#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?

"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.

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

Apart from the bradgate mental health unit, what other inpatient facilities are available for residents of Leicestershire and Rutland? Is this the only unit J can go to? Can you not transfer her? How do others in the area compare from what you've been reading into? I'm aware that the bennion centre has an eating disorder unit but is that, with the BMHU, all that your region has access to inpatient wise? Thank you for any information you can give me.

Anonymous

Hi, not sure how long ago you sent this. This app hides lots of stuff, apologies for delay.
Thankfully J is home, good days and bad days and I’m trying not let my dismay at the local services get the best of me. Little steps. Lucy-cat makes a big difference.
I doubt the local eating disorder service would have her back, and I don’t think J would return there. She says they basically replaced her Anorexia with Bulimia (many years ago), which for her is a sort of living death - the pills do not help with weight, either. With regards to specially dedicated services, I’m not completely up to date with current options for referral in Leics - every time I hear about a service it seems to be about to close or there’s a two year waiting list. The local group therapy for personality disorders doesn’t seem appropriate either, and she’s tried some rather tough psychodynamic (?) at a place where overpaid academics just give you abuse from what I can tell. ;) I’m encouraging her to think about having a counsellor who has nothing to do with this NHS Trust. The good news is that she’s getting on with her CPN, despite the history between them and my letter exchanges with him. She’s applied to have all her records sent to her. It should be interesting with regards to diagnosis prejudice, but I’m also worried the effect reading the notes will have on us both. Sometimes, it’s better not to know.
We’re still waiting for the response to our complaint regarding professionals failing to keep her safe when she needed help the most, before the big overdose.
I’ll be posting the recent response to my letter about her poor ward care. The response was fairly dismissive and came from the highest point in the chain. I still feel that this organisation is repeatedly failing her in unprofessional ways and they have never acknowledged this on any level. We’re also waiting for her Care Plan Meeting / CPA.
Hopefully, the community team will still start talking to her as if she’s grown-up and not a naughty child - if not, I want her to get the hell out. The only problem is the drugs - she’s on so many pills, which get tweaked and the side effects are pretty bad (like with her swollen legs). We need the psychiatrist consultant to okay these pills, especially since her GP feels very out of his depth.
(I may edit this at a later date, depending upon how much information about J we want to be on public view)
I’m behind on contacting a support group for carers for myself, but frankly, we need another organisation like we need a hole in the head. Hey, trepanning, no there’s an idea…!
Incidentally, anyone reading this wanting to know about mental health services and charities in Leicestershire would do well to check out the directory on the LAMP website. http://www.lampdirect.org.uk
Thanks. :)

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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