My local Community Mental Health Center has a 24-hour hotline staffed by an on-call therapist. During weekdays, this is generally going to be one of two staff members from the inpatient unit, but on nights and weekends other therapists are assigned to the task and you have to leave your name and number and have that person call back. The first time I was introduced to the concept was when I signed my first Contract for Safety back in February 2014 and part of the agreement was that I would call the on-call therapist if I were a danger to myself.
I had made use of this service twice, in two very different experiences. First, I called once on a Sunday, during a lunch break at work. The call was returned within 5 minutes, and lasted for another 5 minutes, in which we discussed a few stressors that were compounding in my life and how to avoid self-harming while I was at work. It was very helpful, and I decided to keep an open mind about calling again in the future.
The other time I didn’t call, but walked in to the main CMHC office to speak with the on-call therapist in person. It didn’t end well for me. I was hoping to sort out some issues that were weighing on my mind, but the on-call therapist, Jan, was convinced I was a danger to myself and needed to be in inpatient. That was in August 2014 and though there have been many times since that I felt I should be calling the on-call therapist, I would play that scenario out in my mind to what I felt was the inevitable conclusion, and not call.
Today I am less than 2 weeks away from making it a whole year without being admitted to inpatient. Speaking to the on-call therapist would seriously endanger my ability to accomplish that goal. However, I spent my whole work day having vague thoughts of hurting myself to avoid having to go to my job for a while (if not forever). This feeling has come up a few different times since I started working there, and right now it’s due to interpersonal conflicts. I’m no longer insecure about doing the job well enough, but I’m feeling very unsafe in my work relationships.
I don’t want to get too specific here, but I had a very hard weekend working alone last weekend, and in a moment of panic I asked some coworkers for help. This ended up backfiring on me, with other coworkers becoming involved and ultimately going to the supervisor with information designed solely to get me in trouble. Some of my coworkers gave me warnings about other of my coworkers, and I became a massive ball of paranoia, not only distrusting all my coworkers (including the supervisor), but also distrusting virtually every person I’ve ever met. I mean, I was to the point of wanting to cut off contact with everyone but my family, around half a dozen friends, and my therapist.
I knew suddenly removing 90% of my friends on Facebook would be a total overreaction in classic Borderline Personality Disorder fashion, so I used the Wise Mind skill (balancing emotional and rational minds) and instead deactivated my account for a while. Same effect of removing information from access by potentially untrustworthy people, but much more reversible after I had time to cool down. By lunch today, I was to the point that I could reactivate my account, along with defriending and blocking some coworkers, but even the coworkers who remained on my friends list got demoted from “Close Friends” status as I was still quite suspicious of their intentions.
After work, I was pretty sure I’d be safe through the weekend, but really needed to share how I was feeling and didn’t have a lot of options for who to share with. I sat in my car, staring at the phone in my hand, with the CMHC hotline pulled up in my contacts. I tried to dial it, but I was shaking and near to hyperventilating with anxiety. After a few minutes I thought, “This is really stupid. The on-call therapist is right next door. Go see her in person.” So I put the phone away and walked over to CMHC and asked the receptionist if the on-call therapist was available.
I was required to fill out paperwork, again, which I questioned her about because last time I had nearly finished the paperwork when Jan came to get me and told me that as a current client I didn’t need to fill it out. The receptionist said I still had to, so I sat down and scribbled my answers in as quickly as possible. When I handed it in, the receptionist didn’t even get to call Jan before she happened to come out to the waiting room of her own volition, and moments later she took me back to a tiny little office – the same one where she had coerced me into inpatient last year.
I told Jan that I was having some trouble with work and had thoughts of hurting myself to get out of it. I wasn’t able to be specific about the thoughts, as they were flitting around among options. All I knew was that I didn’t actually want to die. Score 1 point for me. I had to endure reviewing all the background questions that would have been asked if I’d been assessed in the ER, although since it was a review of information already on file it went fairly fast. I had to update her on the medication I’m taking – her records still included trazodone which I stopped over a year ago – and correct her on my tobacco history. She asked about smoking and I said no, so she congratulated me on quitting. What? I was never a smoker, unless you want to count less than a pack total spread out over several years of hanging with the theatre crowd in college. She deleted that from the file.
We did come up with a plan regarding the work issues, sort of. She encouraged me to talk to my supervisor, using my Interpersonal Effectiveness skills to plan out my objective in the conversation and figure out what to say to achieve it. Primarily, I’m to ask for guidance on how to prioritize when the work load gets overwhelming. My difficulty on the weekend was that I was getting bombarded with calls and faxes while also trying to do the usual checking and replenishing of supplies, and I felt like I didn’t even have the time to take 5 minutes to take care of myself so I could handle it better. Jan asked me what my Mindfulness skills would have told me to do in that situation. I said, “Focus on one thing at a time.” I wish I’d been able to do that in the moment, as maybe this whole situation would never have happened.
Jan asked if I needed to be in inpatient to stay safe and I told her no, that I could go home. She said, “If I remember correctly, you’re the one who doesn’t like safety contracts.” I laughed and said, “I’ll sign one if you want, but I think they’re a joke.” She asked me to promise that I would reach out for help again if I were in danger, and said that on Monday she’d be available again and if I needed to come in I could specifically ask for her. Or I could say, “I want to speak to the on-call therapist but not Jan” and she wouldn’t be offended. I talked about how scary it is to ask for help, and she said that I shouldn’t be scared of her since we’ve met 9 billion times. That sounded bad, but she clarified that she didn’t just mean in this context, she was including the numerous times per week that we pass in the halls of the hospital.
I was also asked to promise that I would tell my mother how I was feeling, I suppose so she could keep an eye on me. I really didn’t want to do this, but my choices were promise to tell her or let Jan call and tell her, and I didn’t really enjoy it when Sadie called mom for similar reasons. So I promised. Jan said she had to go consult the psychiatrist to be sure he agreed with our plan, and when she left the room I chanted over and over, “Please don’t send me to inpatient. Please don’t send me to inpatient.” Finally she came back and told me I could go, without ever asking me to sign one of those silly safety contracts.
What was weird about the conversation was that Jan kept talking about my progress. She had commented that when she sees me at work I seem happy to be there, and I said that I fake it really well. She told me that was progress, that when I worked at my previous job I wasn’t able to fake it and that now I was much more consistent about my work attendance. Even weirder was that she used lack of inpatient admissions as a measure of progress, and said that she had just recently been talking to another inpatient staff member about how long it had been since I was in there. I always get a bit creeped out when I find out people have talked or even thought about me when I’m not there. Similar to how babies have to learn about object permanence and understand things still exist when they aren’t seen, I have yet to learn about my own permanence. I feel that no one should or does think about me unless I make my presence known.