As I’m sitting here in the medical hospital after yet another suicide attempt reading well wishes from many around the world, I’m heartened by the concern and love pouring forth. Yet in the same breath say “I’m glad you’re safe and how you can get the help you need.” In those words, most mean that they hope I’ll be shipped off to another psych ward thinking that somehow such a place will give me rest and recuperation. They feel unequipped to deal with mental health – mostly they are scared of mental health illness. They think that psych wards are something they aren’t.
Here’s what the experts say:
“You know there isn’t a single shred of evidence that any hospitalizations ever kept anybody alive five extra minutes.” -Marsha Linehan (the worlds foremost researcher on borderline personality disorder who developed dialectic behavioural therapy)
Research has also shown*:
“Hospitalization is of unproven value for suicide prevention and can often produce negative effects.
- Patients are unlikely to recover as the result of an admission, a stay in the hospital can often be little more than a suicide watch. Although the term “safety” is often used to justify inpatient treatment, we do not know whether patients are actually more safe [sic] in the hospital.
- One cannot justify admission as a way to administer pharmacotherapy for borderline personality disorder (BPD).
- Long-term admission is no longer practical and in any case has never been shown to be effective for BPD patients.
- The hospital environment in an acute ward is hardly ideal for taking new directions in therapy.
- Admission at best puts problems “on hold.”
- BPD patients continue to have chronic suicidal ideation after discharge.
This is the clinical perspective, but the truth behind it is one that most don’t want to hear. That these places are still much more like the one described in “One Flew Over the Cuckoo’s Nest” and a bit like Orange is the New Black (except with fewer rights and freedoms) than what you’d believe you’d wish to believe for 21st century care.
I’ve been in 6 different psych wards in the last 13 years. I’ve been either assaulted or been approached inappropriately in each one – creating a lot more trauma for a survivor of jammy types of abuse. I’ve seen restraints used when they shouldn’t have, meds forced when they shouldn’t have, doctors and nurses and techs who treat people like they are less than people. I’ve seen people of every walk of life, every education level, religion, creed, colour, race, gender, sexual orientation, socioeconomic status, etc. And I’ve not seen people improve in these settings. They aren’t the settings meant to really help people.
Then there’s the issue of treating medical with psychological. Psych is not set up to address medical at any level, when medical issues are directly related to psychology. I’ve come out in worse health every time. They cannot manage type 1 diabetes or chronic pain, autoimmune diseases or chronic health issues. I’ve seen people have seizures randomly and others whose major wounds from suicide attempts become infected because of poor infection control procedures (if any at all). This last time they wouldn’t let me have a cervical collar I wear at night to help with the herniated discs in my cervical spine, cervicogenic headaches, and occipital neuralgia do my headaches became out of control and I couldn’t sleep, but since they wouldn’t let me sir in the hall, there were no meds to take, there’s no calling my neurologist or spine surgeon, and they didn’t want me to sit in the hall after lights out and my roommates didn’t want the bathroom light on, I had to sit in extreme pain, alone for hours and hours in the dark on a cold hard plastic mattress. Tell me how that helps my mental health?
Tell me how it helps not seeing my rheumatologist and wearing my compression gloves so my hands hurt so bad it hurts to hold the plastic spoon to eat my dry chicken with.
Tell me how it helps to have more psychologists who don’t know me or my case and won’t follow my case look at the list of meds I take and have tried and tell me as I already know, there’s nothing else to try. The FDA has yet to approve any drugs for BPD and most research shows that meds are not the first line of treatment, but therapy is.
There is no real therapy in psych wards. There are sessions you have to attend (or you get written up as noncompliant) where, as I’ve written before, they teach the same psych 101 classes about coping skills, self care, and support systems. They are taught usually by young, inexperienced therapists with handouts from textbooks that they recite directly from. They are often interrupted by one individual with acute symptoms – someones someone going on a manic or delusional rant or someone just plain annoying. Little if anything is gained. But it passes the time.
The therapy that most need is a process – something that will take time, probably years. The therapy needs to happen in a supportive and trusting therapeutic relationship that is built over weeks and months. And for those of us with trauma, opening up about it to the wrong people or being forced to talk about it too soon results in more trauma.
The real hard trauma work that I need to do, that I’ve avoided for a long time, has just begun. I’ve been in therapy in and off since I was 17. I’ve done inpatient, outpatient, intensive outpatient, group, individual, CBT, DBT, ACT, etc. Though I’ve talked about EMDR, which dives into trauma, with several therapists, I’ve not been stable enough to start it. Instead, I’m slowly venturing in to areas of schema therapy, attachment theory, sensorimotor therapy, complex trauma induced structural dissociation, and neurobioligical development (particularly in BPD of the right brain and limbic system). And as I approach and understand these, in a very supportive and trusting relationship, opening up about the things I don’t talk about.
Only in somehow understanding these things will I move forward. No amount of DBT or time in psych wards will adequately substitute for that work. And that work cannot be done inpatient.
But the problem becomes – there’s no place to send me now. They can’t discharge me to living in my car or motels again. I can’t afford my own place. Friends who have extra rooms don’t offer them because of their own fears of mental health illness and more so, because it’s inconvenient for them. They say it’s stressful for them. I don’t deny that’s true. But it’s far more stressful for the person who has nothing, who only needs compassion. I don’t want to stay with others, live by their rules, feel like an imposition, but it’s a home and at least there I’m a person and I’m allowed to use a pen to write or the computer/phone to blog. The thing is, many will endure this stress for a loved one – a daughter, sister, wife – but I am none of these to anyone. People may say I am family to them, but when things get hard it is much easier to believe that I will find “help” at a psych ward. The one place that will make things worse instead of better.
It really is easier than you think. What kept me from the hospital and suicide attempts for almost 4 years was an incredibly supportive physician willing to give extra time, a safe home of my own, and babysitting and/or a fulfilling job. As I lost those things these last 2 years, my health declined and my life became completely destabilized. That is why I have suffered so. The stability I fight so hard for, I couldn’t keep and once gone, I found myself alone, still not having addressed the trauma that must be acknowledged.
I need a home. Step one.
With that I can get my cats back. Without my cats I despair, having no hope of seeing them soon makes it hard to breathe.
With a home I have a base from which I can go to and from medical appointments. I have a place to rest after the medial branch nerve blocks I’ve had twice now without sedation, without help of any kind. I have a place to cocoon when the world seems unsafe and I have a panic attack.
With a home, I can start to find structure – go to the Colorado Lawyers Assistance Program meetings for lawyers with mental health issues. I can cook healthy food. I can start to rebuild.
But again, there aren’t any homes. Because I have no money and because no one will open their doors.
I am already working with the Colorado Coalition for the Homeless PATH Program to apply for low income housing, but the waitlists are more than a year – I’ve even been told 4 years.
I missed the Section 8 application when it was open for 2 days in September because I thought I was in a stable environment. It won’t open for another year.
I know the lists of shelters and am often telling social workers of resources they don’t know to look through like auntbertha.com.
I know the resources, the people who know resources are using all available avenues. But the avenue we don’t have access to is simply money and goodwill. Ironic this time of year when all are spending money frivolously and talking about doing good for others.
The same for that vet I met at the Homeless Coalition. He needs goodwill and money too. He has been given neither and yet he still texts to make sure I’m ok.
And to be clear, this isn’t an easy ask. For me it is a symbol of my cumulative failures. It is what brought me to this point, not wanting to ask, not wanting to be a burden. It’s not something lightly requested. It is with deep shame that I’ve found myself begging for help far too often these past few years.
But a psych ward. That’s not the solution. Others are in fact paying for that to – your tax dollars being spent through medicare. My therapist pointed out, had we taken all the money spent on me with ambulances, ERs, ICUs, psych wards and put it toward an apartment, none of this would have happened. So much money, time, energy, effort. But more so, the pain, loneliness, trauma, fear, and almost my life.
Though many say we believe in preventive care and human rights, when the opportunity to provide those things arises, they are often left unmet and it is our health (itself a human right) that suffers. The ultimate price of death often the final price.
There’s more to be said about the human rights aspect, looking at the hierarchy of needs, research on treatment and outcomes. Perhaps there will be a chance to write more of that later.
For now though, there is just the looming prospect of a psych ward – of more trauma and pain to be suffered and endured and realities I’m glad to know most will never encounter.
Unless perhaps there can be a miracle on 34th street (or 9th as it were).
Update on 12/27/2015: Some individuals have generously offered to raise funds for housing for me at generosity.com. While it is rather difficult to ask for assistance, if you are able to help in any way, I would greatly appreciate your kindness.
* Paris, J. (2004). Is hospitalization useful for suicidal patients with borderline personality disorder? Journal of Personality Disorders, 18(3).