The crisis dilemma

*** I don't want this post to discourage anyone from seeking help. Please seek help from your doctor, A+E, Mental health team, helplines (Samaritans: 116 123) or loved ones if you are struggling ***

TW - mention of suicide, self-harm and crisis.

Falling into a mental health crisis is the last thing anyone wants. For some people it can be a part of life. Living with mental illness can mean for some a continuous movement between ‘good’ and ‘bad’ states, you never get to step off this elevator. You can do what you can to prevent getting really bad, but sometimes it’s out of your hands and you find yourself in the gloomy pits of crisis. This is a process I am all too familiar with, sometimes it a slow burning process, sometimes it hits me hard and fast. Each time it breaks my heart because I try so hard to stay well. Crisis is the most frightening, dark and life-threatening place for many people, myself included.

When in crisis I know I need to ask for help. Sounds simple, right? In reality, it’s far from simple. This is where I encounter the ‘crisis dilemma’; a term I’ve invented to describe the round-about, unpredictable and frustrating process of getting help in crisis.

The first step in this cycle is to actually ask for help. Not a small feat. When in crisis the only things on my mind are self-destruct, self-harm and suicide. I am smart enough to know that if I ask for help and get it, I might be prevented from acting on any of these thoughts. Mental illness is strong enough to manipulate what I think I want, it can also make me believe things that aren’t real/true. And so, in crisis, when mental illness is at its strongest, I wholeheartedly believe that I want to self-harm and/or die. Asking for help would go against everything my head is telling me, in fact it feels like every cell in my body is screaming to act on these thoughts – asking for help is acting the complete opposite to what I feel and think. I cannot put into words how hard it is to ask for help when in this state of mind.

Let’s say I actually manage to muster up the courage to ask for help, it can now go three ways; I get appropriate help, I get inappropriate, un-helpful ‘help’ or I don’t get help. In my experience the first option is a rare occurrence. The second option is the most likely to occur. Often well-meaning staff in mental health services do what they can but in a faulty system it’s just as difficult for them to get support in place as it is for me to ask for it. Sometimes it boils down to “go to A+E”, where I will be subjected to an anxious wait in a waiting room that makes me feel worse. I will then more often than not get subjected to the judgemental and misinformed comments from A+E doctors and nurses that behave like I’m wasting their time or be told to go home and wait for a phone call (invariably the phone call doesn't happen). Sometimes I might be referred to the crisis team – who turn up at my house every now and then to check I am not dead (or that’s what it feels like). They leave after maximum 20 minutes after telling to do things that I’ve already tried, such as take a bath, have a cup of tea or watch a film. Things which although distract me somewhat, make no impact on my suicidality. Both of these scenarios would make anyone feel like sh*t and completely alone, let alone someone in so much pain and distress they'd rather die than continue enduring it.

On some occasions there is no help, not even the poor and mildly callous ‘help’ from A+E or the crisis team. I don’t even know what to say about this, other than say it is inhumane. It’s a simple fact that if you leave a person without help in a time of crisis the likelihood they will die by suicide or intentional self-harm will dramatically increase.

Sometimes, it goes completely the opposite way and mental health services have a complete freak out and I end up in hospital (which is sometimes necessary) but it isn’t a very good crisis management tactic. Often, I get worse in hospital because I really struggle with feeling trapped. But the worse I get in hospital the longer I’m kept in and the more trapped I feel….its a vicious cycle that never ends well for me. It is a cycle driven by professionals trying to protect themselves rather than doing what’s best for the ‘patient’.

This is why asking for help has become even more difficult for me – experience has taught me that the probability of me being treated with dignity and respect is very small. Why would anyone ask for help if they knew what experience has taught me!? However, the downside to this is that if I don’t ask for help, I will likely act on my self-destructive, self-injurious and suicidal thoughts. I will probably end up in hospital and get blamed for it, told I’m “not trying hard enough” and be treated like I’m a burden to everyone, undeserving of compassion.

Don’t get me wrong there are of course individuals within this system which do their best and are genuine. But it has become such an insidious system the good gets drowned out by the sheer callousness, indifference and damage caused. I know people will ask,

“what should crisis care look like?”

A question I can’t answer in terms of service provision, service structure or staffing, but I can answer in terms of attitude and values. It’s not rocket science, people, ill or not, deserve to be treated with dignity and respect. They need to feel supported and comforted. In crisis you need to know you can rely on help being there and that the ‘help’ will actually be helpful. What that individual in crisis needs comes first above anything else even if that means professionals have to deal with some increased risk. Whenever I speak to health care professionals or anyone who may come into contact with a person in a mental health crisis, I try to ask one question;

“If it was your loved one in crisis, how would you want them to be treated?”

*** I don't want this post to discourage anyone from seeking help. Please seek help from your doctor, A+E, Mental health team, helplines (Samaritans: 116 123) or loved ones if you are struggling ***