Peer Professionals in Mental Health Crisis Situations

In advance, the moral of this story is not that there is nothing that some helping hands and a little Ativan can't cure. Although, its a good combination.

The experiences of a client with bipolar disorder responded me of the importance of having people in your life -- peer support -- who understand through firsthand experience what it has been like to walk in your shoes. This -- the notion that having help from someone who understands from their own experience can make a difference -- is a common mantra in the Depression and Bipolar Support Alliance of Northern Virginia groups and has become a tool in the vast arsenal at Ashburn Psychological Services.

Bipolar disorder usually presents itself in one of three forms: full-blown mania, hypomania and depression. In the depressed and manic states, some experience psychotic symptoms, such as delusions and hallucinations. Two less common presentations of bipolar are rapid cycling, where an individual shifts from mania to depression in very little time, and mixed states, where an individual is both manic and depressed at the same time (you would think that the two moods would be contradictory opposites, but, sadly, they are not).

One of the clients I share with a psychiatrist last weekend, clearly experiencing rapid cycling and mixed states. She had never been there before, but she was well-read and had no problem articulating to me the spot she was in. The only diagnostics her psychiatrist had to do was make sure that her and my observations were not off base. And they weren't. One common element of mania is having a decreased need for sleep and the client had not slept in four days. It would have been easy to write it off to mania and adjust her mood stabilizers accordingly. But in talking with the client about the history of this episode it is clear that she had been feeling anxious at first, and then the cycling, mixed states and lack of sleep followed. Anxiety is something that can often trigger mania, mixed states and rapid cycling, and so the question became: Were the rapid cycling and mixed states causing the lack of sleep, which was leading to anxiety? Or was the anxiety causing a lack of sleep, which was triggering the rapid cylcing and mixed states?

Between the three of us -- peer coach, psychiatrist and patient -- we concluded that it was the anxiety that was driving the train and that's what needed to be addressed. Part of what lead me to that conclusion was a five-day run without sleep that I had in 2007 that was not caused by mania (anxiety over some life changes) but certainty led to mixed states and psychosis. The three of us knew she was on the fast train to inpatient hospitalization if we didn't act. So, her psychiatrist added a good mood stabilizer, and I sent her to the hospital after not being able to get to sleep again that night to have the doctors administer a sedative that has hypnotic, muscle relaxing and anti-anxiety effects. Two rounds by IV and she was still awake. The emergency room doctors, somewhat amazed, added a dosage of a powerful drug to take the edge off the anxiety, and she feel asleep, and sleep for hours and hours and hours.

When I saw her the next day, well rested, she thanked me and pointed out that it was nice to have someone who doesn't doubt you and who has been through similar experiences when you begin to doubt yourself. Peer support has enhanced mental health in many ways, and, to me, this is just one of them. The other great elements in each situation like this I learn great lessons for myself and my own health, and things that I can pass along to other peers.

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