After spending so many years on the online ‘recovery community’ I’ve learned two pretty big things:
- Inpatient treatment is often seen as a guaranteed Cure
- It isn’t- your attitude is
I remember at 17 being told I had a choice between switching from my Tier 3 CAMHS team to Tier 4- or ‘Intensive Treatment’, or an admission to an adult ward. Obviously. I ‘chose’ the former. But a few months down the line, when I still hadn’t made any sort of therapeutic relationship with my team, I asked to be moved back to Tier 3. A professionals meeting decided that that would not be Appropriate, so out of desperation? Frustration? I asked if I could take up the earlier ‘offer’ and be admitted. My new team backtracked quickly- part of the reason I’d been struggling so much to engage with them was that I’d felt forced into the transfer, with the threat of a psychiatric hospital admission at the back of my head. I got on well with both my Tier 3 psychiatrist and therapist, and after two months with the therapist was beginning to feel I could open up to her. And hospital admission was incomprehensible, a huge No Fucking Way. It scared me shitless. So I ‘agreed’ to move teams, feeling it had been forced rather than the ‘choice’ they presented it as. So when session after session, I sat in tears, staring at the ground, saying nothing, my nurse sitting with her hands folded in stony silence, I’d leave feeling worse, and session after session with my psychiatrist who used 30 words (mostly jargon) to explain what could be said in 5, left me feeling misunderstood, my concerns about the lack of a therapeutic relationship with my nurse ignored, I began to feel hospital might really be my Last Chance- nothing else seemed to be working. My team were quick to dismiss those thoughts, warned me that hospital was not a magic cure, would not offer me the salvation I desperately craved. They were right, in a way.
I know that once you continue to descend into the depths of the rabbit hole that admission ceases to become a Fear, the Ultimate Threat, that in a sick, twisted way, the idea of it begins to seem preferable- comforting, even. When you’re mood slumps to rock bottom or your behaviours become unmanageable and hanging on to any semblance of the life you once lead becomes truly exhausting and your hear your parents having heated arguments about What To Do with you, and scream at you to stop being so bloody selfish, we begin to romanticise the idea of being whisked away in the back of an ambulance, crawling into perfectly made beds and having a team of nurses pander to your every need in a place that is safe and quiet and not the Real World. So it’s easy to do.
But it’s fucking dangerous. Like, really dangerous. It’s easy on some level to see inpatient as something to strive towards, whether consciously or unconsciously. On intsagram people rush home from general hospital and are quick to justify why they’re at home and not in a mental health unit ‘there were no beds so I couldn’t be admitted’, ‘the doctors decided being kept in hospital would make me more distressed’, ‘they were going to admit me but I talked them out of it’. And once you get into the mindset of feeling like you want to be in hospital, you can start to become increasingly frustrated with your ‘lack of treatment’, the ‘uselessness’ of your team; your ears begin to prick at the slightest mention of the H word or the A word, and each time you’re sent home, there’s a good chance you’ll feel triggered into engaging in behaviours. Or, at least, that’s what it was like for me at 17, 18.
But inpatient won’t be your saving grace- not without the right attitude. In fact, nothing will be your saving grace without the right attitude. By the time of my first admission, my fascination with the idea of hospital had melted away, and instead when I was told I wouldn’t be going home after a meeting with the duty officer, I was adamant I had no reason to be admitted at all. I hid blades and paracetamol in my suitcase when I went home to pack, which on reflection, is indication enough that I did need to be in hospital, but alas, at the time I staunchly believed that this whole thing was a waste of time, that I would arrive at the ward and be promptly sent home once the doctors realised I was just fine. My attitude sucked from the get go.
I spent the first few weeks of my admission pissing around. Giving in to my urges to swallow all the pills, slam my head against the concrete wall, self harm, stay in bed all day, or, when I did emerge from under the covers, I would sit on the sofa in silence, ignoring the staff and the other patients. I didn’t speak to staff when I was struggling, instead would steal mugs from the dining room when staff had their backs turned, sit in the dark in the day room and write, or lock myself in the bathroom and cut, staring my favourite nurse dead in the eye and telling her I’d flushed my blades (she didn’t believe me, asked the doctor to leave my curtained cubicle and demanded I take them out from where I’d hidden them (my bra)). Once, I swore at my psych, stormed out of ward round and lept over a fence. Nothing too drastic, but definitely out of character. Definitely showing I had no intention of working with them or of using the place to help myself.
I refused to engage, and predictably, got nowhere. The night of the escape brought about a change: the consultant said if I refused to work with them, I would be discharged. In the days that followed, one by one the nurses told me of his other option, which was a PICU admission. Aware now, that I was at risk of both wasting an opportunity and a lengthier, more distressing admission, I started to work with staff. I attended groups and occupational therapy, shared my writing with the nurses when I couldn’t get the words out, spoke to them when I was struggling, pushed myself to try home leave when the nurses assured me I didn’t have to if I didn’t feel ready for it, insisting that I wanted to try anyway. I became open to the idea of hospital, began to accept why I was there, wrote out a list of things that I’d learned in during my admission under a nurse’s direction, and realised that those things were Important, that they were the foundations to a true recovery. I became more willing to challenge the ambivalence that I’d been harbouring for years; hospital was a bit of a wake up call, and once I accepted that and stopped burying my head in the sand and refusing to take some responsibility, I began to get more out of it, and in the 18 months that have followed that first admission, I’ve made more progress in ‘recovery’ than I did in the 4.5 years I’d been receiving treatment previously.
Since blogging on instagram, I’ve come across dozens of people who seem stuck in the trap of quasi recovery; believing they can’t get better without being in hospital, believing they can’t get better because their team is rubbish, believing they aren’t ‘sick enough’ to recover, perhaps, on some level hoping that if they hold out long enough, admission will happen and all these things holding them back will untangle themselves and they will emerge Recovered. All of those, of course, are valid thoughts and feelings that often are part and parcel of these illnesses themselves. Recently I’ve seen someone gush about being admitted to the Priory, about how now they knew they would be receiving the ‘best’ treatment…yet from their posts, this person seems quick to assign blame to anyone and anything for the fact they are still struggling. I’ve seen outpatients insist that inpatient is their only option, despite skipping appointments or having tried only one form of treatment. I’ve witnessed people being admitted with expectations that hospital will Fix them, Cure them, insisting this is what they Need, and then struggling to comply with meal plans or care plans. I’ve seen inpatients almost boasting about the incidents they’ve had, then act outraged when they are discharged or sent to PIC, and I’ve seen people discharged in much the same state they were when they were admitted and insisting that the hospital was ‘shit’.
And I’m not for a second doubting that private treatment can be better than NHS treatment, or that our illnesses make us refuse to believe we are ill in the first place and make it easier to listen to the voice in our head, or that when motivation is low it is hard to make appointments and that accessing treatment is more than a challenge with NHS waiting times and poor MH services in general, or that being in hospital will not suddenly stop us from using behaviours or mean we can follow our care plans, or that sometimes, inpatient experiences can be really fucking shit- with overworked staff, busy, unsettled words and nothing to do. Because all those things are huge, huge issues.
I just think that sometimes, sometimes we forget that to get somewhere, you’ve got to stick with it, challenge your thoughts, push yourself to do the things you are afraid of or address the thoughts that are holding you back. Because you cannot change what you refuse to confront, and when you are ill and your thoughts are slow and dark and everything is hopeless and overwhelming, confronting anything feels beyond impossible. But if I’ve learned anything over the years it’s that:
- Nothing will change if you are not open to the idea of change
- Nothing will change if you don’t engage with the help you have
- Hospital isn’t a magic cure, and nothing will change if you don’t use its resources
- Accepting responsibility is very important- you cannot help the fact that you are ill, but the same way that you will not recover from a broken leg if you do not wear a cast, or lower your blood pressure if you don’t change your diet or take your tablets, you will not recover from a mental illness if you do not accept that overcoming it is YOUR responsibility
- Blaming other people will get you nowhere- you can say til you’re blue in the face that it is someone else’s fault that you self harmed, tell people that if you kill yourself it will be there fault for saying/doing X, Y or Z, say you would have eaten your meal plan if it weren’t for X, Y, Z happening, blame your lack of progress on a useless team/lack of help, but YOU are the one that ‘chooses’ (I use that word lightly, self harm etc doesn’t ever feel like a choice and more often feels like the ‘only’ solution) to self harm, or restrict your eating or attempt to take your life or decides to engage with therapy no matter how useless you think your team are
- You can’t help being triggered, but you are in charge of how you respond to triggers
- You can have all the help in the world- be in the best hospital, with the best doctors, with the most intensive treatment, and you will still not recover if don’t put everything into it. Hell, you can make progress on your own if you have the right attitude!
- Inpatient or outpatient help will only work if you let it
For years, I went round in circles, insisting that I was ‘trying’- I was going to appointments, talking in therapy, trying not to self harm, but looking back I can see that it was half-hearted. I wasn’t completely sold on the idea of recovery, it involved too much work, would mean letting go of all the behaviours that I had been using for years, would involve addressing thoughts and feelings I was working so hard to avoid. Often, it is easier to let the waves swallow you up instead of swimming against them, to allow yourself to fall further into the rabbit hole instead of having to climb your way back up, it is easier, to blame others for your lack of progress than to admit that actually, you are not doing Everything you can to get better…you are not taking your meds as prescribed, or self soothing or going for walks or getting out of bed, or talking about the things you should be talking about in therapy, or really trying to stop self harming if you are still purging/drinking/headbanging on the side. For years I apologised to those around me, as if that would make up for the fact I was destroying myself, until one nurse gently said ‘there’s not need to apologise to me, the only person you’re hurting is yourself.’ Which I guess hit home. I could continue to bury my head in the sand, insist my quasi recovery was the real thing, throw my hands in the air each time I self harmed or spent days in bed and say in mock surprise ‘how did that happen again?’, but the only person I was kidding, the only person who was losing out, was me.
And so things had to change. It was time to take charge, to begin to try to control my illness, instead of the other way around. Sure, inpatient helped me, but only because after weeks of fighting it, I decided to allow it to.
(And I don’t mean to sound preachy, I really don’t, but I know these things because I’ve been there.)