Tag Archives: Psychiatric Hospital

I’m Officially Home!: The Road to My Discharge from the Mental Institution

It’s official: I am home. Yesterday was my formal discharge date from the institution. It would’ve been May 1, but got delayed one week because I needed mroe time to make arrangements for my after care. Today, I’ll share my journey to getting the care I need and living in the house I want to live in with the man I want to live with.

Like I said, my original discharge date was May 1. However, a week before that, nothing had been arranged in the way of after care yet. I’d have my first appointment with a psychiatrist from the community treatment team that Friday, April 28. That was all my psychologist said she was required to do in terms of making sure I am in care once discharged. Apparently, she and the social worker had deliberately handed me the responsibility of making sure I’d have day activities and home support, only without telling me I had been handed that responsibility. I didn’t find out about this till April 26, when I had my “exit meeting”, as my psychologist called it. Call me a cynic, but I immediately thought of the Swiss end-of-life clinic by the name of Exit.

After my “etit meeting”, I was very much in distress. I called the patient advocacy person, but she couldn’t do anything for me, as I’d be in the community team’s hands. I called my husband, who was on the road. Desperate, I called my mother-in-law. She asked for my psychologist’s number and somehow convinced her to give me that extra week. It was suggested to me that all it’d take to make sure I’d have day activities was a phone call to the day activity place manager, who was on vacation during the last week of April and would be back May 2. It wasn’t exactly that simple, but in the end it was close to that simple indeed.

On April 28, I had my intake interview with the community treatment team psychiatrist and nurse practitioner. They were much more supportive than anyone in the institution had ever appeared to be upon first meeting them. I suspect this psychiatrist has never worked for a long-term care unit, as she was surprised I didn’t get any therapy there other than day activities. “But it’s a psychiatric hospital,” she said. There she nailed the reason I’ve called it an institution for years: there is very little in the way of actual psychiatric treatment. In fact, a student nurse at one point referred to clozapine, the last-resort antipsychotic the majority of the patients on my unit take, as palliative care. I know for some people it’s a miracle drug, but for many on my unit, all it did was keep them just about stable enough that they could handle an unlocked door.

Like I said, my meeting with the community psychiatrist and nurse practitioner went well. We discussed my syptoms and needs. They would be contacting the home support team, which is with the mental health agency, on my behalf. If no day activities had been arranged by May 12, when I’d have my next appointment, they would also work their arses off to get me day activities.

Last Thursday, May 4, I had appointments at two day activity places. One is for traumatic or acquired brain injury survivors, while the other is for people with an intellectual disability. I had my doubts regarding the first one, which I’d visited in August of last year. This was only confirmed when I went back for an intake interview. It was all very formal. Though this could’ve been because I had already visited the place, it made me feel a little unwelcome. When I disclosed I was also going to look at the other place, the staff at the first place said this might be more suitable indeed. I’d still be welcome at the brain injury place. However, I felt there was too little I could do independently enough there.

I had a taxi drive me to the other day activity place. When I opened the door, some clients welcomed me. They found a staff member, who seated me in a spare room and poured me a cup of coffee while I was waiting for the head staffer to come see me. I talked to him and to one of the staff at the group I’d be placed in. The “orange group” is a group of relatively capable intellectually disabled people who do simple manual labor tasks like packaging, sorting etc. Fortunately, there is no pressure to be quick or do it perfectly. I was a little worried the tasks would be incredibly boring and too difficult at the same time, but I realized it’d either be this or no day activities. Besides, the staff and other clients were very enthusaistic and welcoming. It looked like I might actually have day activities right after my discharge.

Yesterday, however, I had a meeting with the social consultant in charge of my case. The day activity place had already made all arrangements so that I could start “working” there and in fact, yesterday morning I was awoken by the taxi driver ready to drive me there. I had clrearly told the day activity staff that I’d first meet with the social consultant and start “working” on Tuesday, not Monday. For a bit, as I met with the social consultant, it seemed as though it’d all been one big mistake and I wouldn’t be able to start day activities today. However, late in the evening, I received an E-mail from her saying she had pre-approved me for day activities and I could in fact start “working” today.

Diagnonsense, Oh Diagnonsense!

A few months ago, I wrote about my changing diagnosis. My autism diagnosis that’s been confirmed three times since 2007, was removed. That left me with just borderline personality disorder (BPD) as a diagnosis. If you thought I gracefully accepted this, you do not know me. I consulted with the patient liaison person at my institution, who recommended I seek a second opinion at another hospital. Now, three months on and we’re back at square one, and it’s not because an independent provider agreed with my psychologist.

On August 15, I talked to the patient liaison person, who on that same day E-mailed my psychologist asking her to make the necessary arrangements for me to get a second opinion. Instead, my psychologist told me she wanted to contact a psychiatrist at the brain injury unit first to inquire about the diagnosis of autism in people with brain injury. This doctor told her that indeed autism shouldn’t be diagnosed in people with brain injury, but the same is true of BPD. My psychologist would need to diagnose personality change due to a general medical conditon instead. I stupidly agreed with her changing my diagnosis herself rather than sending me to an independent psychiatrist or clinical psychologist.

My psychiatrist, who is the head clinician responsible for my care, however, disagreed with my psychologist’s diagnosis. My named nurse said they were throwing around all sorts of diagnoses at my treatment plan meeting last month. Eventually, my psychologist informed me they’d settled on dependent personality disorder, borderline personality disorder traits and a developmental disorder NOS. I hate the DPD label, but can see how I might have some of its features. I needed to see my treatment plan to see what they’d meant with developmental disorder NOS, which isn’t a diagnostic code in DSM-IV unless prefixed by “pervasive”. That would essentially mean autism. As it turned out, they hadn’t settled on this diagnosis, as the developmental disorder was gone.

Instead, I now have DPD, BPD traits and depressive disorder NOS. I asked my psychologist whether this was a coding typeo, but it wasn’t. Her explanation was that I may formally meet the criteria for this, but the main reason for the diagnosis is for insurance purposes. You see, I can’t be in the mental hospital without a diagnosis on axis I (anything that isn’t a personality disorder). A nurse even twisted my psychologist’s actions like she’d done me a favor.

Last week, when I found out my final diagnosis, I lost it pretty much and was considering checking myself out of the institution. My psychologist was called, because the nurses thought I said I was definitely leaving, which I can’t remember having said. My psychologist encouraged me to leave right then, which I refused. My husband instead came to pick me up thee nxt day for a night at home to have some distance.

Today, I spoke to the patient liaison person again. She was not happy at the fact that my psychologist had failed to cooperate with me in getting me a second opinion. This essentially means we’re back at where we started and I’m probably going to ask my psychologist to get me a second opinion again soon.

R – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, day 18. Today’s letter is R. Enjoy.

Recovery

Recovery is the patient-led process of learning to live a fulfilling life with or beyond one’s mental illness. It may mean overcoming one’s mental health problems, but recovery is also for people with lifelong mental illness. It is related to rehabilitation, which I’ll discuss below, but recovery is led by patients.

Like I said when discussing experience and jobs, I have participated in a recovery group. In these groups, people discuss different topics related to getting their lives on track. For example, we discuss sources of support, pitfalls in our recovery, our relation with our treatment providers, etc.

Rehabilitation

Rehablitation is the staff-led process of helping patients live a meaningful life with or beyond their mental illness. Rehabilitation has the patients’ wishes in mind but still is led by staff. It is a common belief, and I’m not entirely sure whether this is correct or not, tht rehabilitation is linked to resocialization, which I’ll discuss hereafter. As such, a patient’s wishes might only be the focus of staff support if they flow towards independence.

Resocialization

Resocialization is the process of going back to a less restrictive treatment setting or back into the community after institutional treatment. It may also refer to independence-focused training in general. Resocialization units in psychiatric hospitals usually allow patients to stay there for a specific time period, usually two years. Rehabilitation units in long-term care may be focused on further independence too, but they have more flexible guidelines on how long a person can stay there.

Restraint

Restraint is the physical, mechanical or chemical restriction of a person’s movement. Holding someone down or tying someone onto a bed are often recognized as restraint, but giving a person a high dose of an antipsychotic or benzodiazepine to tranquilize them is a form of restraint too. Restraint, like seclusion, can only be used to avert the patient being a danger to themself or others. In the Netherlands, mechanical restriants are hardly ever used in psychiatric hospitals. They were up till recently commonly used in nursing homes on patients with dementia who run a risk of falling, but I believe regulations have changed on this. Chemical restraints are still used, though not as often here as in other countries.

Q – #AtoZChallenge on Mental Health

Welcome to the letter Q post in the #AtoZChallenge on mental health. This letter was hard at first, but I still came up with a few words. Here goes.

Quality of Care

Quality of care is important mainly to health insurers. That is, it’s not necessarily the real quality of care that’s importnat but how it’s documented in paperwork. As such, we often get patient satisfaction questionnaires. I think they’re worthless. So is the endless stream of paperwork staff have to complete to justify the care they provide. After all, the more staff have to deal with paperwork and patient satisfaction questionnaires, the less they can actually do the real work of care.

Quality of Life

Another loaded term which is used to assess people’s satisfaction with their lives. We get this scale called the Manchester Short Assessment of Qualty of Life questionnaire four times a year. I laugh at the randomness of questions. Like, inbetween questios about your satisfaction with friendships, your financial situation and such is the question whether you’ve been accused of a crime within the past year.

Seriously though, quality of life assessments have real impact on care and policies. For example, if a lot of people treated in a certain way for a certain condition have a very poor quality of life post-treatment, this treatment is unlikely to be used often in the future.

Quiet Room

The “quiet room” or “time-out” is an euphemism for seclusion or the isolation room. Many survivors of forced psychiatric treatment report very traumatic experiences with the “quiet room”. Others find it helpful when they’re severely disturbed, because they can scream there. I have mixed experiences. When I was still on a locked unit, it was often used as a threat to “give me back my responsibility for my behavior”. Seclusion cannot legally be used in this way in the Netherlands; its only purpose can be to avert danger. Now that I’m on an open unit, however, I find sometimes when I’m in crisis that it helps to have me in seclusion for a while.

P – #AtoZChallenge on Mental Health

Welcome to day 16 in the #AtoZChallenge on mental health. Todays’letter is P. There ae many obvious mental health terms starting with P, but also some you may not know.

Privileges

Privileges are what freedom of independence and movement someone has while in the mental hospital. In Believarexic, the book by J.J. Johnson I read a few months ago, the main character rightfully says that what are called privileges in the mental hospital are basic rights in the real world. For example, every adut in the real world is allowed to shower independently, whereas some people in mental hospitals need to do such basic tasks under staff supervision.

Of course, restrictions to someone’s freedom even in the mental hospital need to be motivated. If a person isn’t a danger to themself or others, they should really be allowed to go wherever they want unless this is a hindrance to their treatment. What I mean by this is of course even a person with full privileges should show up for their treatment appointments. Usually, even people with full privileges need to ask for permission from their clinician to leave the hospital overnight.

Psychiatrist

A psychiatrist is a medical doctor specializing in mental illnesses. NOwadays, they’re commonly seen as human pill dispensers, because prescribing medication is their primary task. However, in the Netherlands every psychiatrist is also a qualified psychotherapist. A psychiatrist is usualy a person’s head clinician. Head clinicians are the only ones who can open diagnosis-treatment combinations in the Netherlands. Diagnosis-treatment combination is insurance lingo for the patient’s diagnosis and the treatment that is suited to that diagnosis according to protocols. As such, a head clinician is the only one who can change a patient’s formal diagnosis. By the way, clinical psychologists and psychotherapists can also be head clinicians.

Psychologist

Psychologists do most of the talk therapy part of mental health treatment. There are three levels of psychologists employed by mental health agencies in the Netherlands. Basic psychologists are fresh out of college with a Master’s degree in psychology. We have a basic psychologist employed at my unit but I’m clueless as to what his duties are. Anyone can call themself a psychologist. Then there is the health care psychologist, which is in fact a protected title. Only someone who has completed two years of additional trainign after college and is licensed can call themself a health care psychologist. This is the most common type of psychologists employed by mental health agencies. They can do basic psychotherapy but cannot be head clinicians. Last are cliniical psychologists, who’ve got two more years of specialized training and many also have a Ph.D. These people can be head clinicians and do more specialized psychotherapy too. Clinical psychologists are often assigned to the more complex cases. My unit currently does not employ a clinical psychologist.

Psychotherapy

There are many forms of psychotherapy, both individual and in a group. Psychotherapy usually employs talking to help the patient recover, though some psychotherapies are partly non-verbal too. In many countries, the term psychotherapist can be used by anyone who so desires. Not so in the Netheraldns: psychotherapists are psychologists who’ve had I believe it’s four years of training in psychotherapy techniques. They are bound by the same laws as doctors and health care and clinical psychologists. A psychiatrist is registered separately as a physician and as a psychotherapist. As such, they can lose one license but keep the other. I once read about a psychiatrist who mostly practised psychotherapy and due to abuse of power lost his license, but only his physician license at first.

O – #AtoZChallenge on Mental Health

Welcome to the letter O post in the #AtoZChallenge on mental health. Here goes.

Observation

Observation is an essential part of a patient’s care in a mental hospital. In other countries, I’ve heard staff are supposed to check on patients every fifteen minutes or so. Not here. In the Netherlands, if a patient is in their room all day – and yes, most mental hospitals allow this -, no-one cares whether they’re in bed or engaged in some type of activity. Even if patients are in the day room, nurses are more often than not in the office doing their business. As such, I have experienced that nurses “observe” that I had a good day while I was in bed feeling too low to get out all day. Then of course when patients are acting out, nurses have to intervene and “observe” the patients’ misbehavior. This is a pretty sad reality.

One-on-One

One-on-one care is where a staff member is assigned to just one patient who needs a lot of care. This is sometimes also called hand-in-hand care. Few mental health units in the Netherlands offer true one-on-one care even to the sickest of patients. Usually, when a patient needs one-on-one support, they are in a seclusion room most of the time and are allowed out to get their one-on-one attention. I’ve heard about real one-on-one care in other countries. Wonder how they fund it.

Outpatient Treatment

Outpatient treatment is often defined as treatment for which the patient has to come to the mental hospital at fixed times during the week or month. However, home treatment, where the mental health provider comes to the patient’s home, is becoming more and more used especially for severely mentally ill people.

Often, care for mentally ill people starts with outpatient treatment. The last step in treatment, after the patient is discharged from the hospital, is also outpatient treatment. This is called stepped care: a person is only stepped up from outpatient to partial hospitalization or inpatent treatment if they need it and is stepped down to outpatient care as soon as possible.

K – #AtoZChallenge on Mental Health

Welcome to the letter K post in the #AtoZChallenge on mental health. I have only one word for you that is truly related to long-termmental health care and a few that are only perceived to be related. Here goes.

Keys

There is a joke that the differences between the patients and staff on a mental unit are, among others, that the patients get better and leave and that the staff have the keys. There are of course the locked units, where the staff have the keys to open the door of the ward. Even on open units, some rooms and cupboards are locked. This goes of course for the medicine room and cupboard, but also on some units the kitchen cupboards are locked so that patients can’t get food outside of meal times. My side of the unit is the only one where kitchen cupboards are open during the day. I was very surprised to find out that, not only are the cupboards locked on the other side of our unit, but on other units, the entire kitchen gets locked sometimes. This means people can’t even have tea when they want to.

Killers

Like I said before, some people get to the mental hospital on a forensic section. I don’t honestly know of most patients with a forensic status what crime they were convicted of. As such, it is totally prejudiced to assume some are killers – except that some people within the general population are killers too. People with psychotic disorders, which are the most common type of disorders in long-term mental health, don’t tend to kill random people even if they are violent. For clarity’s sake: most people with mental illness are not violent and the evidence is mixed on whether people with mental illnesses are more likely to become killers than those who don’t have a diagnosis. Some mental disorders do predispose people to criminal behavior, such as psychopathy or its milder variant antisocial personality disorder. Other disorders do not.

Kleptomania

It is a common belief that theft is particularly common in institutions, both mental and otherwise. I don’t know whether this is true. I for one have *knock on wood* not had anything stolen from me.

Kleptomania though is a compulsion to steal. It is not the same as someone stealing believing (delusionally) that an item is theirs or wanting the money to buy drugs or anything. Kleptomania is about stealing for stealth’s sake. Kleptomaniacs may even steal worthless items. Kleptomania does not usually lead peope to become institution patients. After all, theft is not serious enough a crime to get someone on a forensic section. Kleptomania is an impulse control disorder. Other such disorders, such as pyromania and intermittent explosive disorder, do potentially lead to serious enough crimes.

I – #AtoZChallenge on Mental Health

Welcome to the letter I post of my #AtoZChallenge on mental health. This was a hard letter again, but I stil have a few words for you. Here goes.

Intramuscular Injections

Antipsychotics can be taken by mouth, but many can also be injected in a patient’s muscle. That way, they need to be administered only once every week or two rather than taken daily, because in a muscle, they’re absorbed slowly and steadily. Intramuscular injections, also caled “depot medication”, are often used on patients who refuse oral medication.

Involuntary commitment

Like I said in my letter D post when discussing danger, patients who are a danger to themselves or others can be committed to a psychiatric hopsital involuntarily. In the Netherlands, there are several ways a patient can be committed involuntarily. In acute situations when a patient is a grave danger to themselves or others, they can be taken into care with the mayor’s approva. Usually, this takes the form of a simple phone call by a psychiatrist to the mayor (or their substitute), who will almost automatically give the go-ahead. A judge will see the patient committed this way within a few days and approve or deny the involuntary commitment. An acute section lasts three weeks and can be prolonged with another three weeks once.

If a situation is less of an acute problem or after at most six weeks on an acute section, a patient can be brought to a judge for a longer section. A patient does not need to be an immediate and grave danger to themselves or others; merely being a danger suffices.

There are two newer forms of commitment too. First, there’s the observation section, which lasts three weeks and is meant for people who haven’t yet been diagnosed with a mental illness and aren’t a grave, acute danger either. A patient on an observation section can’t be subjected to force. A patient who realizes they might become a danger at some point, can file for self-commitment, indicating they will be admitted to a hospital and treated if certain criteria have been met, whether they want to at this time or not.

A patient can’t at this point be forced into outpatient treatment unless through a provesional section, threatening involuntary inpatient treatment if they don’t comply with their treatment plan while in the community. The government is trying to change the law so that patients can in fact be forced into any form of mental health treatment.

Milestones in My Mental Health Recovery

This week #theprompt celebrates its 100th edition. I was guessing at the prompt for this week, as I often do, and this time, I was right: milestone. There are many milestones in one’s life. Birthdays, particularly important ones like eighteen or thirty. Graduations, be it from preschool, high school or college. Getting married, the birth of a child or grandchild, and the list goes on. When I thought of the word “milestone”, however, I thought of the milestones in my recovery from mental health problems. I am going to share them here. I include steps I’ve taken in my journey with autism here too.

1. Realizing I have a problem. In a way, I was always aware of my being different, but I didn’t realize there might be somethng really, clinically “wrong” with me till I was fifteen. Then I realized I may be autstic. Or something else. I quickly developed quite the obession with about half of the DSM-IV. Then, when I was seventeen, my parents talked me out of thinking I was autistic or otherwise anything other than blind and extremely intelligent and oh maybe a hypochondraic. Never mind that hypochondriasis is a real mental illness.

2. Admitting I need help. I first admitted this the day after I decided I might be autistic, so when I was still fifteen. Then again, I was too shy to tell my parents or my teacher or basically anyone that I really needed more than a teacher with a social skills checklist telling me all that I was lacking in terms of social skills. I remained too shy to directly ask for help for years. They were other people asking for help for me. First, it was the teachr with the social skills checklist calling the blindness rehabilitation center for me. Then it was my staff at independence training calling mental health services. Then it was the police calling the crisis service after I’d made a suicidal threat in public. I still have a problem asking for help directly.

3. Starting counseling. My first experience with counseling was at the blindness rehabilitation center I went to after high school. That wasn’t all that successful. Then, at the mental health agency where I was diagnosed with autism in 2007, I started sessions with a community psychiatric nurse. This was quite helpful. It was probably my most successful counseling experience so far.

4. Starting medication. I first started medication in the summer of 2007. That wasn’t a success. I hadn’t expected the psychiatrist I saw to suggest I go on an antipsychotic, because the nurse I mentioned above was suggesting a benzodiazepine on an as-needed basis. I did end up taking said antipsychotic, but stopped taking it again several months later. The second time I went on medication, another antipsychotic this time, I was extensively educated and got plenty of time to think it through and make a decision. I consciously decided I wanted this medication and it’s been a great help (with an antidepressant and several PRN meds added later on).

5. Checking myself into a mental hospital. Of course, it wasn’t literally that I checked myself in. I didn’t take the initiative to call the crisis service or my treatment provider, which I didn’t even have at the time. After all, I’d moved a few months prior and the new mental health agency was doing the diagnostic testing all over again. Nonetheless, I consider it a major milestone that I agreed to be admitted into the psychiatric hospital.

6. Moving to a resocialization unit. I spent sixteen months on a locked unit, largely because my meltdowns and emotional outbursts were too severe for any less restrictive unit to want me. Finally, however, the resocialization unit did want me after I half lied myself into being accepted. I think this was a major step, as I got much better care on the resocalization unit than on the locked unit. After spending over four years there, I moved to my current unit, which is also rehabilitaiton-oriented but doesn’t have as strict guidelines on how long you can be here. Not that they were followed by the other unit either. I really went here to be closer to my husband, whicch I currently am not anymore since the move, but oh well.

7. Discharge. This milestone is to come this summer. I’m going to move out of the psychiatric instituttion and live with my husband. I’ll continue to get some form of psychiatric treatment, but of course this is a step towards recovery of a “normal” life.

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Book Review: Believarexic by J.J. Johnson

I have published a few posts that were inspired by my reading of the book Believarexic by J.J. Johnson already. I didn’t share many opinions on the book itself though. Early this morning, I finished the book, so I’d like to post a review. This review contains some spoilers.

Synopsis

Fifteen-year-old Jennifer has to force her family to admit she needs help for her eating disorder. But when her parents sign her into the Samuel Tuke Center,
she knows it’s a terrible mistake. The facility’s locked doors, cynical nurses, and punitive rules are a far cry from the peaceful, supportive environment
she’d imagined. In order to be discharged, Jennifer must make her way through the strict treatment program – as well as harrowing accusations, confusing half-truths, and startling insights. She is forced to examine her relationships, both inside and outside the hospital. She must relearn who to trust, and decide for herself
what “healthy” really means.

Punctuated by dark humor, gritty realism, and profound moments of self-discovery, Believarexic is a stereotype-defying exploration of belief and human connection.

Review

This book is an autobiographical novel. The author describes this quite poignantly at the end of the book as “true make-believe”. What this means is that the author did really get inpatient treatment for her eating disorder in 1988 and 1989, but the details and characters may’ve been changed or simplified. I haven’t yet checked the bonus material, so I cannot be sure whether some of the pretty intriguing events in the book did really happen. For instance, one of Jennifer’s fellow patients is signed out by her parents because they don’t believe the program is working. They decide instead to take her to an orthodontist to have her mouth wired shut. Even though this book takes place in the dark ages of the 1980s, I find it hard to believe such a procedure would be legal even then. I do still see the stark contrast between psychiatric treatment then versus now.

Sometimes, I find that characters have been oversimplified in terms of them being either good or bad. Dr. Prakash, Jennifer’s psychiatrist, is nice from the beginning to end, whereas nurse Sheryl aka Ratched is bitchy and controling throughout the book. Still, some characters make quite a transition through the book, and there are incredible twists and turns.

The book starts out a bit triggering with for example the hierarchy of eating disorders being quite extreme. Nonetheless, this book is clearly pro-recovery. At the end of the book, the author encourages people who even have an inkling of an idea that they might have an eating disorder to seek help. As may’ve become clear through some of my previous posts inspired by this book, Belieivarexic led me to some interesting insights.

Book Details

Title: Believarexic
Author: J.J. Johnson
PUlbisher: Peachtree Publishers (eBook by Open Road Media)
Publication Date: October 2015

For more information on the book and its author and for resources for people with eating disorders, go to Believarexic.com.