Compassion fatigue

In our most recent Counselling and Group Work lecture, one of the things we learnt about was compassion fatigue. One aspect of it stuck out to me particularly, “Loss of compassion towards those who we once would have had compassion for (Figley, 1995).” It describes for me how I’ve been feeling gradually over the years. Obviously I’ve never been a professional counsellor, but online I’ve come across many people who have mental health issues.

It started off during my high school years with a self harm recovery online discussion board. Over three or so years I would visit the site every day, and totalled several thousand posts by responding to almost every thread. I then met both online and real life friends through the mental health volunteering I do, some of whom express their struggles through social media. I was also a peer moderator on the forums of an online mental health service. Then of course, there’s also blogging.

Once upon a time I would have had all the time in the world for people who were struggling. I would try my best to respond to almost everyone needing support with sympathy, encouragement or suggestions. These days however, I just can’t bring myself to do so. After being exposed to so many people’s issues over so many years, I’ve lost the patience and empathy I once had. I now avoid online forums altogether, I don’t read as many blogs as I did, and in the case of Twitter and Facebook where I can’t avoid it, I skip over those types of updates.

I guess it’s also a reflection of where I am at the moment. My sole source of support was once through a computer, but I’m past that stage of seeking help online now. I’m realising that sometimes in order for things to get better, you have to take action in your own life, and I find I get impatient when I see certain people who are stuck in a place of misery but keep making excuses when people offer them suggestions. I’ve learnt that going into hospital is not going to fix everything and it’s frustrating when there are some who think an inpatient admission will be the solution to all their issues.

I know that I’ve been that person too, so I don’t want to be cold and heartless towards people who are still at that stage. But somehow my compassion has waned and I don’t know how to get it back. Sometimes I wonder whether I should have spent less time trying to help people in my teens. Maybe then I wouldn’t have been burnt out before my career’s even begun.

Positive attitude to being an OT/MH consumer

One of the groups I sit on is the area mental health advisory group. Meetings are held monthly and I am one of the co-consumer representatives. The group is made up of two consumers, two carers, representatives from Consumer Advisory Groups, and staff representatives from both government and non-government services in the area of mental health.

During the most recent meeting this November, I happened to be sitting next to the Coordinator of Occupational Therapy of [Area] Mental Health Services. I had a conversation with her and told her I’m an occupational therapy student. She handed me her business card and said “If you ever want a job…!” That was before she found out I’ve only just finished second year and have actually not yet graduated though. Oh well. She also mentioned that she was recently as an OT conference and was just saying there that she thinks there should be more OTs who are also mental health consumers. I think I love you for saying that! She asked if there’s any more like me, who are also studying OT and also consumers. I said I knew of one other, but that it’s not something I’d really know (for obvious reasons). She replied that she’s sure there’s one in five, but it’s good to know that I, an OT student/consumer active in mental health, exist.

It’s just so refreshing to hear of someone like an OT coordinator of mental health services believe that someone with a lived experience of mental health issues can make a good OT. Especially in juxtaposition to my family and relatives, who on the contrary believe it’s a shameful secret to keep hidden and that no one will want to employ someone with mental health issues.

This, coupled with word on the street that the mental health service this particular OT coordinator is employed in is actually the best in the state, and I know where I will hope to get a job one day!

The small circles of mental health consumer advocates

We had a guest lecturer this morning for neuropsych, a woman who has bipolar disorder. I thought her presentation was great; she told us a bit of her story, she emphasized that a person is not their diagnosis and that mental health issues should be treated on the same par as physical health issues. She was rather entertaining too, she told us that psychiatrists have all these letters following their name on name cards signifying their qualifications, so she thought she’d put letters in her name cards too. QBE she has, which stands for Qualified By Experience. Hah, now I have a qualification I could put next to my name too.

When she walked in the lecture theatre, I thought she seemed vaguely familiar, but I wasn’t entirely sure. I knew she wasn’t someone I’d met in hospital, but otherwise couldn’t think of where I’d have met her before. It’s only now at night that I realise I have actually met her, very briefly at a community music festival promoting mental health in 2011. We were both volunteers at this event, though for different organisations. I must say, I’m pretty impressed at my memory, given it was about 15 minutes we actually spoke to her, over a year ago! What really prompted my memory was an experience she had with stigma she shared with us today, which was the same story I heard from her last year. She told us of her psych hospital admissions in which she barely had any visitors nor any flowers, yet when she was in hospital for a physical concern, her room was filled to the brim with flowers. I could reflect and relate to her experience, looking back at my times in hospital. My family thought it needed to be kept hushed up, and during all four admissions I’ve received a total of one card or gift- flowers from a group of lovely friends when I spent my birthday in a psych ward last year.

Whenever we get told we’re getting a guest lecturer in neuropsych, I always wonder whether there would be a chance it’d be someone I knew or had come across before, whether as a patient 0r a mental health advocate. It’s funny that it’s now actually happened which shows how small the circles can be in the area of mental health! I’m glad anyhow it’s someone I met when I was in my mental health volunteer role and not as a patient.

OT in mental health wards

It can be rather interesting listening to the things that OTs supposedly do in mental health wards/hospitals when I attend lectures. It’s a bit like, “Woah really, they actually DO STUFF??!” I should probably have a more positive attitude towards occupational therapy, especially as I’m studying to become an OT… I am only referring solely to OTs who work in psych wards though, as I do know that those in outpatient settings and rehab wards do a lot with their clients.Let’s face it, those of us who have been in psych wards possibly haven’t found occupational therapy to be all that helpful.

In the lecture yesterday, the OT used a person she had worked with previously as a case study, a young man who had been involuntarily admitted to hospital. According to her, an OT would do assessments with him, would do an interview and a Mental State Examination, establish a therapeutic relationship, set goals with the client, carry out interventions… Obviously I can’t claim to be aware of all the happenings within the ward, but I have very rarely seen OTs work one on one in such depth with inpatients. I thought all they did was conduct beading, painting, bored board games or cooking activities! Oh, and possibly a few groups in between.

So me being the cynical and pedantic person I am when it comes to provision of mental health care, I had to go up and ask the lecturers about whether this actually happens. I gave examples of three of the wards I’ve been on, saying that I haven’t really seen that happen. “Is this from personal experience, family members or….” asked one of the lecturers. “Umm, personal experience,” I answered. I can’t quite remember all of what they said, but they agree that in acute inpatient wards it can be more group work as well patronising, primary school level activities such as the art and sports ones. One of the lecturers explained that it also depends on how well the client is, as those who are on acute inpatient wards may not be ready to participate in the one to one actual occupational therapy intervention. Oh, and now all three lecturers who teach this unit recognise me. Heh, awkward.

I’m curious though, has anyone actually experienced proper occupational therapy in mental health, whether as an inpatient of outpatient, that was helpful?

Mental Health Act & A St OT

I guess I knew that when I started studying occupational therapy, there would be certain topics that would be difficult in relation to mental health. This week’s lecture was on the topic of the Mental Health Act, followed by an OT from A St come as a guest lecturer. I decided not to attend this lecture, especially not at this time of the year when I’m just trying to push through. I figure if the Mental Health Act ever comes up in an exam, I’ll just say it’s when “You’re locked up and get your rights taken away from you.” That’s how doctors have put it to me when I’ve been threatened with it, surely it must be an acceptable answer then, right?

As for the OT from A St, well, I’m not particularly interested in anyone from A St at this point in time. Yeah, I’m generalising based on the two clinicians I’ve seen there, but oh well. Though I reckon the waiting room they have in the outpatients department is enough to put anyone off before they’ve even met a member of staff.

 

Because people with mental health issues are dangerous and all, glass is definitely needed to protect the reception staff from us.

The good news though is that because of my prior knowledge of issues related to mental health, certain topics are fairly easy for me to understand, and some of the content I already know. DSM IV, the difference between a hallucination and a delusion, the Mental Health Act and early intervention? I’m all over it! Doesn’t really make up for all that I don’t know in my three other units this semester though. Heh.

People are too difficult

Sometimes I wonder whether I’m just better off by myself. Or better yet, myself with my dog. People however are just too hard and too complicated. People can get angry, they can get upset or they can decide they don’t like you very much. It may not be so bad for someone who can just brush it off and take it like it’s no big deal, but for me; I panic, I cry, I freak out and get the urge to self-destruct. That’s not even when it’s confirmed they’re peeved at me, it’s when I’ve interpreted their actions or what they’ve said in that way. Though I try to tell myself that it’s okay if not everyone likes me, it’s harder to truly convince myself of this. Then there’s the effort involved in keeping friends; thinking of things to talk about, making conversation, ensuring you appear bubbly and cheerful, putting in the effort to keep in contact, saying and doing the right things… Then what about when a relationship ends, and the feelings of hurt that come along with it?

This is why I think I do better when I’m not receiving treatment or therapy. Over the past few months I haven’t been seeing anyone at all, I currently don’t have a psychologist nor a psychiatrist. And I’ve been pretty stable. There have been times where therapy itself and the issues that arise in that relationship that have caused me to self harm or overdose.

Sometimes I question my studying to be an occupational therapist, such a people oriented career. One where you have to be confident and engaging and have the ability to build rapport and a therapeutic relationship with your clients. Clearly not my strongest abilities.

For one of our upcoming assignments, we have to find a child to observe typical development. Because I don’t know any, my only option really is to approach a child care or a school to ask whether I can observe a child there. The thought of having to do so provokes all this anxiety and so I keep avoiding and putting it off. And we have had a lot of these assignments where we had to find a child, have to find a workplace, have to find someone with a disability, find an elderly person…

A part of me just wants to declare this all too hard and pick up all my things, trek to some remote place and go declare myself a hermit. Life would be much simpler then.

Us and Them

Taking a mental health unit this semester in my occupational therapy course, I get the sense that there’s an “us and them” way of thinking. We’re the student health practitioners and they’re the people with mental health issues. Especially when talking about someone who is in a psych ward, described as “very, very unwell” by my tutor. I suspect there’s the belief that one of them couldn’t possibly be an OT student among us. Because if you have a mental health issue and have been hospitalised for it, you’re definitely not functional enough to be studying something like OT.

There may be a number of factors contributing to this. A proportion of students have possibly never been exposed to mental illness or people with mental illness before. It may be how the unit is taught. The examples and case studies used have tended to be rather stereotypical. A 48 year old man who appeared “dishevelled,” “rambled incoherently,” and “held a fixed, staring grin which was punctuated by odd facial grimacing,” a 67 year old man who is institutionalised and “has never been employed,” and a 30 year old woman with BPD who’s “participating in vocational rehabilitation as part of her OT program” (I assume this means she was also unemployed). And of course, all the examples involving a patient who’s been hospitalised have a psychotic illness. Because clearly, there are no other mental health issues for which people end up as an inpatient. Obviously there are people with mental health issues who do present in this manner. But there are also people who don’t, and I don’t think that message has been successfully received by those taking this unit.

It’s incredibly frustrating for me. I want an end to the beliefs of “us and them.” I want an end to the misconception that those with mental health issues cannot also be an OT or any other health professional. It almost makes me want to reveal to people my experiences with mental health issues to emphasise that yes, I have mental health issues but I’m not so different from all of them- in fact I blend in well with the rest of my cohort. I’ve had experiences in hospital where the news that I’m an OT student doesn’t receive the most positive reaction from the OTs there. That is what I want not to happen with the OTs of the future.

Uni Meeting & Avoiding the Professionals

I had a meeting with the OT course coordinator/my gerontology tutor on Monday. Considering she’s been the contact person during all three hospitalisations in my over a year of studying OT, I was afraid of her thinking me too mental to do this course. After all, there’s been a couple of OTs I met in hospital who haven’t had the most positive response when they’ve found out I’m studying to become one of them. She was lovely though and accommodating and helpful. I don’t need something as drastic as being in hospital to ask for an extension on things if I’m struggling, she told me. Oh. But still, I’d feel guilty and hesitant in doing so. She also suggested getting an Access Plan done up through the Uni Disability Office, which is used to provide to lecturers and the such if I for example need an extension, without having to go into detail about my situation. If I did decide to go that route though, a letter from a medical practitioner or psychologist is required. Given my current, self-imposed situation of not having one, that poses a bit of a problem. And even if I did, I’m afraid of people thinking I’m taking advantage and using my mental health issues as an excuse. I was also asked by the course coordinator whether I have someone to talk to for support. “Err…I’m meant to be seeing someone,” I answered. Before I told them all to eff off. Heh.

Oh, and regarding the email I sent D? He hasn’t replied. Apparently if you tell someone to bugger off, there’s a good chance they will in fact bugger off. Hah, who could’ve known? I was curious about how he’d respond to my email, but never mind. I did receive a text message from my GP’s office this morning though informing me I missed their call and to please ring them back. I haven’t. Too much of a coward, I am. I know I’ll have to see her sooner or later for my meds, but I’m dreading being questioned on what the hell I’m doing by refusing to see a psychologist and psychiatrist and how I plan to stay safe and get well otherwise. Lol, beats me. Oh yeah, and the fact that the day straight after I saw her for an appointment, I went and overdosed on the meds she wrote me a script for. My bad :/ But, I am a pro at avoidance and if I keep putting the problem off, it’ll go away eventually, right?

Fieldwork at K Hospital

I’ve just completed my week of fieldwork at K Hospital on the rehab ward. All I can see of myself is “not good enough” and “could’ve done better”, but apparently I did okay. I obtained more than the six out of seven required for a pass. The comments my supervisor wrote were better than I could’ve hoped for:

• Excellent clinical observations & documentation skills
• Very professional behaviour. Respectful, confidentiality.
• Appropriate interaction: colleagues & patients. Great rapport building.
• Evidence of taking initiative & happy to help & follow instructions.
• Remains on task, willing for learning.

Despite my initial pride and happiness, unease and insecurity soon crept in. I don’t deserve those comments. They must be being easy on me.  It also leaves me feeling confused. Don’t they see the incompetence I see in myself? Most of all is fear. Fear that I won’t live up to all that has been said about me; once you reach the peak, the only direction you can go is down.

As for the actual fieldwork, I guess it was okay. Good to get the experience. Not sure I’m keen on geriatric rehab though. Lots of assessing and assisting with showers, and urinary and faecal incontinence. Still, I’m glad it was this rather than being placed in mental health, as some of my fellow second year OT students were.

Amongst the ordinary challenges that fieldwork poses, my background as a mental health consumer was something I had to deal with whilst there too.

It was odd having lunch with a group of OTs, one of which was the emergency department OT I recognised from the times I ended up there as a patient.

My anxiety induced leg shaking did not go unnoticed by my supervisor. “No wonder you’re so skinny, you’re always moving! Could see you moving in the (ward staff) meeting!” *Awkward smile in response.*

Ward meeting, a nurse remarking the reason a patient was lovely this morning compared to the night before was “chemicals,” she said with a laugh. Told us the patient had taken lorazepam and quetiapine. It easily could be me the nurses talk about like that, when I’m the patient.

I ended up exhausted at the close of each day. How on earth do people manage full time jobs?! I’m relieved I have the next two weeks to relax before the madness of uni starts.

Mental Health Guest Lecturer

Yesterday we had a guest lecturer in for one of our occupational therapy units. We had been told beforehand we were to be listening to a person with a disability talk to us, but not much more than that. When she walked into the lecture theatre however, I guessed mental health. And I was right.

Every mental health consumer, or ex-consumer as she calls herself, has a story to tell. She was no exception. She told us of her breakdown after having her child. She told us of the highs and lows she experienced. She told us of the delusions of grandiose. She recounted being scheduled numerous times. However, she is no longer a consumer of mental health services. She’s off medication and hasn’t been hospitalised in twenty years. Currently she works in mental health as an Official Visitor.

A prop she brought in with her was a ceramic mug and a plastic mug. “Why do you think I brought this in?” she asked. After some prompting, people got it and she demonstrated by dropping the plastic mug on the table. The plastic mug looked identical, bar colour, to the ones on the public ward I was in last year. Admittedly then I hadn’t really noticed or questioned the plastic. The plates in the ward were ceramic though and we used proper cutlery. Oh the ironies of a psych ward… She asked us what that said about how patients are viewed. “They’re treated like children,” were amongst the answers given. “Yep, got it!” she exclaimed.

I love it when there are people as cynical as me…then I don’t feel so bad for possessing such negative and cynical views of it all. “Mental health patients are a pain in the arse!” she exclaimed when talking about the at times poor treatment received from health care providers and the gaps in the system.

We were given the opportunity to ask questions after the 15 minutes she took to tell her story. The asking and answering of questions took us right up until the hour. I stuck my hand up and posed two questions to her. My first one was, “Were you always so open about your mental health issues and have you experienced discrimination and stigma when people find out?” Her answer was yes, she is just very open about it all and yes, there have been times when people have stepped back and been wary when she’s told them she has a mental illness. But she doesn’t care and it’s their loss if they don’t want to know her. That’s the sort of attitude I like and try to adopt, though not to the extent that she does and not in all situations. And it’s harder for me to disregard what others think of me. But I really admire when people are able to be open and not ashamed to admit they have a mental illness.

The other question I asked was whether it’s difficult to work in mental health, if at times it hits close to home. She answered no, not really, and she finds it quite therapeutic. I guess that’s one of my concerns as a student OT. Every time a mental health related issue comes up, it does hit close to home. And I identify too much with the client. It can be hard to switch hats and think “No wait, you’re not the client. You’re the student healthcare provider. Get the right hat on!”