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Can we really call it 'care'?
Posted Thursday 24 November 2011
This week Mind publishes its report and recommendations on acute and crisis mental health care and promotes them to Parliament and the Welsh Assembly. Rhian asks about whether it can really be called ‘care’ at all.
Trigger warning - this blog discusses self harm.
For the past year Mind has been investigating the state of crisis care for people with mental health problems, whether it's good or bad (the care, not the mental health).
I say bad, every time. Well, I did before I moved back to Aberystwyth. My mental health hasn't been in crisis really, just once, but I know what outlets are available to me.
Once in the past few months there was talk of having me referred to the crisis team, but I baulked at the mere mention and improved over the next fortnight or so without them.
I baulked because my own experience with the crisis team in Leicester has been less than stellar.
Leicester's a big place, lots of people, lot of people in need of care, whether in a crisis or not. So it's never going to be perfect, but it should be better.
Regardless of the need, care shouldn't be so hit and miss, whether it's for physical health or mental health. But then, we're lucky to have any health care at all, so should we be complaining?.
I find it a bit of a double-edged sword, but then, when I'm sitting in the corner of my flat rocking back and forth and crying and considering cutting for the first time in months, none of it matters. All I need is help. Care.
I didn't always get it.
A lot of the time I just got prescriptions from the crisis team for medication I was already taking, so basically they were making sure I was actually taking my meds.
Which is fine, except at that point I was mostly using my meds for non-fatal overdoses (my psychiatrist at the time called them para-suicide attempts) and helping me get to sleep after a lot of beer and some self-harm. So not quite what I needed.
What else I got from the crisis team were threats of the police (if I didn’t answer the door) and hospitalisation.
The crisis team are only involved for two weeks, and then. If you're not 'better', not out of the crisis, then to hospital with you. And that is not always the most conducive of environments, not even the safest of environments.
People still hurt themselves while on mental health wards, still kill themselves. Hospital wards can do more harm than good.
Even before the stories I heard, even before my friend killed herself, I was aware going to hospital was a bad idea.
But that was the choice I had, more drugs or hospitalisation. Of course, this is just my experience, and my experience with the crisis team.
I've been to A&E a few times, never a brilliant reception there, but I feel that's another post, for another day.
I guess the point is that I didn't feel like this was 'care' but more the bare minimum to keep me alive, before I'm passed on to someone else. I had to fight to get the help I needed to improve my mental health and live without self harm.
We should get more than the bare minimum that the NHS decides we need, that the doctors decide we need, because so often they're not motivated by the right things.
The NHS is motivated by money, too many doctors are motivated by targets, and all I ever really wanted was some help in those moments when even breathing was difficult.
That's all anyone really wants, not to have to jump through the hoops.
Rhian
Rhian blogs at http://scruffy-duck.net
Read Mind’s information on coping with self harm and Rhian’s blog for self injury awareness day.
Excellent crisis care exists, but we need it everywhere, for everyone. Support our campaign, take action now.
9 Comments
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This would never happen in physical healthcare - people would not be turned away by an oncology dept, treated badly in A&E for a heart condition or told to find their own asthma care with a charity or pay for it privately. It does leave me feeling that mental health service users lives don't mean much to government, like it's an acceptable loss somehow
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I have only once rung my local centre after self harming. I was frightened and panicked by what I had done. I was told to come in where I was given a dressing down by a nurse, told to pull myself together and sent home with a flea in my ear.
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You ask what 'care' would look like. Well this week, I hit a crisis point, not an emergency but way too close for my liking. I called my surgery, I dont have any type of care plan, and was treated as though it was a huge bother to even make me an appt for next week. So I went in and camped until they saw me. Accessibility has to be key to any form of emergency care. Actual CARE would be amazing as well, a kind word, or shoulder. If I was diabetic and my sugars out, I would have been seen immediately. The saddest part for me is its not just the staff, its the gps as well.....
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I was under the crisis team a few months ago and to be honest all they really did was bring me some medication every day. I had been overdosing on meds and they just left me with a load more. They discharged me before I felt well and left me only with a place at the bottom of the waiting list for therapy.
I have had to fight and fight for any treatment at all and have been passed around from therapist to therapist to psychiatrist and back to therapist. I am now on yet another waiting list. I have even been told by one therapist that I am hopeless and might as well just carry on the way I am because I'm not going to get better.
I don't feel I have anywhere to turn if I am in crisis. My GP has been rude an unsympathetic. I took my dad with me to an appontment to back me up and she wasn't keen for him to be present. I don't feel as though I am listened to. It is as though they think that it is all my fault so I am put at the bottom of the rung.
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Mynexperience of crisis care has been awful..medical - stitched and stapled with no local anaesthetic, called an attention seeking little *****. Mental - crisis team refused to see me so went to my gp emergency surgery n a doctor there told me I couldn't really want to kill myself or I would've done it by now. In suicidal crisis I am 9/10 times turned away from hospital admission if I want it (it helps as there are people to talk to 24/7 and it's a 'safe' er place for me). If I am allowed in, only ever for a max of 72 hrs whether I feel better or not I have to leave. 72hrs is never long enough for strong suicicidal feelings to pass in me, so now I never ask cos there is no point. I just end up more frustrated. The crisis team who sometimes come out to me when I request it don't help, they say do some jewellery making or fuss your cat. As gorgeous as my cat is I can't fuss her constantly for a month or so - and I don't have the motivation or concentration to do anything creative when I'm like that the only reason in alive today is my mother, no thanks to mental health crisis services.
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GP's by their own admission don't have the training, confidence or time [average appt 5 mins] to assist people with mental health difficulties let alone a crisis. They will have even less time or motivation being under further pressure now they have greater responsibility for NHS budgets and are under pressure to not sign sick notes, review forms, and push for employment.
This means that the thousands being discharged from the CMHT's back to GP will effectively receive little or nothing - discharge back to GP for treatment as usual amounts to nothing other than whatever medication was prescribed by the CMHT/Home Treatment or Crisis service -
The crisis team exists to prevent us having access to a consultant psychiartist and taking up a hospital bed. Imagine if people with physical illnesses were prevented from hospital and seeing a specialist. Well I am willing to have any physical illness on the planet if it means I wont have to suffer depression again. If these people really dont want to help us then how about doing away with the whole mental health system, would we really be any worse off? I don't need to be told that going for a walk doing housework or taking a bath is going to help, it damn well does not, I can get that kind of advice from any old ignoramous. Clinical depression is now being written out of the equation and redifined as 'personality disorder'. There's a reason for that, conveniently 'untreatable'-its just your personality love and you'll have to live with it. There ARE treatments but only for the lucky few who have the right diagnosis. I resent a system that decides who is and who is not worthy of help. Depression feeds on all this and all the other crap we have to put up with in this world. So do away with the whole system, it is not fit for purpose.
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..to be fair, Crisis teams should all have consultant psychiatrists working for/with them. they may not always be available but crisis teams are not designed to prevent people seeing "specialists", they are specialists.
All staff working on crisis teams are required to be qualified and registered mental health practitioners (be they nurses or social workers, although there are also non-qualified members of staff but they are required to evidence sufficient experience).
Beds and wards are being closed down left right and centre, which is something that practitioners are equally frustrated by. As a result, we are required to limit unecessary hospital admissions and to reduce length of stays (while I agree this is mostly done as a cynical cost-cutting exericse there is also evidence to show that hospitals are largely counter-productive to a person's recovery), it would be so much better if there were more crisis houses to offer respite and sanctuary to people.
Please remember that cuts to wards and resources are not carried out by practitioners but by management and (really) the government. Crisis teams do not exist to prevent people from getting support but for them to get the right support. Hospital is not always the answer and it seems that as a health service we are able to use these less and less but without anything different or actually helpful being provided.
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That is the problem isn't it? Reducing 'uneccesary hospital stays' Who decides whether hospital is unneccesary or not? Soon we'll be saying that any help will be unneccessary which will please the cost cutters no end. If you have a diagnosis of BDP that is very much the case anyway-mental health professionals should do away with that diagnosis because it is only used to exclude people that need help. Just think how it feels, you are heading for a crisis but because of your label you won't get the help and the reason you got the label in the first place is because of opinions of professionals, not really much point in going on is there?
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