'Stop Being so Silly' Said the A&E Consultant

TRIGGER WARNING: This blog describes a distressing incident and discusses suicidal feelings and feelings of frustration and helplessness.If you are affected by discussion of these subjects, don't read on

It was early on a Sunday Morning during the Queen's Jubilee Bank Holiday weekend. I had implemented my Crisis Plan following a week of sleepless nights and five days of constant vomiting, which gave way to dry retching. I was not physically ill, but vomiting spasms were one of my most obvious symptoms, during periods of emotional distress.

I was feeling suicidal and needed help - desperately. I phoned the Crisis Team, as per my Plan and after ten minutes was instructed to attend the local A&E and ask to see a member of the Team as they were on site in my local hospital. So, I did as instructed and reported to the A&E reception, where the Receptionist was helpful and clear that I had already spoken to the team and had been told to report to them. So far so good. Thankfully, for a holiday weekend at 4.00 a.m. the unit was relatively quiet, just three others along with me in the waiting room.

The Triage Nurse, again was efficient and reassuring, I had continued to retch violently and had soiled and wet myself by this stage and so was in obvious distress. She was empathic and quickly ascertained that I was already open to the local CMHT and therefore was responding correctly to my Crisis Plan. Again, no regrets, relief that the plan was working. Then it went dramatically wrong.

Enter, the A&E Consultant. Opening gambit: 'Why have you come to the Emergency Department tonight?' I told him I was diagnosed recently with BPD and was experiencing a sustained period of emotional distress. Again, a long explanation about the building distress, finally admitting that I was feeling suicidal had contacted the Crisis Team and they had told me to report to them via A&E, could I please speak to them. 'No, you must speak to me' - cue frustrated banging of head against wall. 'You must stop being so silly and speak to me'. 'What is all this nonsense about suicide?''You are being very difficult and I'm not prepared to refer you on'. I decided to try pleading, 'Please, I don't want to explain anymore, I need to speak to the team, I have already spoken to them on the phone and they told me to come here immediately. That was two hours ago.' He again told me that talking about suicide was 'silly' at which point I exploded: 'Get this bastard away from me, I don't want to talk to him anymore'. Again, banging my head against the wall.

He continued to refuse to refer me on until I had 'stopped this nonsense and calmed down.' Then, a Staff Nurse and HCA appeared, alerted by my shouting, and quickly removed the Consultant. For the first time since speaking to the Triage Nurse, someone asked me if there was anything they could do to help me. It was the HCA. I was able to tell her about my soiled clothes. She quickly arranged some scrubs for me to change into and offered me a cup of tea. Then she and the nurse put me on a trolley and tried to get me to put my head down.

Within thirty minutes of their intervention, a member of the Crisis Team appeared and assessed me. She prescribed a sedative to stop the vomiting spasms and arranged a home visit from the Home Resolution Team the next day. Admission was never an aim of mine, as it is noted in my Crisis Plan that this is counter-productive unless there is an imminent risk of harm to myself. Having removed the Consultant and feeling listened to, my risk of harm had reduced significantly.I was allowed to go home at 6.00 a.m. and had a visit from the Team at home by 10.00 a.m.

The team responsible for my care had helped, but there seemed to be such a disconnect between their response and the response of the Consultant.

Given that the Receptionist and Triage Nurse had noted the involvement of the MH team, why did this man not recognise the fact that my case had a solution in place? Why did he feel that it was okay to belittle my response? Why did he not notice my physical discomfort and embarrassment? Given that I was dealing with BPD symptoms and risk of suicide attached to this condition, why did he not carry out a more thorough assessment of my suicidal ideation?

I guess there are no answers as to why, only he may know that. What worked in soothing my distress and stopping my self harming behaviour from escalating, was common sense responses to a human being in need. In a word, compassion.

The Alien in the Therapy Group

We sat down in a circle, me and five members of staff. I had been left on my own in the 'group room' while the staff sat in a side office drinking coffee and, as far as I believed, discussing me. suddenly I burst into tears. I felt like a five year old, in the wrong clothes, doing something wrong, in the wrong building, on the wrong planet. It didn't help that I was new to Mental Health services.

I was still working four days a week while attending this group every Tuesday, all day. I wanted so much to understand my condition and to be able to manage it better than I had managed it for over 40 years.

When I arrived at the centre I made myself at home, making a cup of tea and arranging enough cups for everyone, very unselfish and 'functioning'. I entered the meeting room which was empty so, eager to please, I set out eight chairs in a circle. After a while of sitting on my own in the circle I plucked up the courage to knock on the closed office door where the five staff were talking - I assumed - about me. So I knocked, they opened the door, looked shocked, then closed the door, without telling me what was happening or when the 'group' would start.

Then they started, the stream of endless judgements and negative thoughts: why am I the only one? I knew it I've done something wrong and now they're punishing me, they don't get me, they think I'm wasting their time, they think I'm a waste of time, I am a waste of time, just look, they can't be bothered to come out and see if I'm ok, I knew I was a waste of space.

Then 30 mins late, they paraded out of the staff room and entered the room. 'Oooh, someone's put the chairs out, that's nice. Wonder who thought to do that?' Ignoring the Alien in the corner. It felt odd in a 'Miranda' kind of way: me, alone sitting in a circle of eight chairs and once all five staff members sat down, I was still sitting isolated, with no one either side of me. And then the stream of powerful thoughts gave way to an overwhelming deluge of painful emotions: anxiety, humiliation, embarrassment,anger, frustration, confusion. One after another they crashed on me, as my sense of alienation worsened. Suddenly, the waves of emotion were out of control and my sobbing broke through the matter of fact (patronising) repetition of the agenda for the morning.

Instead of stopping the farce they proceeded as if the whole group were present. I was clearly very distressed by now, but none of the professionals (or the Service User consultant for that matter) seemed to have the common sense to enquire as to the source of my distress. Being someone who had not had very much contact with Mental Health services, despite struggling with BPD for over 40 years, I didn't know if this was typical and to be expected. All I was aware of was that whatever this process was, it wasn't helping me: I had taken a reduction in hours and pay to attend, committed myself to it for the next two years and THIS was making me feel WORSE - not in any expected therapeutic or cathartic way, but in a way that felt like I was being traumatised.

Suddenly, it seemed a member of staff noticed ME - the large eyes and green skin must have betrayed my presence! 'Maybe the number of staff here are making Alma feel uncomfortable'. No Shit Sherlock! Still, no one thought to ask me what was upsetting me to such an extent - not that I was capable by that stage of articulating anything resembling an accurate picture of what was going on inside me. Eventually, I was left alone with two members of staff, who then proceeded to deal with a recalcitrant child. No mean feat as, by that stage, my willingness to open myself up to further pain and distress, had disappeared.

Perhaps, professionals reading this may recognise the brick wall of resistance in my response. Perhaps, it helps to suggest that professionals don't try to break through this wall, by the time I have constructed it you would be on a hiding to nothing. I would suggest to staff how about acknowledging there is a problem in the relationship and suggest a restart.

I am glad to say that this false start did not put me off persevering with other treatments, but certainly, it reinforced a number of my defences and made it harder for me to open up to staff in succeeding therapy. I am also pleased to say that my experience of DBT has been positive, with staff being consistent, human and willing to acknowledge when they don't have the answers.

Here are some thoughts and suggestions for staff when dealing with someone feeling like an Alien in the Group:

1) Even if a service user presents as really together and confident - please don't assume that is the full picture. If I have been assessed as suitable for treatment then there must be more than meets the eye.
2) If you misinterpret the situation or a person's mood, don't be afraid to apologise, start again and ask for the person's help to understand. Above all listen to the response.
3) Be aware of how your locking yourself away in an office appears to patients, particularly from an individual person left in a group room. Remember, you are often dealing with people who are super sensitive to rejection, ridicule and paranoia.
4) Ask yourself how you would feel if you found yourself in the situation that seems to be distressing to the person you are trying to help - your answer may give you an idea what questions to ask.
5) If you are trying to get someone to open up who has closed down - please give them time to answer, don't jump in with your assumptions as these may well be wrong.
6) Even if you have some idea what is wrong, don't put words in the other person's mouth - all of us have our own ways of explaining things and even if you are close to the truth your experience will not be the same as mine.

Above all, show the person that they are not aliens, but individuals with real needs that deserve to be met and that merit the best of your skills and professionalism.