Update: The rewriting of care-plans. Speaking up and being listened to.

This is a follow up on a previous post where I said that J was being but into a position of risk because she was expected to simply "choose" not to kill herself and wouldn't be stopped by staff if she tried to leave the ward. A few days back we were presented with a care plan and were invited to add our own comments. 

One of my requests was that where I didn't agree with statements that they could be rephrased in such a way that was positive and involving for J.  We also pointed out that in order for J to agree to the care plan it had to be, well, agreeable, realistic and practical.  We both sent back handwritten notes to the nurses' office on the ward. J again reinforced the notion that the template diagnosis of BPD, with all it's "cooperate or leave approach", was not helpful and that she was suffering from depression and anxiety (with OCD and Bulimia) and did not currently have the resilience and self esteem to repel the overpowering thoughts of suicide and worthlessness. I concentrated my response on overturning the premise that by not actively keeping J safe the ward staff created an incentive for her to act safe (hardly mentioning the negative message conveyed by implying a lack of responsibility on behalf of the 'Trust when it came to duty of care to vulnerable patients). I would be calling the police myself if she left the ward whilst suicidal, and pointed out that I did not believe that expressing a desire to leave  and expressing a desire to kill herself constituted the "ability to make decisions" or  "full mental capacity" because she was unable to entertain alternative scenarios (previous example of this: begging a policeman to take her to a motorway bridge because it was "logical" to let her die).  

Anyhow. The nurses we were talking to on this occasion were pretty smart, inciteful and sympathetic to Jo's needs. Despite what the doctor had been suggesting, they reassured J that at the very least a duty doctor would be called to assess J if she tried to leave, and yes, maybe a temporary MHA Section would be used to keep her safe. 

 Another positive in all of this is that is that J and the doctor are prepared to change her medication.  Previously J's anxiety and a string of "don't rock the boat" locum shrinks had made this difficult to implement in an effective or measured way.  I'm pretty sure that the one thing the Bradgate Unit can just about do right is to monitor inpatients whilst changing drugs in a relatively secure environment. Certainly that's all they seem to do with some of the more "hyper" patients, who literally arrive shrieking and leave with quieter demeanors. One of the nurses has also been writing new sections in the care plan detailing ways they might be able to help with each aspect of J's condition (one-size-fits-all BPD umbrella aside), i.e. a paragraph and action points on anxiety, another on OCD and so on.  The nurses seem to be finding time to talk one-to-one with her as well. 

 It's been a really tough couple of weeks, but J has been trying to be honest with staff about thoughts and plans she has about suicide and self harm.  I won't go into details but there's been a couple of creative near-misses, which have led to J agreeing to have her room stripped, leaving her with an unfoldable "seclusion blanket" and she is currently wearing an indestructible "seclusion gown". The heating was broken in her room and another ward demanded the borrowed seclusion blanket back.  J chose to be cold for a few hours, not trusting herself with normal blankets.  It was returned and the other ward was admonished because J's legs still have odema which make them an "infection" issue.  There are many odd institution-centric stories to tell just from the last handful of days, but thankful, in terms of day to day ward care it's so much better than some of our previous experiences at the Bradgate.

  The doctor, who at times, has a very human side, hasn't challenged our alterations to the care plan and is praising J for recognizing and communicating her levels of risk.  Also she is proud of J for committing to the plan to change medication during a 6 month voluntary stay.  

J is very scared and still suicidal, but both of us, no matter how cynical or skeptical we are, seem to be happier with a plan from which we can add flexibility, if that makes sense? Like the first draft of the care plan - it's easier to change once it's in writing.  J has been reassured that she will not be moved from her room. It's normal ward practice to swap and move patients around depending upon many factors which make perfect sense to nursing staff, but for many patients this can be almost traumatic and triggering emotionally. Even if this does happen to J, at least we know she can't be moved into a shared dormitory, because there are none on this ward.

Also, I'm surprised at how much the nurses and the doctor seem to be valuing my own input regarding her care.  My name appears on the paperwork as the partner and carer and I'm seen as an important aspect of support in aiding her recovery.  It's like a strange moment in a dream when you've been shouting forever and they actually turn and look directly at you, and stranger still, they are listening. Again, unprecedented! 

(Posting this now, may return to edit later) ;)