Mental Health Clinical Notes: The Curse of the Paper-Self

This post is from WrenAves’ Psychiatry Is Driving Me Mad blog. It begins:

“Anyone working in or accessing mental health services will be aware of the immense amount of notes one single person can collect during their time as an NHS mental health patient. Sometimes it feels as if the only thing services do is keep notes: seemingly, for many of us, in lieu of actual care. Risk assessments, clinical assessments, MHA assessments, MCA assessments, care plans, crisis plans, MDT notes, session notes, appointment notes, ward notes, observation notes, admission notes, discharge notes, liaison notes, crisis notes, diagnostic formulations, team formulations, emails and letters between staff, letters to outside services, letters from outside services… so many words, all pinging around between people who may have never even met the person they describe; all filled with the thoughts, opinions, and judgements of seemingly everyone in the world but the individual they are about. A person could be crushed to death under the weight of their notes but still not have received any sort of meaningful care. After a while, it feels as if you actually cease to exist, swamped by this paper version of yourself which somehow takes on its own life. After a while, it is your “paper-self” who is risk assessed, diagnosed, and treated. After a while, you realise there’s nothing you can do to stop the rise of your paper-self, because every word, every action, every movement you make only adds to its ever-growing and everlasting presence.

I made the decision last year to request all my notes from my time under services. About 8 years’ worth of words written about me. It made for extremely grim and disturbing reading. It wasn’t like reading a bad story about myself. It was as if I was reading about a stranger who happened to have had some of my experiences. This paper-based stranger sounded awful. She was angry, aggressive, difficult to talk to, unreasonable, challenging, exhausting… She was more of a paper-based nightmare. Reading about her, I had this image of papers blowing chaotically through my psychiatrist’s office, while staff desperately ran around trying to grab them and stuff them into files. This detachment from my paper-self, however, wasn’t enough to quell the devastation I felt at what was written – I was completely aware that while services had succeeded in sculpting a new person made entirely of paper and ink, they ultimately believed that person to be me …”

You can read more from here.

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