home treatment team.

I got a visit from the Home Treatment Team (HTT) psychiatrist and psychologist today. They were here to review my care. They stayed for like an hour. In general, it made me think “Fucking yuss HTT. You’re properly nang!”

For those of you that are less clued in to mental health treatment on the NHS, the HTT are basically a crisis resolution team. They are a short-term team designed to keep people “experiencing serious mental health crisis” (says their leaflet) from winding up being admitted to hospital. This means that they essentially provide all the services psychiatric inpatient facilities offer, but within the home environment for an average of 6 to 8 weeks (though sometimes more, sometimes less, depending on need)  during “acute crisis”. They address you medication, mood, stability etc. daily to make sure you are getting the right level of support (even if that means urgent referral to inpatient services). They have a multidisciplinary team made up of social workers, community psychiatric nurses (CPNs), medical staff, psychiatrists, psychologists, occupational therapists and all sorts. They arrange to see you either once or twice a day, depending on need, with the idea of tapering down when appropriate. They are available 24/7, 365 days a year and provide you with a telephone number to get in direct contact with a member of their team whenever necessary for either phone support, an immediate home visit or to arrange transport to their offices or a medical or psychiatric facility if needed. You are seen by a psychiatrist twice weekly, weekly or fortnightly in order to review stability and medication needs. You are only given the exact dose of any medication needed on that visit and have to take it in front of them to prevent medication hoarding (something I’m really guilty of). They liaise with any other services you may be engaging with, as well as refer you to any further services they think will help you with your long-term needs is they think necessary (tending to lead to referrals being processed faster than when received from other sources due to the urgent needs of their service users), as well as alerting any relevant employers or education providers of your situation and helping you gain the correct support from them. They shape their care package to your needs and rearrange visits in order for you to keep up your daily activities so that your crisis experience has as little disruption to your normal life as possible. Due to the nature of the service, it can be quite difficult as you often end up seeing different people each day (which I find quite hard as inconsistency can make me panicky), but that’s understandable given what service they are providing. Essentially, they are one of the best ideas ever. I didn’t really know about them till a week ago and I honestly cannot stress how fantastic I think this service is. Seriously. The NHS is a constant source of joy and surprise for me. I had no idea anything like this existed before and I just find the whole idea inspired.

Today, they were really great for many reasons.

Firstly, I think I might just be in love with every single psychologist I meet. They are so good at dealing with me I swear. I kinda wish I was a psychologist so I knew how they do it, but I actually don’t want to be one so I guess I’ll never know. It’s ridiculous though. They make you feel so much less stupid and useless and dramatic and undeserving. I cannot stress how much I appreciate the existence of psychologists. Yesterday and today they made me feel so much less fucking stupid. I appreciate all people who make me feel less stupid.

For instance, I was telling them how I’m really not miserable all the time and I really don’t understand my emotions, so I never feel like I deserve to call them up when I’m in need because I don’t know when I’m in need or what I’m in need of, and probably am in less need than their other clients who are obviously much worse than me. Whether it’s true or not, he told me that he thinks I am actually in a somewhat more serious position than lots of other users as I’m so disconnected and unpredictable that I could actually end up in a lot of danger without even realising it. thinking about it or comprehending the consequences. Apparently that’s incredibly serious and dangerous. He understood just how powerful self-destructive behaviours are at connecting yourself and re-establishing your presence, but also just how that escalates and if left unchecked, ends in suicidal behaviours. He says I should just call them up as soon as I start to feel myself getting worked up and agitated. They’re going to leave instructions for others on the team to just talk to me and help to ground me. And also they’re leaving notes that “watch t.v./read a book/have a bath” aren’t acceptable types of advice for me so should be avoided, instead chosing to visit me or just talk to me. Do you know how good this made me feel? Like seriously. I felt like I was being taken serious. And like maybe I actually need this and am not just manipulating everyone. It was nice to have someone actually recognise just how scary these feelings, beliefs and emotions are, rather than just tell me it’s normal and ok. I think I liked him. I felt like he really actually recognised and understood what I was saying and how I felt and he made me feel comfortable and deserving.

And also, he actually sat and talked to me about what the fuck is wrong with me. Quite often, people avoid answering that question. He told me that four separate psychiatrists and he himself believe that I have borderline personality disorder. A couple of members of the HTT had noted that was what they believed so he specially did some research and reading before coming to see me so he could be more sure and everything, and having spoken to me says that actually, my feelings and experiences are fairly typical of BPD. Apparently it is fairly difficult to treat, but with correct treatment and my active engagement, it is possible to recover. He also told me he’s going to find me some good, informative websites to look at. BPD has a lot of haters and there are a lot of sites with people bitching and moaning and blaming and calling people with BPD cunts. He said it’s best I just don’t look and he’ll bring me the links for more accurate sites next week, as well as special sites to direct the Famo to. Serious G.

I talked to him about IMPART and how I wasn’t optimistic that they’d take me on and that I was waiting for something I wouldn’t get. He was very clear in saying that he would be shocked if they didn’t take me on and actually is pretty much positive that they will. He told me how great they’d be for me and how I’ll be given a key worker that I’ll be able to call 24/7 to help me manage my destructive urges in order to help me break the cycle and things. Because (and this is a quote) “It’s incredibly complicated and difficult to break the reliance on self injurious behaviours, so it needs a lot of intensive care and support to manage appropriately.” Again, proper G. Apparently IMPART only take people with “severe” personality disorders and he thinks that I have BPD which affects my life strongly enough to warrant their care. He has been chasing them up for me and because it’s a crisis team doing the badgering, they are trying to see me earlier. Apparently my assessment should be in a matter or “weeks, not months” which is pretty speedy for the NHS. They offer intensive, long-term support with DBT group therapies, CBT individual therapies, mindfulness group, anger management group and anxiety management group. That’d be cool.

So yer, I think it’s basically fact I have BPD. Which is scary. Very scary. I won’t know for 100% sure till my assessment by IMPART, but everyone seems to be pretty clear that they fully expect me to be taken into their care. I duno maybe it’s not so bad. I’m going to try get used to it.

Both him and the psychiatrist (who was also a G, but not quite as much) think that right now, the most important thing is to stabilise my emotions. Quite often, I have no idea if or what I’m feeling because I feel like I’m only performing it and I don’t feel it at all, but I’m performing with so much commitment that it burns me. I have no idea when or why or how to predict this happening, but I get completely overwhelmed  and confused and lash out at myself in order to connect myself to reality and my body again. It calms me, but it’s only temporary and puts me at a significant amount of risk. This idea is stabilising and muting these emotions for a while until I can access the correct treatment, though nothing they can offer is a permanent fix as what it essentially means is I’m just dampened. Intense emotions can suck, but intense excitement and joy are fantastic, so it’s sad I need to be dampened for safety purposes. Their fix is essentially to quadruple my diazepam prescription, keep me on zopiclone and start me on the SNRI duloxetine (which is still an antidepressant, but slightly different to standard SSRIs so hopefully won’t end up with me suicidal. It might, but if I’m being monitored twice a day by the HTT then they hope they’ll be able to catch any negative side effects before they become a problem).

Oh and they also said I could tie in my walking to go see them in their offices rather than have them visit. As long as I organise it with them, I could go in to see them in Walthamstow. That sounds so good to me I swear. It gives me something to do and it gives me some control over their visits. I’m only allowed to once a day, so they’ll still have to come in to see me (their psychiatrist decided I definitely need twice daily visits), but it gives me somewhere to go and a reason to my walking and it just feels nicer.

The nurses that came this evening were also great as they talked to the Ma about their role. what’s been going on etc., as well as further explaining to me what was happening. I like that I’m having things explained to me clearly. It calms me.

So now I’m just dosed up on Valium and seeing what happens. I’m worried about duloxetine, but it’s meant to be weight neutral so I’m hoping that won’t freak me out. I’m also worried that I’ll end up doing even more damage to myself, but I’m hoping it’ll be fine. It’s all just to stay stable enough until I’m getting settled in the right treatment, and with the Psychologist at my EDU keeping on till that point, plus the HTT there to help me navigate my way out of crisis, I think I might be on the right track. And I don’t need to be psychiatric inpatient so that’s good. I mean, as long as I don’t wind up in A&E again. I honestly have no idea how likely that is.

Everything is scary right now. Scary and new and hard.

It’s ok though because I bought an anklet with bells on so now I jingle everywhere I go. It’s lovely. And I bought my favourite perfume (The Smell of Weather Turning from Lush). It smells like rain in the countryside. It’s such a calming smell. Fresh and musty and lovely. And some other silly jewellery. I spent way too much money today, but it’s what I do when I’m anxious. I think it’s ok though as I’d been saving for Istanbul with the Fam, but they cancelled that (which makes me feel awful as I’ve single-handedly ruined my family’s summer because I’m a fucking mental liability. Urgh).

All in all, I hope maybe I’m ok. I hope all of this is the right treatment and course of action. I hope I’ll finally be put in a place where I can actually get better for good, rather than jump from one issue to another. I have a lot of hope. Maybe today has been positive. Or maybe I’ve just been dosed up on enough Valium to dampen all my feelings enough for it to feel that way. I duno. It’s better than yesterday, and though I’ve still had seriously destructive urges, I haven’t acted on them.

Yet I’m still scared they’re just going to reject me and tell me I’m making it all up. Because it still feels like I am. Nothing I do is true because I’m not true. I’m ideas of a person. A construct.

Gah.

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1 Comment

Filed under home treatment team, recovery

One response to “home treatment team.

  1. arabelladesiderium

    I’m glad you’re posting again, I was thinking about you the few days that your blog was quiet. As scary as things are right now, you seem to be so positive about moving forward, which is amazing. It sounds like you have some really great people on your side, and I really hope they’re able to help you out and get you whatever you need. Sending virtual hugs your way.

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