Last November when my parents attended a meeting with my doctor, they said that once you enter the care world, and especially the psychiatric care world, you never get out. At the time, the doctor then in charge of my care, didn’t seem like he was of that opinion, and, in fact, was pretty much convinced that there was no reason why I should be in the psychiatric system apart from the fact that I’d made a suicidal threat two weeks before. Now, things are completely different. Why?
I think very few psychiatric wards, especially admission wards like mine, actually plan on keeping their patients long-term. This goes especially for acute patients like me. When you come in for crisis intervention, like I did, you’re supposed to stabilize and then leave. Stabilization is supposed to take a relatively short time. It is not as extreme as I thought it was, when I was frustrated cause, after seven weeks, I was still unstable, but people cannot take many months to stabilize.
I know quite a few patients who didn’t plan on moving into the psychiatric system long-term, but who ended up on more “chronic” wards because they stabilized so slowly that, apparently, they weren’t considered to be among the “acute” population anymore. This is all the more likely if structural stability requires a change in living arrangements. I am not sure why this is, but I assume that both the waiting lists and possibly not conforming to the new setting’s demands regarding mental stability, contribute to why several patients moved to longer-term wards while planning on moving to supported housing. In this sense, it’d help to have waiting lists for the longer-term wards themselves, as goes for the long-term living wards for adults here in Nijmegen, but, unfortunately for some senior patients, not for the senior wards.
I want to elaborate on that “not acute enough” predicate a little further. All patients I’ve so far met who’ve been transferred to longer-term wards, did not display the symptoms they were committed with, upon their transfer. Hence, it is not an issue of not getting out of their crises soon enough. However, this group generally does not consist of patients who are completely fine when they’ve stabilized, because of a number of social and psychiatric reasons.
In my own case, from the beginning of my stay here on, it’s been pretty clear that I couldn’t move back home, because returning home would be a recipe for another crisis pretty quickly. Now that I’ve stabilized, I’d likely be able to hold on for a while, but not for many months. Hence, it was already relatively clear that I’d stay on this ward for quite a while, just to bridge the waiting list for supported living. Now that I’m more stable, I in fact am willing to consider moving back home temporarily, if it’s clear where I’ll move from there and when – as to not make my hospital stay unnecessarily long.
But there is something else, that makes me much more worried about never getting out of the system. This involves the fact that, once I did not have suicidal thoughts anymore, I didn’t stop having meltdowns. This was not surprising to me, but it was to everyone else – who all chalked it up to unclarity about my future living situation. Hence, once the professionals realized that I’d pretty much stabilized – and once the psychologist who diagnosed me, had informed them that meltdowns are a chronic concern for me -, they swung all the way to the other end of the pendulum and decided I needed longer-term treatment “for my autism” and “didn’t I want to unlearn the meltdowns?” I am not sure if this was explicitly discussed at the “big meeting”, as the autism professionals meeting is commonly referred to, and Gerda denied having come up with her “you can’t do this if you want to be in society” logic, but one thing I do realize, is, in order to get out of the psych system, you have to be much better than you were before you got in.
Like, I came in with serious suicidal thoughts – after the crisis intervention team refused to commit me several times after a very bad meltdown. Well, I’m not suicidal anymore, so can I leave? No, I can’t, as I have meltdowns – that are far less severe than the ones I used to have before I came here. For meltdowns worse than my current ones – not as bad as the ones I experience while home though -, I could be in out-patient treatment in Apeldoorn. Now I’m in-patient (not committed because of the meltdowns!) and it’s said that I need to go to a longer-term psychiatric ward (the one in Deventer), and the meltdowns are the most convincing reason for that. So, I’m not allowed to get out of the psychiatric system, for a reason that I couldn’t get into it for a few months ago. This is a very good recipe to start a vicious cycle, always claiming that if the professionals had known you were this bad, you’d not lived in society for all of these years. It has to end somewhere, if I don’t want to spend the rest of my life in institutions – and I don’t want this.