topic People who don’t seem to get better -Why? in Depression

People who don’t seem to get better -Why?

Ramblify — Sat, 25 Dec 2021 14:48:59 GMT

Hi, I have lived experience with depression and anxiety. I consider myself lucky that I received good help from health professionals. I knew from a young age (16/17) that I didn’t want to be like my parents; and I wanted more from life.
Recently, I’ve done a basic course in Individual Support (Disability); and have been working with people with disabilities and more recently, people with mental health disabilities. What I see a lot of is people who aren’t able, or just don’t want to, engage in their goals. Most have very bad living conditions - mostly dirt and hoarding. Basically they buy things and don’t clean, or have any organisation system. I also have lived experiences with these issues. The difference I think??? Is I was able to ask for help and if I didn’t get the right help or person I could look elsewhere.
Im just rather perplexed at what happens to people to get in the states’ I’ve been witnessing? Have they given up on life? It seems like they don’t want to get better. Are they medication resistant? They don’t seem to like any doctors, Psychologists or Psychiatrists - they think they’re old dinosaurs and they find them pretty much useless. I have certainly had a few experiences like this myself, but I just found someone else. I guess I am lucky I have openess as a trait?
mother people I have know who have had eg: a diagnosis of anti social personality disorder, and once they got the diagnosis they pretty much decided they were f&$@ed and nothing could be done; and stayed in their bedroom in their parents house for 20 years.
I can’t totally relate to fear of failure (or success), low self esteem, low self worth, being and feeing overwhelmed and paralysed, procrastinating. But I guess I am (by nature??) somewhat resilient. I just wanted to get feedback about the notion of people who have mental illness who can’t be helped (usually because of their mental illness). How do people become stuck? Is it a lack of insight? And personality traits!? Are they just a lot sicker than anyone ever knew… I’m struggling to comprehend.
thnaks

People who don’t seem to get better -Why?

Hanna3 — Sat, 25 Dec 2021 15:21:39 GMT

Hi Rambifly

Thanks for asking for help with understanding the problems you're encountering in your (very valuable) work.

May I ask if your clients are mainly elderly or are they mixed ages? Are they all hoarders or have other problems as well?

My limited understanding of hoarding is that it's primarily an anxiety disorder and they find it very difficult to part with their possessions.

Are your clients living at home? Do you know if they also suffer from other mental health issues?

I'm not sure from your details if they are reluctant to part with things or have underlying depression or possible dementia.

It's great that you have come here to try to get greater understanding of how to help the people you're caring for!

A bit more information would be helpful if you can?

Others may come by in the meantime with some suggestions.

I hope to come back to you tomorrow. Meanwhile I hope others can make suggestions to assist you.

I'm glad you're keen to help and understand your clients, good on you. I hope people here can help.

🙂

People who don’t seem to get better -Why?

Ramblify — Sat, 25 Dec 2021 16:04:11 GMT

Hi Hanna,

Ive worked with all sorts of clients older younger, profound intellectual disability AND complex mental health problems (as it’s difficult for professionals to diagnosis people with intellectual disabilities, especially non-verbal clients, hoarders and non hoarders. But to be more specific, My current regular clients that are mental health related looks like this- one is in their early 60’s, a history of mental health - depression- been hospitalised in the past and has also had electric shock treatment, they’re on antipsychotic medication, and also have a leg injury and they use a zimmer frame. They have some memory lost and can be a bit slower to process things. They live with their elderly mother who is their ‘official carer’ but the mother has memory issues too that she tries to hide. I take them to Drs appointments and they come out of the appointment not really being able to explain why they were in there. This client is easy.
I have another client who has a diagnosis of major depression and anxiety- they’re in , probably their 50’s… have been hospitalised many times. Not a hoarder, but after a long time of cancellations I finally met them and they showed me their house. They had posters of stuff piled up - I went for 2 shifts, and scrubbed their dishes that had been sitting there for 12 months or more - they dried some of the dishers and put them away. They’re not able/or don’t want to engage in the work; also can’t answer any questions. Wants to see what I’m doing so as to know I’m doing things in the correct ‘way’, they have no problem expressing the method in which they want their dishes and kitchen cleaned - but won’t engage much. They also have very up and down moods and partake in self destructive behaviours. This client is frightening for me I feel out of my depth - And I worry I’m being taken advantage of and manipulated. Also the fact they seem hesitant to participate could mean I’m enabling them not to face their issues of not cleaning. The client is very closed to conversations they don’t want to have. They won’t talk to anyone else or let anyone in their house. They really need a cleaner. But now I’m the only person they will talk to or deal with. It’s a heavy load and I’m not sure it’s healthy for my own mental health.

People who don’t seem to get better -Why?

Ramblify — Sat, 25 Dec 2021 16:04:37 GMT

I have another client also in their 60’s who is reclusive, their house is very dirty, but they don’t care, their hoarding isn’t that much of an issue- there’s places to sit down. They’re on antipsychotic meds and have been in and out of hospital- they believe people are stalking them. They also cook things in the oven and forget about it for months - then find it rotting. Or put things in their bag and forget about them until they open their bag and it’s covered in goo. That is not really a problem; the problem is they don’t want to engage in activities or really do anything. Somethings they do want to do are unusual, not logical and not thought out well or something isn’t getting through.. I don’t really want to give an example incase it compromises their identity. But I can say their thought process is out of order and either they don’t understand certain aspects or just don’t want to. They also don't like or trust their doctors. I’ve been working with them for approximately 6 months and not much progress - they don’t have a goal so hard to know. I can’t get them engaged in anything.

People who don’t seem to get better -Why?

Hanna3 — Sat, 25 Dec 2021 21:40:33 GMT

Hi Ramblify,

Thanks for that information, it sounds like you have a challenging job. I wonder does your employer give you any advice or assistance with managing your clients? Do you have any training in working with people with mental health issues?

Just a thought, I wonder if it would help to listen to some podcasts about hoarding and Google about it, as it's a recognised mental health disorder. It would be something that's very hard for you to deal with alone I think.

We have talked here on BB about how much people with mh problems struggle with housework. We haven't found a solution! There is quite a bit on the internet about depression and housework if you google that.

I don't know that I'm much help to you and other people may come up with some ideas for you, but it does sound like these poor people are struggling with severe mental health problems which make coping with everyday tasks difficult and often overwhelming.

It sounds like they really need more help than you alone will be able to provide, which makes things hard for you.

Are you able to discuss these things with your employer or other employees? It really sounds like these poor people need more support than they are getting, but I'm well aware mh is under-funded.

I know they do need kindness and compassion. You sound like you are very concerned and trying to do your very best for them, which is wonderful. Just be mindful that you don't want to get too burnt out from it all yourself.

Depression can sap people's motivation, and as housework and cleaning are neglected and pile up it becomes overwhelming. It's really their mh that needs treatment first.

I also wonder if the one with food rotting has dissociative disorder of some kind or dementia? Periods of dissociation, or losing time, can result in things like this.

I really think a chat with your employer or your clients' mental health team would be a good idea.

I hope others will come up with some ideas for you here on BB.

You sound very caring and I really hope we can give you some support in what sounds like a challenging job.

BB may be a bit quiet over Christmas but I really hope others might have some suggestions for you.

Let us know if any of this helps or not! Good luck with your wonderful work! 🙂

People who don’t seem to get better -Why?

Hanna3 — Sat, 25 Dec 2021 22:12:40 GMT

Hi again Ramblify,

I have to make separate posts because of the word count!

Reading about these poor people made me feel sad that they are so alone and neglected and in need of help. It's wonderful that you care enough about them and yourself and your own mental health that you've posted here on BB.

Do you have support yourself? Is there any assistance for you with your employer? What about at home? Dealing with people with these problems and disabilities must be an emotionally challenging job.

I used to dissociate as a child due to trauma and my mother used to find rotting sandwiches in my school suitcase and got very angry about it, but I honestly didn't know they were there. Dissociation can be a way of dealing with trauma.

It does sound like a professional cleaner is needed too, and I don't know if that can be organised for these people?

I feel sad that our society leaves people like these so neglected. It shouldn't be happening.

It shouldn't be all down to you to try to fix it all either.

Mental health is deplorably under-funded and as a country we should be ashamed of that.

I'm so glad you've posted here and I'll come by again later and see if others can come up with suggestions to help you.

Cheers my friend! 🙂👍

People who don’t seem to get better -Why?

Ggrand — Sat, 25 Dec 2021 22:57:21 GMT

Hello Dear Ramblify,

Depression, can have a huge impact on our bodies as well as our thought pattern ina very over tired mind....it isn’t just the mind.

Then add on top of depression, anxiety, fear of people, PTSD or other mental or physical problems...It gets extremely hard to manage everything each day....and a feeling of totally being overwhelmed with every aspect of life, might take over ourselves and it’s hard even to get out of bed some days, and surviving daily becomes really hard.

I have a huge want, to get well as I think at different times everyone struggling with mental health does....and they try hard to...only to be knocked down again, to start all over again....Depression is so complex and different for everyone.

I used to buy ornaments to comfort myself, some buy clothes, trinkets, books, etc....I ended up with ornaments every where....It’s the same I think as comfort eating....Buying something lifts us for a few seconds just like comfort eating, trying to get the little feeling of pleasure that comes with it.

I also have different depths of depression, the deep dark place is impossible to do anything except to try to survive it...other times, I’m fine with cleaning, looking after myself etc.

I have a mental health support worker, I told her my goal over 2 years ago, which was and still is...to be able to go out shopping in my big town on my own or to be able to walk anywhere without feeling so much vulnerability and fear....She promises to take me here and there...but it doesn’t eventuate....she doesn’t follow through with it....slowly my trust for here is disappearing..I couldn’t be bothered to even try now...even though my want is big in doing it....my depression, anxiety, ptsd takes over and tells me...it mustn’t be that important if my support worker constantly let down.

What I’m trying to say...is mental health... depression, anxiety etc..is just so complex, different for everyone...and even if you could jump inside their thoughts....It still will be so hard to understand what a person with mental health diagnoses is actually going through, thinking of behaving within themselves.

Most times it’s because of not wanting to get well....but it’s more like, wanting to just exist and get through each day the best they can..

I do hope you find out what your looking for....but everyone’s depression is different and needs to be treated and supported as such...

These are words of how my mh can effect me..

Kind thoughts Dear Ramblify..

Grandy..

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 02:30:37 GMT

Hello ramblify

I found this post a it upsetting, but that's OK. I think being trauma sensitive would help in that we can understand not what's wrong with ppl, but what happened to them, which leads to this. It's not laziness etc or bad qualities of character.

I've met many ppl whomlive with their parents in their 30s and 40s during my stays at hosptial.

It's different in each circumstance,

Also, privilege of having someone to believe u and support u, helps.

I also feel that this being a mh forum, some ppl here may also be I the potions u mention, do u ask for data from us? Each person is their own world and universe. We are complex and most ppl in such positions have never had anyone love, believe in, or see them. The first step for my healing and getting unstuck,mwas being believed.

People who don’t seem to get better -Why?

mmMekitty — Sun, 26 Dec 2021 07:27:39 GMT

Hello Ramblify,

I'm somewhat reluctant to try to answer the questions you have. I am concerned that with the 'basic course in Individual Support - Disability', that you are working with clients who are difficult to engage, &/or have complex needs. At the very least, I hope someone is supervising your work until you have undertaken much more study & training, & have more experience.

This last paragraph of your first post in this thread, "I can’t totally relate to fear of failure (or success), low self esteem, low self worth, being and feeing overwhelmed and paralysed, procrastinating. But I guess I am (by nature??) somewhat resilient. I just wanted to get feedback about the notion of people who have mental illness who can’t be helped (usually because of their mental illness). How do people become stuck? Is it a lack of insight? And personality traits!? Are they just a lot sicker than anyone ever knew… I’m struggling to comprehend." I'd like you to think more about & try some exercises in empathy.

What do you think it feels like to have no self-esteem, no sense of being worth the time of day, or a kind word? What do you expect someone to want to do when, for them, everything feels 'too much'? How does it feel to be afraid. whatever you do, when failing means you're really the loser you were always told you were, or when success could feel undeserved, or lead to expectations you don't have any confidence in being able to deliver?

I am curious, of the clients you see, how many of them actually asked for someone to come into their home, or was your imposed upon them? That in itself makes a huge difference.

& I think, such significant problems as you've outlined could not be taken on all at once. It may be more useful to take one small step at a time. & try to find out what the limitations of any help you might offer might be.

Oh, & is 'electric shock treatment' the appropriate term?

Finally, how do you regard your clients - as patients, clients, a set of diagnoses, or people? As I read, I wasn't sure.

mmMekitty

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 08:05:28 GMT

Hi all,

Re ect sadly I do think it's still called that. I don't agree with that treatment.

There is a diagnosis , a personality disorder in cluster c of the three clusters, called OCDP. A person may not have all traits to be doagnosed with it, but one of the sympoms can be hoarding. Like a lot of personality disorders, it can be linked to trauma. Maybe reading about this might help u?

Trauma in general has a huge impact on ppl...and myself having trauma means I often feel trapped and alone. People's pasts can shed insight on their struggles, in my opinion.

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 09:19:10 GMT

*OCPD

Obsessive compulsive personality disorder

People who don’t seem to get better -Why?

Ramblify — Sun, 26 Dec 2021 13:32:17 GMT

Hi Hanna,

I'll try to answer these in dot point;

Yes re: the clients. some cope better than others. A lot are too sick to get help and it is very frustrating to watch - (hence the post title). Also, funding gets chewed up pretty quickly. A 'specialist' charges $100-$200 per hour. I am struggling to deal with what I see. I'm on edge and cranky a LOT more and most evenings I lock myself in the bathroom - sometimes sit in the car just to be alone and not bothered by anyone. - I feel aggravated.

No, I don't feel I have enough support myself, what the managers have to offer I don't find that great - some are better than others. it also takes time to build a relationship with a manager.

No assistance at home or family or friends (they don't understand mental health) - I see a private psychologist once a month just so I have someone to talk to. Yes, my work is very emotionally challenging - also psychologically challenging and physically demanding at times.

Dissociation - thanks! - I didn't know anything about it. It sounds fitting, that particular client is very unwell. There probably is trauma there. But I have not been told anything by the client or anyone else.

a professional cleaner - yes, I have been talking with my manager. it's not really up to me - I can try to organize it with my client but they don't want anyone coming into their house. My Manager is thinking of putting a new support worker in with the client who does a bit of cleaning. I've been put in a difficult situation where I have to try to convince my client to give the new support worker a go. (its actually a very hard task), my client won't talk to any of her other 'team' of professionals - they only want to deal with me and me only now.

yes sad that this is what is happening in society. - Psychologists and Psychiatrists seem to have a different approach where if the client/person is not willing (because of mental health reasons), they say they cant help them. I think because they're well trained and they can pick who they want to see and it's probably a lot better to deal with people who want help.

People who don’t seem to get better -Why?

Ramblify — Sun, 26 Dec 2021 14:14:00 GMT

Hi Sleepy,

I'll try to answer your questions in point form (word count ect)

trauma sensitive - is that a thing? Are you saying I should try to be TS? I try. I have experienced trauma myself and understand a little bit about it. I've had times when I find it very difficult to be empathetic - I'm aware and mindful of it. I don't think I'm 'unempathetic'. I don't react, I just don't want to be involved. I've had enough drama and trauma in my own life that I just don't want to 'be there' for a lot of people because I find it too traumatic myself. I've burnt out, and feel I really need to protect myself. I dont have the strength.

I don't like the word 'lazy' - I think it is overused. In regards to 'bad qualities' in one's character - I think openness is the main quality that I see stopping people. And I totally understand that people put up walls to protect themselves without knowing why they're doing it. but no one can help if someone is resistant to help.

The reference to people living in their parent's house at 40 was actually a personal reference to an old friend of mine who struggled with mental health and once they got diagnosed as having 'anti-social personality disorder', they gave up on living in normal society and never sought any other professional help (that I know of). They recently passed away and I can't get any information from their family. I'm not sure if it was suicide. but it was a sudden death and they were only 45.

yes, I agree every person's circumstances are different. My frustration or perplexity comes from individuals who have been hurt and as a result, have put up walls so that nobody can get in - it makes any type of treatment for MH seem impossible for me. I struggle with this and have times I feel like I hate my job because it feels pointless and I feel like I'm wasting my life doing a silly job that isn't achieving anything - except a paycheque (which is often enough for people).

Yes, I also agree some people are very lucky to have supportive families and people who understand them or who are just willing to accept them for them. I didn't get that from my family but I was able to cultivate it from outside sources.

No, I'm not looking for data. But what you said about your first step for you was being believed is uplifting for me. I find I have a very hard time keeping hope with a lot of my clients, - not all, but a LOT of them. It's very difficult to process and easy to lose hope.

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 21:41:03 GMT

Hi,

Trauma sensitive is an approach employed by the more successful mh treatments out there, in my opinion.

It is a thing, and most mh workers in the public system that I've met are, or claim to be, trauma sensitive. There is also a lot of discussion in the peer work community about how some mh professionals and services reteaumatise users. For me, one example was when I sought coles vouchers froma Church. The social worker asked me so so many questions regarding my history and I had to describe my history including my SA....it was not trauma sensitive, her questions were invasive.

Tbh even what u write about openness....let's look at it from a trauma sensitive perspective...I'm betting ppl aren't open for a reason. I'm guessing their boundaries had been stepped over before.

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 21:55:09 GMT

Hi Rambkify,

Being diagnosed with personality disorders does a lot of damage to a lot of ppl,

I'm not sure I believe in personality disorders, but I accept they can be useful for some. The health system makes ppl at times feel sick and incurable. There is a new approach called the recovery model of mental health, which challenges the medical model. It says that as you journey through the mh system u are on the road to recovery.

the sad thing is that openness isn't a good or bad quality.

I was open, and it harmed me, I happily took meds and saw different drs and was harmed in the health system.

I wanted help desperately, but the services let me down. It's not just luck, the truth is sometimes ppl reach out for help and dhe help isn't there. Do we blame them for this? At what point do we understand that the system often now and even moreso jnt eh past, fails ppl.

after I had my SA, many years ago, I agreed to and accepted help from the hospital. The help was poor quality and badly done. For many years I would not seek any hospital help after this.

I was trying to protect myself. Why wouldn't someone who was harmed try and do what they could to stop that harm repeating? I know u say u have been through it and had lived experience, but some of what u write does t sound to ,e like u understand or can identify with ppl in the mh system currently.

People who don’t seem to get better -Why?

Guest_1643 — Sun, 26 Dec 2021 22:11:25 GMT

Hi, another word for trauma sensitive, that you probably have heard more, is trauma informed,

Ppl call it trauma informed care.

People who don’t seem to get better -Why?

Hanna3 — Mon, 27 Dec 2021 02:37:08 GMT

Hi Ramblify,

If you're ever day dreamed or got lost in your own thoughts, dissociating is a bit like that only moreso, and it's usually an escape from trauma. So that person probably doesn't even notice the food going off as their mind is somewhere else.

I think you just need to understand these people probably are simply unable to get better, it's not that they don't want to, they have an illness and for some of them when they needed help it was probably unavailable.

They need compassion and understanding.

I don't know what training you have been given. It doesn't sound like it's been sufficient..

I hope you continue to get support for yourself.

I'm sorry there's not much more I can do but I hope this has helped a bit.

Best wishes!

People who don’t seem to get better -Why?

Ramblify — Mon, 27 Dec 2021 10:51:55 GMT

Hi Sleepy,

yes I think the labelling part of a diagnosis seems to not sit well with people. Personally, I don’t find it offensive, I just see it as a label for Doctors to use to treat a client. Thought the word disorder might imply there is something ‘wrong’ with someone. I think people are sensitive to this notion. Where as I see it more as a unhelpful pattern of coping that people have developed over time.

Yes! I’m starting to realise there is a different ‘model’ that I’m not familiar with - the recovery model. I only know of the social model and medical model. And for most of the help I have received it has been the medical model - And talk therapy. I’ve worked mostly in the community and have only started with home care.

The social model is ‘ok’ but what it really comes down to, I think, in regards to disability, is that it’s society that has done this to people - through stigma. Really it’s society as a whole that needs to change its thinking and approach. And the same thing has to happen with mental health. The system is very broken. You don’t sound like you got the help you needed, I’m sorry to hear that. There seems to be a lack of staff and a lack of trained staff.

in regards to re-traumatisation . I’ve found writing down my experiences and handing people I had to deal with a copy of my experiences was a way I didn’t have to retell the same story over and over. Because it’s hard for them if they don’t know what they’re dealing with.

There are many crap government services and I mostly went private and somehow found a way to pay for it myself. Found therapists that bulk billed ect. I didn’t have help from parents and my friends weren’t going through want I was (well they never let on if they were)..

there are some massive holes in the government system!

People who don’t seem to get better -Why?

Ramblify — Mon, 27 Dec 2021 10:55:08 GMT

for example, the client whos not able to clean their dishes, can work a 9-5 job. So I guess they are not considered ’high level care’, but as a support worker the highest level of care we can provide is physical prompting- it’s when say, I take their hand and put it in the water and wash a dish with them. The client was not able or willing to to do this for whatever reason (that doesn’t matter).

Higher level of care than this is 24/7 care and supported independent living. Where support workers are always at the home and do all the basic living needs. This isn’t seen as an option for mental health disability - why? The people living in these arrangements are people who are never going to get better. They may improve slightly, but they will always need 24/7 care - our government and society only have the option of mental health hospitals (sorry I know there is better term), and they just want people in and out. The people I’ve met who have been in hospital for 20 years or more, still manage to be out in the community- I’m not sure if the sneak out? But they really shouldn’t be out on their own because they’re vulnerable but they also course a lot of problems in the community- the same as people in SIL - even with a support worker some people are violent and abusive or have compulsions that aren’t appropriate in social settings …. It makes me question this ‘social model’ because they really are not able to enjoy the freedoms other have,
this ‘recovery model’ (this is guess for me - will look it up though - thanks btw); seems to be the model that is also used in prisons and criminal settings. The theory that Sex offenders or other crimes can be rehabilitated. Also used for drug addiction and domestic violence… my supervisor is a recovery coach.
I guess that is the answer I was looking for; this is the model being used - it also has good intentions but is highly idealised and suited for people on the upper end of the scale… the people on the lower end (the people who are really very sick), get left behind and don’t get the help they need. It is very unfair and an epidemic. The training I did for disability, I found to be the most over the top study and unnecessarily detailed Paperwork heavy bc I’ve even experienced. Then when you get out on the field you can’t use a lot of stuff and the things you use are things that keep the clients restricted from the ‘model’… so yeah, I dunno … it doesn’t make a lot of sense to me and maybe I’m in the wrong job

People who don’t seem to get better -Why?

geoff — Mon, 27 Dec 2021 16:37:52 GMT

Hello Ramblify, I agree with Sleepy about OCDP, not all psychologists or psychiatrists are able to cope with this illness, although they might be trained, it may not interest them because hoarding is one symptom that is related to OCD.

Geoff.