I’m fully accepting of the need for some people to make suicide attempts and I’ll treat them with the same respect that I treat all my patients. However, I’m only human and sometimes those people really annoy me.
We were called to a 25 year old woman living in a shared flat in a nice part of town – she had taken an overdose three hours earlier, it was now 2am in the morning so we were at the location very quickly.
We were met by a housemate who told us that she had taken some Ibuprofen tablets earlier – she had then sent text messages to her friends telling them that she had overdosed. Then she refused to answer the phone when her concerned friends had tried to contact her.
As we walked in the door the patient told us, “I’m not going to hospital, I’ve taken 20 Ibuprofen before, so I know I’m safe”. The patient had taken around eight of the tablets which, while an overdose, isn’t life-threatening. This meant that the patient knew what she was doing, and I considered her actions to be manipulative rather than a serious attempt on her life or even a parasuicidal action.
Still, it didn’t matter, we still treated her with professional care – we advised she should come to hospital so that we could be sure that what she was saying was the truth, and so she could receive a psychiatric assessment.
But she was adamant that she wasn’t going to go to hospital – we tried to convince her, her friends (some of whom had driven for three hours to reach her) tried to convince her, but she wasn’t going to come with us.
The way she was talking and acting – laughing and joking, not in a “parasuicide has been cathartic” manner, but instead a more, “I’m the centre of attention” fashion – coupled with her history led me to believe that she wouldn’t be in serious danger if she were left in the care of her friends. While I knew that the overdose probably wouldn’t harm her, our protocol and a wise protocol at that because I can always be wrong (IANAD*), dictated that we talk to our Control, and that they contact the poisons unit for the all clear.
While waiting for Control to get back to us, another of her housemates arrived at the scene – he was obviously a very sensible chap, a drug counsellor he told us some more about her history and agreed that while hospital would be the best place for her, we very well couldn’t kidnap her. He told us that he was more than happy to take responsibility for her and would keep an eye out for her.
Just as we got the response from our Control one of the patient’s other friends came running out and told us that she had started to cut herself.
So…we went back inside and found her with some very minor cuts to her arm.
That was the final straw – she had undertaken self harm while her friends were present and while she knew an ambulance was sitting outside the house. There was no way that we were going to leave her at home.
But still she refused.
I’m still not allowed to kidnap her.
I went back outside and told Control what had happened and that they should get the police to come to this address as in cases like this the sight of some ‘boys in blue’ often changes the patient’s mind.
Returning to the house I tried a little trick that has come in useful in situations like this – I offered her a choice.
Choice (a) was to come to the hospital with us under her own power.
Choice (b) was to wait for the police to arrive, we would then arrange for a social worker and two doctors to attend in order to have her ‘sectioned’ under Section 2 of the Mental Health Act 1983. She could then be handcuffed and dragged from the flat kicking and screaming, ending up in the padded room at the local hospital.
With some help from her friends she chose Choice (a)
This is good, because Choice (b) is a royal pain in the rear to arrange, especially at 2am.
So the patient ended up at the hospital where her wounds were dressed and was left waiting for a psychiatrist to see her.
But, as I may have mentioned before, referral to psychiatric services never go smoothly – so when, after three hours, no psychiatrist had arrived (it is after all a long 200 yards to walk from the psychiatric unit to the A&E) she took her own discharge.
Another job well done…
A round of applause though for her friends who were absolute diamonds throughout this whole saga – supportive, sensible and caring – everyone should have friends like them.
*IANAD – I am not a doctor (nor do I want to be one)