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Waiting in crisis
Posted Wednesday 24 October 2012
Being in crisis can often involve stark contrast between bursts of traumatic and acutely stressful series of events, along with long periods of waiting on uncomfortable chairs, staring at the posters on the wall.
When I went into acute crisis in 2008, I felt so hopeless that often suicide felt like the only way out. I would become so distressed, and my friends and family would fear so much for my safety, that it became common for an ambulance to be called. After assurances from well-meaning and wonderfully kind paramedics that going to hospital would result in getting proper treatment, I would find myself in Accident and Emergency.
Ultimately, every time it ended up with me getting home as the sun was coming up: calmer, but just as hopeless. Take this process, repeat it over a number of months – and you have yourself a system that just does not work.
I believe Accident and Emergency as it is now does not work as an appropriate form of crisis intervention for several reasons, and my experiences alone, on top of thousands of others, document why.
Firstly, when in crisis I believe it is just not appropriate to be surrounded by non-mental health patients, particularly on weekend evenings when a lot of patients can be quite drunk and aggressive. I have been groped in Accident and Emergency, shouted at, and on one occasion a man exposed himself next to me and started urinating on the floor.
To someone not in crisis that would probably be disgusting, make them angry, or could even be seen as amusing by some, but when your inner world is collapsing, being in a place which feels overtly hostile can heighten the sense of inner chaos. As the inner chaos increases, you want to get as far away as possible, and not stay to get the treatment you need. It certainly doesn’t feel like a place of safety.
When a psychiatrist would eventually see me, our primary objective was always to get me admitted. I was suicidal, I was spiraling out of control – I was not safe. My best friend, my mum, and I felt unable to manage and that I should have been in residential care. We expressed this in every way we could but each time were told that there was no way they could help me.
Considering I have a complex history of mental illness, I find it hard to believe that staff never seemed sure what to say to me. One psychiatric nurse said “it’s just a break up love” and one psychiatrist said “I am afraid there is no treatment for your condition.” Taking a suicidal patient, telling them there is no treatment and then sending them on their way does seem desperately reckless to me.
In the end, my wonderfully supportive best friend ended up having to sleep in my room and check on me constantly to make sure I was safe, as well as try to contain my emotions when I started losing control. That was her job for me during this period, but really that is the job of trained professionals.
What worries me is that the vast majority of patients would not have that level of support available to them, not to mention the incalculable levels of stress it puts upon those caring for friends and family in crisis and the knock on effect on those relationships.
I, along with Mind’s recommendations in the crisis care campaign, believe that there are many, totally achievable ways Accident and Emergency can be improved, as well as other elements of crisis care for people with mental health problems. That’s why I’m supporting Mind's campaign for better crisis care services.
Rachel
You can follow Rachel on Twitter @randerssays and listen to her podcast about her experience of crisis care.
To get involved, join the campaign for better crisis care.
If you are in crisis and need help, find out what you can do and how to get the support you need.
17 Comments
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Thank you for posting this Rachel as it really does paint a true picture of A&E care of those in mental health crisis. For this exact reason I have recently not rung crisis services for fear of the above happening but ridden it out alone at home.
I remember years ago I was admitted to a cardiac ward after a suicide attempt and two nurses were making the bed opposite me. The ward sister said to the other (loudly so all could hear), " He shouldn't be on here it is mental health"! The reason I was there was I had an irratic heart beat with the overdose I had taken. I was so shocked and appaled by that statement from a senior nurse I still remember it to this day. I should also point out that I am an EX general nurse due to my illness!
I have been lucky to have worked in mental health since then and have heard many people talk about attitudes of hospital staff. As you state paramedic care was good but A&E is a different scenario. I am now a peer support worker with a mental health trust which means I am working with those affected by hospital admission as a person with lived experience. I feel it really is the way forward and crisis houses that are peer run could help to prevent experiences such as yours and in some countries that is now done. The NHS was designed for all but alas as usual mental health comes bottom of the pile. One day I am sure things will be different and it is through blogs such as yours that things can change for the better. -
It's appalling that emergency care for mentally ill people is so shoddy, if a person is feeling suicidal and desperate, where are they meant to go? If you can't have faith in the emergency services to take care of you, what are the chances that there are people out there who will take their lives, or will do something damaging to themselves instead of seeking help?
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Thanks for your post Rachel. As both a former mental health service user and Mind Advocate your scenario is very true. It was very common for me to see patients at their very lowest, almost tramp looking and completely lost in the hospital system. It is so good to see that Mind still strives to stand up for mental health and get patients rights recognised.
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I have been to A and E in crisis 2 times, once when manic and once when very depressed. When I went to A and E all I was offered both times was a chat with a mental health duty officer who didn't have a clue. I was self harming and suicidal and was told to go home and have a nice relaxing bath!! I worry that I will have a crisis after 5pm or at weekends as there is very little help available at those times. The crisis team have been involved in my care as well and they visited for 5 minutes, checked I was still alive and left me to it. Mental health care is not very good.
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i called for an ambulance 3 weeks ago after coming very close to taking an overdose.As you say the ambulance staff were brilliant,but i was shunted from cubicle to waiting room,and then told i could not be admitted to a ward as it was not the right thing for me even though i begged for my own safety.Then i was discharged and told to get the shuttle bus home which was an half hour journey at 6.00am! Luckily i managed to get through the next few days on my own until i got a visit from the crisis team. When i next saw my g.p and told him i had phoned for an ambulance you could tell by his face that he thought i had wasted valuable resources! How can it be wasted if it saves a life.
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Thank you for the comments. I think the care of services such as the crisis team depends completely on the region you happen to live in - postcode lottery. I am not convinced bad A&E care is not pretty universal at this point though. Continued campaigning on this issue is more important than ever with the ongoing political climate regarding the NHS and the cuts to welfare and the voluntary sector.
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I went to A&E after [an overdose].i had an initial assessment and asked if I could wait in a cubical but they said no. I waited a further 3 1/2 hours in reception. I actually took a few more tablets whilst waiting. I then saw a dr who asked me no questions regarding my mental health or if it was delibaerate. I then had an ECG which came back ok and was being discharged. It was only because i insisted that i really couldnt cope that he went away and came back saying he had found a bed on the obs ward. I was put in a ward with a severely confussed elderly patient who probably had some sort of dementia. she cried the whole night and increased my distress massively. The nurses said there was nothing they could do so i didnt sleep making me feel alot worse. the next day i was moved and the consultant said why hadnt i had treatment. to which i was confussed. I then discovered the dr who admitted me should have treated me with a medicine via a drip to stop the paracetmiol affecting my liver. she ordered blood tests and for this treament to be administered. I had the biggest panic attack I had ever had almost passing out, the nurses came over and simply said theres nothing wrong and closed the curtains and left me. I was utterly worse than when i came in. In the end I demanded to see a dr as i was so irate and asked specifically for him to give me some diazapam to calm me down/help me sleep and something for my headache. after 2 days I was discharged after only having a 5 minute conversation with a mental health person not a psychiatrist. THey didnt notify my drs or consultant either. I called up and begged to be re admitted a few hours later but they said no. I had no one to call on. no follow up. essentially my experience was really poor and actually worsened my mental health for a while. (my consutant now is amazing however but my long term counciling was stopped due to nhs budget cuts last year which has put me back)
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This is a scenario most of us with mental health issues will recognise. I was admitted to A & E on my birthday as I was suicidal following a relationship break-up and friends were very concerned for my safety. I was processed & 'tagged' and then left all night, nobody spoke to me until the early hours of the following morning. Thankfully friends stayed with me all night. I was sent home with the promise that the crisis team would be in touch. I was seen by the crisis team 2 days later and basically told to wait for the assessment from the CMHT that I had been waiting almost a year for. When that assessment finally happened 4 months after my crisis incident, lasting a mere 20 minutes, I was patronized & told how well I was doing, the assessor glossed over my lifetime of depression & trauma, and told me I would get over my heartbreak as there were 'plenty more fish in the sea'. The lack of provision of support & care for the mentally ill is a national scandal
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After an overdose I was admitted to a mental health hospital. I was left alone in my room often crying and or pacing. I had a huge row with someone on the phone and went to my room hysterical. No one noticed or if they did did anything about it. My 'named nurse' never spoke to me once the whole time I was there. My experience was one of the worst of my life and I hope I never have to repeat it. The only kind words I had during the whole experience, from A&E to the stay in hospital was from a porter who sat with my outside while I smoked a cigarette.
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I have been to A&E on many occasions in the last year and they have b been absolutely useless. the Crisis Team visited initially after i was discharged but most stayed ten or fifteen minutes and said "if you need us just phone".....emmmm excuse me...i need your help now!!! Some were better than others i have to say, but generally they really werent bothered, i was just another pain in the backside...and to be honest they wouldnt know a crisis if it jumped up and bit them!!! I dont often phone the crisis team because of the above and also because the last time i phoned the woman said "i dont know who you are, i will phone you back in 10 minutes.....and somebody else phoned back over half an hour later!!! And stayed on the phone two minutes, told me to go have a bath and read a good book. mental health care is absolutely diabolical and unfortunately i think the problem is nationwide.
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I am so greatful that people are exposing the reality of mental health crisis care. I suffer from mental health problems and was in an abusive relationship. I was taken to A and E following a suicide attempt and was then left alone in a room with a box of valium for 2 hours. After taking all of the valium. still in severe distress, they decided to discharge me in the middle of the night. I couldn't return to my boyfriend because of the abuse so I ended up on a friend's sofa who himself was suffering from mental health problems. The following day, my abusive partner along with his mother turned up on the door step shouting abuse. Behind them were the crisis team. Instead of talking to me, they discussed my situation with my abusive partner, who I was trying to get away from. They broke confidentiality by telling him about my diagnosis without my permission. In a panic I ran away to a shop where I overdosed on painkillers. In the end my mum had to come and get me, driving 2 hours to take me to her house and it wasn't til the next day that I ended up in hospital because of the painkiller overdose. The only way I could get any proper help was to move away from Derby where the crisis team had let me down. Now I live in another city where I was taken care of by a much better crisis team. I think that treatment varies dramatically between areas and I agree that A and E as it is now is far from being equiped to deal with mental health problems.
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After an overdose I was admitted to a mental health hospital. I was left alone in my room often crying and or pacing. I had a huge row with someone on the phone and went to my room hysterical. No one noticed or if they did did anything about it. My 'named nurse' never spoke to me once the whole time I was there. My experience was one of the worst of my life and I hope I never have to repeat it. The only kind words I had during the whole experience, from A&E to the stay in hospital was from a porter who sat with my outside while I smoked a cigarette.
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Along with the shocking ways in which A&E tend to deal with mentally ill patients, the whole National Health System seems to be deteriorating in terms of the knowledge on the sorts of care and treatment it can offer.
The thing that comes to mind most prominently is the fact that there seems to be a lack of communication between one member and another. As my dad would say: "It would seem that the left hand doesn't know what the right hand is doing."
My dad was scheduled to see a new psychiatrist a while back and the attitude she had inevitably made him never want to go back there again. With a vast amount of medical history and many many notes, you would have thought that they would have taken the time to look in to the patient's history, rather than just assuming that they are there for the first time.
With a lack of cohesion between the services on offer by a range of organisations, it is no wonder that people are finding it difficult to ask for help. Being some what "shoddy" and "unprofessional" gives off a lack of understanding which is something that should be avoided when we are dealing with peoples' lives in terms of the complexity of their mind.
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Mental health workers may not like me saying this but crisis teams are there first and foremost to prevent admission to hospital, they are whaat one doctor told me the 'gatekeepers'. They will tell you you are doing well when your not, there are time limits etc etc.
This is because like in my area wards are being closed to accomodate 'bedblocking' from general hospitals. No one complains because mental health unlike cancer, elderly care and children's services are not media and society friendly. The only time you ever hear of mental health is when someone else is hurt or killed by someone who is severely ill.
The above posts prove that 'danger to self' means nothing anymore, it is not the fault of staff but they could at least speak out and be honest about how things really are.
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It makes me very sad to read all of these comments. I took an overdose 8 weeks ago and was taken to hospital by ambulance. The paramedics were very kind to me on the way to the hospital and tried their best to make me comfortable when we arrived. A&E was extremely busy when I arrived and I had to wait on a trolley in a corridor as there were no cubicles free. I found the nursing staff very rude, proding and poking and doing tests without explaining what they were doing. After a couple of hours I was seen by a doctor and I have to say he was amazing. He took me to a quiet room and genuinely seemed interested in trying to understand why I had tried to commit suicide. I was able to tell him that I had been having regular appointments with the CMHT and how I felt the psychiatrist who was treating me was dismissive and never listened to what I was trying to say. I was getting so frustrated as I knew I didn't feel right and something was wrong but she never took me seriously and sent me back to work when I was still mentally unstable. I felt a sense of relief when the doctor said to me "you're under the care of the CMHT, you're attending all of your appointments so something is going wrong for you to be presenting in A&E". He then went to get the duty psychiatric nurse to come and talk with me and by now my husband had arrived. She was amazing as we both explained how unhappy we were with the treatment we had received by the psychiatrist and everything I had been experiencing over the last few months. It felt so good that someone was finally listening and was able to help. She explained that I could request to see another psychiatrist (it seems obvious now but i never thought i had a choice) and also explained options with medication. The following morning she phoned my GP and my psychiatric nurse and basically kicked ass. I am now working with a new psychiatrist and progressing well.
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My eldest son suffered severe depression and a psychotic breakdown. On several occasions he was taken to A&E or brought home by the police having become lost or confused. Three christmases ago he was so ill that the A&E psychiatrist was prepared to admit him but asked us to please take him home if we could at all cope since it was so horrible on the ward. He was 17 and our son so we took him home. A few weeks after that he begged me to take him to hospital in the middle of the night as he felt so distressed.He was self harming and scared.We called an ambulance and they took him and I to A&E. They stuck us in a filthy side room with no chairs which was so disgusting that the paramedic told him not to sit on the floor and found us 2 chairs. I was left alone with him for 4 hours whilst he bounced off the walls until finally an a&e doctor came. By the time the duty psychiatrist came(not the one who had wanted to admit him)he was asleep. We woke him but he was by then unable to speak as he had crashed so badly.The psychiatrist said 'If he doesn't want to talk to me there's nothing I can do. You may as well take him home' He wouldn't admit him or give him anything to help despite the fact that he and the entire family (he has younger brothers) were struggling to cope. It was not the last time we were to visit A&E but it was the worst. There is however,light at the end of the tunnel. 4 years on he has started a uni course and although not free of his health issues is learning to cope
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A&E and liaison are not interested in self-harm/suicide attempts unless it fits their definition of a serious suicide attempt and the person needs to not have a diagnosis of PD in order to be taken seriously. However that doesn't appear to translate into anything meaningful being offered, as is clear on this thread [as it is in abundance all over the net] crisis services are beyond a joke and are infact actively damaging. The police are getting p***d off with being used as a makeshift crisis service [when they won't attend] or to do their work with 'welfare visits' as well.
If this level of shoddiness existed within in any other medical speciality there would be questions in the commons and inquiries
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