Friday 8 June 2012

The Irony in Crisis

"29 year old female, suicidal, having a break down"

Not wishing to sound like a broken record, mental health is a huge part of what we deal with, yet in terms of training it's what we get least of. I suppose it draws a parallel to the cost mental health has on the NHS compared to the funding it receives. Being able to talk to patients suffering a wide range of disorders is something you either a) have b) get with time and experience or c) never have. I like to think I'm somewhere between A and B with still a lot to learn. My abilities aside, I still have to treat these people regardless of what I know about their condition or mental fragility. 

It was about 8pm when we got the job so traffic was an a minimum and we were on scene within a few minutes. As we entered the road we got a message sent from control.

"Patient now on window ledge, husband thinks she will jump, police on route"

As we pulled up at the house a man came running towards us from the property. I guessed by his mannerism that he was the husband but he got so close to the door I couldn't open it to find out. I had to usher him back just to open the cab door! We grabbed our bags while he frantically spoke (I'm sure he was talking faster than his lips were moving). The gist of it, was his wife was a paranoid schizophrenic and a manic depressive and was suffering a crisis because she had forgotten her morning medication. She was now locked in a room and 'threatening to jump'. We have no training whatsoever in talking down people wanting to jump but I've seen The Negotiator, how hard can it be.....?! With much intrepidation we headed up the stairs. The door to the bedroom was indeed locked, so I knocked. 

"Hello, it's the ambulance service, can you let us in so we can talk?"

To my surprise the door swung open and we were invited inside. On top of her apparent suicidal thoughts she was having a panic attack, never helpful in any situation so that's what we dealt with first. Once she was calm and able to speak in full sentences we found the root of the problem. She was scared of being taken away again. That fear is very common in mental health patients and often due to bad experiences where forceful removal and restraint has been used previously. My thoughts on this and restraint are best left for another day, but they were our patients main worries and cause of crisis. It was clear she needed treatment, be it at home or in hospital. A & E was the last place I wanted to take her and last place she wanted to go. She denied being suicidal and said she was just very depressed and her missed medication had caused her to hear voices and freak out. She wanted to talk to someone. Obviously, I was there, but my knowledge of what to say is hugely limited. She needed a professional. She needed a Crisis Team.

As luck would have it she had the number for her old crisis team. I say old, because they had discharged her a week previous saying she didn't need ongoing treatment. Hmmmmm. Anyway, I phoned them expecting either a constant ringing or a patronising message followed by equally drab digitised music. I was wrong on both counts! The phone was answered within seconds! A lovely, helpful lady who was familiar with the patient gave me a full history about her. I asked if a crisis team could come out to see her. She said they only do home visits until 9pm and as it was now 8:45pm I didn't argue. I asked for advise, wanting to find out what options were open to us and whether she felt our patient would benefit from hospital. She told me that she should be seen, if not tonight, in the morning and suggested she spoke on the phone with an AMHP. Brilliant, this was going well! 

"Shall I pass her over then?"

"I'm just about to see a patient, if you call back in 10 minutes, we'll have a chat with her and see if we can find space to admit her here"

"OK, brilliant, thanks for your help, do I just ring this number again?"

"Yep"

"OK, speak to you soon"

I told my patient the plan, she was happy, I was happy! Maybe crisis teams are not all bad! I started doing my paper work while my crew mate did her OB's, just to make sure there was nothing untoward going on. There wasn't. After 10 minutes I phoned back.......no answer. I phoned again......no answer. I phoned a third time.......eventually a guy answered the phone. 

"Hi, it's Ella Shaw from the ambulance service, Jane told me ring back in 10 minutes so she could talk to my patient and arrange an admission"

"Janes gone home"

"Erm.....I spoke to her 10 minutes ago, she told me to call back"

"Yeah, she left 5 minutes ago"

"Well is there someone else my patient can talk to?"

"No"

"So what are we supposed to do?"

"I don't know, that's up to you"

I spent a few livid minutes demanding names etc and ranting away but it was pointless. On learning the news that no one was free to talk to her, our patient started having another panic attack. She uttered the words 'I might as well kill myself' and 'suicide' amongst others, which until now, she had convinced me that she wasn't. We had no choice but to take her to A & E. The prospect of this started a chain reaction we were powerless to stop. She refused, we said she had to, the police arrived, she freaked out about being taken away, she became violent, she was put in handcuffs, she was sectioned and taken to hospital, screaming and shouting the entire way. The very same person who I had spent 45 minutes with discussing her dream of becoming a midwife or a pathologists assistant. It was heartbreaking. Yet again, another mental health patient let down by the system. Let down by the services there to protect her. She didn't need sectioning, she didn't need handcuffs, she just needed to talk to someone. What will happen about this? Nothing. Why? Because ultimately no one cares enough to fix it. There is nothing more frustrating. Yet again, a patients welfare is dictated by a shift time and the misfortune of time of day. What's the bloody point? A crisis team should do just what it says on the tin. Be there wherever and whenever a patient is in crisis, come rain or shy, regardless of whether it is a convenient time of day. Until these 'crisis' teams (and crisis is not meant to be ironic) are accountable for their failings, nothing will change. They are not all bad, but like everything in the NHS, if it is well run and done properly, we as an ambulance service rarely get to see it. Instead we just end up hitting our heads against the wall passing the patient from pillar to post. Is that what the NHS is for?!

10 comments:

  1. I agree heartily with this Ella! At times I've literally found myself hitting my head against a brick wall trying to help my M/H patients.

    Have you considered putting in a complaint against the the M/H trust involved, as technically you referred her within their opening hours and they refused. An email to the Medical Director might get you somewhere?

    Something that also really frustrates me is the mental health services complete lack of willingness to talk to us as soon as the word 'alcohol' is mentioned. Now I'm not an expert, but from experience I do know that some of our patients resort to alcohol as their way of coping with a crisis. It is a very common occurrance and as such crisis teams and M/H units should be engaging with these people and keeping them from harm until the alcohol has worn off, not palming them off on us and A+E units, which is the least appropriate destination I could think of.

    It is really frustrating, what we really need are direct referrals that we can make 24 hours a day to local M/H units, rather than taking M/H patients to A+E, where let's face it, the staff are too busy and not trained to care for them properly.

    Rant over. Keep up the good blogging Ella!

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    1. The alcohol thing gets me. Its a vicious circle. MH problems are closely related with addiction and alcoholism and rarely do you get one without the other! How can they expect all patients in crisis to be sober when one causes the other. I emailed a complaint but never heard back. Never do. Thanks for your comment :-)

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  2. One of those situations where it's very much "who you Speak to" - sounds like the 1st person was very useful, the 2nd bloody useless. I work in a crisis team and often spend 40/50 minutes on the phone talking to people in a terrible state, liaising with police and ambulance as you've described. It's totally "who you get" which is shit I agree. However the training that most psych nurses get is barely enough to function as a human being (wish I was kidding) and the social workers are being removed. So you're increasingly going to get the options of a) can we sedate them? B) can we section them? Or c) you're on your own. Good luck allied health professionals. Mental health services were poor before, they're going to get even more blunt..

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    1. It so annoying that everyone involved is saying the same thing and it is just falling on deaf ears!

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  3. As a M/H patient myself, I completely agree with you. I am currently in a psychiatric hospital, but am being transferred to a different, non-secure unit this afternoon. I am very apprehensive about this, because I'm not convinced I'll be able to keep myself safe. Its all very well telling the psychs that, but they just assume that if I feel suicidal I'll tell someone - I don't think I'll be in that frame of mind! But they're still going to transfer me, because they need my bed. It seems to me that it's all about money, and not patient safety.

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    1. Thank you for sharing. You're in a horrible situation and I can only imagine how frustrating it is from the patients side. Read my blog Pass The Donkey Parts 1, 2 & 3 for a post with a MH patients view point included. I hope you get the help you want and need. Thanks for reading

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  4. We live near 2 hospitals for patients with mental health. One woman who is 2006 killed her own mother, went to one of them, said she felt that she was going to cause serious harm to herself or others. This was 8.45pm on a weeknight, and she was told that the services had closed and to come back in the morning. The next morning she was arrested after forcing her way into a butchers, stealing a knife and stabbing someone in the neck on a busy high street.
    She was a known patient, a patient they knew had a history of violent and manic episodes and they ignored her plea for help. The lynch mob saying she should die etc was disgusting. The poor woman needs and is hopefully getting help.

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    1. Terrible story. It sounds like a case of 'Failure Demand'. Demand caused by the failure to do something or doing something properly. Wish people would be treated when they need it not whens its to late!

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    2. So often what people need is to just be listened to and yet crisis services dont seem to allow this to happen. There is a false assumption that when you are in crisis you just need to be kept safe from yourself and others and yet often simply listening to people would prevent them from being sectioned. I speak as a current mental health service user and have also worked in social care for 20 years...

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    3. Having depressive episodes for years and a mother who has been for 25 years, I really did feel for the poor woman. Obviously I feel sad for the family of the woman who was killed, but I imagine those in the lynch mob have had little dealings with mental health. Not like she woke up one day and decided to murder someone unlike 'proper' murderers.

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