Hospital at home

Trigger warning: suicidal thoughts and planning

A depressing side effect of being a seasoned blogger with a fluctuating condition is that the archive makes it very clear that I go around and around, having better times, then having groundhog day times when it’s clear that I lived though similar crises to the one I find myself in now. I remember that almost exactly two years ago I was in a situation of extremely rapid cycling, moving from anxiety, emotional pain with a desperate desire to be in hospital, hypomania and a calm sense that there was nothing at all wrong with me, all in the space of a day. I’m in a very similar situation now, although the shifts are not quite as quick. I seem to be alternating between anxious/depressed and “normal”/elated.

Yesterday I refused the offer of a Crisis Team referral from a concerned Community Psychiatric Nurse (CPN). Tom was confident that he could manage me at home over the weekend and we would see how things were on Monday. In the night, when I could not sleep and I could not calm my brain despite diazepam and reading and a relaxation app, I regretted my decision not to involve the CT, because as long as I remain in the community, I feel at risk.

The current state of play is that part of my brain wants to kill me. Its first order of business is to find a way for me to abscond from Tom’s care and make my way to the nearest big city where I can disappear. Its second priority is to visit enough pharmacies to stockpile enough over the counter meds to poison myself to death. Its third priority is to take those meds in an anonymous hotel room. Always with the hotel room! I bet if you put that in as a search term on this blog you would get a lot of hits.

Tom’s plan is to keep me on 1:1 observation. 1:1 or arm’s length obs means, in a hospital context, that you are never left alone. You can’t shut yourself away in your bedroom because someone is always in your open doorway, even when you are on the toilet (assuming you are lucky enough to have en suite, otherwise they follow you to the shower room or the loo). You don’t even get to shut your door while you are trying to sleep; someone watches over you the whole night – although I know I am not the only one who has seen nurses asleep in their chairs while on duty in the middle of the night. Tom is also right beside me all day and all night and, as on a ward, he is making sure I take my meds.

I am allowed to bath and go to the toilet in peace, but Tom’s not going to stand for me leaving the house alone, nor is he going to leave me at home alone, unless there is absolutely no way I can run away from Smalltown and catch a train to The City. This morning I negotiated a walk into Smalltown by myself but to do that I left my bus pass, bank card, cash, phone and Apple Watch, taking only a £1 coin to buy a can of Coke. There was nowhere I could do and nothing more nefarious I could do with a quid.

Because I am not trustworthy. Where there is cash, there could be taxis. Where there is a bus pass there is the means to access a station with more regular trains to The City. Where there is a debit card, there could be train tickets, hotel rooms, pharmacy payments and things to make the pills go down easier. I simply cannot stop thinking this way. Tom offered to take me to the local rugby match this afternoon, but I know that I couldn’t be trusted. One trip to the ladies, coordinated with the bus timetable, would mean an opportunity to slip off.

Of course, here in rural Wales I have to be a bit more creative than in London, where there are night buses and multiple suburban back roads to the station. Much less chance of being discovered. Unless I timed things really well or took a taxi it would be very easy for Tom to drive to the station, or the next station, or the next bus stop and simply bring me home. Presumably if he didn’t find me, he would call the police, and if I hadn’t made it to The City I would be at high risk of being detained under s136 of the Mental Health Act and taken to a “place of safety” God knows where. Maybe a police station. Maybe a hospital miles from home.

There is a lot to risk in trying to sneak off and yet part of my brain insists on playing out every scenario, virtually all the time. I have to be incredibly focussed on something else not to be working out new angles, new opportunities. I have my colouring book out (what a good, mindful girl) and I’m working on a design that’s so complicated I can only do so for about ten minutes before my concentration reaches its limit. But still, that’s 10 minutes. I’m OK while I’m reading in the bath (and I am taking a LOT of baths) but I struggle to read just on the sofa. I might get a jigsaw puzzle out. The only time I ever do them is when I’m poorly.

So if that’s part of my brain, what’s the other part doing? Well, it’s trying to keep me alive. It’s encouraging me to be honest with Tom about my thinking, even though I know it must be hurting him. It encouraged me to get in contact with my CPN to say that I actually needed to see her more quickly than 16 days away, which was when we had originally agreed to meet each other – our first four week gap! Because I was doing so well! Haha. She came to see me on Wednesday, and again yesterday (Friday), will ring me on Monday, and is coming again on Tuesday. If I feel the need for the CT before then, my only option is to go to A&E, because here in this part of Wales you can’t self refer like I used to be able to do in London. That is not something I am keen on.

What will I say on Monday? It depends how the next 48 hours go. Will “hospital at home” be enough? Part of me already wants to go into proper hospital, because based on past experience, being locked in and not allowed leave from the ward knocks the stuffing out my plans to abscond and without absconding, I can’t follow through on my overdose plan. I know that Tom doesn’t think that’s necessary, but it really depends on how exhausted I become by the war between the sneaky and the rational parts of my brain. Just in case, I am already thinking about what I might take. I bought an enormously long book that has been recommended to me by a couple of people. If I went in this time I think I would risk it and take in my laptop too. I know from previous experience that the ward here is the most boring place in the world; no activities or groups, and with a very high patient turnover, little chance to build meaningful friendships. I can’t help comparing it with my first admission, where I formed real bonds with people. I was in text contact with one of my ex ward buddies only this week, over three years on, and we still agree that in many ways that admission was a really positive experience for us.

It will all come down to whether I think “hospital at home” is safe enough, and whether I get so exhausted by my own thoughts that I no longer care that the ward will be a crappy place to be. A complicating factor is that my mum is due to come and stay for a few nights this Tuesday. This could be a helpful thing. It would give Tom a break from having to care for me 24/7. We would go and do touristy things around the area which would be a good distraction. But I worry that I might put her through the kind of pain I am already putting Tom through. I worry about being visibly bonkers in front of her, as she has never seen me in full on crisis mode. I don’t know what to do for the best. I don’t know whether to tell her not to come, I don’t know whether to go onto the CT books. I don’t know what to do.

 

Image shows a red card with the word CRISIS written in black in the centre. It was sourced from Flickr, commercial use and modifications allowed, and was uploaded by Ron Mader

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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