It’s not the quantity but the quality – saying the right words in the moment.

I try not to write posts about treatment I’ve received when I’m unhappy about it. I appreciate that at the moment my mental health isn’t great so my perspective, understanding or recall of a situation may not be correct. However, a situation has been going round in my head for the last couple of days and I wanted to write it down in the hope that it might help others to understand.

I’d like to begin this blog by saying that I understand that Community Mental Health Teams are under great pressures. Having an enormous caseload of people, too many to fully look after, get to know or understand must feel overwhelming. Having to firefight crisis situations, rather than having the time to prevent the crisis in the first place must be a very difficult and stressful situation to be in.  The more cuts there are, the bigger the caseloads and the more pressures on hard working staff. I do however want to reflect in this blog on a situation which could have perhaps been helped in the same amount of time, but with a different choice of words.

I have an eating disorder. At the moment I am eating regularly but not enough to sustain the level of exercise I undertake. I am completely compelled to exercise to a certain amount and if I ignore the compulsion I become extremely distressed. I don’t reach out for help often. I understand people are busy and I don’t want to bother them. Occasionally I might ring the Community Mental Health team to leave a message for my Care Coordinator, but this is no more than once a month. This weekend I woke up feeling exhausted and dizzy, I couldn’t ignore the voice in my head telling me to go out. I left the house barely able to put one foot in front of the other, staggering like a drunk. As the breeze kicked in I became very cold, I had chest pains, extreme dizziness and could feel my body starting to shut down, I was some distance away from my house. Any logical person would have gone home, called an ambulance or sat down, but when you are mentally unwell logic goes out of the window. I reached out and called the CMHT and spoke to the person on duty. Their advice consisted of asking me to phone when I eventually got home (I advised I couldn’t go home until I had met my target amount) and they would email my care coordinator to pick up on Monday (this was on Saturday).

After ending the call I realised I really did need to do something or I was going to collapse as my vision was starting to fade out. I put on all of my extra clothes that were in my bag, took some glucose tablets and sat down. I started to feel markedly better and was able to continue until I had met the amount I needed to do for the day. You could argue that perhaps I should have just done this in the first place and not bothered the CMHT. Thankfully in this instance my brain was able to revert to the guidance which is in my crisis plan from the eating disorder service and I could follow their advice. What would have happened had I collapsed before I could do this? What would have happened if I’d not had the capacity to think this rationally as my blood sugar had dropped too low for me to take action? How would the duty worker have known I’d have collapsed?

If you work on a duty or mental health team and receive a call from a person with an eating disorder in a similar situation you could consider the following:

  • Asking them to either hold whilst you read their crisis plan or offering to call back once you have checked the information.
  • Asking if they have someone they can call that could meet with them and make sure they are safe.
  • Check if they have anything with them they feel okay to eat or drink. Suggest they sit down and rest/stick to populated areas. Take details of where they are, a road name if possible.
  • Offering to call them back after a short period of time to make sure they are still safe/home
  • Talking them through their compulsion to see if they could reduce it for that day and perhaps pick it up the following day if feeling better, I appreciate that this may seem like it’s encouraging an obsession, but if someone is physically unwell the key things is being able to negotiate them into a safer situation.

I know the concept of an eating disorder is really hard to understand, I could never have understood it until I developed one myself. I’d compare it to being brainwashed or under a spell, the individual can often speak very clearly and eloquently, but be in great confusion/delusion and distress at the same time. If someone is on the phone to you and saying their physical health is at risk take a moment to consider what type of questions you could ask them, how you could encourage them to keep themselves safe and what you would do if it was a member of your own family in distress.

As always I’d be interested to hear thoughts on this blog, particularly from people who work in this field.

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