Monday, June 19, 2017

When You're Turned Away

       This post is a hard post to write for me. It's one that I have struggled with whether to write or not for quite a while, because I haven't seen this happen to anyone else I know but by doing research I know it happens. It is a failure in our mental health system, one that must be taken care of if we really want to help people with mental illness and lower the suicide rate. The issue? Blacklisting people or putting them on a "do not admit" list at a psychiatric hospital.
      Why do I write about this? Why would I want to highlight this? Because I've experienced it. Multiple times. Today, there are 5 hospitals that have me on their "do not admit" list. One of those hospitals I haven't even been a patient there.
      You may be thinking, can they even do that? Is that even allowed? General medical hospitals cannot turn away patients, that is known. However, psychiatric hospitals that are privately owned can. State psychiatric hospitals cannot because they are ran by the state. This is something that has been going on for a long time too. One article I read said this started back in the 1960's.
       The next question that comes up is why. Why would they not want to help someone? What I found in doing research about this is that sometimes hospitals won't take patients who are physically violent or have been physically violent toward staff in previous stays. If a person had assaulted staff in previous stays, they may be put on a "do not admit" list. The other reason I found in my research was that if a person had a severe personality disorder and the hospital felt that they would gain no benefit from the hospitalization. The reasons I personally have gotten from hospitals have ranged from "I have reached my therapeutic maximum" at that hospital or "I need long-term care" that they cannot provide or "the doctors there won't accept my case". It can also be a combination of these things. However, this still doesn't really answer the question though, does it?
       Why would a hospital deny a person the help they need? Unfortunately, I can't really answer this question. I can only say that this is one of the many ways that the mental health system fails people. The system that is supposed to help people leaves them helpless. The system that is supposed to give people hope leaves them hopeless. The system that is supposed to guide them through treatment leaves them wandering.
       It's almost oxymoronic in a way, how the system works. Those who are suicidal, have tried to end their life, homicidal, or psychotic are placed on commitment because we value life, or at least we claim to. Until the search to find a hospital becomes too difficult and then it's just easier to give up and let them go home.
       How do I know all of this? Because I've lived it, and not just once. Many times. I've gone to the ER to get help because I was suicidal and knew I needed to get into a hospital, only to get there to find a social worker who gave up after the first set of rejections came in. I've been put on commitment papers and taken off them less than 24 hours later because they gave up. I knew I needed help and I had to find it on my own because there wasn't anyone going to find it for me. I've sat in a hospital for two weeks after an attempt waiting for a hospital only to have the hospital give up and send me home because there was nothing they could do. I've been turned away by hospitals I've never been to before. I've been turned away by a total of 6 hospitals. I cannot even begin to explain the pain this brings to me. The hopeless feelings it has brought on. The dark places it has brought me to.
      This is just one of the many broken parts in our mental health system. One of the many parts that MUST be fixed if we want to see the suicide rate decrease and we want mental illness to be less debilitating. Fixing this will bring hope to more people and make sure that no one is left in the shadows wishing they had the help that so many others had access to. It will mean no one gets turned away.

Saturday, June 17, 2017

The Reality of Psychiatric Hospitalizations Part 2

This is a continuation of my previous post about psychiatric hospitals. Many people don't understand the realities of psychiatric hospitals and what the experience is truly like. So this is my way to help shed some light on the reality. In my last post, I outlined the process of getting admitted to a psychiatric hospital and the sometimes difficult process it can be. This post will focus more on what happens once you are admitted to the psychiatric hospital. Once you enter the hospital, the paperwork pile begins. Paperwork includes another evaluation once you are admitted (you probably go through 3 more after being admitted). This includes explaining why you are there and what led you to be there. This can include things like a suicide attempt, suicide thoughts, self-harm, family member's concern, hearing or seeing things and being delusional. It can also be simple things like you need a medication change and feel more comfortable doing it in a hospital setting. It also includes going through your history (previous hospitalizations, previous suicide attempts, family history and so much more). They also go over your medications and allergies. Usually included is taking your weight and giving your height. Probably the worst part of the entire thing is what is known as the "skin check". That is exactly what it sounds like. It is a check of all of your skin. They document any marks you have on your body including scars, birthmarks, acne, stretch marks, cuts, scrapes, bruises, everything. This is the most humiliating part of the entire process. Some places do it for security, others do it to get an overview of your physical condition when you are admitted. It can be equated to a strip search anywhere else.
       Once the physical check is done and a basic evaluation is done, rules and regulations are gone over. Most places give you a packet that includes these in it. Also included is a schedule. The schedule goes over when the groups are held, when meal times are, what meal procedures are, and when free times are. Additionally are a list of phone times and TV times (more on this soon). Once you go through the packet of information and the search, then your personal belongings are gone through. Sometimes this is done in your presence and sometimes it is not. Essentially, staff goes through everything you brought in to check for anything you may not be allowed to have. This includes sharps (you are not allowed to have a razor to shave with; if you want to shave you have to ask for permission and be observed the entire time to make sure you don't hurt yourself), strings or ties (so you can't try to hang yourself or hurt anyone else), medications (those are all controlled by the nurses there), any toiletries that may contain alcohol and anything else that could be considered hazardous. One surprising thing you aren't allowed to have are pens or pencils with erasers. They usually give you short pencils, often called golf pencils or what are known as flexipens which is the ink part of the pen covered in plastic (they don't work very well) and that is what you use to write with. Some places allow you to have your own personal pillow and blanket. Other places do not. Some places let you bring in coloring materials. Other places do not. Some places let you bring in your own toiletries including makeup. Some provide them (they are usually the cheap kind if they are provided). The hospital is who determines what you are allowed to have. Many times certain items require a doctor's note for you to have. For example, I wear wrist and ankle braces. For me to be able to wear them, I have to have a doctor's note from my assigned psychiatrist. If the doctor doesn't agree to write the note for them, then I don't get to have them and I suffer through excruciating pain. This has happened at many hospitals. One hospital I went to didn't allow you to have hard covered books or journals. Most that I have went to have allowed that. It varies by hospital policy.
        Once your personal belongings have been gone through and thoroughly searched, you are then usually brought to the room you are assigned to. This is another thing that varies by hospital. Some places you have your own room. Other places you have to share a room with someone. One hospital even had 3 people to a room. Bed quality is another thing that varies by hospital location. Some hospitals have hospital type beds that you can adjust up or down. Others have thin twin mattresses on a bed frame that's usually solid wood. The rooms usually have a place for you to store your clothing and personal items. Some places had a chest of drawers and then a nightstand. Others had a couple of shelves to put your things in. One place had each bed assigned to a wardrobe that had shelves in it but could be locked and you were given a key on a rubber band to use to lock and unlock the wardrobe. Some hospitals have a desk in the room, others don't. There aren't usually any useable electrical outlets (as people would try to use that to hurt themselves) and you aren't allowed anything with cords in the rooms. A couple hospitals I stayed in had adjustable heaters/coolers in the room that the patients could change the temperature as they wanted. Many did not. The beds are usually equipped with a set of hospital sheets (which are rarely comfortable) and then some sort of blanket or comforter. These can be thin in nature so many times patients required extras to stay warm during the night. The pillows were usually plastic on the outside for easy cleaning with a cheap pillowcase over it. The beds were rarely comfortable. The bathroom situation can also vary by hospital. One hospital I stayed at, 2 rooms shared a bathroom, meaning up to 4 people could be assigned to use a bathroom at one time. One hospital I was in had 2 showers and bathrooms for the whole unit to share. The bathroom was usually equipped with the basics of shower, sink and toilet. Most bathrooms had the handrails attached to the wall. However, unlike normal handrails which have a gap between the wall and the rail, these rails are covered on the bottom with a piece of metal, making it to where no one could use anything to try to hurt themselves. Some bathrooms had a door that you could shut. Others had just a curtain for the door. The showers also varied. One place had a shower that was a button. There was no temperature control and after a couple minutes, it would shut off and you would have to press the button again to get the water going again. Some showers didn't have a shower curtain and you just got extra towels to put on the floor when showering. Sometimes the bathrooms were really small and cramped and other times they had more room to move around. This is what the rooms were generally like.
      After putting your belongings in your room, you were usually let to roam around the unit a little. Each unit you were on depended on what it looked like. Some had group rooms on the units, some were off the unit. The day room or main area to congregate usually included a TV that played during certain times of the day. Sometimes patients were allowed to control the remote. Other times they weren't and staff controlled it. Usually there were tables and then chairs or couches to rest on. Day rooms also included phones. When using the phone in a psychiatric hospital, there were certain times you could use the phone throughout the day. If it was time for group, phones were shut off. Once a certain hour in the evening came, phones were shut off. When you did use the phone, your phone calls were supposed to be only ten minutes long and no more. Some places even limited you to a number of phone calls per shift. If the phones were on, friends and family could call you on that line but wouldn't always get through depending on if the phones were being used or not. It was definitely a difficult process only having limited phone time and thus limited contact with the outside world. One hospital I stayed in had pay phones on the unit and you could only make phone calls if you had the money to pay for them. Otherwise, you were given one phone call a week with your assigned social worker. It definitely made it difficult to keep any real connection with those on the outside during the time in the hospital. The other way you had contact with people from the outside world was through visitation. This also varied by the hospital. One hospital I was in had visitation every day (probably to make up for the pay phones) while others had it two to three times a week. The times are specific to the unit you are on and usually visitation lasted for an hour on those two to three days. Rules for visitation also vary by place and where visitation took place varied by hospital. Some hospitals had visitation on the unit (but not in patient rooms) while others had it in the cafeteria. Some allowed children to come visit with an adult, others wouldn't allow visitors under the age of 16. Visitors usually weren't allowed to bring their personal belongings like their cell phone or purse back so that they couldn't give anything to the patient that wasn't allowed (though we managed to sneak things in anyway). Visits are always supervised by staff, meaning there is usually a staff member in the room. The one major rule behind both phone calls and visitation was that if staff deemed them non-therapeutic, staff had the right to end them. I have seen this happen and had it happen to me.
       These are the basics of the admission process into a psychiatric hospital and some basics of the environment. Part 3 will go over what the daily schedule is like and the therapeutic aspect of it.

Friday, June 16, 2017

Before the Act

I have been pondering for a little while about what to post next here that others might find helpful and what might help others understand what goes through my head and why I do what I do.

One thing that so few people seem to be able to understand is why I attempt suicide. What goes through my head before I do it. What happens in the days, hours, minutes, seconds before I actually try. What thoughts do I have? What actions do I take? Why do I even get to that point in the first place?

Well I will first review some foundational information that I have covered in my previous blog posts. The first thing is that I am chronically suicidal. I feel hopeless on a daily basis. I am what is known as a high-risk patient to any psychiatric worker because of that. However, I cannot control that. I cannot control whether or not I have the thoughts.
The second thing is that I have BPD (Borderline Personality Disorder). While that is not an excuse, it is an explanation. It means I feel emotions much more intensely than the average person. Marsha Linehan, the creator of DBT, compared people with BPD to third degree burn victims. What would feel like a breeze of air passing by a normal person would be excruciating for a third degree burn victim. It's the same with emotions for people with BPD. A general letdown for someone can feel like the end of the world to someone with BPD. One rejection can feel like the ultimate rejection. It also means that happy things feel like top of the mountains and above.

Taking these two foundational principles into account, what leads me to attempt to end my life?

There are 2 types of attempts that occur: the planned and the impulsive.

For the planned one, the first step that leads me in that direction is a series of stressful events. Sometimes it can be a series of smaller stressful events or it can be one huge stressful event. Having BPD, I don't handle stress well. I feel stress a lot more intensely than most people do and that makes it even more difficult to handle even the smallest stressors. Once one stressor comes, everything after it seems even more stressful because by that point I am already in a vulnerable situation. For example, one morning my car doesn't start. This is the initial stressor. After that, I get a correction from my boss, I forget my lunch and then get into a small disagreement with my friend. This leads me to think (irrationally) that now I may lose my job and lose the friendship I have. All of these fears are intensified by the BPD and lead me to feel hopeless about the future. Then I feel hopeless about life in general. Other thoughts that can be included in this would be that I am a burden to other people and they would be better off without me, that I have no worth, and that this pain will never end. These are all distorted negative thoughts that I have when getting to the point that I am wanting to take my life. These thoughts, combined with the chronically suicidal thoughts, can lead to me deciding that I am going to try to take my life. Once I have made that decision, then the preparation for that comes. I usually try to figure out all the logistics. This includes when, where and what with. This is also the place where goodbye letters are written and last wishes are finalized. This is when the dangerous part comes in. If I get to this stage, this is where hospitalization would take place.

For the impulsive one, it is exactly that, impulsive. It means that there isn't much time between the thought of ending my life and the actual action. This is also something that is quite common as well. According to one study, anywhere from "one-third to 80% of all suicide attempts are impulsive acts" according to the New England Journal of Medicine. This type of suicide attempt is the most deadly and the hardest to help because it comes without warning. For me personally, it usually means an event has happened that upset me majorly and I don't feel like I can handle the pain that I am currently experiencing. It also usually indicates I have access to the means to attempt. This kind of attempt occurs quickly and without warning. I don't spend time thinking it over and I don't spend time preparing for it. I just act on the thoughts that I am having.

Usually when I attempt I tell someone or hint at it somewhere that I am going to do it. What this means is that I really don't want to die, but I just want people to understand how much suffering I am going through. It really is a cry for help and for someone to just notice what is going on with me and try to help me get help. This is also true for many other people. Many people who attempt suicide just want the pain to stop and just need help to get there. Many realize after the attempt that they didn't want to die, they just wanted help. That is what should be focused on.

What I am hoping to do with this post is help everyone realize that those who attempt suicide are not trying to be selfish in attempting. In their minds at that moment, they think they are helping the world and helping their family because they feel like such a burden to them that they would be better off without them. Their thinking is distorted by the pain they feel. People who attempt suicide need those around them to support them, to show them compassion, and to love them. Those things are what will make the difference in recovery.