Home from hospital

No matter how many times I go through this, being discharged always brings about a mix of emotions. Feeling glad to go home yet terrified at the same time. I was discharged yesterday afternoon. The first few days back home are always hard. Feelings of loneliness and everything being too much threaten to push down on me as I try to push them back.

I’ve reluctantly agreed to be referred to the group program. C, who runs the group program and is also my tutor at uni, came to see me briefly. One of the things she asked me is how I feel about her being someone who runs groups as well as my tutor. I wasn’t sure, and told her so. She said that although I may see her at the group place, I probably won’t have her as the actual group therapist because I did already know her. For the actual pre group assessment, someone else came to do that with me. It was explained that to do the DBT group, one must first complete two other groups before being assessed again for DBT. It was decided that I’d first do Introduction to Group Therapy then the Emotional Regulation group. There are two types of DBT groups on offer, DBT skills which runs for 16 weeks, and the full DBT program which runs for a year. All groups go for 2 hours weekly, with an additional 1 hour individual therapy session weekly for the full DBT. During her explanation of DBT, she told me that Marsha Linehan, the creator of DBT also had Borderline Personality Disorder. Is that supposed to make me feel better about it? When I asked her whether there is a waitlist for groups, she answered that sometimes there is, but they’re usually able to get through it pretty quickly. Given I was on the DBT waitlist for a year last time I was referred, it seemed at odds with my experience. I suspect what’s changed is this time I’ve had seven ODs resulting in ED treatment and five psych admissions under my belt plus I’m not seeing anyone on an outpatient basis. Last time I was referred I was still seeing a private psychiatrist, plus I’d only been in the ED twice and had one psych admission.

I’ve decided to go part time at uni, which means dropping out of two units this semester. In hindsight I should have done so at the beginning of the semester. Up to the point where I was hospitalised, I’d attended all classes and completed all the work, so it feels like such a shame that all that time and effort is going to waste. There are both pros and cons to going part time. The pros are that it means I will be less stressed and have more time to look after myself and do other things. The cons though are that obviously it will add more time to my degree and my friends will progress to the next year without me. I hate feeling left behind like this, while it seems everyone else my age has already graduated and gone on to get real jobs.

Full time uni

Sometimes I wonder whether or not I should do part time at uni. For the past two years I’ve been doing full time, and somehow or another, have managed to pass everything. But I also think of the struggles it took to get through it, and that it may be worth it to cut back a bit on the workload. So that I’m not so exhausted and not so stressed. So that I don’t get completely overwhelmed and panic when I have four assessment tasks all due in the same week. So that I have time to relax and do the things that I enjoy and keep me well. Because if I’m honest with myself, stress is a big trigger for me, and I’d like to stay well for as long as I can. And unlike last semester where I had a GP who could write me a letter when I needed extensions on assignments, I don’t even have a GP currently.

At the same time, I reason with myself that I got through the past two years, so I should be able to get through this year and next too. I don’t want to extend my time at uni for longer than I have to. I’ve already been at uni for so many years while friends and people I know have graduated on gone on to get real jobs. Other people’s opinions and approval also matter to me, and I’m afraid of what friends and family may think. That I should just continue on so I can finish as soon as possible or that I’m just being slack. Some people manage/d full time university and jobs with many hours (as my boyfriend has told me he did). I don’t want to feel inadequate for not even being able to manage what everyone else is able to.

Content

It’s been over a week now that I’ve moved out, and I’m beginning to settle in and even enjoy my new found freedom and independence. At first there were bumps, as I was pushed out of my comfort zone. I missed my home, where I had spent the majority of my life. There were tears as I wondered whether I could really cope and even contemplated picking up and going back. But now I’m glad I took the initiative to escape a situation I did not want to be in.

Moving to a new area, I went to see a new GP close by. He issued me the scripts I asked for; Pristiq and Seroquel, with enough repeats to last six months. Prior to this I had still been having only a week’s worth of medication dispensed to me at a time. Though it may be a little deceitful of me not to disclose this to the GP, I was tired of having to go to the pharmacy every week. Besides, I haven’t overdosed in 9 months and if I really wanted to, I could anyway. And for the moment, I don’t. Things are going well. I’ve finally moved out. I passed all my units at uni and will be going into my third year of occupational therapy in 2013. I have friends, and I even have a boyfriend now. The guy I’d been dating has become my boyfriend, in fact my first at the age of 21. And I too am his first, at the age of 25. For now, I am rather content.

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.

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.

That feeling from self harm *PT*

One or two bad days I could probably handle. I could use distractions, for example, painting.

And it did, to an extent, work. I’m obviously no artist but it was somewhat calming and therapeutic to express myself on canvas. In this case, it represented the tears I had cried over two days.

When it’s four bad days in a row though, forget it. Conflict with my father on top of a long uni day and stress over the workload and study resulted in an end to my two month streak of being self harm free. Two months would be a lot more impressive if I managed to resist the temptation despite having a rough ride. As it is, those two months went pretty well for me, and it was rare I felt the need to self harm. Unfortunately it only took four days of things not going so well for me to return to using old ways to cope.

Whether it’s a placebo effect or whether it’s the endorphins being released, I feel so much better now.The sharp sting of the blade and the blood dripping down my leg both calmed me and helped release the tension I was feeling, distracting me from my emotions and tears. And now that I’m reminded of how damn good this feels, gosh I just want to do it again.

Busy volunteering, studying & being a mental

Life has been rather busy up until this point. Doing things I want to be doing, as well as things I not so much want to be doing. Among that which I want to be doing, I attended a youth mental health roundtable a week ago. The first half of the day was spent providing feedback on the National Report Card on Mental Health. The group of young people in the room were great, all had such a wealth of experience and ideas to share and it was so inspiring to be part of this discussion on mental health. A range of issues were brought up including mental health services, mental health in Aboriginal and rural communities, mental health in schools, CALD issues, and others. The second half of the day was dedicated to providing feedback on the new youth mental health service that is currently in the process of being built. This new services is aimed at young people who are at ultra high risk of psychosis or emerging Borderline Personality Disorder. There were a couple of questions I brought up, BPD being something I feel rather strongly about given the prejudice that is often held against those with BPD, even when they’re in a vast amount of emotional pain and in need of support. One of my questions was regarding the six month limitation on this service. I wanted to know how six months is adequate for an illness such as BPD which often has a lot of underlying issues, and how they were going to deal with the issues of rejection and abandonment when the relationship is terminated at the conclusion of those six months. The answer I got is that their service is a starting point before going onto another service is required, which is fair enough, and that often if you’re clear with the young person from the beginning that at the end of six months they’ll have to move on, it will help so that the person doesn’t feel rejected. Is this usually the case? I don’t know. But I know for me, it’s part of the reason why I’m reluctant to see psychologists again. Because it just hurts too much when I’ve started to trust someone, they too leave.

Yesterday I was there while a conversation took place between the people who are setting up this new service. They were trying to work out how exactly ‘emerging’ BPD is going to be defined for eligibility for their service. Another eligibility criteria is that someone has to have had a decline in their functioning. I asked whether someone who say self harms and are showing signs of BPD but are functioning fine in work/school/uni, whether they’d access this service. And the answer was no, they’d probably be accessing another service. It was interesting to me because there are definitions of mental illness that say it must impact on a person’s functioning. When I look at myself however, my daily functioning is very rarely impacted. I have never missed a lab class of uni due to feeling too depressed or anxious. When I’ve made a commitment to my volunteer work or going out with friends, I don’t think I’ve ever bailed because I was feeling too emotionally awful or anxious. The only time I have failed to attend these things is when I’ve been in hospital. Despite ending up in hospital at least once every semester that I’ve studied OT, I have not failed any classes and passed them all the first time round. So based on functioning, you could say I don’t have any serious mental health issues at all. But it’s my coping mechanisms and emotional reactions that get the better of me. Because things that most people are able to cope with in everyday life, I react by having a meltdown and overdosing. So it’s like functioning, functioning, functioning….then have a meltdown and crisis.

I finished my one and last exam on Wednesday. Though marks haven’t been released yet, I’m almost entirely confident I passed all four units. I’m thrilled because in three semesters of OT I’ve managed to pass three semester’s worth of units, whereas when I was studying pharmacy, in three semesters I hadn’t even managed to pass a full semester’s worth of units. Not to mention I’ve been inpatient in psych wards once per semester for all three semesters too during my OT course. I also went out with a group of my OT friends for lunch after we finished our exam, the first time ever I’ve gone out with friends from OT. Yes, after 1.5 years of studying in this course I finally have an actual group of friends that I belong to.

I’ve still been collecting my meds weekly from the pharmacy. An annoyance when I have to stop by on my way home from Uni on Fridays, an even bigger annoyance when I don’t have uni and have to go especially just to pick up meds. Using public transport. To make things worse, a girl I went to school with who was in my year and so we know each other, works at the pharmacy. I see her every Friday when I go get my weekly meds supply. Awkward. And so today being Friday, I went and was informed my box of Seroquel has run out and they’ll have to dispense a new script for me. Fine. Then the pharmacist asks me, rather loudly, “WFH, has the doctor lowered your dose of SEROQUEL?” Just announce to the whole pharmacy that I’m a mental, that’s fine… Turns our my GP faxed a script for two 25mg Seroquel tablets per night which I used to be on, instead of the correct one 50mg Seroquel XR tablet a night which I’ve been on since they changed it when I was in hospital. So it’s back to the GP I have to go, and there goes my plan to avoid her out the window. Not too keen to answer her probable questions about my not wanting to see the psychologist at A St. My answer if she asks what I plan to do in terms of getting help? Nothing. It’s my life and I choose and plan to do nothing.

I’m on break until Uni starts up again on July 9th and I have mixed feelings about this break. On one hand, it’s great to not have to do any study or uni work. On the other hand, it gives me quite a bit of spare time, too much spare time to dwell on how lonely I feel. It’s hard when I see people going out with their friends and I’m alone at home, reminded that I don’t really have people to hang out with. It feels pretty awful when it seems like everyone else has these wonderful close friendships and all these people to spend time with, and I don’t. I am headed to Melbourne and Sydney in a week though. Melbourne just for a couple of days to holiday as I’ve never been before, and Sydney both for a bit of a holiday and the Young Minds Conference, which I obtained a free ticket to.

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?