To the Emergency Room Staff, From a Person With a Mental Illness

Dear madam or sir,

Welcome to your supporting role in my mental illness! Obviously, as I’m presenting myself to you (or if I’ve been presented to you), I’m not feeling well. This could be due to a number of reasons. Maybe I’m hearing voices that are persistent and incredibly distressing and scary. Maybe I’ve hurt myself (or want to) and feel unable to cope. I might feel like I’m being followed, have been bugged or watched. Possibly I feel like the world around me is unreal and find it difficult to drag myself back to reality.

No matter why I’m here, I assure you it’s real.

If I’ve brought myself here, don’t assume I’m “well enough to come to hospital, so I must be well enough to not be here.” Don’t dismiss what I’m going through because I have the insight to know I’m in distress. I’ve worked hard to be be able to do this; it has taken immense strength to get here today. This is true whether I arrived by ambulance, walked, drove or I’ve been brought by the police for my own safety.

From a young age, it’s hammered into everybody that hospitals are serious business. You only ever go there when things are dire. You only ever get to ride in an ambulance when you’re practically dying; any other visit or reason is simply wasting time and important resources. But when you have a serious mental illness (such as borderline personality disorder) you feel like people never take you seriously. You feel like you aren’t important enough to ask for help. You feel like people will call you attention-seeking for doing what you’re supposed to do.

I understand the emergency room can be the busiest place in any hospital, and that every nurse, doctor and consultant will be rushed off their feet trying to hold the place together and save the lives and limbs of the people they care for. When I come to you, I’m in just as much pain as the person with the broken arm, even if it’s invisible. I’m just as scared as the little girl crying for her mommy.

So if I’m left alone in a room with nurses rushing backwards and forwards outside, noises all around, with nobody but myself, I may start to feel like the loneliest person in the world. This makes me feel like nobody cares. My brain then picks up on these thoughts and amplifies them, turning them into malicious impulses to harm myself or to do stupid things just to show the people ignoring me I’m worth listening to. I feel the need to prove my illness is legitimate and that I need help.

And I understand I’m not easy to deal with. I understand you don’t always know what to say. But I’m also a human, in pain. It doesn’t matter that the pain comes from inside my own brain. It doesn’t matter you can’t see where it hurts. If we tell you it hurts, believe us. At least try to understand. 

Just now and again, take a minute to stick your head in and ask if I’m OK. Remember being this ill is very, very scary. Don’t leave me to ruminate by myself for too long. Don’t avoid my gaze. Don’t forget I can’t help being ill and don’t think, “It’s not my job, I’ll wait ’till psych gets here.” A small piece of kindness, even if I can’t respond, drags me back into the real world for a little while. 

I know your job is a thankless one a lot of the time. So let me say thank you for the people too ill to say so themselves.

I don’t blame you, and I’m thankful you exist. This letter will not even apply to a lot of you angels of the ER. But next time you do have a patient cross your path who has an acute mental illness, maybe you’ll remember this article. Maybe you’ll save someone’s life just by being kind.

Sincerely,

Your patient