Documenting my journey through the mental health system

When I was released from the mental hospital last month, it was with the understanding I would be enrolled in intensive outpatient treatment to maintain and continue learning coping strategies, distress tolerance, and better impulse control, among other things. I had my assessment through the mental hospital’s IOP program on Thursday, which lasted over two hours and involved the PHQ-9, a patient health questionnaire measuring depression severity, the GAF – global assessment of functioning test, and the GAD – which measures generalized anxiety disorder severity. My depression score was much better, on the low end of moderate, and my anxiety was moderate. My ability to function day to day has also maintained a steady score of good – just over a month ago it was so low I was legally declared gravely disabled for the purposes of continued detainment and treatment.

Now that my assessment is done, it goes to the VA for authorization. They are paying for it. I will get a call sometime this week letting me know my start date. The groups and treatment are three times a week, three hours a day. I will attend the morning one after work Mondays, Wednesdays, and Thursdays. Mondays will be quite busy as I see Dr Black after work at 8am, then IOP will start at 9:30 and go till 12:30pm. I only work every other Wednesday and it’s a short shift. I have Thursday, Friday, and Saturday nights off, at least when I’m not picking up per diem shifts. So it’s busy, it is like another job. In the past 9-12 months, the need for much more maintenance and monitoring of my illness has grown a great deal. I have to spend a lot more time in therapy, groups, medication monitoring, and safety planning.

“Have you done therapy with groups before?” The assessment lady asked.

“Only a bit, like in an inpatient setting. I was also court ordered to do IOP and anger management back in 2018 when I got a DUI.”

“Tell me more about that.”

“Well, I got the DUI and after the court ordered assessment, I had to attend treatment three times a week, for three hours a day. It was more substance abuse based, but I had individual counseling for the anger management and depression too. I ended up spending a week in the VA’s psych unit, trying to stay alive. So I am a little nervous about it.”

“This will be different. It’s not like the hospital, everyone in scrubs with unwashed hair and under the influence of medications. Everyone is very supportive.”

She asked me about suicide attempts. Detainments.

“I’ve tried to hang myself, and attempted to OD most recently. I tried hanging myself in 2014 three times. My brother caught me once, and I tried again a couple days later locked up in Foothills stabilization, and again at Sacred Heart after they moved me for the hanging attempt. I was manic and hearing voices. They put me in restraints. Last year I was going to do it, I made all the plans, violated the safety plan, and Dr Black said if I didn’t come in for immediate inpatient admission, she was calling law enforcement for a welfare check. I don’t hate the police, but they are a huge trigger for me. So I went in like she said. Spent a couple weeks in the psych ward. Then a little over a month ago I had a hard, fast decompensation. I was manic and suicidal, the voices came back. I just left work in the middle of the night, started drinking hard and fast, and then the fire department and police showed up when I was getting ready to swallow all my ativan and trazodone.”

“Who do you think called in the welfare check?” She asked.

“I think someone at work. But I also texted 988, the crisis hotline, and admitted I was going to kill myself. I just wanted to tell someone, say goodbye and I’m sorry. Then I panicked, I had said too much. I stopped texting back.”

She nodded as I spoke. “You’ve been through a lot.”

“Yeah,” I said. She asked about sleep, appetite. I don’t need much sleep lately. I have more energy and less fatigue because of my antidepressants. A high dose, which is risky with bipolar. But I’m not willing to change them yet.

She asked about my goals. “I need to gain better insight. I was totally blindsided by my last hospitalization. It was a nightmare. I’d like to learn to cope better, have better emotion regulation. The doctor says I feel everything so strongly, he said I have borderline as well as bipolar. It makes sense.” I was rambling now. She nodded patiently. “I hear voices. They’re not talking to me right now, but I call them Jack and Jackie. Jackie shows me things, the 10 dimensions, what they mean, where I’m supposed to go, the beings in them, she showed me. Jack tells me to kill myself, tells me I’m an idiot sometimes but also warns me about things he says are gonna happen. He says I’ll lose functioning again and end up institutionalized forever.”

She kept nodding, expertly hiding any reaction to my admission of hearing voices. I kept talking. “I haven’t been detained in 10 years. I was trying to hang myself and they moved me to Sacred Heart where I tried again and was put in restraints. I got violent with another patient and they put me in seclusion for the day. The doctor was blunt and really tried talking to me through the window in the door. He said ‘Angel you’re manic. I know you’re scared, hearing voices, and confused. I really need you to take this medication, I don’t want to see you back in restraints.’”

“Did that help you, or resonate with you?”

I thought about that. “Not at first. It’s true I was very scared. I took that pill though. Back then, meds like vistaril and ativan had a stronger effect on me. They forcefully medicated me. I wanted to refuse medications, but they threatened me with more restraints and injections. So I took the pills even though Jack said they were trying to put me in a coma to harvest my organs. The doctor said I was manic, psychotic, and very ill.”

Maybe I was telling her all these things because I have been thinking about them a lot, every day. Especially since my recent hospitalization which dredged up lots of terrible memories, and because I started this blog. In addition, I had never been so forthcoming talking about the voices and other auditory hallucinations like screaming and buzzing.

“That must have been terrifying.”

I nodded. “I felt so scared and paranoid. I felt certain the voices were real. Not just a hallucination. I asked Dr Black if it’s gonna happen again, and she said maybe. My hospitalizations, voluntary and involuntary, are getting more frequent. I have new meds, and I get used to them faster, and need changes more often. I was on depakote for mood, I had to switch to lamictal. I might have to go back on lithium someday.”

“How does that make you feel?”

“Afraid and nervous. There are a lot of side effects. It makes the whole world grey.”

“Yeah, I’ve heard other patients say that.”

I shrugged. “Managing this shit is becoming a full time job. I had to cut back on how much I’m working. I take more meds than ever, I have more PRNs than ever. Popping a low dose of seroquel helps with the voices. They are persistent and not quite going away. Dr Black says I have to play therapist with them, that they’re a part of me, but I feel sometimes like they’re real. I feel sure of it.”

“Are you hearing voices right now?”

“No, but I listened to Jack quite awhile yesterday while he talked to me.”

“What do you do to help yourself cope?”

“I listen to a lot of music. In the hospital most recently, they put me in seclusion when I got agitated and played music for me off a bluetooth speaker they put in the room with me. It did help calm me down. They did not let me have my ativan, the doctor in there didn’t like using it. I use music to drown out voices when they are distressing. Even at work I have an earbud in to play music to myself. I write a lot, I write in a journal and started a blog. I talk about things I’ve never really talked about in great detail, like my detainments, what life is like in a mental hospital versus a psych ward, because they are a little different. I will write about this. The blog has been cathartic and helpful. I entered the Veterans Creative Arts Festival and competition. I had over 10 years of classical voice training and I’m singing I Dreamed a Dream from Les Miserables.”

“It sounds like you’re seeing a doctor at the VA, is that Dr Black?”

“Yes she was the one who made me go in the VA psych ward last time. I was seeing her up to March. Now I see her every Monday after work. I called her when I got put in INBH, and she made the appointment for the next week. That went a long way toward getting out on that day, as well as getting enrolled in IOP.”

She listened very well as I rambled. I may be dealing with a little hypomania. I have not needed much sleep or food. I have even had an elevated mood. My thoughts of suicide are passive and quieter.

My eye contact was poor but that is normal for me around new people, especially when I’m admitting and talking about things that make me scared, like hearing voices. I had very carefully groomed myself that morning, not wanting to appear “disheveled.” I still bristled at that verbiage in my court paperwork. “What did they expect after tying me to a bed and keeping me locked in a little room for a couple days??” I asked the assessment lady rhetorically. She asked about my time in the military, which was when I first became sick. I was medically and honorably discharged. I used to be an expert grenade launcher, my pin is still on my class As, inspection ready. I told her about military idol, I was a finalist. I told her about being raped while I was stationed in Fort Hood, how everyone was raping each other back then. I had never really talked about it at length with anyone though. I told her without the VA I’d certainly be dead or in prison.

That assessment took two hours, probably because I was talking so much. But she listened and nodded attentively, making notes. We got to the safety plan at the end of the assessment where I listed off some triggers – work stress, isolation, increased depression, increased mania, suicidal planning and means. Then the coping skills, what to do when triggers become overwhelming – reach out to friends or my treatment team, use the VA crisis line, use music, writing, singing, and the arts in general to distract and cope. My safety plan is pretty cut and dry right now. IOP will hopefully help me bolster it and add to it and make it more likely I will actually use it if and when that time comes.

Now I wait for my start date.