Email to a mental health advocate for carers and J in crisis (sent today)

Hi (mental health advocate name)

Thanks for meeting me the other day.  The meeting to query J's diagnosis and revise her care plan did not go well.  Present were myself, J, Dr Tr (junior doctor) and Dr To (locum). With reservation, they said they might raise the diagnosis issue in a meeting at a later stage, but that they wouldn't change Dr D's care plan for J until she returned from leave.  After the meeting J discovered that one of her drugs had been stopped several days earlier than expected, and this compounded feelings of powerlessness for both of us.

Since then she has been trying to leave the ward in order to kill herself and ligatured with a ribbon she had found. The good news (for me, because I feel would be at serious risk if she left the ward) is that the nurses used a holding section 5.4, then a doctor applied a 72 hour Section 5.2 and finally, with great reluctance, a Section 2 was implemented around 1.30pm today (19/3/15).  Apparently the doctor (Dr -Y---) phoned Dr D (who is supposed to be on leave) who, yet again, asserted that when J is  a voluntary patient that She is "taking responsibility for her behavior" and cooperating with her care.  Yet again, inferring that J's depression is nothing more that acting out, attention seeking or being naughty or disruptive for the sake of it (BPD traits, not acknowledging her depression).  Again, they wanted to discourage the use of sectioning, belittling J's risk to herself. Dr Y kept reminding J that she would be killing other people if she died on the road. Yet again, the emphasis is on negative consequences beyond J's control (she'd be dead anyway) and possibly guilt-tripping - much like the Dr D's statements that J would be stealing the seclusion gown she was wearing when she went to the road.

I'm not convinced that anyone senior has learnt anything from the previous incident when J left the ward, but I am grateful that she has been temporarily sectioned (contrary to her care plan which said she would be free to leave and she should sign a discharge form).

J tells me that she believes that when Dr D returns in a couple of weeks that she will be probably lift the section and then J will be free to continue with her plan to kill herself.  J is being very open with the nurses regarding her desire to end her life.  As I type she is on level two obs (dropped from L1 after the ligature attempt), but I think this is a very temporary measure.  Her named nurse, N is away until next Thursday. J hasn't been sleeping over the last few days and is avoiding going into the dining area for meals except for cereal at breakfast, and, apart from the chocolate I have brought her, she tells me that she isn't eating meals.

I believe one of the nurses has said that they shall put J in contact with a specialist in turning around and challenging diagnoses. I'm not sure if the person they are thinking of is a specific (name of organisation) advocate.  N (named nurse) has already made it possible for a rape counseling service to visit J in hospital.

I don't know what I should do with regards to the ongoing duty of care issues and safeguarding issues (mainly the negative attitude of the consultants towards J, possibly in relation to BPD diagnosis prejudice).  J maintains very good relations with the nurses.

I am now considering making my complaint about safeguarding issues and the attitude (and previous actions) of Dr D into a formal complaint.  However, I am still concerned that this will result in J being moved to a different ward and that in turn would result in J having to build relationships with the nurses on the new ward from scratch.  J is "terrified" of the possibility of being moved (her words).  My instinct is also to wait a few days to see if there are any further developments.

Thoughts on any of this or suggestions for meetings will be welcome.  Although I haven't been able to get a schedule for when the ward rounds are on H Ward, a ward round has been booked in for 3.30pm, Monday 23 March - which her CPN will attend.  I'm inviting you to come along with me if you're available and J says she has no problem with you being present.  Apologies for short notice.

Thanks again / regards
(my name)