- why won’t professionals answer patients’ questions
- Ask the mentalists – Boundaries
- Ask the Mentalists – Artificial Language Barriers
- Ask the Mentalists – Charting
- Ask the Mentalists – PRN Lorazepam
- Question for MN
- Newbie Questions
- What happens to well-meaning professionals?
- What if your patients are smart?
- A question regarding suicide
- Ch-Ch-Ch-Ch-Chan… Oh You Get The Idea
(Guest post by A Mental)
I must apologise for this first introduction as not only are there my normal levels of confusion to deal with, but I have also taken my sleepers, which add all sorts of exciting confusion such as voices and people running around fast etc etc. So this may actually make no sense at all. And it may well be long. I waffle. Writing in a succinct manner is not a skill I have ever mastered – my A level English Lit teacher told me so.
Anyway, as you may (or may not) have guessed from my name, I am not an RMN (does the term ‘Mental Nurse’ make anyone else chortle by the way? Mental Health Nurse or Psychiatric Nurse I could understand, but Mental Nurse?? I can just imagine 2 nurses talking ‘So what sort of nurse are you?’ (asks RMN) ‘Oh, I am a Children’s Nurse, I work with children. What about you? Our imaginary RMN replies ‘I am a Mental Nurse. I work with mentals. Does anyone see my point regarding the slightly odd terminology there used in the titles? Or is it just the Zolpidem that makes me find it amusing? Anyway, enough chortling, back to the point, the point’………………………………. Ah yes, the point is I am not an RMN, or any other nursy type, or anyone professionally involved in mental health. I am a patient (refuse to be client - seems linked to prostitution) under MH services, and have been since I was 17, and am now 23 (or will be in a week). I swear this had a point, I haven’t a bloody clue what it was anymore though. So anyway, I just registered my name as ‘a mental’ since we have already established RMNs treat mentals, and there is only one of me, hence the lack of s in my name. Wonderful, you have had to endure a blog about my name. It really was about something else, I promise.
Yes, my post. So I am a mental. Seeing the local CMHT. I have problems with depression/anxiety/ED among others but I will go into that at another time. My CCO is an incompetant moron, hereonin to be known as twatman (rhymes with batman – get it? 
) At my last session with him 2 or 3 weeks ago I was feeling very low, and I have suicidal thoughts a lot of the time, but can distinguish between when they are just flying around irritating me, and when they are uncontrollable. So yes, I was very low with the irritating suicidal thoughts, so not good really, and twatman said to me ‘Maybe you need to accept that things are never going to change and that this is as good as it gets’ and then asked how I felt about that. I said I would kill myself in a heart beat if I knew that to be true as why on earth would I want to keep on going if this was it – being unable to get out of bed except for appointments, constant thoughts of hurting myself, no confidence, no self esteem, hating myself. You get the picture. a mental is not a happy person, and therefore would not continue to live if she knew nothing was going to change. A mental was also very upset as couldn’t cope with the thought that nothing could change – that is HER thinking but she isn’t used to having it reinforced by the professionals. Following this twatman said well you are your dad’s only child so I want you to sit there as him, pretend to be him and talk to me, as your dad, after you have committed suicide. I refused to do this, so was then told that I was refusing to comply with therapy. I left that appointment very upset, with twatman having given me an appointment for July (and this was at least a couple of weeks ago now), and have been feeling terrible and very suicidal ever since, but that bit is irrelevant with regards to my post. I suppose my main question is, was that session suitable? Should you tell your patient that they need to accept things won’t change and then get them to role play their parent following their death? I genuinely don’t know – I know how it felt, but is this type of, what I find fairly aggressive, therapy helpful to people/suitable/appropriate etc? Any thoughts from all you good nurses would be muchly appreciated, and final apology for the post med rambles!
have you thought about asking to see someone else from the team? you are allowed to you know and if you dont feel like you have a good working relationship with your cco then its possible the whole thing will be futile.
good luck
Thank you for your reply. I have asked many times, and have been doing so for about 6 months now – when I was first transfered to that CMHT from another I also said it was important to me to see a female rather than a male as I am generally uncomfortable talking to men, and was told an initial appointment had been set up for me to see twatman, but if I wasn’t happy then to say so and they would arrange someone else. I said so but was totally ignored unfortunately, and have asked again quite a few times since but no luck.
I want to be your next mental nurse. I love your drivelling humour – It’s almost as if I wrote it myself
) Let me know if u intend to emigrate to Australia.
But the point ……..
Ok – disclaimer first – or more a caveat – tho not an emptor one – I wasn’t there and only have this info to go on so it’s a bit of a ‘no-no’ to make a judgment on others’ practices being right or wrong.
So I’ll just comment both sides -
By default – it’s bad if it made you feel bad – a patient should not leave the session feeling worse than when they went in. Putting more pressure on you than you’re prepared/able to handle is not good therapy – unless you’ve got a good ‘rebuild’ back up plan in place for the patient.
But on the converse – we’re talking about suicidality and potentially the ultimate bad outcome. So how far can a therapist push you when we’re into this kind of issue to satisfy their assessment and management?
From what you’ve written here (and it’s limited in content so I would not consider this a valid ‘clinical assessment’) it seems that you have reasonable perspective on your own circumstance and I’d guesstimate a current mild to moderate risk of things going tits up – but perhaps not a highly acute risk of suicide. If you’ve done stuff before then your risk is higher obviously and that’s not something I need to know about – but you need to consider.
However – in what you wrote here, what have you got to hide from us? Nothing. Our relationship on here is far easier as the power balance doofer thingy isn’t so prevalent. You can tell us how it is without fear of getting anything more than a snotty bunch of text.
But for the clinician who is on the spot and having to doubt (which if the rapport is not good – is going to increase risk of not truly knowing) whether they are getting the full or most or just some of the true picture; that’s not easy and that’s the assessment part of the issue.
Now your Co Ordinated Care Keyworker – or COCK as we call them – has only a few minutes left to ensure he’s got a good enough assessment and that the risk of you acting on any suicidal ideation or impulse is minimised. That’s where the role playing comes in as a way to put dissonance in your head – to argue against the pro-suicidal ideation.
So it’s gonna sting a little even if you don’t want to carry out any ideations – because it’s forcing you to face the reality of something quite stressful.
Asking about ‘accepting’ yourself as being the way you are may have been simply trying to ascertain your reaction if you began to feel hopeless or trapped with your situation – if this is how you see yourself for a long time does this impact on your capacity to keep on going? It seems it does – as you’ve said you’d kill yourself in a heartbeat. Kinda puts the clinician in a tight corner and he may have over-done it with the role play pressure – tho equally he may not have.
wafflin on so I’ll just stop.
You can be my next mental nurse (might start calling you Registered Mentals actually – I think it has a certain ring to it) as long as you promise not to section me or threaten to do so. I don’t like that. I will pack my bags and hop on a plane asap – that might save me.
‘I love your drivelling humour – It’s almost as if I wrote it myself’
Oh god. I sound like a Registered Mental?? That surely means I have had a sense of humour bypass… Eeeek. Actually to be fair, twatman is not in fact a registered mental – he is an ASW. Or a COCK as you like to call them. I like that one a lot. I might call him a COCK next time I see him and then await the response. At best maybe they will let me see someone different for harrassing him.
Had a raaather shitty day. Was thick enough to tell my support worker when I saw her yesterday that I was feeling bad and when she asked if I wanted to talk about it I blabbed all, so then got a lovely call from twatman yesterday who said he had to inform someone and he either had to speak to my mother, who I live with, or alert the police. Bit of a no brainer really. He then called me again today and I tried to say I was fine without telling an outright lie, but that seemed to fail – seemingly saying you are too tired to answer doesn’t let you off the hook. Remind me to think of something else. So now I have to go to stupid A&E in the morning to have a stupid assessment or I will be assessed under the stupid MHA. Yes, stupid is the word of the day – I am attempting to curb my swearing. Impressed? And he had to speak to my mother yet again to basically make her follow me round tonight so I didn’t ‘do anything stupid’. I said it wouldn’t be stupid. That didn’t seem to go down well either. I really do need some new tactics. He helpfully pointed out that a section would be a bad thing to have on my medical notes (no shit Sherlock), especially if it was a Section 3 (fuck off). So hi ho, hi ho, it’s off to A&E we go. Just hoping to stay out of the local shithole that passes for our acute psych ward. Wonder if doing a runner from A&E would work…. Our crisis team really should learn to go and see people at home, and perhaps even let them call from time to time, instead of making everyone go in to A&E. Twatman said I was making a rational irrational decision yesterday, at the end of a little debate. Saying that was an oxymoron stopped him – he didn’t seem to know what it meant. The joys of a private education – if only they knew they were teaching you words to thwart a cock.
Bet you don’t want to be my next registered mental anymore!! Wonder if I could fire twatman. I met a great crazy Irish lady when I was in hospital once – completely barking but no idea why she was on a section as she certainly didn’t seem a danger to anyone – who went round telling people she was going to fire her social worker and her psychiatrist and her GP when she got out. Was never sure that was going to work really. On retrospect she possibly was a little crazy, as she also invited the entire ward to a birthday party at her house, and told me I sounded like an angel when I sung and she was going to be my manager and take me on a world tour, starting the following week. And she wasn’t on a 6 hour hold.
Sorry for the rant, I am pissed off because I just bloody want to be left alone, and I am wanting to punch myself in the head repeatedly (I won’t though because I think a bruised head might make them think I was not as sane as I shall pretend to be) for being stupid enough to talk to my support worker about how I was feeling. I will not fall for the ‘we can just talk about it, it might make you feel better’ trick another time. Ohhhh no!
Thank you very much for your reply, I did appreciate it, and what you said made sense (although I still think the cock is a twat – hehehehe). I will attempt to write less of a rant next time I post here. Unless they lock me up. Then it will be a big rant. I am FINE. Might try just saying I am fine tomorrow. I like words with more than 1 meaning. Easier to bullshit with. End of rant and thank you for reading