I Hate Psychiatric “Services”

Sorry folks, bit of a rant here…but I last slept 22 hours ago…
We got a call to a patient who was “Depressed – not moving”, normally it's some teenager having a strop, but this time it was a little different. Basically the patient suffers from depression, was discharged from the local psychiatric unit three weeks ago and has recently had her dose of anti-depressants reduced. Yesterday she was crying all night, and tonight she was just sitting staring into space, refusing to make eye contact and not talking at all.

One of the things that we as an ambulance crew cannot do is physically remove someone to hospital if they don't want to go – that would be kidnapping and is frowned up by the law. This young girl wasn't going anywhere despite my best attempts to persuade her – she just wasn't communicating.

The solution would be simple – call the Community Psychiatric Nursing Team to come and assess her, and if needed arrange her compulsory removal to the psychiatric unit ( called a “Section” under the Mental Health Act). The problem? It was 11pm…

First off I phoned the psychiatric unit that she had received treatment under, after talking to two idiots who had trouble understanding plain English, I finally managed to get the number of the CPN team. Now the LAS is quite smart; when we want to arrange an outside agency we go through our control and all the telephone conversations are recorded…so if someone says they are going to attend they damn well better. I got onto Control, passed the details to them and waited for them to get back to us.

I'd just like to say that in eight years of medical experience I have never had a simple referral to a psychiatric service, they always seem to try shirking any form of work – by “forgetting” you or by being just plain obstructive. Maybe I'm just lucky and get the idiots every time.

Needless to say we waited…and waited…and waited…from 22:20 until 23:00 we waited; then at 23:02 Control got back to us. Apparently the CPN team all goes home at 23:00 and hadn't answered the phone until 23:00 on the dot. So they refused to visit the patient – the moral so far is if you are going to have a psychiatric breakdown in Newham – don't do it after 22:00.

So we switched to plan “B” which is to arrange the out-of-hours Social Worker to come and visit as they double as Psychiatric liaison. Again we went through Control and waited…and waited…and waited…Finally we heard back that the social worker would ring the family and would like to talk to me. (Outside agencies try this trick, as they know the patients phone isn't being recorded, and so can say whatever they want with any disagreement being my work against theirs) The social worker explained that she was very busy and so would prefer not to come to see the patient and have I tried the out-of-hours GP?

Back to Control I went and got them to try and contact the out-of-hours GP (A GP for those not in the UK is the patients “Family Doctor”) Can you guess what we then did? We waited…and waited…and waited… Finally Control got back to us and informed us that the out-of-hours GP hadn't arrived for work yet and that when they did, they would have to see two other patients first.

All through this time the patients family were very understanding and were happy when I explained that the GP would call at some point in the night. All I could do was advise them to remove anything that the patient could use to hurt herself, and keep an eye on her – calling us back if they felt the need.

Total amount of time an Ambulance was tied up trying to get outside agencies to DO THEIR DAMN JOB – Two Hours and Nineteen Minutes. And not the worlds most satisfactory outcome.

As I mentioned to our Control – sometimes you feel very lonely out there on the mean streets of Newham.

16 thoughts on “I Hate Psychiatric “Services””

  1. Ok, this reply is a tad late – I'm new to this blog (and it's great by the way!)As the wife of a Schizophrenic it's refreshing for me to read someone in NHS services admit that the people who work in mental health are… well… crap. I agree with everything you say. I'd also like to add that psychiatric nurses often treat the patients and there families like an inconvenience – as if they're actually paid to watch tv and drink tea, and patients just get in the way.

    As for the community mental health team – one time my husband had to be “sectioned”. I called the out of hours doctor in the morning at the weekend and it took until about 9pm to finally get the right people to see him before he could be taken in.

  2. You're telling me, there are actually people that come out a visit and do an evaluation!? Wow, we have nothing like that here in the US.Basically, if they are whacked and the cops don't arrest them (or want to deal with it) we have to tote them into the hospital. We can't restrain forcibly either, don't mind if they are violent or anything, we still have to transport them.

    When they arrive at an already overcrowded ER, the Nurse decides if they need the “Observation Room”, or not and maybe a Social Worker or Mental Health Associate will come down and do an evaluation in the ER within the next 12 hours.

    Of course if its BS, we can always tell the nurse the patient needs to go to “triage”, and if its serious recommend that they go to “bed 12” before we get to the ER.

  3. I've had that exact same type of call – I knew that something was definitely wrong with the patient, but I couldn't convince him to go to the hospital. Bad thing is, here in the States we don't have a roving band of psychs who can come in to check on a patient. Pretty much, if they don't want to go and they haven't expressed any desire to hurt themselves or others, and they're oriented to day/time/place, then I can't do anything for them.

  4. This is what I love about the Internet – you get too see how the other half live…The CPN service is part of the local health trust that care for the mentally ill in the community, a bit like District Nurses go around dressing leg ulcers and giving injections to our older clients.

    The CPN service is supposed to provide a community based care package so that people with mental illness live out in the community and not in mental health units.

    It's cheaper for the government, and when a patient kills themselves it's never really reported. It's only when one goes on a killing spree that the media take any sort of notice.

    It might not work so bad except…most psychiatric nurses are well and truly crap. Whe I did my nurse training all those years ago I spent the first 18 months with a load of psychiatric nurses – and they are the laziest bunch around; half of them were on drugs during the weekend and at least two of them were alcoholics.

    Then I spent some time working in a psychiatric rehab unit – and they don't seem to mellow with age…instead they spend all their time in the office watching TV and drinking tea – only emerging to make sure that the “clients” are fed.

    Of course there are exceptions – the Whittington hospital had a good team the last time I worked there – but that is exceptionaly by virtue of it being unique in that they will come and see a psychiatric patient immediately rather than wait until they are “medically fit”.

    I'm getting bitter in my old age.

  5. A viewpoint from Canberra, Australia.1930 phonecall from my teenage nephew, worried about his mum (who lives alone).

    2000 I pick him up

    2030 Get there, my sister is delusional, hallucinating, doesn't recognise either of us, doesn't know what day or month it is, and is covered with self-inflicted bruises and cuts.

    2100 I'm out of my depth, in desperation phone 000 for ambulance.

    2120 Ambulance arrives. After 10 mins, they agree that she needs hospitalisation, They don't even bother calling the Crisis Response Team (they never answer). Her Psychiatrist is out-of-state, his locum phones the CRT with no answer, so passes the buck to the paramedics.

    2200 After 30 minutes of coaxing, ambulance team calls the cops who have the appropriate powers.

    2245 My sister eventually agrees to go with them voluntarily. They've been trying to pursuade her all this time. Cops are still no-show.

    2300 Arrive at hospital. My nephew and I keep talking to her, trying to get her re-oriented, while we wait in the ER after triage.

    0130 She finally gets to see a psychiatric worker to be assessed. By this time, she'd lucid, her case-worker in contacted and they arrange a morning appointment for her.

    0230 I drive her home

    0330 Finally get to bed.

    That's about 2 hours of ambulance time taken up. I have nothing but praise for the crew concerned, they did everything possible.

    The system, however, Sucketh Big Time.

  6. Yep, ambulance crews aren't really “equipped” by law with being able to deal with this sort of emergency – we carry a load of kit for saving lives, yet this is the job we all hate because we are so powerless.Hope everything was alright in the end.

  7. Alright? Well, she's still alive, and getting treatment.BTW the ACT (Australian Capital Territory) is a little larger than Luxembourg. Population 300,000. A 20 min response time from the Ambulance is remarkably good, all things considered. Fortunately one of the 2 hospitals in the ACT with ER rooms was only 20 km (13 miles) away, almost next door.

  8. Actually, we do have what they call “Screeners” in the United States (at least in New Jersey). They work out of a local Psychiatric ER and will come out (with a police officer) to assess the person for danger to self or others. If danger is detected, they can call an ambulance which will transport the person to the ER with paperwork from the Screener recommending hospitalization. If the person is resistant, the police can use force to subdue the person and take them in the police car.In the ER, the doctor must assess the client within 24 hours and if they agree with the screeners, the person can be involuntarily committed.

  9. Er… exactly why is somebody who is just “not communicating” a medical emergency needing an ambulance anyway? Bleeding, yes, not breathing, yes, broken limbs, yes, but who would call an ambulance for a perfectly well person who is just staying silent? Psychotherapy, yes, emergency ambulance, no. Why is this person going to be any better off in casualty? I'm sure if they ignored them for a bit and they realised nobody was taking any notice they would just get bored.

  10. Hmmm I feel your pain as a police officer, getting social services out of hours and GP out of hours is a nightmare. If they are in their own home we can't section them under 136 either we are powerless!! (the odd try to get them outside has been tried and succeeded though! EDT (emergency duty team for social services are a nightmare) one example a young female taken into police care thanks to EDT and their incompetence 3 officers time wasted for a total of 9 yes 9 hours!!

  11. This reply makes me so angry, I just had to comment. Ignoring someone who is showing signs of a psychotic break is as dangerous as ignoring someone who is showing signs of an MI.I do hope to god that you, anonymous, are not in the medical profession.

  12. Thanks, R, for being such a caring person and so good at your job. A few years ago, I was on the other side of this situation and later found that my parents had called the crisis team (about which I will soon be blogging!) and the out of hours GP. The former made my mum feel so angry and let-down that she ended up hanging up on them and the latter were too busy to attend. My dad called an ambulance and the paramedics talked to my parents and then took me to A&E.Routine blood tests proved they did the right thing.

    I don't remember any of this as I was dissociating, but my parents were concerned because I was depressed and then uncommunicative. I am very glad they didn't ignore me and wait for me to get bored…

    Cat

    x

  13. Very good. On the other side from you, have learned the system does not work….for those who need help. So you end up picking the pieces up. But kind of first time heard anyone mention all the people involved who are just not there.Unreal am saying this, the Police have met due to overdosing, meds, drinking have spoke more sense in five minutes then heard for a long time….never knew as they said, how so much they are about helping people.

    Things lead people to this place, after overdosing drinking, refused treatment, despite paramedic, police, at my home, you stated they cannot do anything in your home?, although this policeman took me to the hospital put me under section 136 is it? then in a police cell, then back up to hospital after seeing the Dr there.

    Today am battling with drink (which was vehicle to OD a few times two weeks to be honest…long story, severe illness/depression after years of abuse, but still here) then to get the help from there on, was a time really disliked that police man for taking me at that point, to this day cannot recall how or why he arrived in my home, someone must have asked them to do so, although he was caring, today kind of glad he did, but its a long road.

    So you get the end of it like this girl, hope she finally somewhere gets the real help, you are passed through a system which as you describe not only does not work in an emergency or situation like you were called too but is not working for the ones like the girl

    It is catch 22 now for me, control the drinking, have no medication nothing allowed, then they will detox me, then go on from there. Appointment soon….

    Same for everyone in my place found out.

    They called the out of duty Social Worker for myself, apologised over and over to the policemen who had to stay with me every minute, did not want to be there, certainly did not want to waste anyone's time, my only regret they had found me, taken myself in, they refused to let me go so had to stay, those guys were with me hours sat in A & E from about 1.00pm to 11.00pm…….(Saturday) personally just wanted to go home, kept asking to do so, felt awful about them having to sit there all that time…..although ever so nice about everything. Seemed to me like endless phone calls just like you stated.

    btw think you guys do some real good work, so do the Police, found out that sometimes by the time you reach yourselves, there are people in the system that is what its all about. Even a guy on the crisis care number told myself he hated the system that they all worked in………….. psychotherapist.

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