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?

Employment with a mental illness

Does mental illness make someone a less competent worker? What’s precipitated this question is a comment I received on my previous post. It read:

“…if I had a family member recieving treatment from an OT, PT, any field, even teacher, and had a choice between someone with a history of mental illness and someone without, I would not hesitate to choose the person without. […] I don’t want the people close to me receiving potentially less the the best. [….] I also think that anyone saying otherwise is not being fully honest with themselves…”

Everyone has different perspectives and it’s fair enough this particular commenter has been honest in sharing her viewpoint. Would I be willing to use the services of a professional who has a mental illness? Given their symptoms did not impact on how they performed the job, then yes I would. I see no reason why a person who has a mental illness can’t do as well as a person without. Especially as mental illness manifests in so many different ways. Whereas in one person it may affect their job to an extent where they cannot work, in another it may make a very insignificant impact on the job that they do. On placement I do everything that the other students do and my mental health issues do not influence the quality of my work. I have friends who are student health practitioners with mental health issues, including nurses, social work, psychology, medicine and I wouldn’t hesitate to use their services.

If someone was quite unwell though and it was impacting their work, that’s a different matter. If a person in the depths of a mental illness could not concentrate enough to provide me treatment, if their self care flew out the window, if their motivation decreased to a point where they weren’t completing their workload or turning up, then no, I wouldn’t use them. And as a health professional, one of the responsibilities that come with it is recognising when an illness, whether it be of a mental or physical nature, puts you and/or your client at risk. 

It comes as a sad reminder though that many people out in the big wide world may not be so understanding. This may include both employers or potential clients. They may say ‘no’ as soon as they hear the term ‘mental illness’. They may sack you after a period of being unwell. Just a couple of weeks ago, my uncle went back to work after one or two months as a patient in a psychiatric ward, only to find out he’s been fired. It’s a real shame that employment, especially as a health professional, is yet another barrier that may be faced by people with mental health issues, because of the prejudices that society hold. 

Recovery?

Recovery. It’s the word of the moment with mental health services. They’ll tell you they operate from a ‘recovery framework’. Recovery as the ultimate goal, it’s what we’re all supposed to be aiming for.

I don’t understand the concept.

When I think of the word ‘recovery,’ I think of someone ceasing to have the symptoms of an illness they previously had and are no longer ill. As in someone recovering from an infection, recovering from a bout of gastroenteritis, recovering from the flu. Or if we’re talking mental health issues, recovering from an eating disorder or recovering from depression. As in, they had that illness but do not have it any more, nor do they have any lingering symptoms.

According to the lecture notes from my neuropsych tutorial though, some of the principles of recovery include;

  • Recovery can occur even though symptoms reoccur or remain.
  • Recovery can change the frequency and duration of symptoms.

So then I was just confused.

I Google searched ‘mental health recovery’ and came across a government document entitled Principles of recovery oriented mental health practice. Maybe I’m just slow, but I still don’t understand this elusive concept of ‘recovery’.

But perhaps it doesn’t matter, seeing as whatever this word means, it doesn’t feel attainable, achievable or realistic anyway. I may achieve periods of ‘doing better’ but I don’t expect to be completely free of depression and anxiety any time soon, or possibly even ever.

Mental health screening in young children

A few days ago I read an article that reported that from July 1, three year olds will be screened for possible mental health problems as part of the normal developmental health checks conducted by GPs. It will cost $11 million over four years. There have been people who support this idea, as well as some criticisms and controversy surrounding the idea that three year olds will be labelled with mental illnesses under this scheme and that normal issues will be medicalised.

When I look at it, three years old does sound pretty young. Can you really pick up possible or early signs of mental health problems at that age? But at the same time, I wonder whether having help as a child if my problems had been picked up at about 4-6 years old, if it would have made a difference.

I had huge anxiety issues as a child. I was also very shy. I was terrified of attending school. My one and prominent memory of kindergarten was crying and vomiting because of the fear and anxiety I felt, and my father having to leave work to collect me. He was not happy at having to do so. I would’ve been 3-4 years old at the time.

My memories of year 1 involve more of the same sort of experiences. Crying almost every day for the first half of the year due to fear of school. Throwing up at home prior to leaving for school due to anxiety. Sobbing and begging to my parents to let me stay home instead. Having to endure being put into a situation five days of the week which induced terror and distress in me.

Years after I had left kindy, my mum bumped into one of the kindy teachers who’d had me as a student. Apparently I was rather memorable as she still recognised my mum. Based on my behaviour and what I was like then, the teacher asked my mother whether I still cried at school. This tells me that the extreme fear and anxiety I had was not typical of children of my age at the time. Yet I wasn’t given emotional support or help. Yes some young children may grow out of their issues it could then be argued mental health screening and early intervention at the age isn’t necessary, but what about those who don’t?

This kinda links in too with what I heard from a professor from Canada today talk about. I had the opportunity along with the other youth mental health organisation volunteers last night to hear Dr Shanker speak. He’s an expert in self-regulation in children. He spoke of how stress is anything that requires energy and some people just have a more sensitive nervous system. People then use up their energy resources trying to deal with the stress, and it can come out in externalising, internalising, cognitive, or risky behaviours. It will then affect the ability to self-regulate. Thus, it needs to be identified why the child is reacting in that way and try to calm the nervous system down. He also spoke of a bad back being no different to something like depression and anxiety, as both are derived from stress. My poor summary of what he said really doesn’t do it justice, but it was a very enlightening and fascinating talk, spoken with much clarity and was very engaging.

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.

The term ‘mental illness’?

I read an online article this evening on The Age– Psychologists warn on term mentally ill. According to certain opinions in this article, depression and anxiety shouldn’t be referred to as a ‘mental illness.’ Why? “…because it labels them as potentially ”dangerous, crazy and violent”, a group of psychologists has claimed.” (The Age, 2012). Fair point. Just a couple of weeks ago I was watching the TV series Revenge. It was the episode in which Tyler, a conniving, manipulative and scheming character, lost control and smashed things around the house, tied someone to a chair and stabbed him with a knife, then threatened someone with a gun. Which would be fine and does make for an intriguing show. Except, the reason for his behaviour is that he stopped taking his antipsychotic medication to control his mental illness, and is on the run from a psychiatric hospital. Way to perpetuate the stigma of mental illness.

But back to the article. Apparently the term ‘mental illness’ is okay though for people who have bipolar disorder or schizophrenia. As it states in the second paragraph, “The Australian College of Specialist Psychologists believes the term ”mental illness” can put people off seeking treatment and it should only be used for psychiatric conditions such as schizophrenia and bipolar disorder.” (The Age, 2012). And that’s what irritates me. So according to them it’s okay to attach stigma and labels to schizophrenia and bipolar disorder, never mind they’re already the ones who cop the brunt of it when it comes to stupid misconceptions like ‘dangerous’ and ‘violent’.

Personally I don’t have that much of an issue with depression and anxiety being called mental illnesses. I prefer to use the term ‘mental health issue’ instead, but I don’t really see a problem with calling it a mental illness when that’s what it is- an illness to do with mental health, rather than physical health.

What do other people think? Do you dislike the term ‘mental illness’?

Stepping back from being unwell

I like periods of wellness. It’s….nice. It’s nice not to be plotting my own demise at every spare moment, it’s nice not to be curled up in a ball crying because I just can’t cope, it’s nice when there are things and activities I want to participate in and it’s nice when misery is not all that’s crowding my mind. It’s easier to want to be well when things are already pretty okay. It’s then not so hard to imagine what it may be like. In contrast, when things aren’t so great, it’s hard to see a way out, and harder to let go of mental illness. It starts to feel like a part of who you are, a part of who you always will be.

I feel less of a need to blog when I’m not consumed by sadness and also less of a need to read other people’s blogs. The opposite is true when I’m not so well. I feel drawn to reading about mental health issues, desperate to know I’m not alone. While it does serve that purpose, I suspect it can also become a perpetuating cycle where it isn’t exactly doing my mood any favours. And even when I am quite well, it can still be a danger.

Needing to prove how awful I feel is something I struggle with, and wanting to compete for who’s the sickest is something I feel compelled to do. It can then become quite triggering for me when I read or hear about how unwell someone is. When someone is in hospital. When someone’s attempted suicide. When someone’s lost X amount of weight and now has a BMI of an average 12 year old. When someone has friends, family, partners, relatives, professionals all worried about them. When someone’s self harmed to the point of needing stitches. I found out through Facebook my room mate when I was inpatient at H Clinic almost exactly a year ago is currently back in hospital for her eating disorder. And even though I really don’t like H Clinic, it’s still somewhat triggering to read about it all on Facebook.

Knowing this, sometimes it can be good to take a step back from it all. Participate in other aspects of my life- aspects which don’t involve being sick with mental health issues.

Upcoming Pdoc appt and Mentalism & Driving

It was surprising how many of the other patients when I was an inpatient didn’t actually have a regular psychiatrist. Many of them had their mental illness managed by their GP. Which has led me to believe psychiatrists, particularly those in the public system, are really for those with more severe mental illness like schizophrenia or bipolar disorder. If the statistics are correct, 1 in 5 of us have depression. In other words, it’s rather common. Too common to be seeing a specialist in the public mental health system for?

One of my fears when meeting with a new mental health professional is that they won’t take me seriously. Or they think I don’t really need to be seeing them as there are plenty of people sicker than me. I tend not to talk very much when confronted with mental health professionals. When it’s someone new who knows nothing about me, what if they take my reluctance to talk about my issues and struggles to mean that nothing’s wrong? Or assume that I’m deliberately being ‘shy and secretive’ as the first psychiatrist I saw accused me of being? Another barrier to talking is I can’t help thinking if I do describe in detail what I’m struggling with it will be assumed I’m exaggerating. That I’m deliberately talking up my symptoms to ‘prove’ I have depression and therefore deserve help.

Hopefully what may make tomorrow’s psychiatrist appointment a little easier is that D has been in contact with I, one of the clinical psychologists at A St, and told him a bit about me. While I’m not exactly keen on being discussed without knowing what’s been said about me, if it helps them understand a bit more about where I’m coming from I won’t object.

I’m meant to make an appointment to see my GP as well, but on top of a psychiatrist appointment on Tuesday and a psychologist appointment on Wednesday, a third appointment in a week seems rather excessive. I went to renew my Learner’s Permit in relation to driving and because I’m mental, the Department of Transport seems to be questioning whether I’m fit to drive. Being the honest person I am, I ticked Depression where it asked us to tick whether we have any of the medical conditions listed, and dutifully wrote down Pristiq and Seroquel where it asks for medications. I was then told because of that I have to have a medical, get my GP to fill in a form stating whether I’m fit to drive, and come back next time. Ugh, seriously? My ability to drive isn’t affected at all. And I’m smart enough to know not to drive after taking Seroquel because of the drowsiness it causes. Ever since I’ve been thinking I should have left those sections blank to save the hassle it’s causing.

Shorts

It’s great when I don’t even have to think of an excuse for the scars I have from self harming. Instead, people come up with them for me! “Did you burn yourself with an iron?” my auntie asked me of the couple of scars on my arm, before she found out about my mentalness. Taken by surprise, I gave a vague “mmmmm” in response. More recently in Indonesia, I was again questioned on my scars. This time by my uncle, asking if I got burnt by a frying pan. “Nope, by an iron,” I told him, using my auntie’s ready made explanation.

When I was in the private mental health unit in May, I met another patient who was about the same age as me. She had scars all up and down both arms yet she still wears t-shirts and singlet tops same as everybody else. We got talking about self harm and scars one day. “People aren’t actually that bad,” she told me. “There was one person who stared,” she said, “But other than that most people are fine.”

The two coupled together, and I think I may be a little bit braver. This summer season I bought shorts.  Prior to this season, last time I did was way back in 2008. And as long as I don’t have recent wounds on the show, I wear them too. The shorter ones I only wear with stockings. The slightly longer one I wear by itself. It covers most scars when I’m stood upright, but rides up to reveal scars when I’m sat down. I think I’m okay with that. Others don’t have to be. I’ll never be able to wear the denim underwear that is so popular with 15 year old girls these days. But then again, why would I want to? I’m just happy to be back out in non knee-length shorts, the first time in about three years.