Life in a Therapeutic Community
This time last year I was a sectioned patient on my local acute psychiatric ward. I had narrowly survived an attempt to take my own life and was still actively suicidal, under 1-1 nursing and engaging in highly risky behaviours several times a day. Staff and my family felt powerless to know how to stop me and I was later told by a charge nurse that I wasn’t expected to walk out of the hospital alive.
In one last-ditch attempt to try something different, the complex needs service at the hospital referred me to a specialist personality disorder service in London. I have had my diagnosis of Emotionally Unstable Personality Disorder for several years but help from my community mental health team has been sporadic and entirely non- specialised, treating symptoms of the condition in isolation rather than looking at the whole picture. This referral was to a hospital run as a Therapeutic Community, something I knew very little about but was ‘sold‘ to me on its reputation as my best chance at turning things around. The referral itself did not however, come close to guaranteeing me a place there. The assessment process was long and incredibly intensive – I had to have two separate meetings with the consultant psychiatrist, a nursing assessment and a meeting with the hospital social worker, as well as spending two separate half days with the patients in the community so they could give their feedback too, all involving trips to London from the acute ward. In addition, I had to come off my Section 3 since admission to the Community is entirely voluntary despite its Tier 4 status. The lengthy process was very stressful and brought with it a lot of uncertainty as no feedback was given to me along the way. I was having to curtail my daily self-harming behviours and reduce my risk on the ward so that I could come off my section solely in the hope that I would be offered one of the 14 beds in the specialist service.
With a lot of hard work and many struggles along the way, I made it through and was admitted to the Cassel Hospital in June of this year. Things here are intense to say the least. It is quite honestly the most difficult thing I have ever encountered or been part of but it has begun to change things in me. Being in the Therapeutic Community is an experience like none I have ever had before and bizarrely (or not having EUPD!) I have a very love / hate relationship with it. There is a huge emphasis placed on patients supporting each other as much as having nurses support us and on the whole that works very well - nobody can understand where we are coming from or what we are going through as much as others who have had very similar experiences. In fact, for the first time in my adult life I actually feel as if I fit in somewhere, I belong, I am part of something instead of always being on the outside looking in on others. I have made some close relationships with fellow patients and the majority of the time I feel very supported. However, it can also be a bit of an issue being surrounded by people who have such similar behaviours and thoughts as I do because we can all trigger each other. That's what makes being in each other’s presence constantly such an intense experience in itself - and that's before you add in any official therapeutic input! It does make a big difference being surrounded by staff that actually understand PDs though. They are used to the rapid cycling of our moods here, they don't overreact when we get horrendously angry, understand that we can feel extreme emotions and have truly dark thoughts without panicking and rushing in to medicate or restrain us. (In fact they can't do either of those things even if they wanted to.) The Therapeutic Community approach also brings with it a sense of responsibility towards each other that is, along with a likelihood of temporary removal from treatment or permanent discharge, what has strengthened my own desire to change my self harm behaviours and find new ways to manage my difficult emotions.
A typical week sees me having 2 individual therapy sessions, 2 group therapy sessions, movement therapy and then daily community meetings where anything and everything can be discussed and are usually very difficult themselves. Then on top of that we have daily work groups where the nursing staff and patients work together to keep the hospital in order, have to cook dinner for everyone in a supper team of 3 once a week (that sees us cooking for 15 people with a whole myriad of dietary requirements!) and have to prepare afternoon teas once a week too.
Since I was admitted I have taken part in an official DSM diagnostic test for PDs and have been diagnosed with Avoidant PD, Obsessive - Compulsive PD and Paranoid PD in addition to EUPD. That took me by surprise but I feel it explains a lot about me which the single EUPD diagnosis from my community team still left unanswered.
I think overall, my experience here to date has been a broadly positive one although extremely challenging. I am hopeful that the 4 months I have left will enable me to continue to work on my relationships with people and tackle my previously maladaptive ways of coping with my extreme emotions as well as learn more about myself and how I function. I do feel like I have found a treatment facility that takes me seriously and that doesn't merely 'contain' me which is all an acute ward can ever do for people with PDs. It's certainly not easy but it's something I am willing to commit to because life without it is even more difficult and very nearly was no life at all.