Marvellous Medicine? What is Private Hospital Care for Depression like?My Week.

It’s the end of my week off, hospital done and back to work next week.

Tomorrow I’ll be writing another #dayinthelifeMH post, and adding it to others’ contributions, but in this post I’m reflecting on my experience of taking time out for my depression (as I knew I needed to), seeking treatment for it, and going back to normality (whatever that means – I guess work and living) afterwards.

"Okay, I need help, time to take the mask off for a while and deal with this."

My experience of hospital is of private treatment for mental health patients with a variety of conditions, and it’s private because I am incredibly fortunate to be able to work for a company which provides, as a benefit, private health insurance. I can’t talk about public healthcare for mental health as I’ve never had it (see previous post for more details). What my private mental health coverage means is I have a psychiatrist and a one-to-one therapist I see, and in-patient or day-patient treatment which I can also make use of – depending on the severity of my depression at a given point, and also a fair amount of paper work which my psychiatrist, therapist, key worker (another therapist with whom I make appropriate treatment plans) and others complete to make the case to the insurance company that I should get approval for the treatment we believe I need.

Thanks very much, I'll take all that money from you right now...I need treatment

I knew that I’d be struggling after last weekend and a variety of external matters contributing to my worsening depression, so I took the step to see my psychiatrist beforehand and ask for the paper work to be submitted requesting day care at hospital for a couple of weeks (because it’s always easier to ask for more upfront than go back and ask for more later). Luckily my case was accepted and covered by my insurer. It’s not possible for me to pay for it privately, even on what I know is a really good salary. It’s just too expensive – something like £500-700/day, which, to be honest, if I were well I’d far rather splash out on a new pair of gorgeous Louboutin shoes as a massive extravagance (and a one off, not 5 pairs in a week, although if I ever win the lottery…).

Shoes fit for any Superheroine

The fact is that I might be able to pay for just one day of care at this amount, but I just wouldn't be able to pay for more, without going into debt. Money worries have always been a contributing factor to my anxiety and depression; when teaching I couldn't afford to feed myself without using my credit card (on £17K/year with London rents and prices) and I longed for a day when I would be able to pay my bills and eat, and socialise, without getting further and further into debt. Now that time has come, I feel physically sick at the thought of going back to that place. I cannot go back there. It would certainly worsen my health – probably both physically and mentally, as I know they’re connected (and I describe below).

When Depression Debbie comes calling, she's packs a punch.

Anyway, to hospital. My experience of private day care (as opposed to inpatient care, where I would stay in hospital) is to travel to hospital from home and to attend a number of groups every day which aim to educate and support people like me going through a difficult period of mental illness, whether that be depression, anxiety, PTSD, bipolar, borderline personality disorder. I attend groups which my keyworker and I determine will best suit my needs.

Time for support group. Let's share our troubles and support one another.

The first group of the day is support group, where I and other day patients sit in a confidential environment to share how we are feeling, what issues we’re struggling with that day and what we think we will do about them. We have to go around the room to introduce ourselves and ‘check in’ with our state of mind and feelings. This is helpful since many people are ‘new’ to the group each day. This really all comes down to insurance – if you’re covered for a particular day you turn up that day but not on days when you’re not covered. In the last week I met at least twenty people I had never seen before (and a couple I already knew). We are all taking what we can get. The people I met varied every day, so there’s always something new to talk about.

Time to fight our illnesses together. Pow!

In the hospital environment, the support group is guided by a therapist – in our case the therapy manager – and this helps us to dig a bit deeper with the problems that we’re overcoming, whether our illnesses have been triggered by a family matter, work, other pressures or a mixture of all of these. I love support groups because I don’t have to take notes or apply particular therapeutic techniques, but sharing with others is a kind of release, and hearing and participating in group discussions about issues often help me to unpick some of my own personal struggles and find that I am not alone or that I have new options I had not previously recognised.

Hello Demon Difficulties. Please go away.

The other groups are harder. This week I attended a schema group, which educates us as to our core needs as “newborns”, and how our core needs (whether met, overly met or not met) lead us to ‘maladaptive’ coping strategies – i.e. things that we do to compensate for whatever our upbringing and childhood environment was like. For me there’s a lot to learn about the way that I behave now as an adult which links back to being bullied as a child and feeling isolated. It is fascinating and useful, but it is also very hard to think back to those times where I was in so much pain and had no means of understanding or coping with the situations into which I was placed. You can make friends at hospital - because you may bond with others. It's a matter of choice, though, because if you do make friends you often talk more and more about your and their struggles, making the experience more intense and potentially tougher.

Memory Lane. Tough as nails and stronger than steel. And ever growing.

Other groups look at cognitive behavioural techniques (conscious recognition and rational working through) for anxiety, depression, and other important areas like anger management and assertiveness. Practising recognising our negative feelings and the ways that we automatically respond to them, and hearing how to apply different thinking patterns to try to retrain ourselves is what we do in this group.

I can see you, negative thoughts. I'm ready to fight.

For example, if I text a friend and don’t receive a text back, the lonely and isolated, bullied child in me might apply an automatic response, linked to our old ‘fight or flight’ mechanism. I don’t receive a reply = I’m somehow in danger of getting hurt here; = My friend doesn’t like me anymore; = I’ve done something wrong… and so I start to become anxious because of these worries and start becoming  depressed as I wrack my brain for potential incidents in the past where my behaviour might have caused the person to dislike me. (The first – worry – leads to a build-up in anxiety, as the physical symptoms like a racing heart, feeling sick, feeling dizzy may strike in addition to the ‘cognitions’ or thoughts that I described above leading to the feelings – shame, guilt, fear, etc. The second – rumination – leads to increased depression and may include some of the physical symptoms above, but also add sluggishness, a feeling that one is hopeless, a failure (more shame, more guilt, anger at self and others, fear of never getting better.)

In this case, 'A' is very much for 'Anxiety'

When I read the above and tell you that attending these groups leaves me feeling exhausted, I hope that you are not surprised. It’s quite hard for me (and I think it’s hard for others) to acknowledge in the first place that I need help of this level. Unfortunately the part where I get help is far from easy, as I look to past events and their effect on my feelings and depression, and I have to recognise them and confront them in order to start working through those feelings and events to feel better.

I went through this on Tuesday, Wednesday and Thursday, always attending the support group first thing, and following this with other groups. By the end of each day I am drained and sad, probably sadder than I was when I arrived, because it is hard to go through things from the past. However, the alternative – not to go through those things – not to challenge my past and my negative thinking – not to address the deep depression that is overwhelming me – is not to live. And since I choose to live, I choose to get help, even though it’s hard and afterwards I curl up in my bed under the duvet, with pillows all around me, and I tune out with Netflix or my Kindle, or with a radio programme, and perhaps go to sleep for a while.

Support group. Where we share and sometimes laugh together. 

It's good to know I'm not alone.

I took Friday as my last day before returning to work. I didn't go to hospital because I wanted some time to do more tuning out and re-acquaint myself with the land of the living, thinking a bit about work, doing some food shopping, posting some parcels, paying bills and so on. I also spent a good deal of time cleaning (which is surprisingly therapeutic as a physical activity that allows me tune out) and resting in bed with a book. It's also just good not to think about myself in such a focused way - not to work on myself anymore. It's a relief to stop that and necessary in order to dip into a week of treatment and then return to work immediately. For me, Friday was the opportunity to start back into life and lead into the weekend with rest, and with those sad, terrible thoughts not exactly put away, but left for a while to get some air and be revisited in a smaller way at a later date.

And time for sleep while that works away...

I now feel like I’m ready to work again, and I feel rested, and heard. On Tuesday I felt hopeless; on Wednesday more so; on Thursday tired by the whole thing, and on Friday relieved to be away from all that difficulty, but able to recognise its value. I could see the sun and smile quietly at it. I could walk and appreciate the wind (and drizzle!) on my face and be in the world without anger or self-hatred. It’s a step forward. I will keep stepping forward. 

Time to step forward.  And put my head band and shield back on. Obviously.

A Day in The Life: Depression - Me, Myself and I, Warts, Clutter and All

Today I participated in a project called 'A day in the Life, a project which intends to offer a snapshot of the lives, and wellbeing of people who experience mental health difficulties in England. I and - hopefully - 800 others - will post their 700 word account of their day living and coping with mental health, as it presented itself, today 7th November. https://dayinthelifemh.org.uk/ (#adayinthelifemh)

“What day is it?"

"It's today," squeaked Piglet.

"My favourite day," said Pooh.” 

As I'm working from home at the moment on a phased basis, no one really gets to see what a day in the life, or rather, a day in my life, is like. I might exchange the odd pleasantry with a passing neighbour, with the woman who served me at the post office or (quite frequently these days) at the pharmacy, but then I go home to my flat while Mat is at work and lead what is a sort of hidden life.

Of course, none of us really knows what the other is up to. I have a friend who is a high powered communications professional (as she is so high powered I really feel it should be communications with a big 'C' but grammar forbids it!). When I imagine her at work I see a corner office, both sides floor to ceiling glass, looking out over the beautiful city of London. I see the latest Mac computer on her desk and expensive impenetrable modern art hanging on the other walls of her office as she takes phone calls from Dubai and Hong Kong whilst eating a Larabar for energy, with a coterie of secretaries taking minutes from her meetings and telling the CEO that she will be with him / her in "just a few moments". Carly Simon's "Let the River Run" is playing loudly as the camera pans out to the whole of London, which my friend will shortly be in charge of. That and the rest of the world.

Executive Barbie. Surely an oxymoron?

Anyway, my friend is super high-powered and would be unlikely to wear her hair like this.

Another friend is the CEO of a charity which helps African children. When she goes off to African I imagine her days as Diana-like footage of her in a series of villages where hundreds of children crowd around her, clinging to her legs and arms and screaming her name with joy on their faces (she's wearing a tasteful white shirt and pale khaki trouser outfit) as the music from LiveAid or the Soweto gospel choir (either, depends on the day) plays in the background.

From Working Girl. Still SUCH a good film.

In my case, I'm working from bed because there is no chair in the house that I can sit in for more than an hour without being in such discomfort that work becomes impossible - which doesn't sound like rehabilitation to me. Today I was just getting ready for a snooze mid afternoon after finishing my half day of work when suddenly my phone rang. I had totally forgotten that I was expecting an appointment from Posturite (a company which supplies ergonomic equipment for people like me who've chucked themselves down the stairs accidentally or have RSI etc.).

I think I need one of these home recliners. And the chair, too, obv.

I struggled out of bed to buzz them in and went down to greet them. It was really only when we were climbing the stairs (carefully, always so carefully) that I realised that the flat was (is) in a complete state. There are medication packets and pots and pans all over our kitchen table. There is clean washing in small piles over every visible surface in the rest of the front room and hall. And then there's the bedroom. This is a domestic bombsite. Clothes, unfolded, cover the desk, chairs, and end of bed. On my bed itself are about 6 pillows, several cushions, one double and one single duvet, my laptop, my iPad, two books, medication, water bottle, two phones and chargers, and possibly a plate which once held some biscuits. And the rest of the room was already in a state - bags all over the floor (the edges of the floor, so I can't trip over them, but still) a stepladder in the corner by the wardrobe. Oh dear me. I don't need a Posturite assessment I need the Obsessive Compulsive Cleaners.

I'll spare you the picture of my bedroom. Shame prevents it I'm afraid. Tangerine face: yes. Lying under the duvet: yes. Complete carnage which would make my poor mother die of shame. (And my husband, friends, and even me): afraid not.

Here is what I posted for the #dayinthelifemh collective writing exercise today. This is my day, warts and all. I wish you all good days, and a wonderful weekend ahead, whatever you do and wherever you go.

“Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think.” 

― A.A. Milne

Today: 7th July. Jessica Carmody for A Day in the Life - Mental Health

Subtitle (credit to Pooh): What I like doing best is Nothing.

At 7.04 I slowly rolled and cajoled my frail frame from its imprinted resting place in the bed and put on layer after layer: jumper, cardigan, scarf, woolly hat, woolly socks, Ugg boots. Then I shuffled slowly into the kitchen. Morning breakfast and pills are a routine I go through without much thought or emotion. Rice Krispies weighed, milk poured on, spoon from drawer, vitamin C & pain killers taken. I felt unemotional about the whole routine. Back to bed.

Today was a work day so I looked through my emails. I opened documents sent to me for review and started to make comments on each one. Once I get going I find it easier to do. Today wasn't one of my worst days so I only felt a medium level of fatigue perusing the documents line by line. This woke me up - or woke my mind up at least, and I started thinking about the document from more angles. I'm glad that this works. Work works on my by making me feel more capable of participating in it, of having a view and of contributing to my job. Today - or at that moment anyway - normal me won the depression versus normal me contest that is fought every day.

I worked for 2 hours then went out. Despite the ache in my back today I wanted fresh air. I'd been so exhausted the past two days that I had avoided going out and this had taken its toll on my back which was stiff and uncooperative. So wrapped up in a further thick coat I made my way to the outside world.

Because I have physical injuries you can't see from the outside, I avoid people. That could also be an excuse. I don't much like running into people when I feel low, certain that they can tell I'm struggling and wondering what I will do if they ask me a question, fearing I might burst into tears because that conversation is a step too far. I don't feel too ill today, so when I meet a server from the nearby pub I say "Hello" without avoiding eye contact. It's a slight struggle but I do it, and this is good.

The foot bridge is the hardest part physically, but inside the park I am afraid of other people’s dogs and – complementing this – dog owners who don’t understand how terrified I feel if their dog rushes at me barking. Again, today is a good day and although I have three close shaves with rushing, barking dogs, they keep their distance from me and I kept going. Another fright came when a runner whipped past me too close for comfort. I felt like crying because I was afraid of being hit and upset by the thought of falling.

“Just breathe” I told myself. And I did. “The park is beautiful. Look at the leaves. Look at the deer.” And I saw them. And they were.

I made it to the shop to buy more Rice Krispies but felt extremely tired and weak. I had been out 1.5 hours and now craved secure, locked distance between me and the world outside.
I had lunch –more Rice Krispies, a slice of cold pizza, two biscuits. I can’t be bothered to prepare anything more complex. Food then rest. And I knew I had more work ahead.
I didn’t want to do more work, at this point. I was exhausted from the walk and “depression” was winning over “normal me”. I fought back. I took phone calls, made decisions, followed through with the actions required. “Keep going,” I told myself. Just a while longer and you can rest.

I checked Twitter and my blog to see if anyone knew had followed me or showed interest in my writing about depression / life. Then I relinquished all external communications and picked up my book, ate two chocolate biscuits, and buried myself down into the duvet for a rest. I had gone out, worked, eaten and spoken to people. Enough. I wanted time to rest and gave myself up to reading and then to sleep.