BPD and Recovery

On Wednesday I attended a Youth Leadership in Mental Health Forum, in which I was one of the presenters. I spoke about using my lived experience of being hospitalised under the Mental Health Act for anorexia to advocate for eating disorder services and rights of consumers, and also being a student occupational therapist who has BPD. It’s always a bit of a rollercoaster of emotions when speaking about your own experiences. There’s the anxiety and lead up to the event, the initial high and sense of relief immediately afterwards, then the coming down and self-doubt about whether you actually did a good job or not. My emotions were complicated even further by the fact that eight other students from my OT course were in attendance, and now all eight know that I’ve been hospitalised involuntarily and have had anorexia and have BPD. Which I guess isn’t a huge deal given I am somewhat open about my mental health issues and most OT students are quite open minded. I got some nice feedback from a few of of the OT students, which was nice. Though it felt a bit awkward when I was sitting with them at lunch time and one person asked the group which speakers were their favourite. Me being sensitive and self-critical, when they mentioned other speakers who they enjoyed listening to, it made me think that compared to the other speakers I must be really substandard. Hmm.

One of the points I raised in my talk is the way that BPD has been taught in the OT course. BPD has tended to be painted in quite a negative light, without being very recovery focused. One of the OT students said that she also noticed this in class, and actually asked the tutor why it wasn’t more recovery focused. She said that the tutor told her it’s because “Most people with BPD don’t recover.” Umm, WHAT?!! Excuse me?! No, no, no, no, no! It was really quite upsetting to hear that my OT tutor has this belief and attitude, especially as I had raised the issue last year of the prognosis of those with BPD being portrayed as being very dire in class and with that had revealed to her that I myself have been diagnosed with BPD. It also made me very frustrated and angry. It’s so incorrect that people with BPD don’t recover. There is research that shows people with BPD can and do recover. One famous example is of course Marsha Linehan, the woman who created DBT. I’ve seen anecdotal evidence from people I know online who have recovered from BPD and I know even more who may still struggle with BPD, but are able to live a functional and meaningful life. It is so sad when I see mental health clinicians harbour this attitude and I just hope that those of us with BPD again and again prove them wrong.

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. :P

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?

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.

Fieldwork- OT in mental health

I attended fieldwork today at a hospital. The only area I was hoping not to be put into was mental health. Not because it’s an area I dislike or am afraid of. Rather, I already know what occupational therapy involves in mental health. Guess where I ended up? Yep, mental health.

It was my fault really. The five of us OT students were asked if we had an interest in mental health. I piped up and said yes, not realising it’s because she wanted to put one of us with that area. I then tried to subtly withdraw my interest…which was not very professional of me… :| Made up for it later though!

So the OT and I walked down to the mental health unit. “You’re not worried or anything are you?” she asked me. I assured her I wasn’t. Because today was totally my first time walking into a mental health unit.

I was shown parts of the ward. Wasn’t actually allowed to enter the High Dependency Unit and open ward and only got a brief glimpse of the mental health rehabilitation unit. Time was also spent explaining to me about the ward and mental health. I let her know after a bit that I’m not a total novice, I do volunteer for two mental health organisations. “What made you interested in volunteering?” she asked me. Yes. Good question.

The OT was planning to conduct an interview/assessment with one of the outpatients who’d been discharged and have me sit in so that I could observe. Which was all well and good…except the client didn’t show up! So then more time was spent with her talking about what she does as a mental health OT and me asking questions.

She remarked that when she first met me, it seemed as though I was pushed into coming to mental health and that some people are a bit worried/afraid of this area. Oops. Guess my attempt to withdraw was not so subtle after all. Only because I want to experience another area of OT though, and we only get one day in a hospital this semester. It’s not because I’m uninterested, I swear! I think I managed to redeem myself though when I demonstrated that I am keen in this area and somewhat knowledgeable about it…I hope so anyway.

I was disappointed though when I heard the experiences of others who had gone to other areas of the hospital. One had observed a client receiving hand therapy. One had gone with an OT to do a home visit. Another was in the Emergency Department where they actually worked with a couple of clients. The client I was supposed to meet and observe was a no show.

It felt somewhat weird being in the mental health unit. Especially as a student, someone who’s assumed to be just a student and not a mental health consumer who’s been an inpatient before.  I have to pretend I’m not one of the people she’s talking about when she mentions patients that are at risk of self harm or suicide, that abscond from hospital, that have depression and social anxiety. There’s a part of me who wants to be the professional and move forward. Yet there’s also a part of me that does get tempted to go back, to just be a patient, be self destructive, prove that I’m sick. Just have to push that part of me back.

Anatomy labs

I attended the orientation session for my semester two classes yesterday. I was dismayed to find that for our Anatomy labs, we are going to have to use each other as models to facilitate learning palpations. And no, I didn’t spell that incorrectly, as was suggested by Google. Palpation is defined as: To examine or explore by touching (an organ or area of the body), usually as a diagnostic aid.

While I can’t say I’m keen on the idea of being groped and poked and prodded by my fellow classmates, that’s not the worst part either. The worst is that we’ve been told we must wear ‘singlets and shorts’ during these labs and jeans and trackies are a no go. This is so we are able to feel each other up palpate and draw on each other where certain muscles, bones and ligaments are and learn ridiculous names such as extensor hallucis longus muscle. Um, yeah. Shorts and me do not go well together. I’ve had even doctors and nurses express horror at the scars on my thighs; purplish-red, raised and too many to count. I’d hate to imagine how mere inexperienced first year students would react. Leggings or knee-length shorts better make the cut because there’s no way I’m wearing anything exposing more than that.

And you thought all OTs needed to know was how to tell patients in a psych ward to go tend some pot plants or string beads together to make a necklace…