TW: references to suicide methods
I remember the first time I was in hospital I was sitting on the floor chatting with my friend Phil, when he spotted somebody he recalled from a previous admission. “There’s Paul!” he said, looking really pleased to see him. “Great guy. Lives with his mum. Voice hearer. Whenever the voices start telling him to kill his mum, his CPN (Community Psychiatric Nurse) gets him in here for a few days, they have a little look at his meds, three days later, job done and he’s home.”
I felt sad for Paul. It didn’t seem like much of a life, an existence punctuated by admissions, although I admired his relationship with his CPN and his ability to spot when things were getting risky.
Today, as I was discharged from hospital for the fourth time in two and a half years, I reflected that I was becoming something like Paul. I have to accept now that when I get into a mixed mood state with intrusive, “loud”, relentless thoughts of ending my life, hospital is the best way to make it all stop and give me my head back. A week ago I couldn’t rest, couldn’t enjoy myself, couldn’t focus on anything other than how to run away from Tom and take my life. Now I feel completely normal.
I tried to manage things in the community. I was brave, and confessed to the overdose plan. Tom took charge of my medication boxes. I was brave, and confessed that I had extra boxes he had forgotten about. Then, as I always do, I kicked myself for giving up my means to my end. My CPN was involved in the decision to have Tom hide my meds, but told me that she would be on annual leave the following week.
An overdose now less possible, my whirring brain went on to the next thing. Having thought so much in the past about the train tracks, my mind went there next, especially as around last week I had been, ironically, very triggered by this Samaritans video on preventing railway suicide. I rang my CPN on the last working day before she went away and told her that things were “rough and rocky” (those were the words I believe I used). I don’t think I told her the half of what was in my head, but she was concerned enough to refer me to the Crisis Team.
The Crisis Team were a pleasant surprise. When we moved to Wales we were pretty much told that there was no home treatment as such, and that if I got into a real crisis situation I would have to go to A&E. Yet there they were, within hours of the referral, travelling in pairs and ready to visit twice a day if needed. I wasn’t 100% honest with them at first. My mind had moved on again. I lived in London when I had these kinds of plans before, but now we are in the country where the trains are slow and infrequent and it would have been easy for Tom or the Crisis Team to call the police and track me down. So my next plan was to take a very circuitous rail route to a big city and do the job there. I spent a lot of time thinking about how I could keep changing up my route to evade the police.
By this point I was also into the practicalities. Tom and I went for a lovely country walk but in the back of my mind I was thinking about how to leave him my bank and life insurance details, the contents of the notes I would leave for my children, my social media passwords so that he could notify my family and friends. I couldn’t focus on anything. Being with those thoughts was like standing behind a waterfall; the noise of them drowned everything else out, yet I remained curiously emotionally untouched.
If it wasn’t upsetting, though, it was tiring. Boy, was it tiring. The constant plotting and planning and evaluating was absolutely exhausting and in the end it was the exhaustion that drove me to full disclosure. The Crisis Team and I had been having the “Do you think you should be in hospital?” conversation for a couple of days, but on Sunday morning I had come to a point of such utter weariness that I decided that if they offered me admission, I would say yes. I would even tell them the full extent of my planning. I loaded up a couple of books onto my Kindle and charged my wireless headphones. Just in case.
Once everyone knew exactly what I was thinking, things moved very fast. One Crisis Team nurse called ahead to the ward, who said that they didn’t have a bed for me but would accommodate me in a visitors room until someone else was discharged. I packed as quickly as I could, desperately trying to remember my own advice in this BBC video. Everything felt very unreal. We got in the car and set off, following the Crisis Team to the hospital, and I was suddenly very anxious that I might be doing the wrong thing.
When we arrived, I was convinced that I had made a mistake and told everyone that I had changed my mind. Tom and the staff tried to convince me to at least stay one night; it was implied that now I was there, I would not be allowed to go again. “The Crisis Team are as worried about you as I’ve seen them in a long time,” said the nurse in charge. I cried and cried because it seemed there was no going back. When I saw that there was no actual bed in the visitors room, just a mattress on the floor, I cried harder.
But do you know what? It fixed me. Like all three of my previous admissions, being in hospital took the obsessive thoughts of absconding and/or killing myself and chucked them out of the window. Once in an environment where I can’t carry out my plans, they wither and die. Yes, tragically, people can and do take their own lives while in hospital, but it is much, much harder and only certain methods push my obsessive buttons. Again, I could try to abscond, but if being picked up the police was one of my main concerns, that wouldn’t be the smartest of moves.
On Monday, I felt so much better. I could think again, breathe again. I got my own room. On Tuesday I cried a lot, which I take to be a massive release of pent up tension. On Wednesday (yesterday) I was a tiny bit hypomanic, and woke up desperate to go for a run in the garden. This too, I have learned, is my usual pattern. By the afternoon I felt like… me. Again. I felt so well that the boredom of the ward really began to chafe. I have been on the three mental health units now, and without a doubt this one had the very least to offer in terms of ward activities. Two people told me that they had gone in non-smokers and taken up smoking just to counteract the boredom. I’m pretty sure that’s not the health outcomes the NHS is looking for. I began agitating for discharge and it was agreed that if I went out with Tom yesterday and felt OK, I could go home today.
I did feel OK. I felt supremely normal. “I feel,” I said to Tom, “that I have come back to myself.” He kissed me. I had come back to him too.
Tom, the ward psychiatrist and my favourite Crisis Team nurse were at my discharge meeting today and we discussed what it was about admission that had been beneficial. As a group, we drew the conclusion that in crisis, short admissions are, for me, the way to go. That perhaps I should even be asking for a hospital bed earlier, once I know things have become really risky. I never would have thought of myself as a person needing multiple admissions, but here I am, four under my belt, and all four did the job. Maybe I am Paul, and maybe Paul is an OK person to be?