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.