Saturday 22 November 2014

#crisisteamfail on Twitter, Thoughts of Crisis Team personality types

I'm not sure how long this tag will be useful, but #crisisteamfail on Twitter has seen a lot of activity recently.  Notably from people expressing that they are glad that they are not alone in the absurdities they face when trying to talk to Crisis Team professionals. It's a battle for basic empathy when they at their most vulnerable, and that's before access to practical advice and support.  Also many of the professionals seem to be under pressure to ask the callers clear the line for others, which always works well for people with low self-esteem (not!), who may have already been on hold.  And this is just phone lines.

I was developing a personal theory, which I guess might be a bit prejudicial, but it's based on the fact that most of the MH Crisis Team workers I've met have a background in MH ward nursing.  I often wonder how it is that people lacking "people skills" end up in such jobs, but also I think that there may be a specific mindset which works well in the hectic ward environment but isn't very supportive on the phone.  Maybe there just isn't enough training between ward work and outreach/crisis teams.  One minute , as a ward nurse, you are in a role where you're an expected to be a practical, yet compassionate, hands-on, 15 tasks in an hour, type of person, maybe improvising, maybe observing many rules, jumping through hoops set by a doctor-registrar-matron hierarchy, generally fighting fires and surviving the odds until the end of the shift; and a year later you're having to match you thoughts to someone who can barely visualise stepping out of their door or do the washing up.  Also the really tough ones never leave the service.  Maybe they are encouraged to join the Crisis Teams to get them away from disgruntled colleagues on the ward, or where the patients are more likely to have recourse re. negative incidents and poor care?

In saying this, we've been lucky recently,  J and I have seen some pretty amiable personalities providing some half reasonable support, almost pulling strings to set up care and I still don't know if this is partly the result of our complaints after years of crap treatment.  However, the whole system is still a dysfunctional mess, despite all the faxes, calls and "handovers".  They need more protection for whistleblowers perhaps?

It's been a tough few weeks.  My partner J has asked that I don't broadcast everything just for the moment.

Just as an end note, with 566 comments as I type, I think Rethink might not have been expecting so many responses to such simple questions.  And to think, many of those people will have already filled in NHS feedback forms, questionnaires and made complaints.  I approve of awareness, but it's not enough.  So much needs to change.  
Rethink Facebook: Have you been an inpatient in a mental health unit? If so how would you rate your experience? In what ways could your inpatient stay have been improved?

Monday 17 November 2014

"Go to A&E" says Crisis Team

On the phone the Crisis Team told us that if J became more suicidal to ring an ambulance and go to A&E in order to be assessed by someone (maybe from their team, we’re not sure). It was a hectic Saturday night. Waiting for hours in A&E with the bloodied drunks and injured doesn’t seem right, especially when we were already open to the Crisis Team. Using an ambulance didn’t seem right (we ended up traveling in the paramedic’s car to free up the ambulance, but this had it’s own problems) When we entered Accident & Emergency someone was screaming and as always the paramedics were queuing with trolleys just to admit patients (this is well before any type of assessment or treatment, this is just the handing over part). I just don’t understand any more. J kept trying to leave, to the point that we needed security. After some time in EDU, we get seen by a doctor who says that there are beds locally, but he promises to try to get J a bed at a later date on her preferred ward. We return home a taxi at about 7am. At some point in the evening a security guard disclosed to us that there is a special building adjoining the hospital, with a “place of safety”, i.e. secure doors, no ligature points. This had recently been built by the Partnership Trust, but hospital staff were not allowed to use it because no-one would pay for their training. Apparently, at best, this special mental health related building is used as an office. Also, interestingly, both the paramedics and security guards were frustrated with the local Crisis Teams, and were extremely sympathetic regarding our past problems. There has to be a different system to this. On the plus side, the Crisis Team have told J that she is a priority case and they will be ringing wards daily to get her a bed. She is currently at home.

Crisis Team Phone Support November 2014

(From a private post written a couple of days ago)
J is having a really tough time tonight and was talking to the local Crisis Team on the phone. Btw her care as an outpatient at home has generally been improved since we complained, but I think this is partly a coincidence and perhaps due to the appointment of a psychiatrist to a post which was populated by locums for three years. Generally the personalities of the people she has had to talk to have been appropriate for the role, as was this worker at the end of the line tonight. The phone was passed to me and I was given “the options” with regards to keeping Jo safe tonight. If J was to be admitted to hospital or any place where she can be kept safe from herself (locally or out of county) we are to ring an ambulance and to go and wait at A&E in the nearby city, where we will then be seen by a mental health professional, who will then consider doing an assessment or passing us back to someone else tomorrow. I pointed out to the worker that I didn’t understand the advantages to J that the Crisis Team (now called the Home Treatment and Recovery Team) was open to her. I pointed out that she may as well have rung Samaritans. Why can’t assessments be done over the phone? etc. I must have been sounding pretty churlish because the worker then asked me “Why are you angry?”. I wish I’d said “why are you a cliche?”, petty I know, but hey. He then explained that one of their team goes across to A&E when needed, but generally you still meet a person who hasn’t read a file and is mainly interested in finding out why not to admit you to hospital because of a bed shortage. We’re playing it hour by hour. J has an option of “respite” stays in hospital, but they have to be organized in advance, mainly to make sure she ends up on a familiar ward.

Saturday 1 November 2014

Response Letter from Leics NHS PT re. their inability to safeguard my partner in crisis


Letter from Leics NHS Partnership Trust in response to my formal complaint regarding mental health professionals’ repeated failure to safeguard my partner prior to a massive overdose.





  
In summary, there is a partial apology, but everything seems to hinge on the notion of mental capacity and the ability to make decisions. I do not remember J being offered a place in hospital, and if she was, her not wanting to go shouldn’t have effected the decision to admit her. Whilst reading this it’s impossible for me to forget that J repeatedly told the police and the mental health professionals that she wanted to kill herself and how she was going to do it. There is no acknowledgement of this. Is the Trust really saying that if someone is lucid and yet suicidal, that hospital is not the place for them?

Was this logic also applied by nurses and doctors in the treatment of patients who then died whilst under the care of The Bradgate Unit?

I have blurred the names and locations partly because of the nature of the internet caches.

Our original complaint letter is here: Letter of complaint regarding local professionals failure to safeguard against my partner's suicide attempt

Catch Up - posts ported from Tumblr Oct 2014

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October, 28th, 2014

Public mental health spending in England too low, says Mind - BBC News


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October, 26th, 2014

Your crisis needs to be during office hours
J’s having a terrible time. She’s at home and all the dark thoughts are back. The problem is that it’s the weekend. In order to get any help, support, advice or safeguarding, we have the go to A&E in the city up the road. Both of us don’t drive. I don’t want to be on suicide watch without sleep, but I also don’t think we should go to A&E to wait 5 hours in EDU until the (city, not county) Crisis Team see us, and then some patronizing cunt to tell us to go home and drink cups of tea or some such rot until Monday when we can try to get hold of her CPN within office hours. I mean, they sometimes do this after you’ve been admitted for a physical emergency like a suicide attempt.
Going down her list of things she’s supposed to do in crisis and choosing the one line which was functioning at that hour, J rang The Samaritans last night. They seemed to be supporting her, but then they told her to ring someone she trusted. I live just up the road, and I’d returned to mine after days of trying to sleep on her floor, and naturally she’s worried about disturbing me in the early hours. She waits, suicidal, one hour and half hours, to call me. She is in tears and scared of what she might do. She’s also feeling really guilty about calling me, her self-loathing and low self-worth would prefer death over the fear of inconveniencing others. Nonetheless, she somehow survives the night (negative coping strategies aside) and I was with her most of today until just now. It’s about 2am, Saturday night, Sunday morning.
It’s particularly difficult for me because I still don’t really trust the local services to do the right thing and most of their decisions don’t keep her safe and lead to more work on my part as well. At least it seems that way. We also still have a complaint outstanding about staff dismissing J before her last big O/D. Feeling pretty alienated. I keep putting off calling a carer-support group - the local one is run by Rethink. Lines are open in office hours. Heh. At least she’s getting on with her CPN, at least she /has/ a CPN.
It’s late. Need to grab some z’s next to the phone.

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October, 21st, 2014

Fluro Fridays: Bondi Beach surfers fighting depression - BBC News
:)

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October, 20th, 2014



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October, 20th, 2014
  Mental health: The £8bn cost of poor care for new mothers - BBC News


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October, 11, 2014
Complaint Response Letter
A response to one of our complaints to the Leics NHS Partnership has finally arrived. There has been quite a delay. I won’t go into specific details tonight. It was regarding J’s poor ward care, the 13 nights not in a bed, and a list of other basic ward based problems. It wasn’t intended as a complaint originally, just a rant to the hospital managers.
There is barely an acknowledgement of the misery suffered by J. In summary, it feels like “it’s tough but this is the way it is” explanation. It does use words like “unfortunate” in the context of special circumstances, basically other wards being closed due to rain damage. It talks about bed availability, but it still feels very removed from the day-to-day problems on a ward. Again, it feels displaced and dysfunctional. Like talking to a spreadsheet. I’ll post it in full with the names blanked out soon.
No empathy. No accountability.

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October, 10, 2014

'It's a national scandal': 15 stories which show the state of mental health care in the UK | UK news | theguardian.com
(From Sane Charity’s Facebook feed.)
https://m.facebook.com/story.php?story_fbid=744729345598772&id=111493462255700

Friday 10 October 2014

Lighter Than My Shadow

Just for a change, and I think yesterday was World Mental Health Day, I thought I should post something a bit more positive, well, something with some recovery, and pictures.  ;)

Anorexia explored in graphic novel BBC News Magazine 9th Oct 2014
(video)
http://www.bbc.co.uk/news/magazine-29535202

Katie Green author of Lighter than My Shadow -a graphic novel about her experiences suffering from anorexia.
Lighter Than My Shadow (on Amazon UK)

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From Tumblr:

"I’m very excited to invite you to http://lighterthanmyshadow.com/ where you’ll find a 24-page preview of my forthcoming graphic memoir Lighter Than My Shadow.
In the coming months leading up to publication I’ll be blogging about the process of creating the book, and sharing some sneak peeks and ‘deleted scenes.’ "


katiegreenbean:

I first considered writing a book in 2001.In 2005, I realised I had to tell the story in pictures.In 2009, I started drawing.
Five hundred and seven pages later, it is done.
Lighter Than My Shadow will be published by Jonathan Cape on October 3rd.

Becki Luscombe Campaigner for Mind, dies after being treated in a Birmingham mental health ward

Mind Website:
http://www.mind.org.uk/news-campaigns/news/becki-luscombe/#.VDCL7Nq9KK0

Becki Luscombe   [Posted on 30/09/2014]

We are very sorry to share the news that Becki Luscombe, one of our 10 Voices of Mind, passed away earlier this week.
As an organisation and as individuals we are truly saddened by Becki’s death. She was a wonderful advocate for everybody with a mental health problem and leaves a huge legacy to challenge stigma and encourage openness.
Last Halloween, when two supermarkets chose to sell “mental patient” Halloween costumes, Becki initiated a social media response, tweeting a picture of herself in normal clothing. Thousands of other people followed suit, and her campaign directly led to apologies from both supermarkets.
As a Voice of Mind, Becki launched Mind’s election manifesto in Parliament, worked with her local Mind, met with her MP, and starred in our film about stigma and mental health. When we asked Becki why she got involved in the campaign, she said “through my own mixed experiences, I believe passionately that access to mental health services need to be on the government’s agenda. Our voices must be heard - it could transform and save lives.”
We have spoken to Becki’s family who are very proud of her involvement with Mind and have asked that she continues to feature in our campaigning work, as this was so important to her. We are proud to honour that request.
If you have been affected by Becki’s death, please seek support from those around you, if you can. Our Infoline (0300 123 3393) is open from 9am to 6pm and can help you find support near you. If you need to speak to someone outside of these hours, you can call the Samaritans on 08457 90 90 90.
I've been told that by an online follower of Becki's Twitter account (@DuckBeaki) that she was able to kill herself on an understaffed ward. I am unable to confirm this, and Mind seems to be downplaying the exact nature of her death. Mind, like other charities are often very careful not to describe suicides for fear of triggering upset or even a suicidal act in others, not to mention being respectful to her family. 

Even in her last few weeks she provides some insights into life on her ward in Birmingham.
Screen-captures from her Twitter account:

 
 https://twitter.com/DuckBeaki/status/513622943684108288/photo/1







 https://twitter.com/duckbeaki/status/514830203483611136



'It's a national scandal': 15 stories which show the state of mental health care in the UK (The Guardian UK 8th Oct 2014)

'It's a national scandal': 15 stories which show the state of mental health care in the UK
  (The Guardian UK 8th Oct 2014)

http://www.theguardian.com/uk-news/ng-interactive/2014/oct/08/scandal-mental-health-care-uk

Complaint Response Letter

A response to one of our complaints to the Leics NHS Partnership has finally arrived.  There has been quite a delay. I won't go into specific details tonight. It was regarding J's poor ward care, the 13 nights not in a bed, and a list of other basic ward based problems.  It wasn't intended as a complaint originally, just a rant to the hospital managers. 
There is barely an acknowledgement of the misery suffered by J. In summary, it feels like "it's tough but this is the way it is" explanation.  It does use words like "unfortunate" in the context of special circumstances, basically other wards being closed due to rain damage.   It talks about bed availability, but it still feels very removed from the day-to-day problems on a ward.  Again, it feels displaced and dysfunctional.  Like talking to a spreadsheet. I'll post it in full with the names blanked out soon.
No empathy.  No accountability.

Thursday 2 October 2014

'Don't lock me up' pleads sectioned anorexic teen (The Mirror 1/10/14)

The Mirror (UK newspaper) 1st October 2014

'Don't lock me up' pleads anorexic teen who went on the run after being sectioned

http://www.mirror.co.uk/news/uk-news/dont-lock-up-pleads-anorexic-4355254

There appears to have been a complete breakdown of trust her between the local services and the patient and her family (carers). One wonders whether the right sort of effective help was ever actually offered, or did the GP feel he was doing the right thing with regards to safe-guarding Ruth Geddes from herself?

One of the parents says this:
 "If she goes in there she'll lose her job, she'll lose her flat and she'll refuse to eat. ... Up until Monday my daughter was happy at work and she was eating well. If she goes into hospital she will die."  

They have won two tribunals in the past to have her released. Tribunals are like complaints and investigations, if things are being done right it should never even get to that stage.  For this family, it keeps happening. 

Singeing those bridges

Had a letter back from J's CPN marked "In the strictest confidence" so I won't be quoting him verbatim. ;) I can't work out anymore what's sincere, what's helpful and what's a warning, so I think I'll back down on the petty subject of wanting our complaints letter to be added to J's file notes.  One of his concerns is that including such a letter in her notes, despite her request to do so, means that he is "endorsing" a complaint about a colleague, and that it isn't an appropriate form of information.  Despite all the confidentiality he seems to know that the complaint is still outstanding, but I think he might be trying to do me a favor as well, basically: if we all work together (back down) good things will come of this. Okay, I resent any letter which implies I'm being abusive or accusative when I'm actually holding back (maybe they're actually putting two and two together and are reading these posts, cos I swear here, but I doubt it)  but me dwelling on this point would be cyclical and pedantic. 
The other day, J, who is trying to hold things together at home, met with him for an appointment having rewritten her Care Plan - and he praised her for this.  She is feeling really positive about working with him, so I'm going to back off for now, unless J prompts me for support.
At the best of times my own pomposity (mirroring their own) makes me miserable and I'm trying to fight that sense of alienation one feels when addressing concrete. I keep saying that I'll refer myself to carer support group, because I'm ruminating far too much on things I have no control over.

Reading between the the lines of the letter from the CPN, the delay in the Trust's response to our complaints might be because they are "seeking advice". I also have no idea if the news article has effected any of these proceedings.  Again, I have still have little faith in their ability to communicate between departments.

Tuesday 30 September 2014

Article regarding Bradgate Unit featuring J and myself Leicester Mercury 27/09/14



Article in Leicester Mercury on Saturday regarding the Bradgate Mental Health Unit and our experiences as carer and patient. 27th September 2014. (Yet to appear on the website, so please forgive the photos - click for larger views).
Incidentally to left is a photograph of me looking sad with the caption “ ‘It’s not making her better’ William Meddis, 42, who is concerned about the treatment his girlfriend is receiving at the Bradgate Unit.”
The More supplement in the Leicester Mercury is centred on “human interest” stories. J is very slightly fictionalized here, some generalizations have been rewritten as specific situations and so forth, but it communicates that sense of frustration we’ve had with the Leicestershire Partnership NHS Trust who run the Bradgate Unit. There’s some stats about deaths in there as well. I’m not sure I remember an agency nurse telling Jo to “pull herself together”, but it’s definitely the sort of thing I’d say about the attitude of some professionals we’ve met. It feels good that issues like incorrect medication upon admission were cited, because the head of the Trust has had to respond specifically to that, and she mentions the new pharmacy facility as an improvement (see earlier post where I had to go into the new pharmacy because of their failure to deliver to the ward and then getting stuck there whilst they corrected the prescription, incorrectly). 

Interestingly, the Head of the Trust also says that they would be happy to meet with me. This is funny because letters sent to specific staff seemed to be responded to by Customer Service so far. Also, when someone says that they want to meet you in person it suggests that you went to the papers first, which is not the case.
You can read in this blog the two detailed letters of complaint I’d already sent to the Trust.
My complaint resolution deadline has been extended by Customer Services until mid October. So much for, “we will respond within 25 days”. Hopefully this is a good thing or maybe it just means that some staff are on holiday. ;)

Edit: just reading the article again ... I have to say that when J is in crisis that I am a fan of "containment" or even sectioning because it can be the only way legally that she can stopped from destroying herself, but the Bradgate Unit in many situations even fails to do that. 

Tuesday 23 September 2014

Pharmacy at BMHU. J returns home.


Just when we thought we were ready to bring J home from hospital the pharmacy forgot to deliver the discharge prescription to the ward (they have /one/ job), ;) so I walked over to what must be one of the most temporary and ugliest new buildings in the world. In reception it has a shiny plaque like in all hospital buildings, as if very proud of itself. It almost goes without saying that even when I picked up the prescription that there were three missing items. Some phone calls later, I left with only a partial solution. We’re so tired of having to get a doctor to reconfirm something because a pharmacist’s computer is saying “no” or a junior doctor has filled in a form wrongly. At least we ordered our own taxi, relying on hospital transport is yet another exercise in randomness (even been in the local news because of this, love this county). J is now reinstalled back at home, back in the charge of the local community mental health team, who we may be attending a meeting with this week. Mustn’t grumble, we’re lucky to have access to these people, but quite frankly I’m beginning to believe that these organizations are /not/ better than nothing, because at least with nothing you’re not tortured by the hope of useful support, or just something being straightforward. Another in/outpatient on J’s ward was also having trouble getting meds from the pharmacy today, and when one problem was solved the nurse seemed to think that this would completely absolve the hospital of the 5 hour wait this patient had (in comparison to this I think we were lucky). Then their transport was cancelled. Triggers. Anyhow, J and Lucy cat are very happy to be reunited with each other in the comfort of J’s house and her many books. :)
One day at a time.
(Thanks for reading)

Announcement that J is coming home

From own Instagram http://instagram.com/p/tRPXjqM6zF/ (text edited) pertaining to a couple of days ago.



Top right: yesterday sitting in reception at the MH unit waiting for patients’ mealtime to end, with gadgets and a bag of clothes. News: J comes home tomorrow(!). She’s sounding really positive and is desperately missing her home and Lucy-cat. I just wish they had planned for more support for her, but it doesn’t look like it. She’s less frantic, but to be honest I think this ward stay was a missed opportunity. (Still pretty angry about lots of things like this and realize that I have to eventually move on and move forward) We might be in the newspaper sometime soon, talking about difficulties in accessing care when in crisis - It didn’t appear in last week’s newspaper, hopefully it’ll be in on Saturday. Anyhow, madly rushing around, tidying up, washing, hoovering, converting J’s place back into her “home” and not to temporary man-cave-pit I create when she’s away. ;) She calls me the “Filth Wizard” which is fair enough (her OCD aside, I do tend create nests and piles of possessions, and leave washing-up until the last possible minute etc.) ;) Anyhow, busy but positive. Eating a lot of bananas. #penpal #mentalhealth #dungeonsanddragons #cat


Dr Arun Singhal suspended for telling patient to kill herself -BBC News Liverpool

BBC News Liverpool 18 Sept 2014

Dr Arun Singhal suspended for telling patient to kill herself

A doctor who told a patient who was threatening to kill herself to "go and jolly well do it now" has been suspended for three months.

http://m.bbc.co.uk/news/uk-england-merseyside-29254609

Seclusion Rooms, Blankets and Gowns at the Bradgate Mental Health Unit

From Tumblr blog 18th September 2014

Anonymous query:
do patients at bmhu have to wear gowns or are you allowed own clothes? do you have any pics from inside????

J answers (correcting my own response)

Hi, I’m J. Just read this. The seclusion room is very much like a police cell, nothing in it at all except a plastic wipe-clean mattress, no window apart from the tiny one in the door the staff stare at you through, and a seclusion blanket. This is a navy blue, very tough and hardwearing and sort of quilt-stitched with orange thread blanket. It is very stiff and not very warm. When you get put in seclusion, you are forced into the room by a team of maybe up to 6 nurses who control and restrain you until you are in the room and you can’t escape - there is a seclusion room on each ward. The seclusion gown is made up of the exact same material as the blanket. It is tough, stiff and hardwearing, certainly not comfortable in any way. It is floor-length, and sleeveless. It is fastened by Velcro, down the front. You are not allowed to wear anything else - not even underwear, they strip you totally naked before they force you to put the gown on. Then, when in the gown, they give you a cardboard egg-cupped-like box/tray to use as a toilet, and a couple of pieces of paper towel to ‘wipe’ with. Then the heavy door is locked, and the staff look through a tiny high-up window at you every five minutes. You can be kept in there for as long as they decide you need to be - anything from an hour to a day, is possible.

Tuesday 16 September 2014

You must talk to us. Yes, we have no pills.



Visited partner at the mental health unit today. Mood low, but she was less frantic than on other days, just exhausted, a little scared and depressed.
She is often told by nurses to talk about her feelings and to ask for help.
Just been on the phone to her tonight (after 10pm). Earlier she had been crying. She goes with a nurse to her room to talk “one to one”. She says she wants to kill herself, so the nurse decides immediately to start taking things from her for her safety and suggests that she should be put on a seclusion gown. J then had to say that she wasn’t suicidal and that she was busy and asked the nurse to leave her room. The nurse respects her wishes and leaves. The sad thing about all this is that J is now having to pretend that she is okay because she’s frightened of an overreaction based on risk. I’ve just rung the nurses office and the nurse is denying mentioning the gown, but she did acknowledge wanting to tackle risk before talking further to J. I can, in part, understand how this has occurred (sometimes when in crisis J only hears the extreme statements), but at the same time you wonder how a dialogue is possible once a patient is frightened of losing possessions and dignity. I hoping that she gets to talk with her “named nurse” (the nurse who’s name is on the patient notes) because we trust him.
This has literally just happened. I’m hoping it doesn’t escalate into anything.
Damn. Silly place. Poorly J.

Edit: Not much came of waiting to talk to the right nurse, who was dispensing meds and certainly not willingly take sides in any patient testimonies about colleagues, and so actually talking about how she felt was pretty much a no-go with the reliable-but-busy-male-nurse.
Other fails today: They ran out of antibiotic pills for J’s festering legs, another pill was missing from her medication, and the pharmacy in this hospital have cut off her Zopiclone because that’s what happens after two weeks, regardless of what doctors write, this has all happened before. All hail the computerized dispensing system. Also, a special cream which was recommended by a tissue viability nurse a week ago has yet to appear, despite reminders. Notes were not made, emails haven’t been checked. Some of these things can be temporarily fixed by a junior doctor the following day, maybe if J’s lucky there will be a ward round soon, where they actually let her sit in. Day to day care can be very hit and miss on these particular wards. J is also not really at liberty to leave the ward and go looking for the absent staff with real authority. The powerlessness and hopelessness is tangible.
These things individually would be enough to wind up a well person. I think she is being remarkably restrained, all things considered. 

Sunday 14 September 2014

Return To Sender

I received a letter today from J's CPN (Community Psychiatric Nurse). He was returning the copy of the complaints letter about the Liaison & Diversion Team which was for his information and to be added to J's file. It's seems that the confidential process regarding complaints against colleagues (? not even in the same building) means he is unable to handle the letter in any way. I might post the actual exchange between us here at a later date but it's a bit long winded. However, I described his attitude as absurd and told him to black out the names or hand it to a colleague if that was the problem, as we want other professionals who read her file to see experiences from her perspective and this may help in safeguarding her in future. I sent the letters back again asking him to add them to her file and that since he was our only consistent contact in the CMHT (Community Mental Health Team) that all future correspondence will be going to him. She has yet to see her new consultant for her community care, Dr K. Inherited notes and nonsense prevail. 

Something stinks. 

For the moment I'm trying incorporate the CPN into part of the solution, not the problem. If he doesn't want to cooperate with J or myself then he should find us a new CPN. (If you sack a CPN, they just shrug and you go without a CPN for months, if you get a new one at all) We could decide that some mistakes have been made because of what he writes and says to other professionals about J. Although I haven't actually complained about him yet, he has let her walk out of his office after she has explained that she needed to kill herself. It's only by chance that I met her at the door to building, if I hadn't she'd happily be on a bus to the motorway. In fact, on that day, I had the pleasure of overhearing a policeman tell him off over the phone (whilst J was struggling in the back of a police car) something along the lines of "I know it's in our ... [domain?], we're dealing with it now" and basically stuff about how "yet again" the CMHT had let someone go and now the police had to "clear up the mess". Along those lines. It was nice to have a bit of validation for a change, and see someone else being indignant.

I know there's all sorts of issues here, but why is safeguarding such a problem for these guys? Why is listening to our views in anything other than a 15 minute minute such a problem?

I'm starting to sympathize with anarchists. My passive aggressive fair-but-firm letter writing will only get me so far. Do we need to move counties? We've definitely had it better than this. 

Saturday 13 September 2014

Visiting Hours Random Thoughts



Got a bit frustrated today at always being ushered into this well kept but pokey dining area, after being made to wait at every intercommed door. The room is too warm. There’s window but it’s jammed in one position - there’s no draft. The coffee machine, just off the ward, was bust, but we didn’t have change. Patient’s kitchen is off limits and the toilets are four corridors and three locked doors away. I get a taxi to the unit (mainly paid from J’s savings) because I’ve given up on the ridiculous routes taken by public transport to get to this stupendously badly located hospital. Heat makes me sleepy and grouchy, not the best company for J. Staff are treating her like badly behaved child, she is going along with it. Her legs still look pretty bad, but apparently they are healing (swelling plus eczema plus impetigo). This is one of the better wards. I’m not convinced that staff even talk to her enough. Mental Health care, my arse. She seemed in slightly better spirits today. Almost looking forward to next Saturday when there’s a chance that we’ll be in the local newspaper, mainly about poor access to decent services (I think). It’ll be yet another article to add to a damning pile. Eventually that pile has to get high enough for real and positive change.

Thursday 11 September 2014

Patient being a risk to the mental health professional?

J showed me a letter today from her CPN (Community Psychiatric Nurse - you’re lucky if you can get one these days). I think after the previous admission to hospital, advice was given to the Community Care Team that J would benefit from the occasional visit at home, due to the anxiety she experiences when trying to walk cross town. In fact her referral to an Occupational Therapist (who has since cancelled the assessment appointment) was partly based upon her agoraphobic-like symptoms. She gets so stressed that her legs and back give way and she falls to the floor. To avoid this she has to sit down every 20 metres or so. Naturally this effects her quality of life in a very big way.

In the letter the CPN states that he will not be visiting her at home. The reason given is simply “risk” after “recent incidents”. No further explanation given. Risk to whom? The recent incidents might be her overdoses.

As far as I am concerned, this is a man who has allowed J to leave appointments at her most distressed whilst being a danger to herself (after we had hung on until the next meeting with the CPN, hoping that there would be a message of support, a coping strategy or the offer of extra help). As well as being a means of support for mental illness meetings with professionals can be emotionally triggering for outpatients. His own ability to safeguard and assess risk is in question.

The language used by professionals in the presence of J is utterly soul destroying. Her self esteem is rock bottom at the best of times, and she is talked at as though she is an irresponsible liability. Every time she comes into contact with a consultant or MH professional, she is accused (inferred, implied) of “dependency upon services”. All previous contact with services, therapy and ward stays are cited as though she has somehow manipulated the system. In my eyes she is blamed for not becoming well. Her illness, her OCD, her depression, her self harm and suicidal thoughts become packaged up as a personality disorder. The doors start to shut. Her anxieties about treatment, or lack of, are interpreted as her being disruptive and uncooperative. It’s like a prejudice. Even if she had the worst, most ugliest, hard to work with, aggressive, personality disorder it still wouldn’t warrant the way she is treated. I’m tempted to start citing the Disability Discrimination Act 1995/2005 for what good it would do. I might as well, since patient rights to quality of care mean fuck all in this country.

I hate them. I hate what they write about her, or what they glean from outdated notes. I hate what they think hey are trying to achieve whilst using “tough love” and guarded euphemisms. 


The sick thing is that she is literally one re-assessment or change of diagnosis away from being treated like a human being.

Report on Suicide in Primary Care in England 2001-2011 (March 2014)

I’m a day late for Suicide Prevention Awareness Day. I’m sure there’s a particularly dark joke in there somewhere. I’m always in two minds about awareness campaigns with mental health, since usually thats as far as most campaigns go. At least it seems that way. Perhaps real change only comes about through devastating scandals. I saw this link on Twitter I’ve only read the report in part so far.

Report on Suicide in Primary Care in England 2001-2011 (March 2014)

Glen Parva suicidal detainee 'not kept safe' (BBC Leic 11th Sep 2014)

BBC Local News: 

"Steven Davison died in YOI Glen Parva, Leicestershire, where he was detained after threatening to stab himself. …" “Mr Davison had originally been arrested for possession of an offensive weapon after threatening to kill himself. His mother said: “When he was sentenced, he said in court he would kill himself. “The judge said he would have to go [to Glen Parva] because there were no mental health beds so he would have to go on suicide watch.”

—- “The suicide risk factors and potential triggers included: -His discharge from a psychiatric facility, prior to being imprisoned -Self-harming …”

J, herself suicidal, at present a resident in a Leicestershire “psychiatric facility” brought these articles to my attention today.


This all sounds very tragic and preventable. Glen Parva YOI has a shocking record of at least 26 suicides that we know of since 1988. It doesn’t sound as if this man should have been there in the first place. One thing we may never hear about is the conditions of his discharge from a psychiatric facility (possibly in Leicestershire, possibly run by the Leics Partnership NHS Trust)

Tuesday 9 September 2014

Chief medical officer: Make mental health bigger priority

BBC News  9th September 2014

Chief medical officer: Make mental health bigger priority


http://m.bbc.co.uk/news/health-29116354

Visiting Hours Thoughts

billiambabble:

Drawing desert tiles, whilst charging phone, in reception at the hospital before visiting J. An efficient use of spare time. ;) 
An odd day. Felt like we were brokering a deal with the doctor in charge of her care. Pragmatism usually wins at the expense of optimism, and maybe at the expense of recovery. Hard to explain. Reluctant gaolers asking prisoner patients to be in control and choose to be free? Informal stays vs. MHA Section, are you safe from yourself? Take responsibility whilst we’ve taken everything away? If you don’t get well then maybe you’re not working at it hard enough? No therapy, just containment.  Keep her safe.  This isn’t a paranoid rant about social control.  This seems real. It feels like being at school in the headmaster’s office. The questions all seem tortological. We’ve all been here before. It’s like having to retake the worst classes with teachers you no longer have respect for (because they keep failing you). May have to write about it at a later date - with the actual details. Really trying to avoid making generalisations atm. Must keep mind open. People genuinely want what’s best. 
The worst hand at a game with the highest stakes.
No, it was a better day, some switches have been reset, things will move forward. Onwards and upwards! ;) Thanks for reading. 
#visitinghours #Latergram #mentalhealthward #hospital #diagnosis #carer #patient
billiambabble (via Tumblr):
Drawing desert tiles, whilst charging phone, in reception at the hospital before visiting J. An efficient use of spare time. ;)
An odd day. Felt like we were brokering a deal with the doctor in charge of her care. Pragmatism usually wins at the expense of optimism, and maybe at the expense of recovery. Hard to explain. Reluctant gaolers asking prisoner patients to be in control and choose to be free? Informal stays vs. MHA Section, are you safe from yourself? Take responsibility whilst we've taken everything away? If you don'™t get well then maybe you're not working at it hard enough? No therapy, just containment. Keep her safe. This isn't a paranoid rant about social control. This seems real. It feels like being at school in the headmaster'™s office. The questions all seem tortological. We've all been here before. It's like having to retake the worst classes with teachers you no longer have respect for (because they keep failing you). May have to write about it at a later date - with the actual details. Really trying to avoid making generalisations atm. Must keep mind open. People genuinely want what's best.
The worst hand at a game with the highest stakes.
No, it was a better day, some switches have been reset, things will move forward. Onwards and upwards! ;) Thanks for reading.
#visitinghours #Latergram #mentalhealthward #hospital #diagnosis #carer #patient

Saturday 6 September 2014

Family of hanged Nottingham pensioner say "system failed her" Nottingham Post 4 Sept 2014

Family of hanged Nottingham pensioner say "system failed her"

 Nottingham Post 4 Sept 2014

As I read this I became more and more angry at what the doctor says at the inquest. It certainly raises more questions regarding hospital accountability than it answers. Really shocking.




Visiting Hours




billiambabble:
From the other day. Although I approve of extra precautions, getting the visitors to wait in a small dining area, where they are then joined by the patient, can at times, remind one of how prison visiting is portrayed on TV. Of course it’s nothing like that really. This modern MH ward is a big improvement on the others. #visitinghours #mentalhealthward #nophotos  Got really pissed off with the stupid doors and intercom system today, misdirected frustration? J is pretty unwell, and there’s still the odd care issue, but like I said, this a much better ward than the others.

Rise in self-harm incidents in Leicestershire's mental health wards | Leicester Mercury 3 Sept 2014

Rise in self-harm incidents in Leicestershire's mental health wards
Leicester Mercury, 3 September 2014

http://www.leicestermercury.co.uk/Rise-self-harm-incidents-Leicestershire-s-mental/story-22870617-detail/story.html

This article is mainly focussed on the Leicestershire Partnership NHS Foundation Trust (which includes the Bradgate Mental Health Unit)

From what I've seen as a visitor and heard anecdotally (locally) the approaches and responses to patient self harm vary from nurse to nurse and ward to ward.  Also I believe that with statistics like these that there is a confusion over actual suicide attempts, sudden acts of frustration and ritualistic, negative coping repeated self harm of a specific type.  This may depend upon how it reflects upon the staff on duty and whether or not they have properly risk assessed the patient and taken sensible, yet sensitive, precautions.  Sometimes having a room stripped of possessions or being put in a seclusion room will happen after a traumatic self harm event or suicide attempt and the patient will feel as though they are being punished by staff.  I am unaware of any specialist therapy or advice provided by LPT in the cases of self harm, apart from "talk to staff".  It's one thing to have policies about patient risk, to have rules about "collapsible ligature points" and so forth, but it's another to actually train staff in understanding some of very common acts of mental health sufferers.  Perhaps they do they train their nurses, but maybe some days the staff all come from an agency where the nurses barely understand what a mental health ward actually is. (Just surmising here)

Regarding Self harm and injury two good UK resourses are
LifeSIGNs   http://www.lifesigns.org.uk/
and
NSHN  http://www.nshn.co.uk/

See also:
Mind Charity - Info on S/H 
http://www.mind.org.uk/information-support/types-of-mental-health-problems/self-harm/
Suicide help from The Samaritans
http://www.samaritans.org/

Wednesday 3 September 2014

Query: What is the Bradgate Mental Health Unit like inside?

What is the Bradgate Mental Health unit like inside? Is it modern? It doesn't appear to be very 'homely'. Most units are less 'clinical looking' but I've heard that BMHU is lots of different 'wards'? and that it looks just like a hospital inside, unlike other units? Is this true? Like are the beds hospital beds? Are there any single rooms? and apart from the bedrooms, what other rooms are available to patients to utilise? Thank you
Anonymous, Sept  2nd,  2014 (on Tumblr)

Hi, Sorry for the delay. I’ll try to put together some pictures taken over the last few years. Basically there’s older wards which have a mixture of single rooms and dormitories and then there’s some very new wards where patients get their own rooms with en-suite loos and shower. The newer wards have more small lounges for special activities, whereas the older wards have one dining area and lounge which doubles as a TV room through which can be accessed a kitchen for making hot drinks. The older wards have toilets and showers which are shared. Every now and then they redecorate the wards, but the older wards seem very institutional. The dorms aren’t like the bays with beds in normal hospital, it’s quite literally just a room with four beds in (no nurses’ station).
I’ll ask J if we can use her couple of her photos of her room on the newer ward, and we can compare them with the rather stark and functional environs in the odd picture I’ve been able to take. The main experience of a ward can often be down the the personalities of staff and patients. I’ll try to post some pics and diagrams sometime.

Monday 1 September 2014

Today at the Bradgate Mental Health Unit




There's nothing more reassuring to wake up and to find that the organization which is caring for my partner's welfare was in the newspapers yet again for professional misconduct. However, in the greater scheme of absconding patients and deaths at the Bradgate Unit, a nurse flirting by text with a patient is hard for me to gauge without more information. Nonetheless, there's vulnerability, safeguarding and possible grooming issues, and just straight forward unprofessionalism.

The current ward J is on is a world away from Bosworth and Ashby Ward. It's one of the more newly built wards, and although I have no access as a visitor to the main ward or rooms, J has shown me photos, and the accommodation is of a better quality. She has a room with an en-suite loo and shower. This is a far cry from her sleeping in chairs because she was petrified of her bed in a shared dormitory.


She's still pretty unwell, but at least the ward itself, the staff, and the other patients seem to be less triggering. I won't go into to details but she is still managing to do things which shouldn't happen in a safe and secure environment, and she even managed to escape off the ward and run down a couple of corridors. The new secure doors and intercoms were out of order (possibly due to recent rain damage). It's very easy to see how this place can go from being secure to open, due to one electrical fault and staff not closing doors properly.

Mental health nurse Leigh Jennison struck off for sex messaging (BBC News Leicestershire)

Mental health nurse Leigh Jennison struck off for sex messaging

http://m.bbc.co.uk/news/uk-england-leicestershire-29012119
BBC News Leics.

The nurse in question was working for the Leicestershire Partnership NHS Trust and at the Bradgate Mental Health Unit (based on on article at the time of posting)

Wednesday 27 August 2014

Leicester Mercury: Bradgate Unit patient died days after being found unconscious, inquest told (Feb 2013)

Bradgate Unit patient died days after being found unconscious, inquest told 
(February 2013) Leicester Mercury

Ms Adom said despite having only qualified earlier in the year, she was left as the most senior nurse on the ward on August 21 when her deputy manager to attend a tribunal."There were sufficient staff in numbers but not in skill because of the juniors present," she told the hearing.Ms Adom said it was not the first time she had been left uncomfortable about the staffing situation on Bosworth ward.
Read more: http://www.leicestermercury.co.uk/Mental-health-unit-patient-died-days-unconscious/story-20618623-detail/story.html


Talk good, death bad

Yesterday, my partner, an inpatient on a mental health ward, who is "prone to suicidal ideation" and trying to act upon those thoughts, was told by a senior nurse that she must "talk to the staff" because they didn't want "another death" on the ward. 

The advice is sound, but actual disclosure of a patient death can be disconcerting. 


There have been many deaths at the Bradgate. I'm assuming that if it is being talked about at the moment in this way that it is in recent memory (or the inquest was recently held). 

A better day


Today was a better day. Once a few care issues had been cleared up (errors with medication being one) with a decent ward round, I think J might be able to settle on this ward. Some of the staff even have "people" skills. ;) I managed to get a some tile art done whilst J was on the ipad. On this particular ward, visitors (especially men, it's a women-only ward) are only allowed in a small dining room near the entrance. I'm always grateful for a table. ;) Her room (she has a room, hurrah!) sounds as though it is modern, comfortable and safe. 
The radio in the taxi home plays Smooth FM.
Thanks for reading.

Monday 25 August 2014

City Crisis Team lives up to lowered expectations at LRI A&E


A&E, Leicester UK. Partner had another overdose (52 pills, diazepam 10mg). Physically okay. Wants to die, tries to run away twice to get to a busy road, escorted back by hospital security, and the City Crisis Team try to send her straight back home. Had to really argue her case about her need to be kept safe from herself after they had lectured her about “responsibility” and the importance of staying out of hospital. Fuckers. They think she wants to go back to that shithole. Patronizing fuckwits. They eventually conceded to arrange a place on a local mental health ward. (Possibly just for a night) I already have two separate formal complaints in investigation regarding Leicestershire Partnership NHS Trust at the moment. I don’t even believe this is to do with diagnosis prejudice anymore. Jaded fuckers. It’s the hope I can’t stand.

#LeicsNHSTrust #Leics #MHUK #mentalhealth #hospital #dutyofcare #patient #NHS #EDU #AnE


Thursday 14 August 2014

Letter of complaint regarding local professionals failure to safeguard against my partner's suicide attempt




Sent today first class (as dated, see below)
_____
(own address)
Leicestershire Partnership NHS Trust
Customer Services Team - Complaints
Lakeside House
4 Smith Way
Grove Park
Enderby
Leicester
LE19 1SX 

 14th August 2014

 Dear Sir / Madam

Re. Formal Complaint against Ms.N__ W___ of the Liaison & Diversion Team for failing to safeguard a mentally unwell person, namely J_ ( address removed ).

I am writing this to complain specifically about the conduct of your employee, NW who, in her role as a mental health worker with the new Liaison & Diversion Team, met with my partner, J_ (dob _) on Friday, 18th of July, at Loughborough Police Station.

For several days prior to this, J had been talking about ending her life. She had only just left the Bradgate MH Unit on the 2nd July after an 8 month stay (including a Section 3 MHA order). Her recovery was not absolute, but ourselves and the consultant were eager for her to start a life again at home. 

J has a very specific plan of suicide which involves going to the motorway bridge at Junction 23 with the intention of throwing herself off into oncoming traffic. She was starting to express a desire to do this on a daily basis. By Thursday 18th July things became critical again, and having worked in mental health drop-ins myself, I prompted her to follow instructions in her Care Plan. Firstly, she contacted the CMHT and talked to a duty CPN, who, due to the lateness in the working day (4-5pm), told her to contact her GP or the GP-out-of-hours service, failing that, to go to the Urgent Care Centre (Epinal Way, Loughborough). She rang the receptionists at her GP surgery, who could only offer her appointment for the following week. There seemed to be some confusion over what they could do. 

We then caught a taxi to the Urgent Care Centre. All the while, J was not sure what to expect and just wanted to leave my side to go to kill herself. We saw two nurses who explained that we would have to go to A&E in Leicester to see the City Crisis Team. J was distraught and left the Urgent Care Centre, and she was running towards the road. As I left to follow, the nurses told us that they would be calling the police. Much further along the dual-carriage way (Epinal Way), J was trying to get to a bus to get to the motorway. 

Eventually a police car catches up with us and takes us back to Loughborough Police Station, where we wait in a police car until the Liaison & Diversion team arrive. The mental health worker who saw us then was called V_ (I forget her surname). After a long, practical, yet sympathetic, chat, she told us to wait for a day whilst she faxed and phoned the community team (at Town Hall Chambers, Loughborough) for extra support for J. This gave J something to hold on to, but she was still wanting to end her life. The police then gave us a lift back to J’s house. Still worried about J, I stayed the night. 

The following morning I had to leave her briefly, to call at my own house, which is just around the corner from her’s. By the time I returned she was dressed and preparing to leave for the motorway again. I must stress that at no point was J trying to gain access to hospital or asking for special treatment, all she kept telling me was that she wanted “to be dead”. She keeps telling me this. She locks the house door to slow me down. I follow her outside, trying to negotiate with her to come back to the house. Whilst still with her, I called the police. J boards the number 127 bus and buys a ticket to a stop near the motorway bridge, I joined her on the bus, with the police on the phone. I pass the phone to the driver and he is asked by the police to stop the bus. Then the police arrive. 

Off the bus, J tries to run away from the police, but we corner her and get her to sit in a bus stop. The police take us back to Loughborough Police Station. J is weeping and apologetic, the whole experience is clearly harrowing. After another a long wait, the L&D Team arrive. This time the mental health worker is NW. 

Ms.NW appears to have known J from the past, from when she was working with the County Crisis Team. Her generalisations about J’s lifestyle are based on a woman that I do not know. J is asked if she still sings and why doesn’t “she go back to church?” J currently does neither activities, the last time J did these things was over 12 years ago. NW was very patronising in her manner. Even her way of addressing me with an aggressive “And you are …?” I did not find welcoming. 

She described J as having a “robust” care plan with the CMHT and inferred that she should be grateful for an appointment at the end of following week with an OT for an assessment. At this time we were not aware of the appointment since the letter had yet to be received, but events of the following week seemed irrelevant considering the fact that J was in crisis in that very moment.

I remember at one point NW told J “not to be so negative” which I found to be astonishingly dismissive of her problems. She recommended that J went home “…have a cup of tea and something nice to eat, which will make you feel better”, seemingly unaware of her 27 years of eating disorder history (firstly anorexia, then bulimia -J was treated for 10 years at the Leicestershire Specialist Eating Disorder Service which should be in her file), This would have been triggering and alienating to a person in J’s state of mind. NW seemed to be trying to negotiate a little with J, but it mostly comes out as dismissive platitudes, along with something about “choices” as though J was in full control herself. There is no talk of any help or assistance being provided today. 

Ms.NW also tells J that if she attempts to go to the motorway again that she “will be arrested for wasting police time”. This upsets J greatly. She regularly suffers from intense feelings of guilt, as part of her anxiety, this makes it worse for her. J is clearly frightened of being arrested, and for the first time mentions that she will “take an overdose”. NW explains that they can give us a lift back to J’s house. J again, says that if she goes home that she will take an overdose with the intention of killing herself. 

J determined and frantic, then leaves the foyer where we were talking. The L&D policeman (who gets my name wrong) says that they will catch up with us. I am trying to reason with J. J doesn’t feel that they understand her. The L&D van pulls up and they ask us to get into the back. We comply and they drive us to J’s house. J mentions again that she plans to take an overdose with her prescription medication, of which she has plenty. We are dropped off and left on the pavement near her house. 

J is still pretty upset at the thought that she could be arrested by police. Back inside her house, I go to get her a drink of water and she starts taking handfuls of pills from packets in a drawer where she keeps her medication. I physically fight with her, trying to stop her taking the pills. I call the police. We struggle, she keeps swallowing pills. Eventually the police arrive, as does a paramedic who later calls for an ambulance. Before we get into the ambulance we count the blister packs and empty packets, J has taken over 120 pills – some of which are very powerful drugs. She is woozy and later passes in and out of consciousness. She is rushed by ambulance to LRI A&E taken straight through into the Resuscitation Dept. She is flushed through for hours with drips and given a special formulae which fights one of the pills (cannulas, a catheter, monitors are used, she is wearing an oxygen face-mask and slapped by a nurse to wake up, it was fairly distressing to see, and that was only after I was finally allowed in). She spends the night in the LRI wired up to monitoring machines and is on oxygen. I stay with her until 3am. The following morning she is told by a nurse that “it had been a very close run thing and [that she] had been very lucky to survive it”. 
Later that morning, before any assessment, J tries to leave the hospital to run away with the intention of going to kill herself. She is brought back in by hospital security. At no point does J say that she wants to be admitted to mental health hospital. It is my firm belief she wasn’t, in some way, trying to manipulate or “play the system” and that every aspect of her crisis was genuine. 

Eventually, after a bed search over the phone, she is admitted to Bosworth Ward at the Bradgate Mental Health Unit on Saturday 19th July. She is told by hospital staff that she is “lucky” to have been given a bed locally.

In light of the fact that J had recently left hospital and was struggling to cope at home, I am dismayed at the attitude of NW in her assessment of J’s risk to herself. The fact that we were finding ourselves in these situations seemed to be used against J, as if this was a type of stock behaviour designed to provoke a certain type of response in professionals, when in fact she was a genuine danger to herself, and that my (and the police’s) efforts to her keep safe up to that point were meaningless. The fact that it was I who was phoning the police and not J, seemed to mean nothing. The fact that I had begged J to co-operate and come with me to the Urgent Care Centre or to let the Police take her back to the station without her struggling, bore no evidence to your staff. Even if she was merely “crying for help” I still believe that Ms.NW’s assessment was grossly negligent, because my partner would be dead now. This was after trying to reach an identified hotspot twice, declaring an alternative method (overdose by pills) and being allowed access to the means to doing that (taken home where her medication was). Had J been taken straight to a place of safety and admitted immediately to a hospital for treatment, many of the events of Friday 18th July could have been avoided. I believe that by belittling J’s views, dismissing her difficulties and saying specifically triggering things, that NW turned J’s complicated plan of suicide (the motorway bridge - a specific location, outside of Loughborough) into a more easily accessible plan – her pills at home (for fear of police cells, or worse, people thinking badly of her). 

I am especially saddened by all this because, until recently I ran two mental health drop-ins in Loughborough (Age UK L,S&R for LCC) and we advised service users of the drop-ins to do all of the things that J did when in they were crisis (within the differing contexts of care plans where present). I was appalled by the attitude of Ms.NW, especially in a role where she is assessing people who the police have already deemed as unsafe to themselves. At least on the previous night J had felt she had been taken seriously by mental health worker, V_, despite her failure to also affect any real change or to keep J safe from herself. 

 Yours faithfully

 (my name)
Partner, and informal carer for J.