Still not discharged

It’s been over 6 weeks and I’m still in hospital. My 22nd birthday came and went, the second birthday stuck in a psychiatric ward. The Form 6 of the Mental Health Act which allows for a patient to be held involuntarily for up to 28 days expired, and I was put on a Form 9. I thought 28 days was long, but a Form 9 allows someone to be kept for up to 6 months. Not that I’m going to be here that long, but it’s scary how much power psychiatrists hold.

I was told a few weeks ago by the psych registrar that I’d need to get to 38kg before discharge. When I next saw the consultant psychiatrist however, he said he doesn’t know why I was told 38kg, and that I have to be at a BMI of 16 (40kg) or close before going home. I asked both the registrar and the consultant whether I have to maintain that weight for a certain period of time before being discharged- both told me I wouldn’t.

Come Monday I hit 40.1kg. Okay, so it may have taken a bit of water loading, wearing shorts under my pants and having a deodorant and mobile phone in my pocket. However, both doctors have gone on leave and I’m stuck with two completely different doctors until my doctors come back. Apparently it’s not documented by my doctors that I don’t have to maintain, and the only documentation that IS on my notes is by the dietitian, who’s written I DO have to maintain for a week.

It all just went downhill from there. I was fed up that they keep changing the target and angry that they didn’t keep their word about being discharged once I hit that 40kg. It seemed as though even if I comply, I still don’t get to go home, so may as well not comply. I started refusing to have the Ensure Plus.

Tuesday night was an absolute low point. As I’d previously self harmed and had just come back from leave, two nurses came in to my bedroom because they wanted to search it. I was told to get off my bed and stand by the door, which I refused to do. Security was called and I ended up being restrained by three of them on the floor. When they let go of me and left my room, I lost it- I smashed my mug on the floor and started chucking stuff around my room. That’s when the security guards again entered, took me to the seclusion room and I was restrained while given an IM injection of midazolam. I was then left in there and they locked the door behind them.

Yesterday I absconded from the ward. I left at about 10:30am. I ended up being brought back by my parents as the police had contacted them. I wasn’t going to pick up the phone when my mum called, but after 6 missed calls I felt too guilty.

The weigh ins of the past two days I got found out about having stuff in my pocket. Unfortunately it means my weight has dropped- it was 39.2kg this morning.

I’ve repeatedly told everyone that I don’t want their help and I don’t want to recover from anorexia or stop self harming. I don’t see why they insist on keeping me here when I’ve made it clear I intend to lose weight all over again when I get home and I won’t attend outpatient appointments. A nurse has warned me they could put me on a Community Treatment Order. I replied that I don’t care, I still won’t come to appointments, and besides, I don’t think they would anyway.

So it looks like I’m here for yet another weekend. Well, at least I still have stuff to self harm with that the nurses haven’t found for now.

32 thoughts on “Still not discharged

      • If you don’t get your weight up, you will.
        Seriously.
        Being so underweight has very serious consequences and being so underweight for an extended period of time, it will kill you.

        • You are painfully ignorant and stupid to boot. The whole BMI concept is bullshit – it was invented in the 1800’s by a mathematician for 2-dimensional objects! BMI is no indicator of health. Here in the USA, more and more physicians ignore BMI and prefer to measure body fat % which is a better assessment.

          Being OVERWEIGHT, which millions of Westerners are, is the REAL problem as it is linked to diabetes, heart disease, etc. So shall we round up all the fatties and institutionalize them? How about we take anyone with a BMI over 25 and toss them into a mental institution and starve them to be slim? Does that sound fair to you?

          Actually a BMI of 16 – 18 is the ideal so WillFindHope is probably much healthier than you are. Maybe we should throw you into a mental institution and inject you with drugs against your will – would you like that?

          • Maureen, it’s not polite to call people stupid; however much you disagree with them.

            Yes, I appreciate that the BMI is a fallible measurement system, but it is an approximation for healthy weight. I understand that it is not always accurate or applicable, for instance most professional footballers would be classed as super-mordibly obese, with their high weight due to their large amount of lean muscle mass.
            But it has been shown in research that a BMI below 18.5 is classed as underweight.
            An analysis of her lean muscle mass and adipose tissue would be a more accurate measurement of whether one is “fat”, but these are more difficult to apply and for the purposes of her clinicians BMI is a good rough and ready measurement.
            A BMI below 18 is not classed as “healthy”, and 16 is most certainly not, additionally WFH’s BMI on admission was 14, weighing 35.4kg, below your specified 16, and far below the established guideline of 18.5,
            If you believe that the ideal BMI is 16-18 I would love to see your evidence, as a medical scientist I have not come across any data that indicates this and if you do I would appreciate it.

            Anorexia also has the highest mortality rate of any mental illness, and you don’t have to be “skinny” for this to be the case. Additionally anorexia has high levels of morbidity associated with it. The loss of muscle mass due to starvation can result in damage to the heart, which can be permanent and deadly. Osteoporosis, brain atrophy and altered electrolytes (hypokalemia and hyponatremia) both due to anorexia and re-feeding syndrome and can be deadly.
            It is also important to note that many of the health issues related to being overweight are slower onset illnesses. Anorexia can kill relatively quickly in comparison. I do agree that we need to readdress our approach to obesity, while it is not a mental illness, there are often psychological issues, inherent to the disease, like anorexia.

            Anorexia and Bulimia, irrespective of one’s weight is a problem. It is a classified mental illness. WFH has demonstrated significant altered behaviour regarding eating and her body mass. She has also in the past stated that these feelings and behaviours are troublesome for her. Often anorexics do not have insight to their weight, and will perceive themselves as fat, despite being very underweight. They will continue to restrict and purge, irrespective of their weight, continuing to do so, potentially until death. Targeting her weight is an important part of treatment, particularly in the immediacy as the risks of complications of her weight loss, but her behaviours and perceptions also need to be rectified. Which will require therapy.

            WFH was restrained and medicated due to her behaviour, not as a consequence of her weight. If she had not lashed out and started throwing things around, she would not have been medicated and placed in seclusion.
            It is important to realise that the nurses were conducting the search in her best interests. She had previously self harmed and after leave, they were checking to see if she had brought things back to the ward in which to harm herself. I think that she may have been resistant to this as she had brought in items to self harm with.

            Lastly, I read this blog because WFH interests me. Through her writing I have found that I empathise and care about her. I feel almost like a big sister – I’ve had my own struggles with mental illness and watching her I feel that someone needs to tell her straight up what the results of her actions may be. I find it frustrating that she has wanted help for so long, but each time she is in hospital she resists the help she is being provided. And I get frustrated that help for mental illnesses are so hard to come by in the first place. Maybe hospital is not the best place for her to heal, but at least it is some form of treatment and I wish she could let herself receive the support she is currently being offered. It’s not perfect, but I do believe that the doctors in hospital have her best interests at heart.

          • And how is a BMI related to 2 dimensional objects?
            2-dimensional objects by definition cannot have mass.
            Therefore you cannot divide the mass of an object over the square of their height unless it is a 3-dimensional object.

          • Bec, I am disappointed to see that a medical scientist such as yourself is so poorly informed. BMI is NOT an accurate assessment of health and the arbitrary 18.5 cutoff is laughable. There is no evidence that having a BMI of 16 – 18.5 is unhealthy in any way – it is not correlated with an increase in disease. Actually human fertility peaks in this range and thus it is the healthiest. In comparison, a BMI of 25 or over is correlated with higher rates of Diabetes, heart disease, etc so it has been proven to be unhealthy. Perhaps we should force all people with BMI’s over 25 into mental institutions?

            WillFindHope has stated her BMI is around 16 now so that is why I used the 16 example. And a BMI of 16 is certainly not unhealthy. Actually I think the 25 cutoff is too low. In Asian countries 23 is often the cutoff for being overweight.

          • Moreen,
            As I said before BMI is used as a ‘rough and ready’ way in which to interpret a persons weight. As I also said, I agree that it is not the be all and end all for assessing someone’s mass and their likely body fat/ lean muscle mass percentages. But for the purposes of her clinicians it is appropriate.

            Why is the 18.5 cutoff laughable? This is the cut off that all medical professionals use as the distinguishing step between a “healthy” weight and a “low” weight. If you look into the academic literature a BMI below 18.5 is associated with complications in patients with anorexia. A BMI of <16 is associated with even more negative outcomes and is the criteria used for designation of whether a patient needs to be hospitalised. See references below to support my argument.
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275451/
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812624/
            I would be very interested to see some evidence for your claims that having a BMI of 16-18.5, is not unhealthy. Also some evidence for your claim that an underweight BMI is correlated with a peak in fertility. As shown by the references above on of the distinguishing features of a low BMI, and the disease anorexia is the cessation of menstruation. I am interested how a low BMI associated with cessation of menstruation can be linked to an increase in fertility. Additionally BTF has started having lighter and lighter menstruation, indicating that her body weight is too low to continue with normal physiological function.

            As has been stated by others (bob) BMI is not the only distinguishing feature of a person suffering from anorexia.
            http://www.mayoclinic.com/health/anorexia/DS00606
            Is a very useful resource that outlines many of the 'symptoms' and features of this illness. It is important to remember that anorexia is a mental illness and weight is a result of disordered behaviours and cognitions. BTF needs psychiatric help to overcome this illness

            I would also be interested in some evidence for your claim that the BMI of 25 being too "low" and should be rectified.

            I look forward to your veracious response to my questions.

      • You don’t want help to recover from this disease. You don’t want recovery at all. The only alternative is a slow death. That’s all there is to it.

  1. You have spent so long complaining of about how difficult it is to get access to treatment and mental health services and now you have them, you’ve changed your tune entirely. Your behaviour is that of a very angry, immature twenty-something, and it rather mimics a toddler’s tantrum when they don’t get their own way.

    Have you ever considered that you will only be treated as you behave? If you behave like a child, you’ll be treated like a child. If you lie and cheat, why should anyone else be honest with you? Maybe the first step will be practicing what you preach – treat others how you want to be treated. If you want to be treated like an adult, act like one. If you want consistently and honesty, demonstrate you have the capacity to practice consistency and honesty yourself.

    This behaviour is a hallmark of a borderline personality, which is great, because it means that it isn’t permanent. It’s something that you can alter. The catch being, you have to put in the hard yards.

    • Treat others how you want to be treated? Ok, then all medical practitioners should be tossed into mental institutions, force-fed, tied down, physically assaulted, isolated, pinned to the ground, and emotionally abused against their wills. After all, that is how they treat WillFindHope and other patients.

      It used to be that doctors practiced under the mantra “Do No Harm”. By assaulting and torturing psych patients, they do the opposite, making them no better than psychopaths who rape and beat people. It’s quite sickening that you support such an act.

      • There is a difference between “assault and torture” and therapeutic restraint and sedation for psychiatric patients who are deemed to require it.

        I do not support assault and torture. I support therapeutic restraint and sedation for psychiatric patients employed under the law that authorises it. Australia is a democracy and it’s laws are created through a democratic process. Therapeutic restraint is one of those, developed and employed for the safety of the people requiring such an interventions and those whom it effects.

        As for treat others as you wish to be treated, if the blogger had followed requests and directions and had expressed her anger in a mature manner that did not threaten harm to others in the direct vicinity, she would not have been treated in a similar manner that was threatening nor meeting her requests.

        You have obviously had negative experiences with healthcare providers. I am sorry for you – but you cannot tar all with the same brush. It is short sighted and narrow minded.

  2. The reason they are keeping you in is because you don’t want any help. You’re actively pushing them away. The only way the doctors can keep you alive is by keeping you in hospital.

    If you want to get better, if you want to get out, if you want to live your life again you’ve got to decide that you want to get better.
    From my personal experience this is the decision that everyone with a mental illness needs to make at some stage in their journey. Before they can get well, before they can be healed, they need to decide for themselves that they want to get better and they want to accept help to do so.

    If you want off this merry-go-round, you’re the one who needs to decide to get off.
    You need to decide that you want to get better.

    And I know that it’s not easy. Deciding to get help is going to be one of the hardest things you’ve ever done. But it’ll probably also be one of the best things you’ll ever do.

    I’ve been there and I know what it’s like. I’ve had to make that decision and then have had to work hard to get better.
    But you CAN get better, and you WILL get better. You just have to make the choice.

      • it must have done your head in how difficult it used to be, veing shunted back and forth through services. Having gone through similar, this made me not trust them, and want to just push it all away, until i guess i kind of gave in. Anyway, i do wish the best, because you have had a long battle with this., Ask if you can get a care plan in writing with your weight target on it. I wan’t having a go with what I asked, just so you know! I just wondered. I know it gets so damn intense when services get involved. Take care x

  3. I think people find it hard to watch you throw away your opportunities. I know you wish you could leave hospital but I wish I could trade places with you. I can’t afford any treatment and I can’t live with the hell of my eating disorder for much longer.

  4. P.s I am in Australia too!
    It feels like my only option is to clearly get below 40kg. I vomit everything I eat yet am too fat for treatment apparently.

    • I wish I could trade places with you too and I’m sorry that there aren’t any options for treatment for you at the moment. I do get it’s frustrating when you want help and don’t get it, and others don’t want help yet get it. I’ve been in that position before too- but right now I’m just not in the mindset of wanting to get better.

  5. It disgusts me how these so-called medical professionals repeatedly physically assault you and emotionally abuse you – holding someone captive against their will is kidnapping and pinning someone to the ground and injecting them with chemicals is illegal. If I were you I would call the police and report the staff of whatever institution you’re in when you’re able to leave. My experience with the medical industry is that most of the people are morons at bests and sadists at worse.

    A BMI of 16 sounds perfectly healthy. I’m a competitive runner, eat very healthy and train hard, and my BMI is usually around 18 and I’m not even that thin – you’re slightly underweight but nothing wrong with that.

    It’s funny how people who are slightly underwear are forced into mental institutions but all of the fat people out there aren’t – hypocrites! Maybe we should round up all of the overweight people in society and force them into mental institutions and assault them against their will – we might start seeing real change.

      • You are a very opinionated, highly unformed person. Please employ some form of Fact Check before publishing your comments, as encouraging anorexic and borderline personality disorder behaviour and opposing their treatments to the suffer is very difficult for the sufferer to content with, whether they realise it or not.

        BMI is not the only diagnostic indicator of anorexia nervosa. Other indicators include fear of weight gain and refusal to eat an adequate amount of food (all demonstrated by the blogger). Furthermore, it has significant health complications, both physical and psychological, resulting in it’s status as the most deadly mental illness with the highest mortality rate.

        Without weight restoration (to a full and adequate weight for the suffer, not just a weight that scrapes through the marker of ‘healthy’) suffers of anorexia experience persistence of symptoms that prevent them from living a full and satisfying life. Full weight restoration is the best indicator of long term prognosis for such patients and suggesting otherwise is inherently flawed.

      • I’ve wondered about that myself, why it is that being underweight warrants someone to be locked up and force fed, yet society deems it okay for someone to be morbidly obese without forced intervention.

  6. Why do you want to become an occupational therapist & did you see any OT’s doing anything useful for you or anyone else while you were in hospital ?

  7. PS. And if you do still want to be an OT, how do you think you will handle a similar situation like yours? For eg What if you work with someone who wants to self harm but tells you otherwise & hides the means to do it – As an OT health professional i’m guessing you all (drs, nurses, ots etc etc) have some kind of obligation to prevent a patient from hurting themselves?

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