Mental Health Crisis Services: A young adult's perspective
We are used to hearing that Mental Health services are in Crisis, but what provision is out there when we ourselves experience a mental health crisis? When things feel overwhelming, where can we turn for help and support? We met up with Islington student, Kate, to get her perspective.
Interview by Jeni Kent
Kate is a university student who uses mental health services in borough (and also blogs for us about her experiences).
Kate told me that in Islington we seem to have better crisis provision than in the rest of the city. The Camden and Islington NHS Foundation Trust (CANDI) operates both a Crisis Team and several Crisis Houses which offer a range of interventions for those in mental health crisis. It seems that more and more people are presenting at A&E in mental health crisis which can sometimes lead to a hospital stay. We were interested in finding out whether there were other options.
Q: Kate, could you tell me about the first time you came into contact with mental health services?
"When I was 17 I took an overdose and I ended up in hospital. I was treated in general hospital for a few days and then I was taken directly to a psychiatric ward. I wasn’t allowed to go home. I had to meet a psychiatrist and because I’d never been in contact with services he was trying to ask me about what had been going on. I didn’t want to talk so played it down saying ‘it’s not a big deal, it doesn’t matter.’ When I left the psychiatric unit I was seeing CAMHS every day."
Q: Could anything have been done to support you better before you attempted suicide?
"None of my family knew about what was going on, so that was the main barrier. Stuff had been going on for years and I was just too scared to tell anyone about any of it. I didn’t really know what was going one because no one had ever talked to me about mental health. I had no idea I was depressed! I was using ChildLine for a few months prior to the overdose. I was speaking to them using an online chat system because I was worried if I called they would trace my phone. They kept saying ‘you need to tell someone’, but I just didn’t feel able. However, if I hadn’t been speaking to them I might not be alive. The night I took the overdose I was talking to ChildLine, saying how suicidal I felt and that I was thinking about taking an overdose and then I logged off. About an hour later the police turned up and they’d tracked the IP address because they thought I might have attempted suicide.
"It’s hard to talk about mental health. When I was a child no one really spoke about it, so I didn’t know what was wrong with me. It was very close to my overdose that I thought maybe I was depressed. I was googling symptoms. When I read stuff on depression I was like ‘that sounds exactly like me!’ But even then, how do you even say that to someone? How will they react? What will they think of me? Will they think I’m weak?"
Q: Can you tell me about the first time you accessed a mental health crisis service?
"That would be in 2013 when I went to a Crisis house for the first time. It was 6 months after I’d left hospital and I’d just moved from CAMHS to the adult team, so I was 18. My care co-ordinator said she thought I needed the support so she referred me and I was admitted for 4 weeks. At that point my understanding of everything and my ability to talk to anyone was very low. I don’t think I ever spoke about how I was feeling, I just stayed in my room and stared at the person in my one-to-one. I was the youngest there by a lot as well. It was an adult service and I hadn’t been to one before so that was the main reason I was scared. I was also scared it would be like being back in hospital because I found that really traumatic."
Q: What was your view of Crisis Services, and how has that changed?
"After my first stay in 2013, I didn’t think much of them, or find them helpful, but that’s because I didn’t know how to engage with it. I was too frightened and it was all new to me.
It was probably last year when my view really changed. That’s when I went back to the Crisis House. I realised how helpful it can be to have somewhere you can go, or people you can talk to just to feel safe. Partly it’s changed because of me actually being able to use the service and be honest with people, and trust them and even understand myself better, what I need and what will and won’t help."
Q: What hasn’t been so helpful?
"The problem is that the Crisis Teams are very very overstretched because of the cuts. When you see them it feels very rushed and they seem very stressed. When I’ve been to see them they haven’t read my notes properly, they’ve got things really wrong and when I’ve been talking they’ve forgotten things I’ve said. Also, they ask you really general questions, they must ask them to everyone. Even if they’ve got your notes they’ll ask; ‘are you psychotic?’, ‘do you self-harm?’, ‘have you ever been in hospital?’ For some people maybe it’s helpful. They’re very much geared towards keeping people alive and measuring risk. It’s not therapeutic, it’s not about how you are. It’s also very difficult because you tend to see someone different each time you use the service. The good thing is they can visit you at home and you can phone them 24 hours a day."
Q: What has been helpful?
"I haven’t spoken to anyone who hasn’t found their experience at the Crisis House helpful. You can be there from 1 to 4 weeks and you’re assigned a key worker. Each day you get two one-to-one sessions (one in the morning, one in the afternoon) and there’s always staff around if you need to talk to someone. It’s just a very safe, supportive, and calm environment. It’s not clinical like hospital, it’s a house. You can also keep working or going to university because it’s not a locked unit. Also, people can go if they have children. There is a crèche and they have family rooms. You can come and go whenever you want. They have a lot of groups too; support groups, art groups, massages, therapy groups.
"When you’re in hospital everything becomes about you being in hospital and you lose so much control over what you do. In a Crisis House you can access the support you want but you can pick and choose how much support you want. It’s very much your choice."
Q: How do you access these services?
"If you’re already under a team and have a care-coordinator or psychiatrist then they would tend to suggest it, or you would ask them and they would refer you. Other people might come straight from hospital if they’re ready to leave but not well enough to go home. You can also phone up the Crisis House and refer yourself and the procedure is exactly the same. You will go for an assessment at the Crisis House and then it will be decided whether or not there is a bed available for you."
Q: Generally people go to crisis houses because they want to avoid going to hospital. Is Islington different?
"I know that Islington and Camden (combined service) are different to most of London to be honest. I don’t know what other boroughs, if any boroughs have crisis houses. And if they do it’s very limited. Whereas, if you’re in Camden or Islington (because you can be in either borough to access them), there’s about 4 crisis houses I think and there’s one all-female one.
"I think crisis teams are present in most areas, I think that’s quite a standard thing."