation to become well enough to live in the community. They need time to find the right combination of medications and skills in order to be able to function in a community setting. Consigning them to acute wards that are ill-equipped for long-term care is not good for them, and not good for the wards.

The stability of well-designed long-term residential care would be better for people who need such care. Seeing acute cases come and go while long-termers are stuck can be very demoralising. Being in a community of long-term residents would be easier than being in an acute ward.

Long-term facilities would also be able to have life-skills programmes that acute wards cannot. The aim of long-term care should not be to keep patients permanently, but to give them the tools needed to survive in the outside world. Life skills and education could be offered to help people do better in the community.

Learning therapeutic techniques to help in living a more normal life would be part of the treatment plan, and a sheltered environment to practise these skills before needing to use them on the outside would be useful.

The spectre of the old lunatic asylums looms over any proposal for long-term residential care. But I believe that while we need to learn from the past horrors that occurred, we also shake off the stigma and seriously consider the needs of the people being failed by the community care model.

What a Depressed Day Looks Like

Getting up is almost too much effort, but I manage it eventually. Getting dressed is a huge challenge – sometimes I need help, or I end up a crying mess because I can’t manage it myself.

The day is dominated by reading – it takes my mind off my unhappiness and lets me lose myself in another world. Tears come easily and for no particular reason, and I can get very upset about tiny things.

Getting food is too much effort, so I don’t eat unless someone else makes me. Making decisions about what I want to eat is paralysing.

By evening I’m so would up that taking care of my kids is another challenge, one that I often can’t complete on my own. Meal times are particularly bad.

With the kids off to bed I’m back to being utterly paralysed – I don’t know what to do with myself, I feel guilty for not achieving anything all day. I read until it’s time to go to bed, then I drop off in a medicated haze.

A depressed day is unproductive, aimless, listless. Achieving anything is near-impossible. The guilt over not achieving anything makes it all worse. And the tears and misery exhaust me.

A depressed day is a day wasted that I can never have back, but I can’t do anything about that waste.

Leaving Home

The day I ‘left home’ is a bit of a hazy memory now. I think I remember what happened, but no-one who was there will ever talk honestly about it. I can only go on my own fallible memory.

It was a weekend, but I’m not sure if it was a Saturday or a Sunday. My brother had left home a few months before, and gone to live with my mum. I didn’t have anyone to protect any more, and I had become more reckless. I didn’t just accept what was happening as completely as I had before.

I was hiding from the storm brewing in my stepmother. My room was just across the hall from the kitchen/dining room, so I could hear her temper rising with the sound of her voice. My father was her target this time.

I couldn’t listen to my gentle father being abused any more. He never did anything that I saw to make her treat him the way she did. He did everything she wanted, turned a blind eye to the horrible things she did. But it wasn’t enough to stop her from screaming at him rather often.

So I came out of my room, shaking with fear but determined to have my voice heard. I still couldn’t stand up for myself, but I could stand up for my father. I felt like I might have deserved the abuse that rained down on me, but he most certainly did not.

I stood there and told her to stop. Told her that she couldn’t treat my dad like that. And I turned a fairly normal storm into a screaming tempest.

She screamed at me to get out, and the look in her eyes was enough to tell me that walking away was not an option. I had to run. Somewhere in all this my father told me to go to my grandparents’ place, a half-hour walk from where we lived.

I left with the clothes I was wearing. As I ran down the street, she threw crockery out the window after me. I hated to leave dad to deal with the tempest I had caused, but I had no power to change his choices, and he chose to stay. As ever, he chose his abusive wife over his victimised children. He may be a gentle man, a loving one, but his choices are still misguided, and the results are still awful.

My father came down a few hours later, and dropped off my school gear and some clothes. I was to stay with my grandparents for the forseeable future. I decided in that moment never to go back. I did return once, but that’s a story for another time.

I was fifteen years old, and I was out of my father’s home. A few months later, I moved out of my grandparents’ home, and struck out on my own. I’ve been more or less out for the past ten years, with a few brief exceptions. It hasn’t been easy, and the support of my mother and her family made it possible to survive some very rough times. It’s a life I wouldn’t wish on anyone.

How Could The System Improve?

The first thing that would make the mental health system better is a whole lot of funding and enough staff. But that’s probably not going to happen. Neither is anything I suggest, in all likelihood, but I have some ideas.

1) We need long-term inpatient facilities. They went out of favour sometime before my time – I think they were mostly closed down in the 80s in favour of community-based treatment. They were not perfect, and there was a lot of unethical behaviour associated with them, but I still think they need to come back.

Why? Because the current acute units are forced to deal with long-term patients, who spend months in them, taking up space that was supposed to be for emergency acute care. Allocating resources to facilities designed for long-term care will take the burden off acute care units and allow them to deal with acute patients. Additionally, long-term care facilities can target their treatment, and institute therapeutic programmes to help their residents prepare for the outside world.

What could go wrong? The biggest worry (apart from the dire lack of funding) that I see is the risk of institutionalisation. People can become so used to their sheltered facility that they never reintegrate into society. However, I would argue that it’s already happening in acute facilities. Additionally, there is the sad truth that some mentally ill people will never do well in the community, and many end up on the streets or in prison. Many families cannot cope with their mentally ill relatives, especially in the long term, and the mentally ill are left with very little to fall back on. Long term care must be looked at as a viable option ofr both individual and community health and safety.

2) The range of therapeutic programmes needs to be broadened and made more accessible. Community programmes are overburdened and under-funded, and inpatient programmes are often non-existent.

Why?┬áBeing well needs a combination of drug therapies and talking/skill-building therapies – and both should be readily available and accessible, both in inpatient and outpatient scenarios.

What could go wrong? Well, bot a lot that I can see. More availability of services can’t be a bad thing, except maybe for budgets.

3) Sub-acute facilities need to be more readily available.

Why? Sometimes mental health patients need time away from their own lives in order to sort their mind out a little. Short-term sub-acute facilities are ideal for this, and early intervention could take pressure off acute care wards. But sub-acute ‘respite’ care is not readily available. Some areas have none at all, and others have very little.

What could go wrong? If people needing acute care are sent to sub-acute facilities due to poor needs assessment or lack of space in acute wards, neither the others in the facility nor the patient are safe.

These are just the things churning around in my mind at this point. There’s probably more that I will think up at a later date.