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.