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.