How It Feels To Be Recalled To Hospital Under A Community Treatment Order

If someone had asked me what it feels like to be recalled on a Community Treatment Order (part of the Mental Health Act), before it had ever happened to me, I am not sure what I would have said. Possible guess answers that I might have offered would have probably included things like “scary”, “shocking” or “dramatic”. Probably one of the last answers I would have given, would have been “it feels like having your car stolen by a band of incredibly apologetic thieves who are very sorry for your loss”. However, as it turns out, that is exactly what it feels like…

As you will all know from the fabulous explanation of the Mental Health Act that I posted last year and linked to again last week (hint…it is right here: Demystifying The Mental Health Act…With Penguins), when you have a CTO, you have a list of conditions hovering over your head which must be adhered to if you want to avoid being legally recalled to hospital. Rather than conditions hovering like ominous wasps at a picnic who like a look at your jam sandwiches though, I like to think of them as “things that hold you accountable” or “reasons to do things”.
Every time I was scared to challenge my eating disorder and follow my meal plan I had an argument I could use, that being, “you have to do this because otherwise you will lose weight and go back to hospital”. It was a system that worked but admittedly I felt really trapped by it.
Every day I would wake up and force myself to eat a number of calories that made me feel depressed, knowing that it would keep me at my CTO weight which felt equally depressing.

All I wanted to do was give up, give in and lose weight but I felt I couldn’t because that would only involve being recalled to hospital which was simply not an option. My CTO weight was the border to a war zone and I was not taking a single step into no man’s land.
Then however, the recent hospital surgery medical drama, naturally led me to lose weight and I crossed that barrier without even intending to. Before, that CTO number had held a power over me, every digit had felt significant, like a law from the gods that I would probably find carved into one of those massive rocks at Stonehenge if I visited and looked close enough (a lot of people have theories as to why those mysterious stones are there including “for religious reasons” and “rituals”…My theory is that they were simply put there by some cheeky prankster who wanted to leave a pile of stones lying around so that future generations would ask “why the hell are those stones there?”)

When I went under the weight however, the power of that number and the spell was broken. I had thought that one step over the border would have resulted in guns and tanks sending bullets and bombs flying all over the place…but nothing happened. Of course it would have had the weight loss been “my” fault, but I had an excuse, my appendix did it not me, so it was almost allowed. Obviously the CTO weight still mattered and I had to get back to it, but with this medical “it isn’t my fault” get out of jail free card, I knew that I could take advantage and lose more weight without getting into trouble.

Thus it was that, as you know, I ventured further into no man’s land, and it was a sudden surprise when after all this “oooh this feels quite safe and allowed” turned into the previously expected “guns and tanks and swords and back to hospital for you”. Unsurprisingly, it was pretty distressing and traumatic, so a lot of people have been very sympathetic which has been lovely. I really appreciated comments from people online who were not directly involved in the situation because they felt genuine, but it is when we get to the words of the people closest to me that we get to this whole “I feel like I have had my car stolen”.

To use another analogy, I suppose you could view my body as a car that the garage have been keeping very strict rules on. I may have owned the car but there were restrictions as to what I could do with it, what colour I could paint it and how far I could drive. Then, when the CTO barrier was broken, I suddenly regained control over that car, so I grabbed that wheel, painted it purple and zoomed off into the distance (I suppose if we are combining this with the other analogy I zoomed it off into former no man’s land…just like people did with BMWs in World War Two…I may need to retake GCSE history).
With the car all to myself I set my speed limit, I pumped the tyres to a level that I wanted and I filled every seat with penguins because that is what I wanted to do. I could chose…until I was ambushed by bandits who seized the car and stole it, meaning that it didn’t belong to me anymore. Suddenly they would decide how much petrol went in, how plump the tyres were and how many miles it could run and my opinion was irrelevant (the bandits in this analogy being all the doctors and psychiatrists who recalled me to hospital).
Naturally, having just had my car stolen, I was not best pleased. Thing is, when you ACTUALLY have your car stolen you never tend to see the thieves who are the new owners enjoying a trip around the block in what used to be your very own automobile, and they are unlikely to be very apologetic.

Being in hospital though, I am not only seeing the “thieves” every day, I am living with them, and watching them abuse my car. The doctors and therapists decide what I eat now, when I sit down, where I can go and it is all very hard so I try to talk and work through it with them. I say how scared I am to eat, how scared I am to gain weight, how scared I am of everything and like many people online said last week, they say things like “I am so sorry you are in this position”, “this must be very hard and scary for you” but unlike when people online say it, it makes me angry, and all I can think is “WELL YOU CAN’T BE THAT DAMN SORRY BECAUSE YOU ARE THE ONE DOING ALL THIS. YOU STOLE MY CAR, I AM UPSET ABOUT IT AND CRYING AND NOW YOU ARE SAYING HOW SORRY YOU ARE ABOUT THE SITUATION BUT YOU ARE THE THIEVING, HYPOCRITICAL VAGABOND! VAGABOND I SAY!”

I don’t believe that they can really be sorry because they have what they want, they have the car and are legally allowed to do whatever the hell they want with it. I feel the same way about professionals as I do about close family members like my mum, which I know is terrible and I know I shouldn’t feel that way, yet still as much as I love our visits and I would not be able to get through this place without her, what I get out of them is entertainment, love, company, kindness and knickers (she brings in my clean washing…thanks mum). What I do not want from my mother, is sympathy because in my eyes she is kind of like a thief. Admittedly she did not do the legal act of stealing the car, but she gets something out of it, she now has a say over the car and the thieves will take her views into account. If my mum insists on yellow wheels and the thieves like that idea, those wheels will be the colour of sunshine within 24 hours. She could not have stopped the legal act from taking place but she has more say in it than I think she has used, I am sure if the next of kin kicked up enough of a fuss someone would have to listen, but no fuss has been kicked. On top of that, by me eating and being forced to stay in this hell hole gaining weight, she has benefitted from the thieving.
Again it sounds AWFUL to describe it like that, to compare my mum to someone who is in cahoots with criminals and joyrides around with lemon wheels, when I know she would argue that all she has actually done is not try to stop the people attempting to save the life of her offspring by their actions. She isn’t joyriding (my mum is not a joyful driver…especially if there is a cyclist nearby), she is finally offloading this nightmare she has been living with to professionals who can look after it instead and she can finally sleep rather than stay up into the early hours arguing about sweetcorn. She is benefitting because she gets a break, because as I gain weight she will feel safer and therefore I assume happier yet again, any “I know this is hard and horrible and I am sorry” inspires that same “WELL MAKE THEM GIVE ME THE DAMN CAR BACK AND WHY DID YOU PAINT THE WHEELS YELLOW” rage.

That is why if you were to ask me “how does it feel to have been recalled on your CTO and sectioned back in hospital” I would tell you that it feels like some very apologetic thieves (some of whom are related me), have stolen my car.
Now I am just watching them all make the changes they want, implementing the modifications they have decided, desperate to run out and stop them but with my hands tied. I am just an observer watching people do things to my car, watching things happen to this body that I have had to disconnect from and pretend isn’t mine anymore for my own sanity. I guess a more accurate explanation/analogy then would be to say it is like having your car stolen and then having the thieves force you to be a mechanic carrying out every wish of theirs or risk being whacked on the head by a spanner, but that isn’t how it feels. It feels like things are being done to me, any movements I make are via the puppet strings that they hold, I have no say. When it comes to living with an eating disorder you don’t have much say or control either, but this feels different, this feels more stripped, more naked. This is not my body, it is just a body that I am trapped in, and I am witnessing it be torn to pieces every day. Every meal. Every bite.

CTORecall

The Difficulty Of Trusting Psychologists When You Have Mental Health Problems

Trigger warning: This post mentions the eating disorder behaviour of distorting your weight from professionals, so if that would trigger you then flee! Flee I say!

When I was younger, I was always taught not to trust someone who promises to give me sweets if I climb into the back of their van (unless of course those sweets involve any kind of combination of chocolate and peanut butter in which case who cares about potential kidnap, get in the damn van and don’t let those beauties drive away).
Unfortunately, somewhere in my brain as I have got older, “don’t trust strangers with sweets in a van” has morphed into “don’t trust psychologists” (regardless of whether or not they drive a van containing a portable candy heaven). Turns out however that when psychologists say they are going to do something and give you ultimatums, you should believe them.

Since coming out of hospital post “appendix explosion gate”, every week in my eating disorder appointments my psychologist has been telling me that I need to increase my intake in order to regain the weight I lost. To be fair, I have been trying, but a problem I have is that unless someone gives me specific deadlines for things I am scared to do, I will procrastinate until my arms fall off and tentacles grow in their place (not eight tentacles like an octopus though…that seems a little excessive…four is enough for me thanks.)

Every time my psychologist would tell me to increase I would hear her, try, but ultimately think “it is fine, she will just say the same next week and I will do it then”. Two Tuesdays ago though, my psychologist gave me a proper ultimatum with proper dates and deadlines by which I had to carry out her instructions. I was given one week to gain a certain amount of weight with the alternative being that I would be recalled back into hospital under the Mental Health Act. Seeing as how my brain works, you would think that this fairly clear statement would be easier to adhere to than the alternative casual “you need to eat more”, but still my head found ways to procrastinate, not because I wasn’t listening, but because I didn’t believe her. This was a mistake.

As much as I know I am mentally not very well at the moment in some aspects, physically I am finding it hard to see that there is a problem at all. Hearing threats and statements about my health that are designed to scare me, therefore make little sense. It is like telling someone over and over again that they are going to die of alcohol poisoning and that their liver is failing because of alcohol when they know that this can’t be the case because they haven’t touched a drop of liquor in their lives.

Back home I tried to increase but I was so scared of gaining weight that it didn’t go well, partly because I didn’t believe the “consequence” I was told about were I to fail to do so. Still, I didn’t want my psychologist to be disappointed or angry with me for failing her, so on the morning of weigh in I drank the weight I had needed to gain in water so that the scales would show the increase required and keep everyone happy. I hate “water-loading” before weigh in (aka the behaviour some people with eating disorders do whereby they drink a lot of water prior to weigh in to manipulate their weight on the scales and prevent therapists from knowing their true weight). It always freaks me out because even though I can know that I have just drunk water, whenever I see the number go up on the scales, my head will convince me that it is real weight and not just excess fluid swishing about in my bladder.

Thus I stepped on the scales prepared to be triggered, but somehow, it didn’t work, and I saw that I had not reached the goal set for me at all. Initially I didn’t really panic because I thought as always that my psychologist had been lying and that I could get out of it. I thought I could easily insist that I would just “meet the target” next week, but she hadn’t been lying and to my utter shock and horror, I couldn’t get out of it. What happened next? Well, considering I am writing this at a hospital desk in an inpatient eating disorder unit, I think you can guess. That’s right, that is the update this week, Born Without Marbles is back in the loony bin, and to be blunt, it sucks.

People keep saying things like “at least you know the place” and “you have done it before” but that doesn’t serve as much comfort because even though I know that, this time it feels different, so unnecessary and therefore scary. If you believe there is a physical problem it is easier to understand the need to take the medicine needed to cure it (in my case that medicine being “Food/general nosh”), but this all feels like one terrible mistake. I don’t need to be here and thus I do not need the medicine.

I am almost waiting for ward round on Tuesday where everyone discusses how things are going and for them all to turn around, apologise for the inconvenience and send me on my way.

The scales may say that I am under my CTO weight (a full explanation of the Mental Health Act and CTO’s can be found here: Demystifying The Mental Health Act…With Penguins, but basically a CTO is a legal document under which you are sectioned but allowed to live in the community as long as you adhere to certain conditions aka in my case, stay above a certain weight), but I don’t think I have actually lost any weight. I can read the scales and everything so I know that the number is lower but I am 100% sure that this is purely because I had my appendix removed and thus the weight of a whole organ has gone. If you chop someone’s arm off their weight is obviously going to go down but it doesn’t mean they have lost “weight” all over, it just means that there is some rude reckless person running around cutting people’s arms off.

I am so scared in here and I don’t know what to do. I am trying my very best to work with people and “listen to the professionals” but it is harder than I thought. Trusting them feels the same as trusting all those terrifying people with vans and sweets when I was a child (especially that particularly frightening lollipop obsessed child catcher in Chitty Chitty Bang Bang…seriously if you ever need to teach kids that “don’t get into vans with sweets lesson” just show them that film and you will be sorted…of course they will also learn that cars can fly and that dressing up as a Jack in the box will get you through security at a royal palace, but I think the worth of the sweets lesson trumps the potential misinformation spread by the latter).

So yeah…Mental health awareness lesson of the week: trusting professionals with medical degrees and things who should technically know more than you is hard when you have mental health problems. Very hard.

Other than that, I don’t really know what to say today. I just want to go home. I feel I should write an extra good, extra long blog today considering I am in hospital and certainly have free time to write but the words won’t come. Maybe I should offer them some sweets as encouragement.
I am also struggling to keep this update upbeat rather than explode all over you, so I think I will sign off for now and hope that I am a little bit more coherent in the next post. Sorry.

Take care everyone x

ChildCatcher

Demystifying The Mental Health Act…With Penguins

If there is ever a widely reported act of violence on the news orchestrated by a single individual, the majority of the time it will be equally widely reported that said person was mentally ill and most likely “detained under the Mental Health Act”. Understandably then, when people hear of people being detained under the Mental Health Act, they associate the Act with danger. To be fair I can understand why people may jump to this conclusion.
If every time I heard about some violent crime I simultaneously heard that the perpetrator was addicted to coco pops, I may naturally make a connection between violent knife attacks in the street and coco pops. When the coco pops are simply mentioned as a “thing” and there is no explanation to tell me that coco pops are actually little puffs of cocoa sugar covered wheat based cereal with the key ability to turn the milk chocolatey, how am I to know any different?
Therefore, seeing as I am currently “detained” and have recently been given a load of forms explaining the official legal terms of it all, I thought I would do a post to clear up any confusion and to give a purely factual explanation of what the Mental Health Act is, what it does and what it means.
I don’t however want this to turn into some boring school lesson, so to liven it up I am going to provide my explanation via little examples involving “Patricia the penguin”. You know what they say: “When life gives you lemons you make lemonade”, so when life sections you under the Mental Health Act, you use the lump of paperwork dumped on you to make a post explaining what it means, with pictures of penguins to help clear up confusion and reduce mental health stigma. I think that’s the saying anyway…so here goes…

What is the Mental Health Act?: It is a law that enables professionals to admit and detain patients for a compulsory admission to hospital. It doesn’t have to have involved any incidents of violence, much like the consumption of coco pops does not have to be involved with criminal activity. Alas, unlike coco pops, the Mental Health Act does not turn the milk chocolatey, for there is rarely any milk involved.

How does one come to be sectioned under the Mental Health Act?: This is a question that will vary between the sections of the Act and individual circumstances, but as a basic principle a Mental Health Act Assessment will be called by professional people (I am not sure what they are professionally qualified in exactly, but they are usually people holding clipboards, stroking their chins, squinting/looking thoughtful), and they will interview you and ask questions in order to assess your health.

Are there different sections of the Mental Health Act?: What a marvellous question dear reader and one I can respond to with the knowledge that indeed there are several, the differences between which I will explain below with the help of Patricia…

Section Two: Recently, Patricia the penguin has been acting unsafely (skating on thin ice as it were), and is suspected to have a mental illness without the capacity to see that she is putting herself in danger. She is not however diagnosed with one, nor has she been in hospital before, so a group of professional penguin Doctors with specific training may place her under a section two, aka a legal detention to hospital for an assessment of her mental health, in order to establish whether or not she needs treatment. It can last up to 28 days and in that time they aim to discover if she has a mental disorder. Under this law she can be treated against her will if it is deemed in her best interests, and discharge or transfer to another section can happen during, or at the end of the 28 days.

Section Three: A section three is a detention in hospital for treatment, so if Patricia were to be put under this section it would mean that she were well known to hospital services, would have a diagnosis and not require assessment. In the section two admission, the focus would have been more about finding out why Patricia was found skating on thin ice in the middle of nowhere and deciding whether or not her reasons were rational, but for the section three they already know why she was skating in such a reckless way, for she has a diagnosis of “Skating on thin ice syndrome”, a common mental health problem in penguins that requires treatment when severe. On this section Patricia can be held for up to 6 months, but may be discharged sooner, or later if the section is renewed for further treatment. Again under this section it is possible for Patricia to be treated against her will (e.g. in her case, forced to skate on thicker blocks of ice even if she doesn’t want to).

Section Four: Section four is pretty much like a section two in that again it is a detention for a short period of time (72 hours) for an assessment of one’s mental health. This is more commonly used in emergency situations as you only need one special doctor to enact it, unlike a section two which requires two. For example, if Patricia is skating on thin ice at 5am in the middle of the arctic and two doctors with the ability to enact the Mental Health Act have been sent for, but one got lost by turning left at the second igloo (use your imagination kids), the doctor with superior navigation skills could potentially hold Patricia under a section four for 72 hours until the other Doctor hurries up to give his second opinion, which then may result in her being placed on a section two.

Section Five: In this circumstance Patricia has realised she may have skating on thin ice syndrome and has voluntarily admitted herself to hospital. However, twenty minutes into her admission she is overwhelmed with the desire to skate on thin ice and asks to discharge herself. The Doctor does not think this would be a good idea in terms of Patricia’s safety though, so he can put her on a Section 5(2), aka use his “Doctor’s holding power” for up to 72 hours. If there are no doctors available at the time Patricia is asking to leave however, a nurse can enact a section 5(4) which lasts for 6 hours or until a doctor arrives. This section will be used if there aren’t specially qualified doctor/doctors around to enact a section two/four available and can take place in general as well as mental hospitals.

CTO: This isn’t technically another section it is tied up in it all, as a CTO is a community treatment order that it’s possible for someone who has been detained under a section 3 to be discharged on to. Basically, it’s a legally binding order of conditions someone has to meet in order to be allowed to remain in the community (e.g. Patricia must attend weekly appointments/hand in her ice skates, cancel her membership to the local ice rink and take her antifreeze medication.)

And there we have it! Now of course this is a very brief explanation as to what the Mental Health Act is and there are far more details and legal jargon/complexities that go into each section, but hopefully I have demystified The Mental Health Act somewhat, albeit with a very basic, penguin centred outline. Hopefully if you are reading this you will never have to have anything to do with the Mental Health Act personally, but at least you will know what it actually is that is being referred to when an article brings it up in relation to something unpleasant that doesn’t put any effort into explaining the Act itself.

Finally, I just want to let everyone know that if anyone is concerned, I can confirm that Patricia the penguin is merely a fictional character created for the purpose of educating and reducing stigma, so please do not go away and worry about how she is doing after having been through all these sections. As a product of my imagination, I can assure you that Patricia is just fine, and I hope you all are too. Cheerio.

Patricia
(I hope the above picture serves as enough evidence that Patricia is safe and sound/not in any danger. As you can see she is merely enjoying a bowl of coco pops in her safe ice igloo and has not been ice skating, nor will she be doing so in the near future.)