Mental health beds search 'a scandal' BBC

 Mental health beds search 'a scandal'  BBC
 11.2.16
http://www.bbc.co.uk/news/health-35521180

We live in the East Midlands and J was offered a bed in Essex, and she was told that seven other outpatients were queued to be admitted to the Leics unit.  After a days wait she gained access to the Leics unit.

J’s care update - Leics County Crisis Team refusing to assist

I think it was on Tuesday, but I'm getting confused about the days. Today is Thursday.  On Tuesday, J asked the ward consultant if she could discharge herself and come home (to be with her shelves of books and Lucy-cat).  She was an voluntary-informal patient.  The consultant agreed to her leaving on the grounds that she would accept support from the Crisis Team (Acute Care, Home Treatment, Recovery Team, or something which doesn't actually have the word "crisis" in it, but absolutely everyone, including themselves, still call them the “Crisis Team”).  We wait most of the day on the ward for the Early Discharge / Crisis Team to arrive (after several phone calls from nursing staff, possibly to a building next door).  As always, they did not have the best people skills, as always, only one talked.  They certainly didn't like me in the room prompting J (I pushed back a bit this time).  They weren't happy with the fact that J had recently ligatured and that her meds had been put up suddenly.  J wanted to come home partly because day-to-day care needs were not being addressed (phobias, OCD, leg ulcers, diet, sleep).  The Crisis Team told us that they wouldn't be providing support because J was too much of a risk.  We were stoic and reflected upon accommodating for the randomness of the Crisis Team’s appointments and logistics in the past (i.e. they turn up when they want, they can’t find J’s address and on at least two occasions just give up).  I don’t think they liked that either.  I think that they may have been trying to force the hand of the ward.  Whilst I sympathise with the Crisis Team’s position, and am pretty worried about her safety at home, this doesn't help J, who has had the blessings of the ward consultant to lead her own care and return home.  I too would have preferred J to stay in longer so that they could monitor the meds change, but I also welcome being in the same town as her and not having to ferry supplies, fix mobile phones, cat-sit without an end-date.  A nurse told us that the team had then told them that J had “declined” their help.  Which was simply not the case at all.   Apparently phone calls were being made and arguments had.  The opinion here was that they couldn't be bothered with the paperwork and had already decided to reject J’s referral before talking to J in person.  End result: we pick up meds and get a taxi home and J’s CPN is expected to fill in any gaps.  What I like about this scenario is that the Crisis Team managed to irritate everyone and lie to other professionals in a way which surpassed expectation. Astonishing.  

J is saying that the strength of the voice has lessened with the use of a new anti-psychotic.  Already her PA has started working with her again, and we've seen her GP.  Naturally there’s a few issues about who’s in charge of prescribing the new meds (deferred to local CMHT shrink, not GP), but J was so desperate to leave hospital that we’re seeing this as a minor complication.  I'm pretty baffled about the whole situation.  Whilst she was at the unit she never even saw a care plan.  

Is she better than she was? Probably.  

Is she safer at home than she was on the ward?  No idea.

A return to hospital (J's care, update)

J's back in hospital.

At some point around two weeks ago, she started begging to be kept safe.  On the 28th January (also my birthday, she gave me presents at midnight the night before cos she's smart like that) she was finally admitted to my least favourite MH unit. In saying this, I don't have any to compare it with, and I hoped that when they said that there was a queue of seven other outpatients in the county needing a bed, that she would be sent somewhere else in the country.  Looking on the bright side, at least she is only two bus rides away for me and perhaps three or four for her father. 

Over the last year she has mentioned a disconnected whispering chorus of voices, but now she is talking of specific presence, a male, who shouts terrible things at her.  Bizarrely, this took away some of the fears we had that if she was admitted again that she would be sent away for some sort of year long therapy for suicidal BPD-ers.  It's a screwed up world when you think a psychotic episode might bypass institutional prejudice about personality disorders.  The consultant on the ward still insists that she is BPD (despite J not corresponding to half the factors in a standard diagnose of BPD) and that this sort of thing is common.  I think someone, the CPN perhaps, has also suggested that voice hearing can be borne out of dissociation.  

J is currently a voluntary patient, not, as yet under section, which changes the control somewhat.  The one thing NHS MH hospitals seem to be able to do is alter medication in a safe-ish/controlled environment (I always have to remind myself of this).   Having seen, read and attended a few talks through work, regarding voice-hearing -none with much useful conclusion or explanation, mainly recommending empathy- it makes sense to me that the brain might close off one pathway in the mind when there is too much traffic of a single type, and yet the activity may still pass through another part of the brain, like the bit which interprets speech or perceives sound.  A little knowledge might be a dangerous thing, but although the voices are from a named presence, I don't believe J thinks she's listening to metaphysical devils of angels.  She seems to accept that it all comes from her, but scarily, she's starting to believe that the presence can affect/infect/permeate the rest of us (like the black poisonous miasma she normally imagines coming from inside of her).  She wants the voice to stop.  It shouts at her if she sleeps, so she's terrified of resting.  If we talk about the voice it tells her off and becomes unbearable.  

The doctors are tweaking her pills, throwing in a new anti-psychotic and so far there has only been a couple of minor screw-ups with the meds.  Any of you who regularly read this blog will know that one of my pet grudges is the fact that when a person is admitted to a local ward there's a good chance they will go without the correct (or amended) medication for at least 24 hours (when the need it the most) and that junior doctors, available at night (and weekends) don't want to take any risks which will challenge a consultant in the morning. Randomly, an error this time was junior doctors taking it upon themselves to reduce J's PRN meds*, because she wasn't using them efficiently, or effectively or some sort of nonsense.  This was put right immediately the following day by the consultant.

* ”PRN” (Latin medical gobbledegook “pro re nata”) These are the pills a patient can have throughout the day, "as and when" they need them; provided the appropriately qualified nurse can be found, with the right key for the clinic room and pills cupboard, and that they are able to log on to the dispensing computer, that the computer and network is working, that the pharmacy hasn't hopefully capped the meds on the dispensing list, and that they actually have those pills on that ward, and that the nurse in charge doesn't have some absurd reason to make the patient wait or try to talk them out of having medication (which was policy on one ward).  They'll say all this crap about self-empowerment, but they might not let you have same diazepam which you are trusted to take at home when you likes.  The responsibility here is on the patient to identify when they need top-up medication, and they should be championed and even rewarded for doing this, i.e. plucking up the courage, whilst in crisis, to ask a stranger for help, but no, like the twisted morality we apply to smokers, some nurses who have just met you feel that their platitudes will be more useful than sixty years of brain science.  But I digress.

She has her own room (very rudimentary) on one of the older wards, where they still have dorms, a handful of toilets and a couple of shower rooms.  Some of the staff seem to be okay, and yes there's a few turkeys in light blue I wouldn't trust with dog walking.  Some of them remind of beleaguered school dinner staff told to watch the special needs kids whilst the teachers go off for a smoke.  I'm winding myself up again.  

I visited her today. She was spaced out, more from lack of sleep, than from the pills (the meds barely touch her).  She was colouring-in mandalas in a book for distraction.  Apparently, the voice was loud and present, but we couldn't discus it because we made him angry.  It’s a “he” and he has a name.

(And yes, I'm hoping the voice isn't based on me.  I think that's a joke I'm making with myself.  I think.)

Poor thing.  The phone reception sometimes goes bad and drops.  That doesn't help.

I'm cat sitting at her place, Lucy-cat is being adorable, as always.

Argh.

___

After I finished typing this she texted me to call her.  She says she didn't plan it, or conceal the bag, but she managed to ligature herself around her neck using a plastic carrier bag and a door handle (plastic carrier bags have been banned from the ward).  She was found by a nurse and they cut it from her.  She says the voice wants to kill her, and she has to kill herself before he "breaks her down".  This is new to me.  Unfortunately, the MH unit is very poor at tackling anything resembling self-harm and suicidal behaviour, so I'm concerned where this may lead.  But, she's alive.  Honestly, I'm not making anything of this up, and I don't want to be sensational or to create a reaction, but things have to get better than this.  I'm angry with myself for typing these things as though they were the most normal things in the world.

Get this. The carrier bag had contained dressings for her legs, given to her by a nurse on a trip to a leg clinic, whilst she was still in the care of the MH unit.  She didn't think to declare the bag.  A suspicious person might suggest she had concealed it specifically to ligature with. The idea only occurred tonight - cue BPD argument about “impulsive” behaviour.  Her legs are another casualty of many years of medication related weight gain (severely aggravated several years ago on another ward in the same unit, when she sat up for 13 nights because she was too scared to sleep in a dormitory with other patients).  The sores on the legs get worse if she doesn't elevate them, like in bed, when you sleep.  And now she can’t sleep because the voice is telling her not to.  I can draw cause and effect flow diagrams, but eventually they stop making sense because there’s too many lines!

She’s safer in hospital. Not safe, but safer.  I keep being told this by friends and professionals.  

(Apologies for mistakes or typos, too tired right now)

Personal Complaint to BBC regarding suicide news article

Email sent my myself to Newswatch re. news item today 4/2/16 on the 6 O'clock News:

I take a keen interest in all mental health related news and welcome the mention of the shockingly high statistics of suicide being a major killer for men under 50, but an emphasis in the interview with a bereaved wife was on whether or not she thought the act of suicide was “selfish”. I’ve since watched a more balanced clip of the same interview on the BBC Health news feed and that question was not included. 
This was all used as an introduction to a story about Mersyside Mental Health Services investing in an “app” which can predict suicidal behaviour. There was an opportunity here to ask if people who ask for help are getting adequate mental health support, medication or counselling. Risk assessments of suicidal patients on wards is a very different problem to suicide in the community. Fortunately, helplines were mentioned, but the whole article was painfully clumsy, alienating to mental health sufferers and seemed to ignore anti-stigma advice given by charities in recent years.

Regards
(Name, number etc)