Yesterday on the psych floor, a woman told me about her struggles with living in an severely abusive home and was being released that day and had no where else to go, but back into it. I gave her basic info about the Artemis Center, which I even pointed to and read out loud to her because she didn’t know how to read. I thought about her this morning and I hope she used that to better her life. I remember people, their faces stick, their stories make me a better listener, a more perceptive student nurse, a better human being. I know our mental health system fails us in the U.S. It apparently fails in the UK too. Worldwide in fact, it’s just so full of stigma that it’s not given the importance, treatment, and prevention work it deserves. Many people work hard every day to help mental health patients and clientele.
I am writing about stigma. About what I can do as a nurse to change that stigma….I think first it boils down to learning about my own mental health before I can properly assess others. It’s something I work hard on every day as I reflect on what I offer.
I am reminded of a patient from 2 weeks ago whose demeanor was so calm, cooperative, and easily placated that it was hard to believe him as anything other than sad. But sad IS an illness and this man surely had so much of it in him. He was at a loss for self esteem, had no social system to call his friends, and a young daughter that he only saw here and there. His struggle was so real, sober from his addictions for over a month, feeling trapped and “boxed in”, he self admitted himself into the ER, worried he would harm himself. Once on the floor, he was a perfect patient if one could be charted and written up. Med compliant, listened intently, showed intent for change, contracted for safety, kept to himself and made little to no noise. But as my patient, I realized he was still struggling hard with his withdrawal symptoms and not smoking (his very last vice he’s allowed himself). His anxiety was peaking and he had none of his prior substances to help him cope. And NO meds listed. None. Not even a nicotine patch to help cope with the cravings. But….he told me he didn’t want to “rock the boat”, so he just suffered through it. Told me these feelings are what drove him to things like alcohol and sedatives. During his entire stay, the man never had a med assigned to him and was released back into the world, free to make the choices he was going to to survive.
It is this patient which makes me wonder…..do the quiet ones slip through? In the world of mental health, do you receive treatment based on how much attention you can garner for it? The ones who are compliant seem to sit on the sidelines while the acute patients, the more volatile ones, the more “difficult” ones, receive new meds, frequent doctor visitations, assessments that delve a bit deeper….just more focus their way. And it makes me wonder if they know this too and so the survival for many chronically ill psych patients depends on their outbursts from time to time? Not in a manipulative way (though that does occur), but more from a “I am falling through the cracks, not getting well and no one is SEEING me, hearing me, or feeling my presence today”, kind of way.
I imagine if I began to notice that being “good” meant being forgotten, my survival instincts would kick on too. Mental illness isn’t something you can see, like a wound or record like an EKG. Often the nurses and doctors rely on the patients behaviors and conversations to find out what’s going on. And in the case of my patient above, sometimes being quiet in those areas will result in you slipping below the scope of treatment, falling into an area where you’re “safe enough”, “treated enough”, “calm enough” to be sent on your way so someone “worse off” can take your place in the facility with only so many beds and space.
I have seen a lot of good come from these places, but I definitely got my first look at a moment when not enough was done for someone and I couldn’t advocate enough as a student nurse because I had to leave.