Hi all!
I show very strong traits of a disorder I really hate in general as a diagnosis. At present due to certain family issues. Mental health services and hospitals in general have kinda steppes into that role by the behaviours I do. So I self harm for example and I get some form of care from hospital whether that be stitches etc. My question/issue is now I have recognised this how do I go about NOT have services fill in the gap as the... care givers??
I think there's a difference between legit needing medical attention and getting it, and like, steps to not do the thing in the first place to not need medical attention. I guess to me if you do something and need medical attention, that's kind of a required thing to get. So maybe I am unclear what you are asking?
Please do not give me virtual hugs unless you are only using the hug function on threads. Thanks.
You can't always keep it separate.
This is happening, this is part of you.
Do you mean that the acts of self harm etc are a way to gain ‘care’ from professionals? And that the care you receive then feeds into increasing the behaviours?
People self harm for many many different reasons and you certainly will not be alone in doing that if that is the case. In fact I think that would be a very insightful recognition. Just trying to make sure I understand correctly though before replying x
Kinda. Almost like... I know if I sh badly I will go get medical attention. But I also know i will get care there too. And I guess it's the care thing that is... annoying me in a way? That I almost have to go to such lengths to get care. If that makes sense?
Do you mean that the acts of self harm etc are a way to gain ‘care’ from professionals? And that the care you receive then feeds into increasing the behaviours?
People self harm for many many different reasons and you certainly will not be alone in doing that if that is the case. In fact I think that would be a very insightful recognition. Just trying to make sure I understand correctly though before replying x
YES!!!
It was only actually pointed out by my nurse when I was under HBT and I guess it's stuck with me.
I don't know if this is useful but what helped me stop that cycle was realizing that by doing that, I was getting care for the wrong thing - i.e. the physical things, and it wasn't actually changing anything inside my head. Because then when I saw anyone outpatient they were also focused on the physical things and behaviors, and nobody actually was willing to help deal with what was causing the behaviors in the first place. So for me what helped was first being aware of that, and second making sure I found providers who were willing to look past the behaviors if or when they occurred, and essentially ignore them. That in turn made them occur less often. It is unfortunately a bit of a loop that can be really hard to break.
I think with something like DBT there's actually a thing where you're supposed to have zero contact with providers for a set time period after doing anything for similar reason. You might look up that type of information and see the reasoning and/or skills they recommend using?
Please do not give me virtual hugs unless you are only using the hug function on threads. Thanks.
You can't always keep it separate.
This is happening, this is part of you.
I imagine that might have led to some really mixed feelings for you. Have you discussed it with them since?
I think it’s really important to acknowledge that you are not alone in reacting like this, and also that it serves a purpose for you and is a way of communicating maybe. Is it the healthiest way? No. But it is a way that you’ve found to get your needs met. I suppose the ‘answer’ is kind of two fold. First of all, whilst nobody wants you to be self harming in order to get that care, it is ok to be really worried about how you will manage without it. And just because we are aware of difficulties we have, doesn’t mean we suddenly know how to resolve them. So I just want to acknowledge that it’s ok to be anxious or any kind of emotion really.
I know DBT will suggest self soothe etc and whilst I certainly think that is very important, I know sometimes it’s not enough. I think it might be helpful to have a meeting with your new CPN and the crisis team and also a non service person so you can devise a plan together. Perhaps something like when you self harm either via cutting yourself or overdosing, that visits are not increased etc. Camden is right that in dbt often there is a cool off period following self harm in order to avoid reinforcing the self harm by providing a care role attached to it. I think it would be worth discussing with them other ways you can communicate that you are reaching breaking point and also them agreeing how they will respond if you do that. I think it’s a massive flaw in services that risky actions often prompt a response and that’s a general flaw, nothing to do with you personally. Having a friend or other people who can support you and who is aware of the plan might be really helpful. I know you have a friend who you’ve stayed with etc but maybe having everyone ‘singing off the same sheet’ might be helpful?
The other thing that can be helpful is doing chain analysis. I’m not sure if you are aware of these. Your CPN will hopefully be trained in SCM and that can also be a really helpful way of professionals supporting people with your kind of difficulties. Maybe it’s worth asking CPN about it?
Lauren, I saw you overdosed last night. Have you spoken to them about the reasons way etc? I note you were saying you didn’t want to die but also we’re trying to leave- is that linked to what this thread is about do you think?
I don't know emma.
Possibly... I don't like when people control me or put things/ boundaries in place. I still don't want the treatment Emma but they won't let me leave!!! I told them it was self harm.
I suppose, when you’re trying to leave against medical advice (which I totally get cos I have a bit of a freak out when I feel out of control) and also saying that you don’t want to die. Then saying you’ll stay, before removing the IV and trying to leave etc etc, and it’s repeated ods etc, some general health care staff won’t feel comfortable and will deem you to be a risk to yourself and want an assessment with someone more experienced. For example, capacity is, as you know, a changeable area. If you are saying you don’t want to die but you want to leave, that could cause them to question whether you understand the potential implications of leaving, and in turn could cause them to feel risk and uncertainty re capacity warrants that further assessment, using legislation such as the MCA le MHA if necessary. That process is not always quick though (although with MHA obviously has time requirements), which is one of the reasons they want you to finish treatment. Your overall risk might not be high to warrant compulsory admission, but the risk you pose on the moments when you’re trying to leave etc is high enough for them to hold you if they doubt your capacity or believe you are such a high risk to yourself. The interaction between risk and capacity is incredibly complicated (just starting a BIA course alongside so it’s hot in my mind atm).
When you’re treated for an OD though, you can request to see psych liaison who can talk to you and also put across your point of view and help general staff understand where you’re coming from. Perhaps that’s something to consider, should this happen again?
I have never actually thought of getting a and e psych to speak to the general nursing team.. Good point!!
But as I told them! I knew the risks and I have capacity. No follow up plan. They have emailed my cpn who is on leave regarding dbt.
My parents where over protective with me as a child and teen. Like seriously OTT. So any boundaries that are put in place like been told I can't leave for example. I rebel as I feel they don't trust me, don't feel understood and want my independence
That might be something to speak to your CPN about when they’re back so they can put it on shared care and general nursing staff are aware of your feelings. I mean, there is still a good chance they will respond similarly but at least then it can be an open discussion without you having to bring it up.
Now you’ve had the parvlex, how do you feel?
Also- maybe think about how you can explain to them that you understand the risks in a way that explains the disparity between what you’re saying and doing (like trying to leave but also saying you don’t want to die). If you can explain how that works, that might also help general practitioners understand and might be something to consider putting in the plan with your CC as well
When is CC back? I’m glad they’re going to ask re DBT.
I don’t know exactly what area of MH you work in, but what would be your employers protocol for managing someone in your care who has OD’d and trying to leave against medical advice?
Tbh Emma. I'm annoyed. Annoyed I had to have it and annoyed as I want to do it again. Cc back Monday I think.
It would depend whether the patient was on a section or not. If so, but they have capacity they can refuse. If they don't have capacity then they can't.
If there informal it's there choice basically.
Someone can be sectioned and have capacity, like you said. But equally, NOT being sectioned doesn’t mean a patient has capacity. Being able to recite the basic principles of capacity under the MCA does not mean a person necessarily has capacity. Even in these two threads you’ve switched what you’re saying re dying. On one hand you said you don’t want to die, then on another you said you don’t care if you have liver damage. Feeing intense emotions of any kind can influence anybody’s capacity but it doesn’t mean they have a mental health disorder of the severity etc that requires compulsory psych admission.
Sounds like it is really kind of conflicting and shitty in your head and thoughts right now. But can you also see why maybe staff aren’t confident enough that you do understand and can weigh up and retain that information and so sought (or seek) to get a more specialised assessment?
Re tonight and you going to a&e again....I’m glad you’ve gone before harming yourself. What do you think they might be able to help with? Now you’re there, I presume you will stay to see psych?
That second paragraph does make sense actually Emma. I can see why they would want to seek more advice.. Yes I did stay and see pysch. I wasn't actually sure in terms of how they could help... it was more a place of safety
