About formal plans

[Guest guest]

Oh and for a little perspective, it isn't really the hospital's fault at

all. I've been in many care places and schools and all, and no-one ever

cared about formal plans. Rehabilitation plans were introduced a few weeks

after I started at the blind rehab center, so I didn't benefit, but I was

already told that a formal plan wouldn't really have made a difference

anyway. I found it easiest to discuss interventions directly with the

trainers/therapists rather than through my case manager/counselor (who

didn't keep track of my progress or what therapies/training I was doing at

all), but this was of course not possible with places whose intervention is

officially plan-based (although my individual sports/movement therapy, which

is my only useful therapy here was started before it was put into my

treatment plan, too). Same in the independent living training home: my care

plan was only revised if we needed funding, and my goal-achievement plans

were revised when I insisted but apart from their being written, they were

generally ignored (and my startign in mental health, which led to my autism

diagnosis, was never put into any plan until we needed extra funding and

used the diagnosis as a rationale). In school, we were supposed to have some

kind of plan with the special ed folks, but I only found out that it had

certain goals in it when my teacher of the visually impaired sent me a copy

of something he sent to the blind rehab center. This was at the end of 12th

grade. Maybe it's just me, but I get the impression that professionals in

general just don't like to be held formally accountable for what they are

and are not doing, so keep both positive and negative off the plans. I'm

however too cynical to believe that insisting on everything being in writing

will change anything. In my experience, they just don't care. I refused to

sign two treatment plans here in the hospital because they were bogus, but

no-one cared and the plan was just followed through with anyway. Technically

this is illegal (both these plans had time-out in it, which can *not* be

enforced on a voluntarily committed patient without consent, and one had a

meeting in it which was about me without me - but maybe that one is legal

anyway since I was discussed as an anonymous case), but I haven't complained

because the one time I did, I was threatened with forced discharge.

Astrid

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[Guest guest]

I was just reading the " Get everything in writing " thread, and it reminds

me... formal plans are just that, formalities. I've given up on getting

anything useful out of a treatment plan (psych hospital). One nurse, who

tried to temper my expectations of my second last treatment plan, blamed the

uselessness on my having been on the same ward for a year (while you're

supposed to stay only three months) and " If it's still not clear after this

long or there need to be changes, it will never become clear " . The one thing

that I expected to get out of the treatment plan, was to agree on how we

were going to approach the resocialization ward (where I'm supposed to move

to) about the fact that I was still having significant meltdowns and my

meltdown action plan wasn't working (my meltdowns were one of the reasons

reso ward initially turned me down). The reply was to plan on revisign my

meltdown action plan, which did happen, but the new plan was never put into

effect (my primary nurse is still needing to give me a copy). The meeting

was Nov 10, the plan was changed Nov 19 and there was another meeting Dec

15. Between Nov 10-Dec 15, I had quite a few meltdowns and one way more

severe than the one that earned me time-out policy in June, and suddenly it

was all blamed on unquiet fellow patients (which wasn't the case) and the

one really serious meltdown wasn't even mentioned. I tried to voice my

concern about informing reso ward again, but was just told that reso ward

didn't expect perfection ( " perfection " was my word, but I explained that I

didn't mean it literally). There was no mention of chaning my meltdown

action plan (apart from my request for a copy), of course no mention of

time-out (the only reason the policy was terminated was cause I couldn't go

to reso with it), no caring for what caused the meltdowns (bad overload and

uncertainty about my situation) because they have no clue how to change that

anyway (well, I agree, since they've been so inconsistent/unclear that

nothing will calm me no matter how " clear " they claim it to be), and my

assertion that I was badly overwhelmed and pretty much couldn't handle it

anymore, was greeted with " Oh, you can sure write that down at treatment

plan meetings. " Uh-huh! Great thing was that I'd expected to be treated even

worse (told that I lied about my overload " because you still make jokes " or

that I should be happy cause " the social worker is working really hard to

figure out your placement " ). Fearing such a response (most likely from the

psychiatrist, who comes across like he thinks that not having a problem that

he can treat means the problem can wait) was the reason I didn't place too

much emphasis on my problems.

Then a few days later, I had a discussion with the reso psychologist again,

and decided to be honest and just inform him about the severe meltdown and

the action plan not working. He seemed to let it go in one ear and out the

other, but I'm not sure whether this is a good thing or not. And then yet

another few days later, I had another severe meltdown. While it is in my

action plan that I shouldn't go outside while in a meltdown unless I know

where I'm going and know the way (we're still needing to have me learn a

familiar route to walk for such occurences), there is nowhere the nurses can

send me other than my room now since the time-out policy was terminated (I

had already been to my room quite a lot) and there are no strategies apart

from the things I can do in my room (which I had already tried) and taking

an emergency med (which I had already done, too - this med is rather useless

but I've tried to tell my doctor so many times that I've given up). The

nurses, all substitutes who are even more clueless on how to deal with me

than the regular staff are, decided to almost pick me up and push me out the

door. I went home because I had planned to go there for the week-end, but I

was really pretty much melting down at home, too. I called the ward because

I wanted to come back, but hte nurse informed me that I had been granted

off-ward time till Sunday (it was then Friday), in a tone of voice as if to

say I shouldn't come back till then (there is no rule that says you SHOULD

go or stay away). I ended up needing to have my boyfriend come over to stay

with me over the night till my sister came Sat afternoon (planned visit),

and she took me back to the ward in the evening (regular staff allowedme to

come back). The weird thing is that I did exactly the same things that

earned me the time-out policy in June: going off-ward in a meltdown (the

difference being now I was pushed off the ward and then I asked to go),

wandering (I did reach me home this time, but from my home went on to wander

again), calling the ward because I didn't know what to do... And the

substitute rationalized the having pushed me off the ward with " the

psychiatrist approved of it " . So suddenly going outside in a meltdown and

wandering is not dangerous, while it used to be dangerous enough to threaten

time-out for (time-out is only allowed to prevent/avert danger)?!

Okay but then again, my situation is screwed anyway: I am at this place,

which is mostly for schizophrenia/bipolar people, because there is no other

place I can go. Autism may be in the DSM, but not in the part of the DSM our

staff knows about, and I have no other psychiatric disorders. The reason I

came here was that I fell apart (no real psychiatric crisis, my dx was

" adjustment disorder " ) at home, so the solution is for the social worker to

find more suitable placement ( " adjustment disorder " is also in the DSM, but

psychosocial intervention is recommended - I no longer have that label by

the way). Of course, no-one (except for maybe me, they would say if I shoved

the matter into their face) can help that it takes fourteen months and

counting (waiting lists and functioning requirements that I don't meet), and

everyone is trying soo hard to find appropriate placement for me, and of

course they are punishing the meltdowns, since these are in the way of my

getting into some new placements, and of course they don't care about my

emotional state because it isn't in the DSM (not that meltdowns are in the

DSM, but) and " everything (except for the meltdowns) will go away when we've

figure dout placement " or " that is part of Asperger's, accept it " . Oh sorry

this has become so long and cynical.

Astrid

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