Saturday 24 December 2011

Failed by the system........

"43 year old male, brain injury, feeling suicidal"

I have very little empathy for most of our regular callers, normally it is an attention thing or poor management of a chronic illness. I had similar feelings for Mr Smith but after the first 10 or so meetings I realised he needed empathy, and he needed help. Mr Smith called a lot of ambulances. Sometimes as many as 5 a day. More often than not he went the 600 yards to hospital but sometimes he stayed at home. Mr Smith suffered from schizophrenia which is a mental disorder characterised by a breakdown of thought processes and by poor emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganised speech and thinking, and it is accompanied by significant social or occupational dysfunction. I believe he also had some learning difficulties. His usual complaint was feeling suicidal, stating he wanted to jump in front of a train. He claimed he had had a traumatic brain injury aged 11 but there was never any evidence to suggest this. Every attendance to him followed a similar pattern. We took him to hospital, the nurse sent him to the waiting room and he walked home where he would then call another ambulance. You can see the cycle.

Regular callers are very frustrating. It's a waste of resource and when they are so prolific in their calling the expense is huge. In one calendar year Mr Smith had 478 ambulances at a cost of over £250000 to the ambulance service. Unfortunately this is a bi-product of the system we are in. As previously discussed the care pathways for mental health patients are poor at best. The nearest mental health unit to Mr Smith knew him well but wouldn't allow us to convey him to them without him being assessed in A & E first. On the rare occasions where he did stay in hospital long enough to be assessed, the unit would discharge him to be 'treated at home'. The problem with mental health in A & E is that there are not only very few staff trained to assess him but there is usually a very long wait. Certain nurses knew if they left him for long enough he would just leave. To be honest, myself included, no one really took his threats of suicide seriously. He didn't seem the type. There was no history of self harm and he'd been threatening it for so many years it didn't seem likely. Regardless, he wasn't getting the treatment he desired or needed. He was being let down by the system in a never ending loop of hospital admissions and self discharges and no one who could buck the trend was willing to do so.

It's a far too familiar sight with mental health. No one wants to know. Even the mental health units generally are not interested. They certainly aren't helpful. They make admitting a patient as hard as possible for us and the police. They have so many rules and conditions that must be met before they'll consider even laying eyes on a patient. Because of this the cycle continues. If i'm honest I didn't really know what Mr Smith wanted. He never really said. I tried talking to him, I tried referring him onto every service I could. I filled out frequent caller referrals, vulnerable adult forms and flagged his address. I tried to argue on his behalf to immediate assessment in A & E but everyone has their priorities and he was never going to be one of them. He only ever called from his home. He was never rude, always polite and therefore never had anything to do with the police. The police have more powers than us and can be very useful with mental health and enforcing assessments but this was an avenue which was never open to us. He always agreed to go voluntarily and as such, was never in a position to be held against his will. Unfortunately about 4 months ago a crew not familiar with Mr Smith attended his home. I imagine he told them the usual and he was taken to the hospital. Once at hospital the nurse sent him to the waiting room. 20 minutes later he walked out. 20 minutes after that the following call was sent to a local crew.

"'One under', male jumped in front of Intercity train. ? Life status"

Like he always claimed he would, Mr Smith jumped under a train. From what I have heard he would have died instantly. The train was travelling in excess of 90mph, he didn't stand a chance. Or did he? He had a chance twice on that particular day. Twice he was taken to hospital and twice he was ignored. I suppose it was only a matter of time before he did it. He'd been let down by the system that is there to help him, and he was let down because he was submissive. He didn't complain about lack of treatment. He never raised his voice. He just quietly walked away unnoticed every single time. The cynic in me would say that now he is dead, that is a huge financial burden lifted and it's what he wanted. In reality, I felt crap. He didn't need to die, he needed treatment and help but it was treatment and help I wasn't able to provide. It was treatment and help 'the system' wouldn't allow him to have. I'd like to say that would be little consolation for his family and friends but he didn't have any. All he had was us and we failed him.

1 comment:

  1. I'm very sorry. I always feel shit when I lose a regular from the totally fruit loop female who was the last patient on my first day in the job (OD four years later) to George & Lynn, a pair of battling alkies who died in a house fire after having an ambulance at their door at least 4 times a week for 3 years.

    Some do turn a corner though and I like to think I'm part of the system that help get them back on their feet.


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