For Customer Services - feel free to forward this email to others.
Patient: J-
Inpatient on H-- Ward (Bradgate Unit)
Myself,
Carer/partner/next of kin: (name and address etc)
13th February 2015
Dear Sir / Madam,
I am frightened that my partner (J) is in a very real danger, of the kind that I hoped a hospital admission would prevent. Last week she was allowed to leave the ward by Dr D-, after she had repeatedly told staff (over several hours) that she planned to kill herself on the A50.
(I'm attaching map of her route from the entrance to the road taken on Wednesday 4th February 2014).
(Edit: blog readers: for map see earlier post)
The nurses had encouraged her to stay on the ward until Dr T and Dr D were available to talk to her. I was visiting that day. When I arrived she was pleading with nurses near the ward entrance to let her go so she could kill herself. Both doctors, attending later, reiterated that if J was to leave the ward that she would be "refusing treatment" and would be discharged, and, importantly, would not be stopped by staff in the hospital. They said she was "free to leave" the ward, adding "perhaps for a walk". J again said that she planned to kill herself on the road.
When J left the ward via the MDT Room door to the corridor, wearing only slippers and a seclusion gown, on February 4th, at no point did Dr D raise the hospital alarm. The only extra help we had by the road, pushing J back from the road was from two female nurses who were on a break from other wards. It was purely upon our own instincts did, the ward matron and I follow J and Dr D - who was still asserting that J and her were "going for a walk". I don't understand why there wasn't a lock-down of the intercom doors, J managed to leave the building faster than I have been able to enter when visiting (J is also unable to run due to swelling in her legs and back pains). Dr D was happy to have the police called (but no point did she use a holding section). The police finally arrived, after a our long struggle by the road-side, and J, exhausted, was driven back to reception.
The whole event was distressing for all. This letter/email is not a formal complaint about that avoidable incident, but I am using the incident as an example of why I am concerned about the care plan conditions of J's stay on H-- Ward.
H-- Ward is a preferential choice for J, she gets on well with the nurses and having her own room is invaluable and essential for her recovery. We are very grateful for this. J also trusts Dr D to help with a gradual change in medication. I don't believe she would want to change the ward or consultant. I have mixed feelings about this.
My main issue is with the arrangement/ behaviour contract of her stay, written into her care plan, which I think is supposed to help J, in a voluntary way, to "own" her recovery, but in fact is negative, blame-based, emotionally invalidating, lacking in compassion or empathy, devastating to her self esteem and alienating for both her as a patient and myself as her carer.
J has been told by the Dr D (and it is written in the care plan) that any acts of self-harm or suicide will be interpreted as "a threat" and she will be immediately discharged from ward care. Dr D has said that J will also discharged from all community treatment (terminating continuity with a CPN, a new psychiatrist and an OT). Can she really do this?
J believes that by even expressing a desire to self harm will lead to this punitive action.
I do not believe that J is given any genuine choices here. This must be disempowering and can add to the sense of feeling trapped and low self worth (on top of wanting to kill herself).
It was always my understanding in the past that if a ward cannot treat or help J to recover that she would at least be kept safe until an alternative therapy is found. There is so much misery in J's day to day life, that an invitation to leave the ward whilst she is at her most in pain, merely confirms for her that staff want her "to be dead".
In the debriefing meeting after the road event, J was told by Dr D, that by her wearing a seclusion gown, whilst leaving, it would be classed as "theft of hospital property" (this was also inferred beforehand, because at that point, she offered to pay for the gown). To me, this sounds like the gown was of more value than the life of my partner. Charging a dead person with theft makes no sense. It is not a sensible deterrent.
I wasn't at the debriefing, but J has informed me of other things that Dr D said to her:
"She also told me she is going to be having a meeting with the police to tell them that if they are ever called out to help in a crisis situation, they are not to intervene or get involved in anyway, and should let me kill myself. She is already thinking about what to say to the coroner at the inquest into my death, feeling satisfied that she is blameless/faultless, and she is merely waiting for the inevitable."
Regarding the coroner remark, even if this is psychological coercion to stop Jo trying to kill herself, it is in extremely poor taste. We are reminded of the inquests that have been reported in the local press regarding deaths of inpatients at the Bradgate Unit.
Dr D has also told me on two occasions, in person, that "you cannot prevent people from killing themselves". I've pointed out that the new doors at the Bradgate had been doing just that, she didn't seem to feel that that was relevant. Even when a patient is voluntary, the doors can remain closed whilst a patient is talked down, even before anything legal has to occur.
Regarding police not helping J - I don't understand how this can work. In the same way that Dr D felt that she could stop traffic, when (ironically) putting herself and motorists in danger, whilst we kept J on the verge, she believes she can order the whole of the Leicestershire Constabulary to allow J to leap from a motorway bridge. I can't imagine what J makes of this. Suicidal J might be even be relieved to hear this, since it was the police who brought her to hospital, in a prisoner cage in a van (after I had called them).
I believe it is very unfair on the nurses to allow her to leave the ward if they think she's not thinking clearly, as was the case on Wednesday 4th. Some of the nurses on H- Ward who had been trying to keep her safe have even told J that "... they believe that I did NOT have mental capacity at that time. They also believe her [Dr D's] current and ongoing attitude towards me is punitive, and far from supportive or therapeutic." (J's own words)
When J is frantic and suicidal, she says that killing herself is the "best thing" and that all alternative paths are "illogical". By my definition she is unable to make a decisions or choices (other than those which end with self-destruction) and could be considered to be mentally incapacitated. I have seen her beg policemen to take her to the motorway, as if they were a taxi. I have seen her beg nurses to let her die. These are not rational choices.
Incidentally her medication dosages had already been reduced on the day the road incident occurred, and yet this was not seen as an endangering factor.
J is co-operating with her care to the best of her ability, she is taking a keen interest in the change of her medication, she sometimes makes friends with staff and other patients, when her anxiety allows.
I cannot keep her safe at home when she is unwell, I cannot legally lock the doors or take away her medication to prevent an overdose. She doesn't "want" to be in hospital, who would "want" to be at the Bradgate Unit (?) but she in-part acknowledges the need to be kept safe, whilst also wanting to be dead. I don't think she has the inner strength (because of low mood and low self-esteem) to just "turn off" suicidal urges in response to a care plan contract, otherwise she wouldn't need to be in hospital. Also, her medical history (including ward stays) is repeatedly used against her by assessors and the consultants, as if imply that she is somehow "dependant" on services. Again, this creates negative reinforcement that she cannot be helped by the NHS and is alienating for us both.
I am unsure how to proceed. I thought about meeting with the ward matron (-), but since she was present for the whole of the road incident I'm pretty sure she knows my opinions on these matters. Without the blessing of the consultant, would the ward matron be able to change anything? I.e. overturn Dr D's directions re. J's safety and day-to-day care? J wants to remain on the ward under the care of Dr D, but neither of us feel the threat of treatment-denial is useful to her recovery. It is not a true partnership between patient and doctor, despite Dr D's repeated use of the phrase "are we agreed?"-usually after presenting an ultimatum (certainly forgetting that the patient is relatively powerless at the best of times).
Would it help if the unit managers were made aware of tactics like these, where a patient's life is gambled with? (I'm not being rhetorical, there may be a broader picture here.) Do they have a say in these matters?
This is difficult for me because the LPT is involved with every aspect of J's mental health care, from community team, ward staff and home treatment (crisis teams). We have come a long way, and there's been plenty of positive advice and coping strategies, plateaus of stability, amidst occasionally bumpy care in hospital and relapses at home.
Somehow in all of this J believes she is "wasting everyone's time" and is "better off dead". The scenarios and methods of death never leave her, but her resistance weakens. She is not impulsive, it's just that during the tougher moments these planned suicide scenarios seem normal for her to take to their conclusion (which may also relate to her OCD mindset, where completion is paramount). Her suicidal behaviour has nothing to do with wanting care. Therefore her self-harm and suicide attempts are not a manipulative currency of blackmail. I want to put this absurd idea to rest. Frankly some of the ward care just isn't that great when compared to being at home, but sometimes it's a grim necessity. She would not have adopted a cat if she thought she was going to be spending time in hospital.
Every day this arrangement with Dr D continues I believe that J is very unsafe. I would like to see a rapid resolution, or some sort of mediation between us and Dr D. I regret to say that in the past I have become frustrated by the Trust, in some cases taking up to three months to respond to what were very immediate ward care issues. Even advocacy groups can take up to two weeks to write letter representing a patient or carer's views to staff. This is why in the past, being so frustrated, I've turned to organisations like the CQC, posted online and even written to newspapers (such is my desperation). There is also no point of me going to the Ombudsman until a complaint has been resolved (I think). I am grateful for replies when they do arrive, but unfortunately circumstances have often changed and the damage has already been done to Jo.
I am open to any suggestions to resolve any of the above issues and am also in favour of face to face meetings, or just phone me or email me.
Since J is currently residing on H-- Ward, I recommend sending permission-to-share forms there, or to her home address, where I am looking after her house cat (we have had mix ups before, B-- Ward did not forward letters from the Trust for several weeks).
I am concerned that if I make this a formal complaint against Dr D, that it will prejudice against J's care on H-- Ward, so I'm not sure what to do, and yet still I have no guarantees that J will be kept safe when she is in crisis.
Again, I must stress, J seems to want to keep Dr D as her consultant, due to her pharmaceutical knowledge, but I believe the basis of this all-or-nothing-free-to-leave care plan needs changing. If this remains in place, I genuinely believe that J will die whilst being either in the care of the Bradgate Unit, or immediately after she has been discharged. Please help me prevent this.
(my name).
(for details see above)
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