Earlier this year I found myself in A&E, knowing something wasn’t quite right. I had hardly slept the week before, and was so delusional I reduced my best friend to tears when she insisted I get medical assistance. So I found myself sat between two women, one about to throw up, the other patiently reading with her leg stretched out in front of her. I spoke to the latter, who turned out to be Donna Freed of Radio Gorgeous. She kept me sane with her kind, open face framed by grey curls and her soothing New York accent.
After a few hours and consultations with nurses it turns out I had slung myself into a manic psychosis with a concoction of no sleep, no appetite, black coffee, Co-codamol (a strong painkiller), alcohol and a few puffs of marijuana. The psychiatric liaison nurse I found in the bowels of A&E was a supple, smiling, delicately built angel who coincidentally shared my Zimbabwean Shona name, Nyasha (meaning mercy, grace). She took me to a dark, quiet room and listened to me for almost two hours whilst I explained the life journey I had travelled that had resulted in me being there. She patiently took notes and kindly explained that I was on a high I had to come down off, as my mind was whirring so fast my mouth couldn’t keep up. I was spewing gibberish and going off on tangents I never came back from. She insisted on sending me home with a potent sleeping pill rather than sectioning me, and referred me to the SLAM (South London and Maudsley) Home Treatment Team. Months later, after responding to a request for feedback, we started exchanging emails. What follows is my response to her questions.
What worked for you and what did not?
The infrastructure of the NHS regarding a mental health crisis funnels you through A&E, the Home Treatment Team and then finally the CMHT (Community Mental Health Team). As I have been diagnosed with Bipolar Affective Disorder I will then be transferred to something called Optima, which is a bipolar-specific support framework. Treating and monitoring patients at home is a great initiative as it saves the often-traumatic experience of being on a psychiatric ward. The nurses who come to your house daily are most helpful to talk to and are knowledgeable and sensitive to medication side effects, as well as supportive of emotional wellbeing. Speaking from personal experience, although I appreciate the roles of the different teams (including my GP as a fourth party), I found the communication between professionals, particularly on behalf of the multiple psychiatrists in charge of my care, patchy at best. As mental health is not an exact science when it comes to treatment, multiple practitioners naturally have differing opinions on what course of action to take when it comes to medication. Unfortunately for the patient, this means being on the receiving end of conflicting information, including the often-traumatic side effects that come with chopping and changing the prescription of pharmaceutical drugs. That said, the response to feedback in this regard was taken most seriously. As everyone responds differently to doses and combinations of meds, it is understandable that it is a somewhat hit-and-miss or trial-and-error endeavour. However, I did feel that communication of this was mediocre and the transparency of decision-making opaque, which was consequently detrimental to the healing process. Another framework that is essential in this regard is that of close friends and family. How to help someone in a mental health crisis? Simply being there can be enough. The saying “we have one mouth and two ears” comes to mind, as in this case advice, of which there is plenty in the medical sphere, is sometimes unhelpful. Listening and heeding to accounts of the rollercoaster ride that is the road to recovery is often not only sufficient but refreshing and most welcome. I can only thank those close to me for remaining close, and be grateful for their unwavering support.
What do you wish could be done better?
First and foremost the psychiatric support needs to improve. I had no therapy whilst being weaned onto the mood stabiliser Lamotrigine, whereas it would have been most helpful to talk to a professional regularly about the side effects I experienced. Unlike in private hospitals, the NHS does not offer any therapy until it reaches the end of the line of support it provides. I am still waiting on a course of CBT (Cognitive Behavioural Therapy) even though it has been over five months since my first trip to A&E. In my opinion and experience, therapy is a vital support to the taking of pharmaceutical drugs. Secondly, there should be a better filter as to who works in this line of care. With each team I encountered a so-called professional whose ability to offer support was insufficient. For example, my first CMHT care coordinator refused to listen to me when I said I was noticing the triggers of rapidly descending into a depression, and instead rather patronisingly stated that it was all in my head and we had to instead focus on my care plan. Furthermore, a couple of nurses who visited me under the HTT were not fit for the job. My time spent with them was a waste and completely unhelpful. Finally, the psychiatrist I was under at The Priory (a private hospital the NHS sent me to as there were no beds available in the Trust) had previously been filed for abuse of his staff. My father discovered this through a simple Google search when we were deciding whether or not to continue under his care after I was released from hospital. People like this should be banned from practicing. That said, the level of care I received from those who were excellent at their job was unbelievable and most humbling.
How did you find resolution?
The first personal barrier to coming to grips with a mental health condition is accepting that it is of no fault of your own that it has manifested itself in the intimacy of your head. Often there is a hereditary disposition, and triggers are more often than not unavoidable. After all, it is simply an unbalance of the chemistry in your brain. With Bipolar Affective Disorder the highs and the lows are more extreme than they are in people without the condition, and it is common to get stuck on either end for extended periods of time. Learning to live with these swings, and appreciating the unique qualities brought about by them, is the first step to resolution. For example, being sensitive directly results in me being a highly intelligent and creative being. I am also empathetic with an attention to detail that allows me to really feel emotions, whether my own or those of others. It is in these periods of crisis when you learn who your true friends are, and it can make you grow closer to them as well as forming more intimate bonds with your family. I must say I still feel like I am on the path to resolution rather than it being a final destination, as each swing is different and requires relevant attention. As life is a journey, one can only learn to live with and love oneself.
What are your day-to-day struggles?
I never know how I’m going to wake up. Generally speaking days are either good or bad, in the true black-and-white polarity that is characteristic of bipolar. That said, a day could improve, and equally could get worse. It is this instability and unpredictability that is a real struggle. The highs are obviously more fun than the lows. When I was at my most elated I felt invincible. It was really difficult to accept that this was not a place that was healthy to be in for any extended amount of time, as the lack of fear and misanalysis of risk results in bad, often dangerous decisions. Another struggle comes in the form of self-doubt. It is difficult to live with oneself on a day-to-day basis when reactions to mood swings can prove you are your own worst enemy. However, I am slowly but surely learning to be sensitive to my own needs and to take care of myself when I start to swing in either direction. Finally, one of the biggest barriers to living with a mental health condition is the secrecy and shame that comes with it. You feel judged by others, and more often than not see it as a sense of personal failure. Things are slowly changing as more and more people are speaking up about their experiences, and I can only hope that the wider community will prove a sense of support rather than attack when it comes to helping those with – let’s face it – really common mental health concerns.