A Series of Sarah-Shaped Holes

The public mental health system is a system in crisis, and I say this as someone who experienced it three years into covid. You’d be forgiven for thinking that it might not have always been this way, but unfortunately, you’d be wrong; it was already in a bad state well before covid hit. Post-covid? It got worse. This isn’t to say nothing has been done to address the problems with the system and how that is able to be accessed, it’s a case of there’s never enough funding allocated, and there are impossible expectations placed on funding that’s granted.

Instead of fixing the existing mental health system within the public sphere to cater to a wide variety of consumers, we’ve instead decided to shunt the problems off the public line and into the “community model” which sees private organisations pick up the lion’s share of the work. While a community approach to mental health absolutely has its benefits, it’s one that still has a lot of holes in it that people inevitably fall through.

In my experience as someone with cPTSD and Major Depressive Disorder, and also as someone who masks extremely well, almost all of my referrals to services were knocked back because I “seemed too well put together”.

One of the biggest problems with the public system is that unless otherwise diagnosed, almost everyone who presents to places like Community Mental Health (or CoMHET) is labelled as Borderline Personality Disorder and treated accordingly because (as I was told when I queried this on my file) “the public health system treats everyone as a nail, because that’s essentially all we’re funded to do”. There are no doctors, psychologists, or psychiatrists within the public system to even help address, for example, someone in crisis with a mental health condition that’s being complicated by ADHD or autism; “we can’t touch that, it’s not within the scope of what we can do”.

How does this get further complicated? Imagine the above person presenting in crisis is transgender, which begins to complicate things even more since there is an assumption that comes with a presentation that a large part of the distress is the result of issues surrounding transitioning. Never mind that a large chunk of the problem has been that she had just experienced the implosion of a marriage that had become abusive and now had to deal with everything that came with that. To complicate it even further? Discrimination in the workplace, the loss of a parent to cancer within the previous twelve months, family complications, and health problems resulting from the sheer amount of stress.

My being a trans woman was the thing I was most comfortable with, and since I transitioned, I kinda thrived.

There was no talk of my suicide attempt/s being the result of spousal abuse or domestic violence, which was a major factor in what caused what happened to play out. It was a major factor in how I ended up being repeatedly failed by the public system, and discovered some interesting flaws in the private system as a result.

But my presentation was recorded as Borderline Personality Disorder.

That’s basically the only way I could get any help.

Which didn’t help at all.

My initial arrival in ED was the result of an intentional overdose on prescribed medication. I was brought in by ambulance, spent the night in the resus bays, and begrudgingly worked my way through a bottle of activated charcoal. Then? I spent the rest of the night watching my heartrate drop, waiting for that moment where I was supposed to regret what I’d done and suddenly I’d be better. That didn’t come.

The staff in ED, and everyone I interacted with on that side of things? Lovely. I couldn’t find a problem with how I was treated by nurses and doctors alike.

Early the next morning, a worker from the mental health unit upstairs had come down for a chat about the situation and what to do going forward.

“Do you regret doing it?” she asked, almost in a tone that could be interpreted as scolding. This was someone who had already decided how this was going to play out just on how she came into the conversation.

“You’re asking me if the thing I did, and very much didn’t want to be rescued from, is something that I regret?” It felt like a question that didn’t even need to be asked, which is perhaps the thing that irritated me most. The notes were there, I wasn’t under the influence of drugs or alcohol, and I was pretty lucid the whole time, save for half an hour where the ceiling looked like it was melting. “That doesn’t sound very positive”, genuine disappointment.

“I knew what I was doing. I went into that situation with a very specific outcome. You’re asking me if I suddenly regret what I did, want to hang on to life and pick everything back up?” I started asking myself if it was possible to undo the decision to drink the activated charcoal, and that was only done because my dad was sitting across from me and it would have broken him for me to refuse in front of him. I drank half and hoped it wouldn’t change the outcome.

“Do you?”

Irritation had now become plane old frustration, and I need to check out of this conversation for my own sanity “I’m sorry, but I can’t give you the answer that you’re after”.

“How do you feel about being admitted to the Mental Health Short Stay Unit?” There was no other way to hear this other than a threat. The system was going to put the misbehaving Sarah away until she gets over her tantrum.

“That’s fine, I think we’ve gone past the point where I have much of a say in this.” We both knew that there was only a slim chance I would be discharged after what I’d done to find myself in here. Honestly? it was the only way to keep me safe. Part of me knew this, but most of me was still angry that I’d survived, and I would be fighting against this again over the coming months. A warning would have been nice, but life doesn’t give you much in the way of a heads-up at the best of times.

“Well, yes. I’ll get things organised and you’ll be transferred at some point through the day”

“Thanks for the chat”

I took a deep breath, pulled up the blanket, and tried to get some sleep.

Later into the morning, the ED was being smashed. They needed the bed, and I’d passed the window of time where if something critical was going to happen as a result of the overdose, it would have happened. From resus, I was moved to acute care, and some time around midday I would have my second meeting with someone from the mental health unit upstairs. It was short, to the point, and left no room for movement: “we’ve decided we are going to discharge you, all you need is some sleep and then you can go home”.

That’s certainly a decision, given the situation around somebody who repeatedly stated that their intention was to end their life. My brain started ticking… now? Later? We’re going to end up at the same resolution to this eventually. Just wait.

My only question was how she expected me to sleep through the chaos that acute care had become. I hadn’t told any of them that the screeners for ADHD and autism returned results that were “clinically significant” and was trying to access services to be formally diagnosed.

“I’ll have the doctor chart something to help you sleep”

The medication never arrived.

The acute care section of ED continued to grow louder.

In the bed next to me was a guy who had come in, very agitated, telling anyone who would listen that he needed help and nobody would help him. He was suicidal. His agitation kept getting out of hand. One security guard turned into two, then he started yelling about being handcuffed to the bed.

Machines beeping loudly and without any discernable rhythm.

The lights were too bright.

I ask the nurse when she comes around to check obs what is happening and if it was possible for me to go somewhere quieter, which wasn’t really possible given that I was there because I’d been sectioned under the mental health act and I needed to stay where I was. She saw what was happening, she said she knew that it was sensory overwhelm and gave me a set of tasks to do while I was there: count the doors, count the clocks, count the windows. It worked, for about half an hour.

I offered to leave my Nintendo Switch as collateral in case I didn’t come back. I don’t know what I was thinking. She ended up telling me I could go stand outside as long as I promised to come back.

I wasn’t okay.

I still wasn’t okay by a long shot.

At some point between talking to the second mental health worker from upstairs, being told I was being discharged, and my sensory meltdown in the afternoon? A decision had been made to move me upstairs to one of the wards because it was quieter and I’d be able to get some rest.

I ended up being moved to a ward. Nothing was said about where I would be moved to. Nobody mentioned anything about whether I was still sectioned or not. Just… moved to a ward. An hour or so later a nurse appeared with some tablets, I took a call from a concerned friend from Twitter, and then I went to sleep.

With no information when I woke up, no explanation about where I was, and working under the assumption that enough time had passed for me to no longer be under section or even how they work, I went for a walk to get coffee.

To the coffee shop that is at the front of the private hospital the next block over.

On my way out, I talk to the nurse at the desk and ask her how to get out of the hospital, she gives me directions and tells me that the staff member at the door will open the door. You'd think by now that something would have clicked. Why did I need to be let out? Why are the majority of the patients elderly? No, none of that even crossed my mind. I put my coat on and I started walking.

It wasn’t until I was outside and halfway between the two hospitals that I stopped.

What happens if I wasn’t supposed to leave?

There’s likely to be security, police, a whole lot of angry people, and me not leaving hospital today. I could go home. Then the spiral started winding: I could just go and finish what I started.

Scratch that, what’s a second outcome that’s not quite so terrible?

I could just continue, grab my coffee, and head back to the hospital. I was already halfway there, and if I was going to cause someone some kind of upset over this, the coffee would be worth it. I kept walking.

I’d taken no more than ten steps before the phone rings and there’s a very stern sounding woman on the phone asking where I was. I tried to explain to her that I was just grabbing a coffee and coming back. Apparently, that wasn’t okay.

“We need to send security to come and get you”

That’s a little dramatic.

I tell her it’s fine, that I’m coming back, I’d ordered my coffee and was waiting for it to be made (a lie, I hadn’t gotten to the café yet), convinced her that I was safe, nobody needed to panic, and I’d be about ten minutes.

“You’re not supposed to leave the ward”

I stay calm and explain that I have no intention of going anywhere but back to the hospital, once I’ve got my coffee, and that I didn’t understand why there was such a big fuss being made over this. I also couldn’t work out why I was so fixated on getting this coffee. It was a thing that was going to happen. The things in life that are inevitable: death, taxes, and apparently now Sarah’s cup of coffee.

“Fine, but I’m sending a nurse to come and get you”

She lied. We’re one for one.

As I’m heading out of the café and around the corner I spot the nurse who I had seen this morning, and walking beside him with a concerned and guilty look on his face was my dad.

“It wasn’t my idea”

It seems funny, and when I tell this to people when they ask how my time in hospital was, we all laugh. But then there’s the eventual “oh shit” moment where they work out just how badly the system had failed. It’s become a running joke of sorts that they don’t design things to be “Sarah proof”, and this would be proven repeatedly over the coming months.

That afternoon I was transferred to the Mental Health Short Stay Unit (or PECC).

It was perfectly boring, in the best way.

Quiet. Very few people. You have your own room. The door closes (but doesn’t lock). It was the perfect spot to disconnect. Unfortunately, my brain didn’t get the memo, and it was a series of careful conversations with the doctor on the first night to get me recategorized to voluntary just to get the anxiety to settle. I didn’t realise that voluntary doesn’t exactly mean voluntary until the next day. You see a psychiatrist or registrar daily and it was here that the public system somehow managed to make my already dire crisis worse.

Because of the situation that preceded my suicide attempt, I had asked for my wife not to be present when emergency services turned up, this was further translated to a request from the mental health peer worker who coordinated them trying to find me to take me to ED that my wife not be allowed access to me in ED. That’s a piece of information that has some important implications around safety for me as someone in crisis and having explained that what triggered my spiral had been an incident of abuse, they still thought it was perfectly fine to contact her and get information.

That phone call resulted in whoever spoke to her misreading information and telling her that I hadn’t been seeing my psychologist for six weeks and that was one of the reasons my mental health was the way it was. I’d not missed any of my appointments, and instead of querying the information received with me, my wife took that information and ran with it. What followed was a decision by her to leave because I was apparently non-compliant.

At every point along the way I had stressed that there was no one reason for what happened, it was a series of events that piled up on top of the other faster than I could deal with any of them individually. I explained in detail. They still felt the need to get extra information from someone who was not mentally well herself at the time, who I had expressly stated was unsafe for me to be around. How does this even make sense?

I spent three or four days in the short stay unit before being discharged with a seven day supply of Mirtazapine that they had added to the Effexor I take daily. Apparently this combination is their one-size-fits-all approach because everyone I’d spoken to in there had been given the same (and this started its own series of problems that would play out later).

Everyone is a nail.

I wasn’t given a copy of my discharge summary, I had to chase that up the next day when I saw my GP, and when I did get given a copy none of the information was recorded properly. Things were added that I hadn’t said, and they couldn’t consistently identify me as either he or she. It started to make me wonder if there is just a lack of care because it’s a mental health case, or because they aren’t used to dealing with transgender patients, was it just straight up contempt because I’m transgender? Who knows.

They’d consistently gotten details wrong and the report made me out to be completely unhinged about a situation that involved my wife and a mutual friend, despite explaining to them numerous times that this was only one of the things that was contributing to my suicide attempt. Completely left out of the notes that the night I attempted suicide that she was dissociated and used everything she knew would hurt me the most to make her point. She didn’t raise a hand, she didn’t have to. When you know how to use words to hurt someone, physical violence is irrelevant.

When I made a complaint to the Mental Health Liaison Officer, who did her best to follow it up and have mistakes corrected, I eventually got a call from the unit manager who basically apologized and left the conversation with “it sounds like you and your wife needed to break up anyway”. What needed to happen is that I needed to be treated like a person, not someone who has just been tossed in the corner and occasionally prodded by doctors until I was “safe” enough to leave.

Once I was discharged I had access to a psychologist cut because they thought I was “too high needs and needed face-to-face support” to be seen by their service, referred to Grief Line, and told to ask my GP for a referral to counselling or psychology through… a telehealth service.

My initial call from the lovely woman at Grief Line ended with “I don’t understand why you were referred to us, we don’t know how to help you”. Another service had closed my file because I seemed fine and didn’t present as though I was in distress. By this time I was having a panic attack whenever I had to deal with a service that refused to deal with me, and one of them said that I was simply getting upset because things weren’t going the way I wanted them to. I was in distress, I was suicidal, I was fighting to access anything that could help keep me here. I threw myself at everything, I was still applying for jobs, I was still working part-time. I was “functional”.

I was losing chunks of myself quicker than I could put myself back together.

Eventually I had to offload my medications to friends who would take turns dropping them in of an evening so I didn’t have enough on me to do anything with, conversations I don’t even remember having. One friend described the situation as watching me play 4D chess with myself in order to keep myself safe. I’d spiral, get frustrated that I didn’t have anything to use, completely forgetting that I’d sat down and spoken to them about why it was important that they held onto my tablets, then ask why I was being treated like a child.

“Sarah, you asked us to do this”

No, I really didn’t.

“This is how it happened…”

Well, fuck.

What I can tell you is that it is a completely surreal feeling to know that contrary to some people who dissociate and do questionable things, my brain’s approach to this was to do things that would keep me safe later on when it would inevitably be set off on a dive into the abyss.

It was during this period where things spiraled so spectacularly that a group of friends needed to intervene because Kayleigh found me particularly distressed (I’m great at understating the severity of the situation) walking through the shopping center. She stops me, asks where I’m going, and I give her the honest response: “bridge”.

“Oh nope, you’re coming with me, we’re going to sit down and figure out who we can get to keep you safe for the night”. Where she caught me was about 40 meters from where I was trying to get to. In the space of five minutes she had asked who was local and who I trusted, so I gave them Brett’s number, and a couple of friends who were on the way anyway.

Brett turns up, still in the period of six weeks where he had no idea of what was going on or why, just that a friend was in trouble and occasionally needed help, or company, or someone to keep her meds in the boot of his car, and he’s just trying to work out how he can help. Other friends arrive, and out of the car comes a person I’ve only met once in my life previously, let’s call her L, who says nothing and just walks over to me and wraps me in a hug out of nowhere. Conversation happens, I’m disconnected and not paying attention, we go back to their place and the only thing I’m interested in is going to sleep.

I wander into friend’s bedroom after being offered his bed, drop my stuff on the floor, get out my tablets I need for the night, then lay down. L wanders in and casually sits on the end of the bed and starts chatting away. I don’t know this person, but she’s lovely and a little bit anxious, but I’m happy for the company while I fall asleep. Sleep isn’t happening for me though, despite the tablets, so L asks me to come chat while she smokes a joint and says “I knew you were going to be in a state, so I didn’t know how prepared I needed to be so I just packed everything”. It’s the first thing in probably a week that’s gotten a giggle from me.

We go out the front, we share the joint, I go back to bed.

What was particularly amusing was that during the whole period of time from sitting on the end of the bed, to rolling the joint, L had just slowly made her way up to the head of the bed, stretched out, and made herself comfortable. Apparently, this was how she decided to make sure that I was going to be safe. She fell asleep. I fell asleep a little later. Things were fine…

Until she freaked out the next morning when she woke up and saw that I wasn’t there (I’d gone to the bathroom because that’s what you do first thing in the morning), but from the loungeroom all I could hear was “Where’s Sarah?! She was there when I went to sleep and she’s not there now, where has she gone!”.

I yell out from the other end of the house “bathroom” and everything settles back to normal.

Looking back on this particular interaction blows my mind that here was a person who I knew nothing about, spent ten minutes talking to once-upon-a-time, who would just decide that she was existing in the same space as someone to keep them safe, for hours if necessary.

It was a chilling indictment on the mental health system that this should even be a thing.

What I was left with two months after my first suicide attempt, and after exhausting all of the options myself and a mental health peer support worker could dig out of resources, was accessing a private clinic by taking out private health cover. Want to know how easy it is to access psychiatric healthcare with private health cover? Pretty damn. As long as you wait two months after you take out a policy. You also have to take out the highest level of cover.

My one saving grace was perseverance and even in crisis being able to approach problems from different angles.

Eventually I was able to talk the health fund into backdating my onboarding date by two months and I’d simply pay the premiums for that period of time, then I’d be able to access the private clinic for their three-week program. It took catching them out on repeatedly being given the wrong information to correct this mistake.

Admission involved twice weekly consults with a psychiatrist who works at the clinic, daily group therapy in the mornings, and in the afternoons it was a choice of things like yoga, use of the gym, sensory group, craft, or as much as they grumbled about it, sleep.

Three weeks turned into four.

It took me a week just to settle into the place, partly due to hospital admissions only being a thing that happened in the last couple of months. I’d not spent a night in hospital since I was an infant, so this whole idea and change of everything from what I was comfortable with was jarring, then factoring in that I’d been in crisis for so long by this point that settling was something that just wasn’t going to happen overnight. I wasn’t going to get any benefit from the program if I couldn’t take anything in. Too overwhelmed, too stressed, and everything that I’d been trying to stay one step ahead of for the previous two months hit like a freight train once I stopped moving.

“I just keep breaking”

My psychiatrist worked harder than he should have to get me to even come close to trusting him. I only had to see him for 3 weeks and that was it, I wasn’t going to be able to afford to see him once I got out. I barely make enough on a good week to survive, and a little extra if I’ve found freelance work writing articles, reviews, or putting my theology degree to work with a gospel reflection for the Uniting Church now and then.

Adjust my meds a little, sort out what’s going on, a fixed and functioning Sarah.

Job done, right? Ha.

Three weeks would eventually turn into six.

I saw a near-complete rotation of people into and out of the clinic while I was there, broke the rules and made some wonderful friends that I would stay in contact with. But while I was working through my own mess, I got to hear the experiences of other people who had to go through the public system. None of them good. Liverpool PECC (Psychiatric Emergency Care Centre) was consistently spoken about as somewhere to be dreaded; which for me was odd, given my only point of reference for this was the one at Campbelltown Hospital, and while my experience with staff there was bad? It wasn’t an awful space to be in. I would find out about Liverpool though in my own time.

I started actually learning stuff in group, that started an interesting cycle of “I’m learning how to make healthy decisions about how to deal with situations, how to regulate a little better, and how to set healthy boundaries in relationships and friendships” that led to “I can’t believe this was happening to me, I can’t believe I let this happen, God I’m such a mess” that eventually found some kind of equilibrium. A tenuous equilibrium, as there was one particular Tuesday after a session with my psych where I decided I’d go for a walk into the CBD (down two streets, take a right), and on my way back the spiral wound itself tighter.

I keep telling him that I don’t get angry, that I don’t experience anger, and that the most I deal with is frustration.

My brain had found itself going through things unpacked during my chat with him, then I found myself metaphorically sliding down to that ledge. It was right at the first set of traffic lights that the thought just dropped itself into every part of my brain space that I could make use of: you’re a theologian, Sarah, what good are you if you can’t find a reason to stay here?

“What good are you? You’ve spent years of your life living and breathing an unconventional approach to your faith, and you can’t figure this out”

Intrusive thoughts are fine when my brain is occupying itself making music out of random sounds from machines, traffic, and electrical equipment. It happens when I’m not consuming information, learning about something, or keeping that part of it busy with sensory stimulation of some kind. Things get a bit uncomfortable when the questions start popping up.

By the time I got to the next set of traffic lights to cross the road I didn’t even bother waiting for the walk signal, I was ripping pissed. I had it all worked out, I was going to ask to see him, then sit down and calmly ask “I’m supposed to have some kind of insight on reasons to stay here so that I can pass that on to other people who might be in crisis. I can do that in a heartbeat, but I can’t find a reason to keep myself here.”

“Pull up, Sarah.” My internal monologue was beginning to become annoyingly intrusive.

Somewhere in the middle of the storm that’s barreling toward me, there’s calm. It’s there. It’s small. It’s kinda useless.

“I exist in a social context where the world is becoming much more dangerous for trans people, and here I am advocating and speaking up. It’s literally harder for me to exist because of who I am before we factor in any of the other things everyone else has to deal with. What the fuck? Why *should* I stay?”

By now I’m back on the same block as the clinic; my face is covered in tears, my breathing is very much on its way to hyperventilation, and I’m still stupidly determined to have this conversation. I get to the door, and I’m a wreck trying to hold herself together, failing spectacularly.

This conversation isn’t happening. The storm hits. I break.

I get back to my room, a nurse close behind because someone’s yelled out “what the fuck’s happened to Sarah!”.

Through the door, I just need to get to the window.

I fall to the ground. I’m just a ball of panic.

The nurse asks if she can get me anything; a cup of cold water, some ice, something warm. Part of my brain is like “this was in the coursework! Look at us go!” Excellent work, we could have used this twenty minutes ago.

“I need to breathe”

“I just need to breathe”

I said it, I tried to pull everything back together.

Slowly it all starts to resemble calm and I can have some sort of conversation about everything that’s just happened. I hadn’t factored in that it was the first time I’d been for a walk by myself in the whole time I’d been there, there were misunderstandings with communication at work, the session with the psych unpacked some pretty significant things.

Messy was to be expected, apparently; and I don’t give myself the space or time to deal with it. If I can’t have it neatly packed away and everything fine in x amount of time, then it just doesn’t get dealt with. Things that take significant chunks of time? Trauma. I’d accumulated more than a few people’s lifetimes of it. The latest addition to Sarah’s closet of bad things really was the one made my brain decide that it was done with my shit, and it needed to be dealt with. Somehow we were going to address it, and if that meant my brain near-self destructing, then that’s what was going to happen.

What it took me a little bit longer to figure out was that I was actually getting the stuff we were learning in group. That panic attack? I found somewhere calm, somewhere safe, somewhere quiet, where I could just focus on my breathing and bringing myself back together. I was putting it into practice. By the time I got myself composed again, I walked past one of the common rooms where sensory group happened to be running and I sat myself down with a Tibetan singing bowl and just calmed myself in the resonance.

The bowl rested in the palm of my left hand, it was cool, and the skin on my hand started to mold to the bumps in the metal. My left hand started to rub the mallet around the lip of the bowl, and the sound from the vibration of the mallet against the metal made it resonate until the speed and pressure were right enough to use the shape of the bowl to amplify the sound. The sound has colour, and the larger of the two fills the air with waves of violet, while the smaller is tones of yellow.

I settle into it, the whole experience is almost hypnotic, and it’s a few more minutes before everything slows down. My heart stops pounding, the roar of blood rushing behind my ears dies back, and the sound of the singing bowl has offset the constant ringing in my ears. There’s a contradictory silence in the way that everything together cancels each other out, and it’s beautiful.

I’m calm, the psych pops his head in and has a brief chat to make sure I’m okay. I still wanted to call him an arsehole, but I don’t care now. What I do know is that the next day is going to suck, because after a panic attack comes the adrenaline crash. It came, I was exhausted, I kept moving forward.

After a certain point of being at the clinic I’d decided that I was going to carve out a Sarah-shaped space for myself. I’d brought my acoustic bass along with me, and at certain points in the day I would just exist on the lounge out the back in the sun and either practice one of a half-dozen songs I was determined to memorize, or just playing and going where the rhythm took me. Whether I can play particularly well is irrelevant, there’s just something about resting your chin lazily on the curve of the body near the neck and playing a tune. It was here I figured out that sound and vibration are a big factor in being able to regulate.

My time at the clinic had been, up until this point, about finding out that I had been the victim of abuse of more than one kind, trying to accept that this was actually my reality, trying to work out strategies to deal with the emotions attached to that, and ways to try and not have that happen again. That was already a lot to deal with, and I was working my way through it, but underneath that all was a rumble of growing anxiety that would spike and settle. Depression was fine, I’m always in a state of “okay” and only rarely will it slide into a space where I’m not looking after myself.

Leading up to discharge is when the anxiety really started spiking again, and I was warned it could be bumpy. I had another panic attack, this time actually asking if I could access medication to settle myself, and spent the afternoon trying to avoid my psych because I didn’t want to have to hear back from him what I’d already figured out. I’d gotten to a point where I was able to start sorting myself out again.

Well, sort of.

The intention was there, but I would find myself really struggling with execution in typical Sarah fashion.

Discharge itself was easy and hassle-free. I got a bag with my medications in it, a discharge letter, and once I put my stuff in my dad’s car I was off back to the house I’d moved into a couple of weeks before my admission happened. I get picked up by a friend to go back to their place and then things started unravelling. One friend said it would be best if I stayed with them for a week until I decompressed from my six weeks of decompressing, which wasn’t going to help because I have trouble sleeping in unfamiliar spaces; this was only going to stress me out even further. I explained this, they were unhappy with this decision, and I got dropped off back home via the hospital to visit a friend who had been admitted with heart failure.

Friday Night

Brett recently told a friend: “Something wasn’t right. She came to visit and when she was talking to me she was happy, active, present, it was Sarah being Sarah. When she wasn’t talking? She wasn’t okay. She just vanished, a thousand miles away and she would only flicker back when her name was mentioned.”

He knew something was up.

I would get home, put my stuff on the floor at the foot of the bed. My backpack dropped to the bed with a thud. My housemate was still awake and in the living room using the computer, just doing her nightly thing. Reaching out, I pull the blanket down and look at the bed.

I just need to lay down. If I lay down, I can go to sleep and I can wake up tomorrow and deal with everything that I need to.

This wasn’t a decision I was going to have any control over.

The thing I’d been running from for months now had all of the things shrouding it stripped away and it was now for lack of better language, breathing down my neck. It wasn’t hours of planning, indecision, and trying to work out if this was something I was committed to doing. That had already been churning away in the background. I’d already been to the chemist and got prescriptions filled, I remember fiddling with them in my backpack while I visited him.

“… a thousand miles away”

I flickered out.

I was home for twenty minutes.

I downed the tablets. All but 4 in a bottle of fifty.

What I remember from there is being concerned that my housemate would find me. I grab my headphones, my tablets, my wallet, and as I leave the house I tell my housemate I’m going for a walk.

From here I have to piece things together from Twitter posts, conversations with people over SMS and instant messengers, and recollections from people who dropped in to check on me over the course of the next four days… I also dropped into the police station to try and fill in the blanks,

I was not an okay Sarah.

Police officer: “you came in very upset, you said everyone else was okay but you weren’t…”

I wasn’t.

“…then you had a panic attack and passed out. We called the ambulance, found an empty bottle of tablets and some other meds in your pockets. The ambulance took you to the hospital.”

I sighed and said thanks for that.

“You don’t remember any of it?”

Nope. Bits and pieces. Feelings. Nick Cave and headphones. The part of my brain that was in a rage for brief moments began to become coherent. Psychosis? No, it doesn’t fit the symptoms. It wasn’t intrusive thoughts, they were mine. I didn’t hear voices or see things. She was a part of me that I very rarely communicate with, for good reason: a very hurt and very wounded Sarah.

“You can’t sit here and let some stranger find you and have to deal with that trauma. This isn’t who you are.”

You want me to end our life, but you’re suddenly concerned about how this looks?

“No, I’m concerned about hurting others unnecessarily.”

Solution, then?

“Police station. It’s their job to deal with these sorts of things.”

It’s really not, but there’s no convenient way to do this.

“You could not do it at all?”

Make up your mind?

“Walk.”

My feet move, I can feel them hit the pavement. My phone is vibrating and only stops for a few seconds before it starts again.

Police station doors, panic attack, lights out Sarah.

Saturday

I wake up at about 3pm, stare at the ceiling. My head feels weird, I’ve been asleep this whole time? Nobody will give me answers as to what happened. There’s a cannula in my arm. I hate these things. My boots are on the floor. I look at my arm again and noticed there’s nothing attached to the line.

“We really fucked that up”

I’m still not okay.

I start peeling the adhesive patch that they put around the cannula to keep it in place, those things are painful to remove. Next the cannula comes out and my usual aversion to blood is nowhere to be seen, and I’m watching it come out with a weird curiosity.

“That was rude, they didn’t even ask me”

The nurse comes over in a bit of a flutter and says I’m not supposed to pull that out.

“It was inconvenient, and this is too loud by the way” I gesture to everything. The nurse just glares. She walks away and that seemed like the perfect time to get out of bed. Was that a mistake? Absolutely. Did I persist? You’ve read this far, and by now it’s easier to just assume that if there was a bad idea firing through my brain right now, we were going with it.

“She’s sedated, she’s not supposed to be awake, let alone getting up…”

It’s this or I piss myself, lady.

If it was possible for me to feel shame right now, I would have hidden myself back under my blanket. Unfortunately for myself and anyone around me, the part of my brain that controlled shame wasn’t functional.

I go back to bed and at handover I finally find out what’s happening. Would you believe this is the second time now nobody has explained that I was sectioned? Thank goodness I didn’t feel like a cup of coffee.

“Sarah is being transferred to Liverpool PECC, she’s curiously non-compliant but harmless”

Half an hour later the security guard gets up, patient transport is here, I’m being relocated to Liverpool and they hand me a bag with my belongings in it. I dig through it and find the empty bottle of tablets and a box of beta blockers left over from the night previous, they go straight into my pocket.

We were about to discover another Sarah-shaped hole.

The ride to Liverpool was quiet, I was anxious, I didn’t want to go. The security guard is sitting across from me watching videos on his phone, headphones in. My hand goes into my pocket and pops the box of beta-blockers from the sheets into the box. He looks up, I smile, he goes back to his phone. I open my bottle of drink and take a handful of tablets, wait a couple of minutes then take another handful.

When we get to the other end I’m taken into PECC. It’s grim. It smells. It reminds me of what you see in movies. What am I feeling? Terrified. I don’t want to be here, and if all went to plan I wouldn’t be for long. Just wait it out.

It isn’t long before a nurse comes out and asks me if I’ve taken anything on my way to Liverpool. I tell her I hadn’t taken anything.

The nurse goes back to the office and as I pull my hand out of my pocket two more tablets fall onto the floor. Without even thinking about it my hand reaches down, picks them up, and I swallow them. How do we know something is wrong? I can’t take tablets without water.

A couple of minutes later the nurse comes back out and says she needs to do an ECG because someone had been in contact and let them know I’d taken a box of the beta blockers. Who? How? There’s a message waiting on my phone saying it was unfair that I’d put her in a position where she didn’t have enough information to do something. I scroll up. I’ve been pulling the rug out from underneath myself the whole time. No memory of the conversation.

The nurse doing the ECG is having trouble getting the machine to work properly. I’ve got my top up around my neck. Another nurse comes in. They’re still having trouble, they’re also getting a little panicked because more time is passing, by now they know what I’ve taken and roughly how much.

Another nurse, and this time they finally get it working. It’s right around this time that the ceiling looked like it was melting again, I look to my side and say “Hi, I’m Sarah, and I usually prefer to meet people with my top covering my boobs. Sorry about that.” One of them snorts as she laughs. I have no idea what I’m doing.

I get taken to the cardiac unit because whatever the ECG showed was enough to rattle the nurse. A new security guard, who is completely unthreatening. The staff here are lovely, and I discover that they place yellow slippery floor signs out front of rooms where sectioned patients are kept. A nurse comes in and says they need to insert a cannula because if something goes wrong, and it's very likely to given what I've taken, then they need quick access to flush things through. I politely decline and tell her it's not going to be a problem. She looks at me like I'm not actually crazy and I know what I'm doing. Either that, or she knows what I'm trying to do. "You can't do anything, and that's okay" I say to her, she nods and leaves.

Two friends who I met at the clinic drop in and visit. The ceiling is still doing funny things. I look out the window and pretend I'm paying attention. It's night outside and the deep indigo of the sky starts to drip over the windowsill.

"Eventually it will seep over the floor, up to the bed and cover us"

It's okay, I want to go now too. My heart rate keeps dropping lower, and I feel like I'm tired enough to get some sleep. I roll over, pull the blanket up, and snuggle into my pillow.

"Sarah, you need to wake up". A nurse has come in sounding concerned.

No

"Sarah, I'm not joking, you need to wake up. If I can't get your heart rate higher than where it is now I need to hit the button."

Fine, I'm awake, but I'm not impressed.

"Why are you so stubborn? You seem so lovely."

You wouldn't get it.

She clips the leads back on to the pads on my chest and shoulders, runs the ECG again, looks at the screen and exhales in exactly the way someone does when they’re frustrated.

“I need you to take some deep breaths every couple of minutes. It will nudge your heart rate in the right direction. I don’t know what happened that was so bad that you needed to do this, but I'm here if you need to talk, okay?"

Can I go back to sleep?

"I'd rather you didn't, you're still in danger"

Sunday

The next morning I get a visit from the doctor to make sure I'm okay. He's in a suit, he's loud, he's happy. I remember his teeth, why? They were too white. I explain to him the things that contributed to my suicide attempt, and his response to the part about me being worried about being homeless is "have you tried couch surfing? A lot of people do it and I'm sure something can be sorted out" My only regret now is that there weren't more of the beta blocker to take. I was so close.

After the doctor, I get about half an hour before the social worker comes in for a chat. She bowls in confidently and wants to chat about why I’m here. I’ve lost count of how many times I’ve been through this now. Outside the door a nurse is going off about the social worker being in my room with the door closed. I’m sectioned, I’m apparently dangerous.

What I am is offended.

“It says you made a suicide attempt…”

She’s going to go the same route the mental health worker from Campbelltown went, I can sense it. I know those words are coming.

It wasn’t an attempt, at this point its dumb fucking luck that I’m awake and breathing.

“So you wanted to end your life?”

I have to check myself, because I was ticking over how much more I could do this before launching into a monologue about self-determination, autonomy, and the right a person should have to end their life.

Yes, that’s exactly what I did. Yes, I meant it. No, I’m not sorry. Nor do I regret it.

We chat for a little and her solution to all of my problems is to apply for the Disability Support Pension with all the confidence of someone who has no idea how hard that is for people with mental health issues. I’m so done with people.

Changeover is happening again, and even at Liverpool I don’t get any information about what’s happening to or with me until I overhear it from conversations between other people.

A chatty nurse comes in and finally tells me what’s happening and asks if I’d like to go and have a shower before I get taken downstairs back to PECC. I tell her it’s fine, I will have one when I get down there.

“It’s less a suggestion, and more a case of you really ought to. The facilities down there are shocking.”

I take her advice, have a shower, and prepare myself for heading back downstairs.

The nurse comes back in, chats for a couple of minutes about her experiences with her own mental health and asks if she can hug me before I go. She was sweet, and as far as the horror show of protocol being thrown out the window? This was probably the moment of genuine humanity that I needed, never mind that it was extremely unprofessional; which was a theme that would continue as we rolled downstairs to the PECC unit.

The nurses are chatty, one is a bit too excited about getting to escort someone down there.

“They call this the dungeon when we get people on the ward from here, is it really like that?”

The second nurse answers, “sort of, I’ve only been down here a couple of times, but it’s pretty accurate.”

“So it’s the kind of place they keep school shooters?”

What little faith I have left in humanity has been taken out back and unceremoniously drowned. There’s zero consideration that the person they’re escorting for handover is actually fully aware of what’s happening, or even a human it seems. It kinda tracks with my whole experience so far, it was just depressing to hear it so explicitly.

The doors to the PECC unit open, I’m taken inside, it’s as grim as I remember it from the day previous.

“This is where Sarah meets the consequences of her actions”

I roll my eyes and try to work out whether my internal monologue can pick a tone and just stick to it. It’s much easier to deal with when it’s remembering chunks of physics videos from YouTube, or occasionally gets itself stuck on a song; best when it’s working out how to write code for something in Java.

I take some time to try and settle myself in. I’m allocated a bed in the room with four beds. One of the nurses queries this and asks why I’m not put in one of the single rooms “because you can’t mix people like this in with…”

Don’t say it.

“She’s trans, what if something happens to her?”

Well, fuck.

After I put my stuff on my bed, I go and sit in the common room where one of the nurses from the day previous comes out and asks me if I recognize her. My mind went blank trying to figure it out.

“I’m one of the nurses who was trying to help you yesterday. It’s good to see you here because, I don’t think you understand, but people who have done what you did generally don’t come back.” She looked kind of spooked, so I asked her what she meant.

“You’re not supposed to be here is what I mean. People don’t really survive the sort of overdose you put yourself through.” She was awkward, I told her I was okay and that I’m not planning on doing it again anytime soon.

My definition of “anytime soon” and everyone else’s would suddenly become very, very different.

There were moments that helped though, just small observations about things that made me feel like it wasn’t quite so awful. One of these was the attention to detail at dinner one of the nurses would put into making sure everything was set out nicely, and then he would come and get each patient individually and show them to their seat. I mentioned to him that it was beautiful that he put so much care into making people feel comfortable. “We’re all human, even in here; and if there’s anything I can do to make that a little easier? Then it’s no trouble at all”.

Sleeping in the mixed room was an experience. Was sleep difficult? Absolutely. It’s hard to sleep when you are in a room with three other people, you don’t know what they’re there for, and whether or not they are going to be a threat to you. Suddenly you’re aware of your vulnerability, and you’re on high alert.

Monday

The next morning I spent on the couch in the common room, and after breakfast there was a First Nations kid who had come in at some point overnight asking to speak to a liaison person and getting agitated. The discussion between this kid and the staff was that it was agreed upon that he had been discharged and was okay to go home, but nobody would actually open the doors for him to leave. This meant that the kid continued to get agitated, the nurses dug their heels in, and instead of letting him go and resolving the situation, they ended up calling security.

When security showed up they wasted no time in jumping in and grabbing the kid, then wrestling him to the ground, one of them saying “you don’t want to resist this”, because that’s not some terrifying language to hear from a guy that’s trying to pin you to the ground.

It wasn’t until one of the nurses shouted “he’s voluntary” that security immediately let him go and talked to him like he was one of their best friends. The sudden attitude change was something that made me wonder where they hire these people from, and just how prepared for violence are they in a situation like this? There was no attempt at de-escalation, no attempt to talk this kid down, they just leapt in.

I grab my phone, I make a post about it to Twitter, something that would cause trouble later on.

The psychiatrist comes around and asks what it is that I think they can do for me at PECC, she’s short-ish, straight to the point, and almost completely uninterested.

“I don’t actually know what this place is for, and if I don’t know what it’s for, then there’s not really anything you can do to help me?”. Recovering from overdose number two meant that even if I did know, that information wasn’t accessible at the moment. What I needed was somewhere safe. This wasn’t it. Her response to my question basically confirmed it.

She looks like it was her get out of jail free card: “you’re right, there’s nothing we can do here to help you, so we will have your papers done and you can head home this morning after we’ve contacted someone to pick you up”.

These were no longer Sarah-shaped holes in the system, they were gaping black holes, and I wouldn’t find out until later just how dreadful Liverpool hospital’s reputation is for mental health is.

Feeling completely hopeless, when the nurse came out to tell me my dad would be there to pick me up in a few hours, I told her it would be fine and I would get the train home. She starts to look worried and goes back to the office. A few minutes later she comes back out and says that my dad would be there in half an hour. I say okay just to get her to leave me alone, and as she leaves I get on the phone to my dad and inform him I’ll be taking the train home because it’s something I need to do.

The nurse comes out, I fill her in about the phone call with my dad. She’s stressed.

I get my bag from the storage room, start getting all of my stuff together and as I’m getting ready to leave she stands in front of me and asks “are you going to be okay?” she’s worried. Really worried.

I’m trying to be. I need to be able to do this on my own. It’s all I can say to her because my voice is cracking. I know I can’t keep myself safe.

“Promise me you won’t do anything silly on your way home”

It’s not a question, it’s not even a request; at this point it felt like she was pleading.

I tell her I can’t make promises like that, but I will do my best to make it home safely.

She opens the doors, I leave.

I didn’t make it home.

As I got out of the hospital I walked across Bigge Park pulling my stuff behind me. The sun was hot, it was loud, everything smelled offensive. Construction was happening not too far from where I was walking, which only added to how utterly overwhelming it was, and overwhelm means panic is coming.

I start to breathe funny, it’s getting harder to catch my breath. I pull my hood up to hide beneath it so people can’t obviously tell that I’m crying. I’m fighting with everything I have to get to the train station.

I’d sent a message to a group chat saying that I’d been discharged and was getting the train home. They weren’t impressed. I reassure them that I’m relatively safe and that getting home will be a piece of cake.

“You’re not safe until you prove to me you’re safe” was the response I received.

Cool, so we’re heading into territory where friends are going to alienate people with overbearing language and treat them like they’re completely incapable. If anything, the exchange made my situation worse. I was already stressed beyond breaking point, I didn’t need to be pushed around and treated like a child on top.

He tries to call, I hang up.

I tell him that it’s fine.

He responds with “it’s illegal for them to release you like that into nobody’s care”. I don’t think any laws have been broken, but I do know that a lot of protocols to keep people safe have been ignored.

The train arrives, I step onboard, I find a seat. The ride home was the hardest thing I’ve ever done. I could have gotten off the train and walk up the train tracks, find an overpass to jump off, I could wait until I get to the station, walk across to the shopping center and see what prescriptions I have on file.

I’m crying the entire time because my ability to stop this is now non-existent. I give in.

The train pulls into the station I need to be at. I get off, drag my bags with me, and head to the chemist.

“Hi, I would like to see what prescriptions I have on file?” The chemist goes to the drawer, pulls them out and puts them in front of me. I flick through them and see that all of them have “to be dispensed in seven day supply” printed across them. I hand her the prescription for Mirtazapine and hope that she doesn’t read the note in capital letters. She doesn’t.

Five minutes later I have the prescription and a bottle of gin. I go for a walk and find somewhere to sit. I’m calm. I have the tablets in front of me, crack the gin, and start putting the tablets in my hand.

Out of everything that happened over the last few days, this was the thing that felt like a rational choice. Not because I’d decided that I was okay to do this and this was the logical conclusion to everything that had just happened. No, I thought about everything and the effect this whole series of events would have on my family, how I would be the “crazy” one, and how this is now the reputation I would have with people who follow me online and saw this whole crisis unfold on social media.

I was embarrassed.

It wasn’t depression or despair that engulfed me so completely now, it was shame.

I took the packet of tablets with half a bottle of gin.

I broke twenty minutes later while I just waited. There was a person who I should have spoken to at any point over the last few days and it was only now that I swallowed my pride and called Kayleigh. If there was anyone who was going to understand, anyone who was going to get it, it was her.

“I need help”

What I tried to say is that I don’t want to be alone while this happens.

She dropped everything and came to sit with me. Her first question was “why the fuck did they discharge you when you are very clearly not okay?!” I smiled and told her about how much of a disaster this whole thing has been. Explained it start to finish, by now it’s taking me much longer than normal to get my words out. “How?!” was her only response to it all. I get it, I really do.

“I’m not going to call the ambulance without your consent, but if you lose consciousness, that decision becomes mine to make”. There’s a certain reasonableness to this that kind of tricks you into thinking that it was always your decision to make (it wasn’t really).

Then it hits like a truck. First, it’s the nausea, then the light-headedness. I’ve never felt so sick in my life. I ask her if I can go to the bathroom to throw up. “You’re not going to the fucking bathroom, you can barely stand up”.

Ambulance then?

“Is that you asking for one?”

I nod, then I nearly fall off the bricks into the garden

The ambulance eventually gets there, we have a chat, they’re absolutely lovely

“Sarah, because you have already been through this I’m just going to give you the short version”. She’s trying to be as gentle as possible.

I interrupt and tell he that I can make it shorter and follow it up with the word “section?”.

“You know the drill” she says, and after they figure things out and how to monitor for complications from this particular overdose, we’re on our way back to Campbelltown’s emergency department, arriving in the ambulance bays and sitting in triage out the back. It was here that a doctor came around and insisted that she was going to try and put a cannula in my hand. I asked her not to, she insisted and said that she needed to try in my hand.

She wasn’t going to find anything, I hadn’t had any fluids in more than 36 hours. She tried anyway then said “what? There’s not even any blood when I took it out?”. I informed her that the paramedic had tried on the way and wasn’t able to. The doctor kept insisting this needed to be done, I asked her not to, so she said she would try once more in my arm and wandered off. It was about 10 minutes later she returned with an ultrasound machine and another doctor to try and find a vein to put the line into, worked at it for a couple of minutes, then made her first attempt.

“Can you please stop, this is hurting me” I said, patiently, because both my arms had already been bruised from the amount of times this had already happened over the last few days.

“I just need to try once more”, she pulled the needle out, then pushed it back in. I tensed up because by now the pain from it was too much on top of everything else.

I raised my voice a little: “I asked you to please stop, you are hurting me!”. She pulled the needle out and pulled the other doctor into the corner and mumbled something. I looked across and said to them “just because I’ve been sectioned doesn’t mean you can treat me like I don’t deserve to be treated like this, I’m a person, I still have rights”. They left with the ultrasound machine, and I didn’t see them again.

When they eventually found me a bed in acute care, a nurse came around to check information and everything was correct on the system. She walked off when everything was confirmed, then returned about twenty minutes later and her tone changed from being pretty stern to being genuinely concerned.

“We need to ask some questions about a few things just to get some background about why you’re here. I know that a lot of people will skip this and just make the assumption that you’re struggling with being transgender and that’s where all your problems are coming from, but something is telling me that isn’t it”.

“Being trans is the least of my problems, I love the person I am, I love the person I was becoming. That wasn’t what played into any of this.” I replied.

“Are you scared of your partner or ex-partner?”

I turned white.

I took a minute to get myself together, this was going to be a hard conversation, and then explain that my situation was complicated because none of what happened was physical.

“So it was emotional and psychological abuse?”

For once in this whole process someone was prepared to listen, and she was sympathetic. When she asked questions, I explained the situation and gave examples and asked if it qualified.

All she could say was “oh, honey”.

This whole thing was triggered by domestic abuse, and everyone was trying to address it from every angle except that because trying to deal with that problem was going to be a lot harder than just throwing tablets at it and sending me on my way. What made it more complicated was that I wasn’t aware of how bad the situation was until it was too late. I couldn’t talk to friends because they all loved my wife. On the outside she was lovely, charming, and completely likeable. What I saw and experienced was someone who was struggling with their own problems, but because she couldn’t address any of them with the people she had issue with, I was inevitably the one that wore it.

What makes it harder is that while this was all taking place, I’m studying to be a mental health peer support worker, and a big part of the course is trauma informed care. The situation I was going through was there, word-for-word, in the coursework. Symptoms of interpersonal violence and abuse on the victim can take the form of anxiety, depression, risky behaviour, or seeing suicide as a way out of the situation.

It’s there in black and white, but we treat everyone as though they have Borderline Personality Disorder. Domestic abuse is an afterthought.

We discussed this for about 45 minutes, and we’d only gotten to what happened in the last twelve months, that’s all that was really important. The rest of the trauma would have to be dealt with in its own time: childhood sexual abuse, witnessing domestic violence as a kid, being tortured by a sibling and brother-in-law, the death of my daughter, being raped while I was overseas, a very close call with a serial killer, being on the receiving end of domestic violence, and then this.

Monday night ended up being kind of calm. My friend was discharged earlier that day and asked if there was anything I needed or wanted to eat, he dropped in with KFC and we both sat on the bed in acute care, ate dinner, and chatted about everything that had happened.

“Being your friend is a fucking adventure, but do you think at some point you’re going to be able to pull back so we can stop spending quite so much time in hospitals? Don’t get me wrong, you’re a great friend, but this can’t be good for you”. We both laugh, and it turns into one of those awkward moments where neither of us knows exactly what’s going to happen next.

Tuesday

I barely slept Monday night. It was strange though, because there was a point at which everything suddenly stopped, my brain was calm, and it was as if nothing had even happened. I felt, for all intents and purposes, normal. By this point I’d been moved to one of the fast-track bays and put in a chair. This is where I would stay for the rest of the night, and as it turns out, well into the next morning when hell broke loose in the bay next to me.

The psychiatrist came down to chat, he was pleasant, he asked what situations had contributed to this, and I explained. When I started getting upset he reached out, put his hand on my knee to calm me and said “you’re only human, being emotional is a part of that”. His phone rings, he answers, he explains he has to go and address something elsewhere in ED and he’d come back.

In the meantime, a young woman had been brought in saying that she needed to be taken to jail because she was scared she was going to murder someone. One of those moments you take a deep breath and understand that the rest of the morning is going to play out one of two ways: either she’s going to be listened to and they’re going to do everything they can to try and calm her… or she’s going to be ignored, she’ll go off, and she’ll need to be sedated.

The psychiatrist comes back as this has hit its half-way mark and she’s only getting more agitated and loud. Instead of maybe looking in to see if there’s anything he can do to help the young woman, he insists that he’s here to talk to me. He tries to carry on the conversation, but she eventually got to the point where she’d been ignored enough that she physically assaulted one of the nurses and screamed that this is what she was warning them about.

I raised an eyebrow and say to the psychiatrist “this is probably something you should take control of, you can help her”. He gets a puzzled look on his face that this suggestion came from someone he was considering putting back into the Mental Health Short Stay unit.

“I probably should, are you okay for me to come back?” this was bordering on bizarre.

“Go and do something” I replied, exasperated that it even had to be said, let alone from someone who herself was feeling like Little Miss Crazy.

Security is brought in, the poor young woman is sedated and moved to a bed for her to settle. Fast-track is quiet again and the crowd of people disperses. It’s another few minutes before the psychiatrist returns and we chat about what my plans are to keep myself safe if I get discharged, which involve me giving my medications to my friend for him to hold onto and I’ll go back to getting a couple of days supply at a time. I think I’m being clever, but he asks for my friend’s phone number. I oblige.

My dad hadn’t been made aware of this recent admission, so I called him and just told him if he wanted to come down and have a chat that I was sitting in ED: “Fuck! What?!” he was in panic mode, and I totally get why, he’d already been put through hell. He came down, we chatted, and the psychiatrist came back after contacting my friend in regards to the plan for discharge.

He asks dad if he has any concerns or questions about what’s happening, and dad asks if it’s okay to chat in private. This gets my back up. I remind him that I’m an adult and he’s not my carer, and after taking a moment to breathe, I tell him it’s okay for him to go and chat. When he comes back 20 minutes later dad and I have a chat about where I’m at.

“I just want you to know that this isn’t me giving up. I have just been through so much in my life and I can’t keep having to go through it the way that I have. It’s not fair that I’ve had to have been through so much in my life that’s hurt me, and been hurt by people who promised they never would or had a responsibility to keep me safe”.

Dad says “I know” and gives me the biggest hug he’s given me in a long while, when he lets go he says: "we've watched you struggle through everything and you still managed to keep going. I know life hasn't been fair and you keep ending up in situations that nobody should ever have to go through, but I'm proud of you for making it this far. You say every now and then that your mother and I must think you're such a failure, but we see everything you've done and become in spite of everything and are so proud". I start crying because it's the first time any of it has been acknowledged. But it's kinda nice, you know?

Psychiatrist comes back and he’s all chirpy about the mental health team deciding to discharge me, and this would be running at odds with the conversation he’s just had on the phone with the friend now responsible for holding my medications who arrives to pick me up 5 minutes later. We walk back to his car and he just lets fly with a rant about how condescending the psychiatrist was.

“I’m not going to give you the word-for-word conversation, but I will tell you that I said to him that myself and a couple of other people were concerned that they were even discharging you after the weekend you’ve had. But the thing that got me was him saying that we don’t have the funding, services, or staff needed to be able to keep Sarah safe, so that falls onto her family and people around her until things fall into place.”

He seethes.

“I said to him you are woefully unprepared to have this conversation with me, because I have experienced how bad the mental health system is and how it wholly and utterly fails people, I’ve watched it fail Sarah several times now over the last couple of months. Now I’m seeing it fail her again!”

At the time I finish writing this, it will have been nearly a month since I was discharged after the weekend that nearly killed me. Four suicide attempts later. I’ve had next to zero contact from any community-based services, and had to have a senior mental health peer worker advocate for me to be referred to the Suicide Prevention Outreach Team. All of my access to services has been done by myself and a friend who I would be lost without.

A person in crisis should not have to work this hard to try and keep themselves alive, it shouldn’t nearly financially cripple them to be able access decent psychiatric care, and as I write this I am aware that there are people who won’t survive purely because access is next to impossible.

The kicker? It wasn’t until not one, but two friends (one who works in mental health, and the other with considerable experience around the systems) asked if there was anything medication-wise that could possibly have made this situation worse. I went through the timeline of events and looked at when things started getting out of control, and it lined up with the one-size-fits-all combination of Effexor and Mirtazapine from my initial visit. The severity of panic attacks and suicidal ideation increased alongside increasing of the dose of Mirtazapine, which has a reputation and history of doing exactly this to people in rare cases.

It comes back to the problem of neurodivergent brains and the assumption that medication is going to work the same for everyone for the same problems. It shouldn’t have been up to people who weren’t my treating clinicians to flag this. It shouldn’t be up to neurodiverse people to constantly have to educate about things that affect them. But we also have to accept that sometimes doctors just don’t know enough, like possible interactions with HRT meds and beta blockers, and a dozen different other things.

The public system shouldn’t just address everyone as though they have the same problem when people present for a whole range of reasons. Similarly, the private system shouldn’t be allowed to exist in such a state where they can just bleed health funds for as much as possible purely because they can, which drives access to much needed and life saving services out of reach of people who need it most.

My experience of this system isn’t the only one. I’m just (un)fortunate enough to see an injustice and have the (and I hate this word) resilience to be able to sit through recalling it, typing it out, and taking regular breaks because I’ve broken down and sobbed through paragraphs of text.

At the end of the day we’re people: we’re your brothers and sisters, your teachers, your employees, your spouses or partners, we’re people you listen to or interact with on social media; and most of the time we struggle in silence. Some of us *coughs* manage to broadcast our mental breakdown on Twitter, and for all the grief that place causes on the whole? It’s a community of complete strangers who saved my life.

I didn’t find out until half-way through writing this that there was a very coordinated effort from a group of people who saw that something was up, grouped together and tracked down contact numbers for my family to let them know what was going on. When they weren’t working at contacting my family, they were desperately trying to get through to me. I still haven’t worked my way through the messages, missed calls, and I don’t think I’ll ever get through them all. I’ll keep them as a reminder that there are good people out there.

Those who couldn’t contact, sent their concerns to people who knew my details.

To them? You have my thanks, and my heart.

All of you.