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Mandy's advance directive
This is a good news story. The story is also true.
In the middle of a Friday afternoon, although she did not have an appointment with them, Mandy went to see her Community Mental Health Team. She wanted to see them because she knew that she was going to become ill very quickly.
How did she know she was getting ill? Mandy has a diagnosis of manic depression. She has sufficient experience of her illness to know that when she is starting to go high she reaches a stage where she needs her medication adjusted to stop her going too high.
She had not slept for a couple of days and had now reached that stage.
Mandy knows that if her illness is left to go too high it will take her a long time to recover. In the past she has usually ended up in an acute ward of a psychiatric hospital. This is often after getting into a confrontation with the police as a result of her actions being guided by her deluded thinking. This time Mandy hoped it would be different.
But her psychiatrist was not available and her CPN, who knew Mandy very well, was not in the office. In fact nobody who knew Mandy was available at the Community Mental Health Team. The hard-pressed receptionist relayed the message that it would be best for her to come back on Monday.
Many of us, who have experienced first hand the process of a rapid relapse of a mental illness, will have come across the Catch 22 of "You are not unwell enough yet to need help." Like Mandy we also know of well-meaning people who seem to believe that if you are saying now that you need help, you can not have yet lost sufficient insight or become unwell enough to actually need that help now. In a survey carried out by the National Schizophrenia Fellowship in 1999 (Better Act Now, NSF consultation report on the Mental Health Act Review, NSF, London. ISBN 0 904854) over one in three of the respondents (35%) stated that they had been turned away when seeking help.
Mandy knew that the most likely thing to happen was that by Monday she would be very unwell, but would feel very well and then her delusions would make her think it unnecessary to seek further help.
So Mandy persisted. She asked the receptionist to ask the CPN to look at her advance directive a copy of which she had given to the Community Mental Health Team. Eventually the CPN on duty did just that. She read about Mandy's symptoms, how in the past when she has asked for help she has needed it and about what happened if she didn't get that immediate help.
Her usual CPN had discussed all this with Mandy and had recorded her approval of the content of Mandy's advance directive. The duty CPN was thus enabled to help her in the most appropriate way. Mandy is convinced that her advance directive kept her out of hospital and out of trouble. The duty CPN was convinced that life could be easier if more people had advance directives.
Mandy believes that she has saved the statutory agencies a lot of money by compiling her advance directive. More importantly than that, she believes that she has also saved herself and those close to her from much unnecessary distress. The word empowering comes to mind.
Text written by David: e-mail mdf.southend@btinternet.com.
The text is fully endorsed by Mandy
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