Reflections About Safety, Part 1: My Perspective as a Mental Health Consumer
April 8, 2022 / Mental Health
by Diana Spore, PhD, MGS
This is the first part of a four-part series about safety.
When I, as a patient, am struggling and voicing concerns with my psychiatrist or other mental health care provider, I am almost always faced with two questions immediately: “Do you feel safe?” and “Are you having any thoughts about taking your own life?” From what I have learned as a mental health consumer in the specialty mental health sector for almost 30 years (I have a “Bipolar Disorder” diagnostic label), both questions are loaded. Mental health professionals should take a patient’s fears and past into account when framing and posing these questions.
I have been delusional in the past. Will the mental health professional believe me if I say that I don’t feel safe and am afraid of my neighbors? I have heard voices in the past. Will he or she believe me if I say that I hear my neighbors talking about me, that they think I should be locked up in a psychiatric ward or placed in a nursing home? Will he or she listen to me long enough to consider if what I say I am hearing is “real,” rather than a mental fabrication or an auditory hallucination?
Will the psychiatrist or therapist tell me that I must be too sensitive to noise (which is an indicator that I am becoming unwell) or that I am misinterpreting what I think I am hearing? Will I be told that I should ignore background noises, wear headphones or turn on a fan? Would they listen if I told them that my neighbors’ yelling matches upset my emotional support dog? Would they consider that “real” or even “excessive” noise?
Should we be discussing the need for me to have a safety plan in place, and for me to actually consider setting the wheels in motion to find housing elsewhere? Shall I admit, even to myself, that I am afraid of being overmedicated again, of being shipped off to a psychiatric hospital where I was traumatized in the past? What are the negative ramifications of simply telling the truth that “I don’t feel safe, and this is why...”? It seems that no one ever talks about the time that is lost in recovering from a traumatizing hospitalization experience, at least not in my world.
If I am actually being closely monitored by neighbors, experiencing defamation and discrimination, will I be believed? I know I will definitely not be viewed as a trustworthy informant. Will I need to rely on others who can speak on my behalf, experts who can attest to my competence and wellness? If I am – in reality – unsafe, will a safety plan be discussed and implemented before my physical and mental health, livelihood, productivity and emotional well-being are negatively affected?
I believe it is the job of the mental health provider to clarify what he or she means when referring to safety and to explore how the question can be framed better so that I do not feel alienated or defensive. All that may be needed is for me to be heard and for us to discuss my safety, as defined by both of us jointly. This should be part of shared decision-making, based on a shared dialogue.
Diana Spore is an advocate for individuals facing mental health challenges and those who are living with dementia, a writer/editor, and a mental health consumer in recovery. Spore received her Master’s degree in Gerontological Studies from Miami University (Ohio), and earned a PhD in Human Development and Family Studies, with a concentration in aging, from Penn State. She completed postdoctoral training at Brown University. Spore’s areas of expertise include mental health and aging, mental health recovery and trauma-informed care, medication optimization, long-term care, caregiving, and psychotropic drug use and inappropriate drug use among older adults. She is a former Board member of the Mental Health and Recovery Board of Ashland County (Ohio; MHRB). She was Editor-of-Chief of TAPESTRY OF OUR LIVES, an anthology of works created by individuals in recovery, a project that was done under the auspices of the MHRB. Spore served as Project Lead for a “Writing for Recovery” initiative, MHRB, and engaged in all aspects of the project, which has resulted in sustained spin-off efforts. Diana Spore has expertise in creative writing, writing for recovery, journaling for caregivers, legacy writing, and advocacy writing.