Continued testimony from my client Carlie at how she ended up on high-dose multiple medications in a psychiatric ward after going to her GP with depression. See Part 1 here.
I tried moving counties in the hope of a fresh start and new beginnings. My “mental health” problems followed me. My highs were getting worse and lasting longer in the summer, subsequently I experienced my most severe low. I was in excruciating mental pain, I was not sleeping at night, and therefore being prescribed Zopliclone1 sleeping tablets to help. However, Zopiclone increases the normal transmission of the neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system, via modulating benzodiazepine in the same way benzodiazepine drugs do. My experience was, they completely knocked me out for the first two nights of taking them, then I would take them and I would be awake until five or six in the morning unable to sleep, feeling restless and twitchy. When I then did fall asleep I would be unresponsive until midday and would feel so unbelievably groggy for the rest of the day I was awake. My understanding is that Zopiclone should only be prescribed in small doses for a few days at a time. This was not the case for me as I was issued with large amounts, and anytime I saw my psychiatrist and explained of my nightmare sleep pattern I would be prescribed more. I would spend hours researching the net on different ways to commit suicide, the easiest, the quickest at the least messy when I couldn’t sleep. Then one day I woke and could not cope with these thoughts and feelings any longer. I always had a massive supply of prescription medications to hand as I was prescribed a month’s worth at anytime. My mother had already taken me back to the local chemist on the Friday before this particular suicide attempt to return another mass of medications I had been given. My mum was always worried about me having access to such a vast amounts knowing what my suicidal tendencies could be like. Having said this, I still had six months worth of Depakote to hand alongside Zopiclone, Diazepam, both prescribed, paracetamol and ibuprofen and morphine I had obtained from someone I knew. Quite a cocktail for anyone’s body to try and tolerate. The result, I was in a coma for 5 days on a life support machine and I was not expected to make it through the night. I was a mere 27 years of age and the staff advised to call any family members in. How I pulled through, I have absolutely no idea? All my organs were shutting down and in one final desperate attempt the intensive care staff linked me up to a machine to take all my blood out to clean it and put it back in my body. I was absolutely distraught when I came around that I was still here. I was then admitted to a psychiatric ward again for another three weeks.
In this psychiatric ward I met a lady who had Post Traumatic Stress Disorder who had previously been in the Army. She was in this psychiatric ward with myself diagnosed with Bipolar and Borderline Personality Disorder and her with PTSD. We were both prescribed Depakote. There was a lady who was in the ward because she had epileptic fits and was wheelchair bound and was waiting to be rehoused to somewhere that was more suitable than where she currently lived. I don’t understand why a psychiatric ward was considered to be somewhere for her to go whilst waiting to be rehoused. A lady in her fifties who had been diagnosed with Bipolar and told me she had been in and out of the place for years!. Her brother was fighting to try and get her released. I witnessed another patient who used to wash her hands in the toilet with the bathroom door open, staff would walk past and look and carry on walking. The people who self harmed on their wrists and arms tried to hide it, but even I, as another patient, could tell what was happening. They had new cuts visible under sleeves if they moved their arms. There was a lady who was taking coffee mugs and tea cups from meal times and breaking bits off to cut herself with. The staff cleaned the rooms in the ward and would have come across these broken cups, but didn’t intervene. The lady disclosed to me that “it was the best hospital she had been in, because they left the broken cups in her room when cleaning.” Despite all of this I think my heart broke the most for the woman who had been locked in the ward for fourteen months. She had spent two Christmas’s there. She would be pleading and begging to go out with a member of staff supervised which was refused daily. To watch people go out supervised with staff and watch new patients come in for periods of time to then be discharged must be unbearable. She would understandably be distraught and would react by kicking her bedroom door, the responses from staff would be “Go on, kick it a bit harder!” I wonder what progress she made on the medications she was overloaded with in the 14 months I had known she had been there for?
I was given my first Lorazepam in this ward2. I was used to taking 5mg strength of Diazepam but these were available to me in a 10mg strength and anytime I felt anxious or stressed I could ask for one. I was being supervised and helped to continue my benzo’s addiction in a psychiatric ward, my mum wasn’t there to be able to try and hide these.
Half baked, and about to be set free into society again after the biggest close call of my life. I had my final meeting with the hospital staff and they told me I was to be discharged home under the care of the Crisis Team. Mental Health Crisis Resolution and home treatment services (CRHT) Teams are designed to “treat people with severe mental conditions who are currently experiencing an acute and severe psychiatric crisis, that without the involvement of the CRHT, would require hospitalisation. Psychotic episodes, severe self harm and suicide attempts are examples of acute mental health crises.” NHS website definition.
At this point I was living alone, and I was told that the Crisis Team would check up on me regularly via home visits to support me being discharged from the hospital. My medication wasn’t ready at the time of my discharge, so someone would bring it out for me at my home address later that day. I was supposed to now have my tablets dos-setted twice a week to reduce the risk of me overdosing so easily. Why on earth am I sharing this you wonder? Well that’s because somewhere along the line between the hospital staff and Crisis Team agreeing that this should be the new process for me, someone dropped a clanger. The delivery driver arrived with a month’s worth of medication of four different brands. He gave me two bags packed with loads and loads of pills in boxes and none had been dos-setted. I could not take this in, and I remember I stood at my front door struggling to breathe. I tried telling him that it was wrong and I couldn’t have all of these boxes of pills in my house. I said I have just left hospital a few hours ago because I have nearly died from overdosing. Thinking back to this day, it makes me absolutely furious now. If that man had had any empathy or understanding about his job role he would not have just shrugged and said something along the lines of “I can’t take them back, that’s not part of my job.” Couldn’t he have just made a phone call to anyone, anywhere? How did such a huge mistake take place with an extremely vulnerable mental health patient. Really? Is this the support that is on offer? In my ill head at the time, I was thinking well it’s meant to be. I should have gone already, there’s a higher power telling me this is my chance to try again.
My elderly next door neighbour came round to check on me just after this man had left. He saw my facial expression and asked what was wrong. I was on the sofa with the two bags full of tablets. He looked over at them and said “you shouldn’t have all that in your home, do you want me to take them? Do you have anyone you can call or do you want me to ring them?” Now if an elderly person who is not trained in this field but can see the risks and can intervene in a situation like this to try and stop it from happening again, why can’t the mental health services? My carer rang both the hospital I had been discharged from and the Crisis Team about what had happened. We never got an explanation or apology for such negligence. It makes we wonder how many others in the country are put at risk like this everyday from the organisations that are supposed to care for them. This thought breaks me. I know I was never prescribed Lithium because of my history of suicide attempts because I was told by psychiatrists that I wouldn’t come back from a Lithium overdose. Yet I can be prescribed various alternatives in dangerous amounts. I can’t see the logic. I did end up back in that psychiatric ward for a few days, a couple of weeks later after another overdose. I was probably considered to be another “revolving door one.”
So came another geographical move again as I couldn’t mentally handle living in a house I had almost died in. Complete new area again, fresh start. This time things are going to be different I told myself. I was still signed off sick from working and had decided to move away from my family to be more independent and to try and give them a break from my illnesses. The mental health team seemed so promising and I thought I might have new beginnings here. Instead I had a Community Psychiatric Nurse (CPN) who told me that she didn’t do home visits which I later discovered wasn’t the case for other people under her care. This CPN was coming out to do home visits with other people who lived very close to me who they themselves drove, and would have been able to attend appointments very easily. When I tried asking for her to visit me at home when I found out this information she still refused. I still wasn’t allowed to drive at this point on the grounds of mental health so I would trundle out on the bus (bus pass in tow), medicated up to the hills struggling with my social anxiety to my appointments with the mental health services. I would be reduced to tears and got told off by the new psychiatrist because of my behaviours. I had no offers of talking therapies in the previous counties prior to this and here was no different. I had frequently asked if there was anything else I could do but take medication, and was told that these were proven methods.
I was told by a psychiatrist that I didn’t have a drink problem because I hadn’t consumed any alcohol for two days, even though I had drunk and taken illicit drugs everyday for the past three months. I was forever in tears after appointments with the services here. I would be self medicating alongside taking prescribed medications. I would manage small periods of stopping drinking and taking illicit drugs, then start again. The mental health staff working with me were aware of this, I even had my CPN come and meet me in a public house I was drinking in for an appointment. I would be overdosing frequently and being taken into Accident and Emergency. I was never told to wait a while after an overdose, I was told to continue taking the prescribed mood stabilisers and anti psychotics. The vast majority of people I came into contact with under the care of the Mental Health Services all self medicate with either or both alcohol and illicit drugs. Yet we are still all prescribed prescription medications with the psychiatrists and Community Psychiatric Nurses knowing this.
My mum had to arrange for an advocate to start attending some appointments with me with the services that she could not attend because of work commitments. I was always in bits when I came out of appointments I had gone to on my own. A couple of examples of things they were said when my mum couldn’t make appointments:
“You are avoiding life because you’re not going into alcohol aisles in supermarkets, or going to pubs for meals or going to clubs.” The service staff were aware I have stayed in a residential rehab and have attended both Alcoholics Anonymous and Narcotics Anonymous meetings.
“You need to take a knife to a cushion and keep stabbing it to release your anger.” Suggestions like this cannot be safe, needless to say my mum was both fuming and concerned about what else might be being suggested to me.
The services did not suggest that any Advocacy Service was available, it was someone from a support group that my mum took me to and another carer there gave her the details for it. An advocate is someone that can attend appointments with you with the mental health services. I used to feel safe when they went to appointments with me because the demeanour of the mental health staff was completely different with me. “What is advocacy? We all know how frustrating it can be when people aren’t listening to us. Unfortunately, having a mental health problem can sometimes mean it’s even harder to have your opinions and ideas taken seriously by others. This can be very difficult to deal with, especially when you need to communicate often with health and social care processionals. You might find they don’t always offer you all the opportunities and choices you would like, or involve you fully in your decisions about your care. Advocacy means getting support from another person to help express your views and wishes, and help you stand up for your rights. The role of the advocate depends on your situation and the support you want. But they are there to support your choices.” Mind website definition.
I was then prescribed Aripiprazole, sold under the name Abilify among others, it is an atypical antipsychotic3. I cannot say what side effects I had from this medication as I was already being prescribed and was consuming 2000mg of Depakote, 150mg of Quetiapine and 25mg of the Aripiprazole a day. I still had elevated moods, rapid speech, impulsiveness, Obsessive Compulsive Disorder (OCD) symptoms, anxiety, insomnia and severe mood drops which rapidly made me suicidal. Not quite sure which medication needed to be increased to stop this!
Again I was held in police cells under a section 136 where I was classed as a risk to myself or someone else after suicide attempts because there was no where else to put me. I would be released with no support. Can you imagine a worse place to detain anyone to who is so desperate that they have tried to take their own life than a police cell? A tiny cell with human faeces on the walls a tiny window at the top which doesn’t let any light in, a plastic foam mattress and if you are lucky a thin blanket and it’s freezing. On top of that because you are fortunate enough to have come in under a section 136, it means you require to be monitored the whole time. You might think that people would be looking through a shutter or watching on a camera. No, this is not the case. In the 21st century I have spent numerous days and nights in a police cell with the door wide open with two police and they can both be men, sitting on chairs at the door entrance. There is a small metal toilet in the police cell which was my only option to use. I have had to use a toilet in front of two policemen with the door wide open with police walking past and other members of the public walking past who have actually been arrested for crimes. This was my normality.
The advice from the Crisis Teams when I have rung in suicidal states has been to take a hot both, have a cup of tea, listen to music or take a walk. When you are planning how to end your life because you cannot bear the mental torture any more, these suggestions don’t mean a thing. When I have been lucky enough to get a home visit from the Crisis Team, I have waited, hanging on for a minimum of 6 hours or they have not showed up. This would normally result in me ending up in police cell held under a section 136 anyway. contd
- Zopiclone is a nonbenzodiazepine hypnotic agent used in the treatment of insomnia. Zopiclone (brand names Imovane, Zimovane, and Dopareel) is molecularly distinct from benzodiazepine drugs and is classed as cyclopyrrolone
- Lorazepam, sold under the name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, active seizures, alcohol withdrawal, and chemotherapy induced nausea and vomiting.
- It is recommended and primarily used in the treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressive disorder, tic disorders and irritability associated with autism