Having worked as a mental health nurse for many years, it would be easy to assume that I’m usually the one doing the teaching and my clients are usually doing most of the learning. That assumption would be completely wrong. Yes, I’ve learned a lot in school and through continuing education, plus I’ve learned a lot from my own experience of mental illness, but I have also learned so, so much from my clients. (Note: my use of “psych patients” in the title is only because it’s conveniently concise.)
One of my regular clients for several years was a transgendered woman with bipolar disorder. She was the first trans person that I worked closely with, and I had the privilege of being able to support her through sex reassignment surgery and the various pitfalls she faced along her journey with transitioning and managing bipolar. In Canada, public health insurance covers genital surgery but not procedures that are assumed to be “cosmetic” such as facial feminization and tracheal shaves. I have vivid memories of making calls on speakerphone with her in my office about various issues. The person we were on the line with would refer to her as “sir”. My client would say “no, actually it’s ma’am, not sir”. A minute later, it was “sir” again. And then again. My client’s eyes, posture, and voice all reflected her frustration and defeat, and I grew increasingly outraged at the casual, everyday stigma reflected in this call centre agent’s use of pronouns. Every time I’ve worked with a trans client since then I can’t help but remember those phone calls as a microcosm of the stigma against transgendered people, and how much this parallels the stigma against mental illness. But my client bravely soldiered through, and her capacity to cope despite the challenges of her mental illness was astonishing.
I have had some very interesting relationships with clients over the years, and one in particular will always stand out. She was an older women with schizophrenia who I rather fondly thought of as crusty and cantankerous. She was chronically psychotic, and frequently called the police because she thought poison was being placed her room. It drove the building staff crazy, and I would regularly get calls from them asking me to come by and check on her. The client had a fun, quirky sense of humour, and this produced some amusing insults directed my way; she wasn’t too fond of me because a) I didn’t believe her about the poison, and b) I came to stick a needle in her every couple weeks. In time she ended up being diagnosed with terminal cancer, and moved into hospice care. The change in her was the most remarkable thing I’ve ever seen. After years of being continuously actively psychotic, her delusions abated, and she was the most relaxed and content I’d ever seen her She enjoyed my visits, and while she still had the energy I would take her out for coffee. She found greater peace as she neared death than she had experienced for many, many years. Sometimes the world works in mysterious ways.
My own experience with mental illness has made me a strong advocate for client autonomy, although I’ll freely admit that at times I’ve seen involuntary treatment work wonders. I had one client who came to me after a long stay in hospital. He’d originally been admitted because he was making threatening gestures with a weapon, triggered by an uncommon symptom known as Capgras delusions, which involves the belief that familiar people have been replaced by imposters. The client was released on a community treatment order, which mandated ongoing involuntary treatment in the community, and he was on an injectable antipsychotic every 2 weeks. He was cooperative with the conditions, but was never uncomfortable with the idea of having these restrictions hovering over him, and he didn’t want to take the medication by injection. The psychiatrist was concerned because the client didn’t have insight into his psychotic illness. However, the client did believe he had depression, and I was able to work with him around that and he agreed that continuing to take the medication in oral form would be a good thing. So I supported him in pushing the psychiatrist for a switch to oral meds and eventually the discontinuation of the community treatment order. And it worked. The client thrived. I like to trot out that story when I’m advocating for other clients, because it’s such a great example of how empowering someone high risk can turn out really well.
Sometimes people get written off as lost causes, but there’s really no such thing. I had one client who had fetal alcohol syndrome, was psychotic, was a heavy crack cocaine user, and regularly prostituted herself to feed her drug addiction. She was behaviourally erratic and would blindly wander into traffic. Staff at the ultra-low-barrier residence where she lived were terrified for her safety. She had been started on an injectable antipsychotic, but it was hard to track her down to actually get a shot into her. Luckily, my office was only a couple of blocks from where she lived, and I became a bit of a stalker. My persistence paid off, along with a few cigarettes as bribes; once she was getting her shot regularly, her behaviour settled down. She realized that the shot “helps my schizophrenia”, and she would approach me spontaneously with a smile if she saw me on the street. I will happily take those small victories.
I have also had other clients teach me never to lose hope. I had gotten a call from a local homeless shelter about a man who was extremely paranoid and ranting loudly about his various delusions. He was tough to track down because as soon as he found out I was from the mental health team he avoided me (can’t say I blame him). Getting him to hospital was quite dramatic, involving chasing him down the street, miscommunication with the police, and handcuffs. But we worked with him, got him stabilized on meds, changed his meds when he had side effects, got him good housing… and now he’s doing great and running a fantastic peer engagement project. Success stories like this give me hope, both for myself and others.
Those are some of the clients that I think of often because of what they have taught me. There is always reason for hope.