Had another good meeting today, this time with my new CPN, C. We went through my WRAP plan, and from it created a new, short WRAP - something I can use as a daily checklist possibly, certainly as a checklist when I meet with her, and aimed at stopping me from deteriorating into crisis.
This, together with the appointment I had yesterday with Dr K, and a post Mandy has made on her blog, have me thinking about crisis prevention, relapse prevention. I now feel I have a set of tools coming together which hopefully can be used to stop me from deteriorating in future. It strikes me that this is not how things have historically worked for me, or the way that Mental Health is focused at present. There is a lot of talk about the Recovery Model, and help is usually provided for those who deteriorate into mental health crisis. Such was my experience over Christmas when the involvement of the local Crisis Team played a major part in helping me to cope in the midst of my own crisis, and in recovering from it. Mandy is finding that help for her Dad is now being provided. However, it all seems to come too late.
Why can't the resources be put in at an earlier stage? Common sense would suggest that this would be a much cheaper option to providing crisis treatment, often at great expense in hospital. It would also be of massive benefit to people's long term mental health - not only in terms of preventing a distressing crisis, but in terms of making them feel they are worthwhile and can be successful. It would prevent a lot of sickness absence; apparently mental health issues are the second largest cause of time lost due to illness in the UK. It could remove the need for higher doses of expensive medication. All of these would save money. My experience is that once I go into crisis it takes time and effort to get out of it. How much better to avoid the crisis in the first place.
I accept that I have an illness which, statistically speaking, is now almost certain to recur for me. It's clear that I have some kind of predisposition to depression and anxiety. This may be biological, may be behavioural, may be a result of my experiences. It's almost certainly acombination of all three. So what I need is a way of recognising my early warning signs and tackling them, while addressing all three factors in terms of prevention, as far as is possible.
The biological aspects can be addressed, as Dr K suggested yesterday, by proactively increasing my anti-depressants at times when, historically, I am prone to deterioration. For me this is closely linked to the seasons. I recognise this is not the case for everyone, but suspect many of those of us who struggle with mental health can identify certain times when we are more vulnerable. The behavioural and historical aspects have been and are being addressed by talking therapies. And underpinning all three is the need for monitoring. That's what I hope my new short WRAP will help provide. Initially that will be with the help of C. Hopefully at some point I will be able to monitor it myself. But I also need the certainty that, should I notice signs that things are not going well, I can access the support I then need. That has not always been my experience, and that is what we should all be entitled to. If a professional (or in my case, several professionals including GP, counsellor and psychiatrist) recommend that access to further support is merited, then that support should be available. Maybe that way crises can be managed and minimised, if not avoided altogether.