Last week I was grateful to be one of the speakers at a National Summit on trauma.
It was clear that many of the speakers felt that all psychiatric services need to be more trauma-informed. Trauma is not just the domain of psychologists. We need crisis team staff and community mental health teams to understand and actively help people who have experienced traumatic events.
After a traumatic experience in 2012, I was referred to the crisis team.
GPs at my local surgery started to notice that I was experiencing symptoms of Post-Traumatic Stress Disorder. I told the crisis team about this and they simply replied “Is that what the GPs think?” The crisis team didn’t offer any help for the symptoms I was experiencing, nor did they pass the information on to a psychiatrist.
A member of the crisis team did recognise, however, that I was experiencing a post-traumatic reaction called dissociation. An Approved Mental Health Practitioner (AMHP) within the team noticed that I was a “witness to my emotions”. She called out a psychiatrist, who pointed out that there was a “disconnect between my thoughts and emotions”. It was as if I could stand outside myself and comment on how I was acting and what I was feeling.
They were clearly concerned about the potential impact of dissociation on my suicide risk. However, it was looked at in isolation, not as part of Post-Traumatic Stress Disorder.
Whenever I asked the crisis team a question about dissociation, their reply was “You can ask the psychologist that” or, more accurately, “You’ll have to wait to ask the psychologist that”. The waiting list for psychological therapy was long and it would be months before I would see a psychologist. They knew that. They predicted it would be an eight-month wait. That was hopelessly optimistic. It was far longer.
So, I was experiencing dissociation but no one within mental health services could help me with it, other than psychologists, who I couldn’t access for months. Why can we not train members of the crisis team and community mental health teams to know how to help and support – and answer questions – in this situation?
As well as no help for dissociation, I was also getting no help for the other symptoms of PTSD. It took over a year before a psychiatrist under my local NHS Trust diagnosed me with Post Traumatic Stress Disorder. In the year leading up to diagnosis, I felt an increasing sense of despair that my symptoms would ever be understood or addressed by psychiatric services, and I attempted suicide twice. It is documented in my psychiatric records that the two suicide attempts within a week were the result of a loss of hope that clinicians would ever understand or offer appropriate help.
After a traumatic event, the internal chaos you experience can feel frightening and inexplicable. I had never been under mental health services before. I had never experienced serious mental illness before. I wanted to understand more about what was happening to me. That’s what my questions to the crisis team were about – trying to understand a condition (dissociation) that I had never even heard of, until a psychiatrist walked into my home that day it was first recognised. And I wanted support and access to people who understood about dissociation and PTSD. The crisis team and community teams seemed to feel that it was the area of psychologists, not their area.
It is their area – or it should be, if they want to prevent people from dying. I was very fortunate to survive my second suicide attempt.
My experiences were the driving force behind the setting up of a Suicide Crisis Centre and a Trauma Centre in Gloucestershire. Originally, the plan was just for a Suicide Crisis Centre. However, it was clear that there was a profound lack of support and help for people in the aftermath of traumatic events, before they were able to access psychological therapy.
Our Trauma Centre is staffed by people who understand about trauma and how it affects people. They provide one to one support and understanding. We have also provided psycho-education via groups, and these have been run by a psychological therapist with input from psychiatric advisers. These groups help participants to understand the symptoms that they are experiencing. The therapist also provides techniques which can help reduce post-traumatic symptoms.
All of this was what I wanted, when I was under services.
If we want to ensure that more patients survive after traumatic events, then crisis services and community mental health teams need to have a trauma-informed approach. And we need to put an end to waiting lists of several months to see a psychologist.
For information about the Suicide Crisis Centre: www.suicidecrisis.co.uk