Thoughts About Things

I’m writing this as a “blog” type of post. It has been written as the result of an exceptionally difficult 2 weeks with my son that has seen him self-harm, go AWOL and threaten suicide, all as an “inpatient” and under the care of a team of clinicians.

I write this as a means of offloading, but also to speak openly about my experiences with the mental health system and to offer my critical analysis of it.

My son was admitted into a CAMHS unit in March of this year with a diagnosis of Major Depressive Disorder and Social Anxiety Disorder. The program he is engaged in runs through 4 phases, the last of which is integration, which is the stage he is currently in. Integration aims to do exactly as the name suggests …. integrate … back into school and life at large.

From the day my son entered into the integration phase things started to change for him. He began experiencing anxiety and mood swings that had previously been corralled into a safe and acceptable place. He digressed back into zones of despair and overwhelmingness and his motivation dropped. He began displaying wayward behaviour - from determined non-compliance, to self-harm, to going AWOL and saying he was so over everything he wanted to end it all.

Despite his mental health decline, the integration plan forged forward with no allowances or amendments. Nobody thought to ease back or slow down the pace because he was not coping. As a result his mental health declined further and despite his overt distress things still forged forward to the point that he was so overwhelmed with everything he wanted to end his life and I had a mental health crisis on my hands.

A meeting was convened with his treating psychiatrist, who had been on leave during the two weeks in which all of my son’s adverse behaviour occurred. After coercing my son to attend and assuring him that it was because we were all concerned about his mental health, we finally got there. The meeting commenced by addressing integration - a known trigger - and not his mental health. The fact that my son presented in a low and dissociated mood, coupled with his recent suicidal behaviour, did not take precedence at all. As discussions about integration continued he became increasingly agitated and then walked out of the meeting in a mindset that said he was over everything. He again, for the second time in a week, took off into the the “wilderness” in an angry and suicidal manner. Thankfully after a combined effort of nursing staff and myself to intercept him we were able to get him into my car to go home. I was then presented with a boy who was so over everything he wanted to end it all because he no longer cared about anything and for the best part of last night (not to mention other nights) I was on”suicide watch” because I felt that he may not be able to hold his own safety.

Then I thought about things and this is what I came up with.

Despite knowing and seeing the obvious decline in my son’s mental health, the integration plan forged forward without any consideration for his flailing mental health. How far were they going to push? They had an adolescent who had self-harmed, drawn a picture of someone hanging and then went AWOL. Clearly they were indicators that he was not coping with where he was at … and yet despite this, all continued according to the plan. I fully understand that individuals need to be pushed beyond their comfort zones during integration, but question what the threshold is, and what the criteria are, to know when enough is enough. Is it fair to push an individual with a known mental health disorder into a crisis where death feels like the only way out and the only thing which would alleviate suffering? Does anyone look at the big picture and question it, or are they all just doing what they’ve been told to do regardless of the consequences?

When my son attended the meeting with his psychiatrist they did not focus on him, his feelings or recent past experiences. This was bypassed in initial discussion in preference to talking about integration - which is a known trigger. It may have been prudent to begin conversation by openly addressing his emotional state and validating his recent and current feelings and actions. I believe that starting from a base that empathically acknowledged his feelings would have made him feel that someone actually cared about how he was feeling, rather than how he was progressing with integration. When in dark and desperate places there is nothing more therapeutic than to hear words that offer validation, understanding and concern and to feel that someone actually cares about you and wants to help.

And so my conclusion is this:

There comes a point in time when all text books need to be thrown to the wind and for a clinician to connect at a human, person-to-person level with those that they treat. Although this is not the mainstay of clinical practice, and often an impractical approach, it should never be forgotten and intuitively interspersed with “cold” clinical care. In the mental health field this could be the difference between simply helping someone or saving them.

Janna ❤️