But this deal has worked. In a limited way. There has been a reduction in the incidents of self-harm (though they have had to turn a blind eye to one or two major incidents). This drop in self-harm is encouraging: as days free of self-harm lengthen into weeks we know that the risks drop away.
In other ways it hasn't worked. With no additional support on offer, Julie has had to grit her teeth and hang on grimly to that promise of time in hospital. Throughout much of this time her mood has been very low. It has made her more dependent than ever on the hospital staff and less willing to work with her regular team, who seem to have nothing to offer. The inpatient admissions play havoc with normal routines and support structures. She has almost stopped going to college, or studying, does virtually no exercise, gave up volunteering, and for a while withdrew from the family. Looked at from the outside (which is the only place her family seem to be allowed to stand), it doesn't really look much like a success.
However, there is nothing we can do about it. And we have been down to these depths before and still recovered. I have managed to persuade Julie not to drop out of college or make any other major decisions for the moment. And things did seem to improve over Christmas week: her mood brightened, and she became more like her old self, funny, kind, full of ideas and future plans. She saw a lot of her friends, and we have had fun together over Christmas. But it's clear this recovery is very fragile - just mention the start of the college term next week and her mood drops.
If she can manage through this week, then she goes back into hospital for a planned stay this weekend. After that all bets are off. Will this stay in hospital consolidate a recovery? Or will the return to college the following week push her back off balance? There is no sign of the therapy they say she needs (she has been on a waiting list for assessment for months), so we will have to improvise. I will hope for the best, while quietly preparing for the worst.
I admire you all hugely as you walk along this narrow plank together. I know that's small comfort and doesn't help at all but I just wanted to say it.
ReplyDeleteMuch love
J x
Thank you Joy. The image of a narrow plank is a good one. I think we're becoming expert plank walkers in our family. Any more of this and we could start our own circus!
DeleteOh man that is such a weird strategy to reward a vulnerable person with hospital. I guess its to prevent her self harming worse and worse to get herself admitted. I suppose its more helpful than encouraging her to have the lengthy emergency admissions but Id hope this is a very temporary solution. Similar to DBT not giving your therapy for 24 hours if you self harm. Hopefully she gets in a dbt program soon
ReplyDeleteGlad someone else finds it weird too! It seems to be based on past experience of the staff on the ward: if they do this then people don't come back in quite so often. But they don't seem to be interested in what happens to people when they're off the ward: whether it reduces distress, or makes them less dependent, or improves the long term outlook. I'm hoping DBT will be offered and that it works (eventually).
DeleteYikes it just sounds kind of bad. It doesn't sound like julie enjoyed hospital before and now it's her reward. But maybe it will mean she doesn't get the reinforcement out of hospital thay she hopes for (ie not caring for her when she's distressed and teaching her to do that on her own). Dbt sounds like it would be good for her as she needs the skills for when things are bad. Seems unfair that she's being asked to do this with no real help. I do know that planned admissions are pretty common with bpd. When I've been in hospital, people have been on them but it was normally around anniversaries or if things had escalated so they would get a few good nights sleep, prn and feel settled to go back home. It must be so hard that you've been shut out of her healthcare so to speak. But I guess she's coming to terms with a new diagnosis and things are bound to be rocky so perhaps she needs to do this alone for a while. All the best xx
DeleteOh boy. This 'reward' of theirs is far more likely to reinforce a key weakness of BPD - we fear abandonment and embrace it! :( foolish of them
ReplyDeleteI truly hope that Julie will finally be offered DBT and that it will help, managing crisis is important but the key is the level of emotional distress being manageable *hugs*
I smiled at the image of the plank walking, then a thought struck me... how many planks before you look back to see you built a bridge? :)
take care of you all xx
And in fact the end result was, as I half suspected, that she did go back to self harming as soon as she was discharged from the 'reward' admission. It would be nice to think the hospital staff can learn from this - but of course they don't follow up on what happens *after* admission! If they don't see her again, they think the policy has worked.
DeleteBetter go... Got that bridge to build. Thanks for the support.