The crisis is not “the cutting”

In mental health rhetoric, a “crisis” is usually defined, or talked of, as when a person engages in a suicidal, or otherwise dangerous act in an effort to seriously harm themselves, or end their own life. Of course, I don’t dispute that this is a crisis of sorts, but I’d also like to explore the idea (from my own perspective and through reading other people’s opinions on the matter) that the crisis actually happens long before the “act”, and it is at this point (when a person feels that they are deeply unhappy, unsafe, or otherwise highly distressed, but haven’t actually done anything to themselves) that the crisis actually begins and therefore requires intervention/help.

I myself have often spent months being suicidal, severely depressed, not functioning properly or otherwise unwell and been told repeatedly that because “I have managed to keep myself safe” that no intervention is warranted. When I’ve then (unsurprisingly) given up on the hope of help during that time and acted on my thoughts, I have been told that I should have sought help sooner. Well, I did, and was told exactly as I described above – essentially, that I wasn’t in enough of a crisis because I hadn’t demonstrated suicidal intent.

It was on a recent-ish A&E trip that I was told crisis services were for people who have “deteriorated to the point of actively trying to end their own life” – in other words, if you try to kill yourself, you fit their definition of crisis even if you succeed and therefore wouldn’t need their help (because you’d be dead). However, if you ask for help before this, you are deemed as possessing enough insight to know that ending your life is unreasonable and therefore no crisis action is needed to be taken. So people are often faced with few avenues to turn down other than “demonstrating” they are in a crisis (often with disastrous consequences) simply to be helped. This is probably one of the most well known double bind situations in the world of mental health service provision.

So from here, I can pose the question, is it fair to leave people hanging in a state of complete despair, and not provide them with the intervention they would otherwise get if they had actually acted on their thoughts ( and possibly succeeded in killing themselves). Is it fair that a person must be half way dead or physically ill before it is justified in allocating precious resources to them? I think I know the answer.

I get tired of the constant “distract, distract, distract” mantra banded around. At the point at which I feel I am unable to cope, I simply do not have the strength to summon the right frame of mind to do something else other than be immersed in my own suicidal thoughts. To do something banal in order to “distract” yourself directly contradicts the frame of mind you are in. You are past that point. There are plenty of other times that watching TV in order to distract yourself would be a suitable activity to turn to – but those situations can generally be condensed into the “mild distress” category (e.g you’re just “having one of those days”).

It is not a case of likening suicidal thoughts to a bad day at the office, and that you can just get over them by talking yourself out of your feelings and watching some TV. Depression is more than often not relative, it’s an innate force that twists a persons perspective to the point where they are so fragile they cannot possibly contemplate anything else other than their own unhappiness.

I have been depressed on and off for a long time. I am currently depressed. In these states I need someone to listen, to be compassionate, possibly an urgent appointment, I need empathy, understanding. Yes, that might seem “demanding” but when it boils down to choice between being demanding and potentially severely disrupting my life by being unable to cope with myself – I think “demanding” is the lesser of two evils. I don’t want to be this person. I don’t want to be depressed, and believe me I don’t enjoy asking for help, I find the whole process humiliating. So to be told that my feelings are in fact a product of “a bad day” and I should simply forget about them by “doing something nice” is not only patronising, but beyond the point of stupidity. Telling someone who is in the middle of a depressive episode to “do something nice” is like yelling at someone who is drowning in the middle of a storm at sea to admire the weather. Doing something nice can avert an episode of amateur dramatics – it does not, unfortunately, dissolve suicidal thoughts or other unusual experiences.

So, even if you did kill yourself, your death might not be the responsibility of the crisis team, because they assume asking for help constitutes full responsibility over your actions. You are to them, sane and in full control. I have heard several people say that you are more likely to be acknowledged in a crisis if you refuse all attempts to help you. Their failure to act on the threat of a potential suicidal action is supposedly their version of “not encouraging/enforcing self destructive patterns of behaviour”. They achieve this by actively ignoring almost all pleas for extra support and encouraging you to self-manage. Of course, being systematically ignored when you are desperate is a really great way to encourage keeping yourself safe – we all know that.

When I have been in a completely distressed state, I have been left with the choice of continuing to deal with my pain on my own for a set length of time (or indefinitely) or to face (or rather be pushed by virtue of having my beliefs that I am unworthy of help enforced) ending my own life or succeeding in self harm that I then come to bitterly regret. I’ve always afterwards been told “I could have prevented it”, when that is simply not the case if services were not willing to assist at that time. When I am incapable of preventing something because of my state of mind (not just in that moment but for many weeks/months beforehand) that is when the crisis needs to be recognised. Not after an overdose, not after hacking my arm up with a bread knife, not after weeks of hardly any sleep, food, or human contact. Now.

If a person is diagnosed with cancer, you don’t wait till they die and or become seriously ill before you recognise that they are in dire need of help. At the point when a person makes a decision they need help, and then requests or voices that need for help, that is when help is needed. No more, no less. You don’t say, “Oh, maybe just forget you have cancer and try to get on with your life, you just need to try harder to forget and things will get better.” It doesn’t work that way. You have cancer, it is happening, it is real, it urgent. Everybody has a right to receive appropriate help for health problems, even if those problems are the result of a complex and often confusing interaction between mind and environment. It is still suffering, and it can result in some serious consequences if ignored.

5 thoughts on “The crisis is not “the cutting”

  1. Dounia

    I don’t know in which country you live but I’ve heard similar stories to your and I honestly I’m sick to my stomach for knowing you have to prove to be sick in order to get help. It’s a shame that such things still exist in the year 2014 :(…

    1. Alex Dale Post author

      Hi, I am in the UK. We’ve had nationwide cuts to mental health services, with a measly part of the overall health budget being allocated to those in crisis, and an enormous proportion of funds going on NHS consultant psychiatrist wages who are raking in an obscene amount of money for relatively little work in contrast. We are flooded in a sea of bureaucracy and paperwork and ticking boxes takes priority over medical care.

      We have a national bed crisis. People in a mental health crisis are being sectioned unnecessarily to secure a bed and then being un-sectioned because no bed can be found. People are being sent to hospital hundreds of miles away from their home town and are having to sleep on sofas and in toilets because there is a 101% capacity of patients in certain areas.

      The bits and pieces are being picked up by the police. 136 suites are nearly always full, but because of bed shortages and other resource cuts there are no services to provide to many people and they are being sent home with no follow up support and an ear full of “advice”. We have a huge drugs budget, so people do get drugs to make them numb and often that is what they have to accept in absence of any other choice being offered and GP’s being unable to refer quickly to any other type of support. NHS therapy waiting lists are very long and their duration is short lived and ineffective. Private therapy is either extremely expensive or extremely hard to get a referal to. CBT is now being used as a cure all and if it hasn’t worked that is used as leverage for benefits sanctions.

      It wouldn’t be an exaggeration to say we are living in the dark ages of national health care. More people are in need and less people are receiving adequate care. People use alcohol and drugs as crutches to cope with life and mental health problems that we cannot afford to address. Yet, addiction services are sorely underdeveloped and underfunded. In no way can we call ourselves a civilised society when people are being left to suffer needlessly. The care on offer falls short at every hurdle.

      1. Dounia

        What you are writing is completely true. The UK and America are indeed less developed in mental health which is sad to see :(. I live in Belgium but the care you get here is enormously good and helpful. Its weird that care is so different in other countries

  2. sharingrecovery

    I am so sorry you’ve had bad experiences with the mental health services too; I was turned away when I first went to the GP with an eating disorder (he said it was just a phase) and consequently ended up in hospital for nearly a year. Because I am under 18 I got help much quicker, but even then it was a push and my parents were practically my lawyers in the way they demanded my help and never stopped pushing. Without their constant push for support/therapy I think it’s unlikely I’d be here today.
    So many times people have brushed off my problems simply because I haven’t attempted suicide. No amount of self hate or even self harm matters, and it is shocking. How could someone turn away another who, in turn, may end up killing themselves due to lack of help? It is truly awful and it is times like these I despair for those struggling with mental health conditions. I am lucky I am receiving help, I just wish everyone could get the same treatment.
    I’ve rambled enough now, thank you very much for the article – if is a very important topic that needs discussing and is extremely thought provoking. Keep writing, these things need to be said.
    I might link you on my blog in a future post if that’s ok with you, it’s perfect for raising awareness.

  3. Pingback: Thoughts on mental health services (UK) | Surviving the mental prison

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