"42 year female, having a breakdown, smashing things, possible mental health issues"
As I have briefly discussed before, the problem with Mental Health in this country is huge. For many years the issue wasn’t really in the public eye, patients were kept in large hospitals / asylums and forgotten about. This much criticised institutional care of the 1960s and 1970s finally ended in the 1980s when Margaret Thatcher introduced Care in the Community. Its aim was to deinstitutionalise mental health and adopt a new policy of care, whereby patients could receive their treatment in their own home. A great idea in theory, but in practice it has failed on a monumental level. And why? Because communities themselves are scared of mental health. Inaccurate depictions of conditions in the media have fueled stigma and has caused the problem to be feared and ignored. Despite the systems obvious failings the government has no intention of doing anything about it, so for now the vicious circle of hospital admissions, discharges, sectioning and no access to treatment will continue. Come 5pm GP's don't want to know, crisis teams go radio silent and unless patients are willing / able to travel many miles for expensive, private care there is no help available at all. And don't even get me started on weekends!
Like the police, the ambulance service is stuck between a rock and a hard place when it comes to treatment. Although there are various sectioning options to both of us, implementing them is an uphill struggle and more often than not the patient is released by the hospital hours later. In an archaic system, the police have very few powers when a patient is in their own home. The only tool at their disposal is a section 135 of the 1983 Mental Health Act which allows a patient to be taken to a place of safety, but it isn’t a decision they or we can make ourselves. If certain criteria are met, 2 Doctors (one who is section 12 approved, a social worker and an ambulance are required to implement the section. Obviously, thanks to care in the community, the vast majority of patients we see are in their own homes and there lies the problem. Trying to organise all these medical professional at short notice is near impossible, time consuming and costly. It is of no surprise this is normally a last resort.
This particular day, we arrived on scene and waited for police as is customary on apparent violent patients. We entered the building (hovering behind the boys in blue) and headed up to the 8th floor. Our patient was cowering in the corner of the corridor screaming. The police made the first contact and were met with more screaming and swearing. Unfortunately she was Romanian and didn’t speak any English. A glance inside her flat showed extensive damage, everything appeared broken and looking at our patients hands it was clear how. In between the screaming she would mutter words to herself, her manner was very nervous and edgy. I tried talking to her but it enraged her more. She started spitting and trying to bite so was restrained. Not arrested. It was clear she had to go to hospital for a Mental Health assessment. The question was how and under what method. For us, her being under section would be ideal, for the police, her going in voluntarily would be ideal. There was also a grey area as to which section she would come under. Did the corridor outside her flat constitute a public place? If it did, the police could remove her to a place of safety. Or does it come under that of a private dwelling? In that case, a team of Approved Mental Health Professionals (AMPH) would be required for a section 135. Unfortunately for us, the patient, and the hospital, none of the above happened.
I don’t know police policy, but in this instant, I believe correct procedure wasn’t followed. The patient was handcuffed, brought downstairs to our waiting trolley bed and put on our ambulance. She was neither under section, nor under arrest. Technically, she was being taken to a place of safety ‘voluntarily’ yet her struggle would suggest anything but. We conveyed to hospital and handed over to the nurse. She called the police over and asked if the patient was under section. They told her they couldn’t 136 her because she was at home. 135 wasn’t mentioned!! (To be fair, read my October blog ‘Kum Ba Yah, my Lord’ and you’ll see why!). This is where the problem lies and the never ending circle of mental health begins. Because the patient isn’t under section, the local agreement between the hospital and police is that the police only have to stay there for an obligatory hour. Realistically, with the best will in the world, an hour isn’t enough time to have a mental health assessment in a busy A & E department. Once the hour is up, the police can leave, the hospital don’t have the staff to be able to stay with the patient, nor do the security have the powers to detain. As the patient is there voluntarily, she will be free to leave at any point.
To cut a long story short, we left, an hour later the police left, 20 minutes later the patient left and we are back to square one. A mental health patient, walking the street, striking fear into passers by. And what do passers by do when scared or concerned. Yep, phone 999. And what gets sent to a ‘woman having a breakdown, being violent, bleeding from hands’? An ambulance and the Police. Money, money, money!
While the current laws stay the same and while no alternate care pathways are available, this will be an all to familiar occurrence. No one wants to know. As the side effects of mental health include unemployment, and a side effect of unemployment is alcoholism and drug abuse, a huge percentage of mental health patients are intoxicated. Mental Health units will not accept any patient showing any signs of intoxication so A & E have to pick up the slack, but A & E department don’t have the specialists to deal with it. The police are reluctant to section because of time, the law and paperwork required so will generally assist in convincing a patient to go voluntarily if they can. This however, will prevent a prolonged stay and full assessment in an appropriate unit. Finally, the ambulance service has limited time, resources and options so will generally have no choice but to convey mental health patients to a hospital where they can walk out at any time. Nobody wants the hassle or the responsibility and its a case of cross ya fingers, stick your head in the sand and hope someone else deals with it.
The lack of mental health training that nurses, police and ambulance staff get is a stark reminder of what little priority is put on their treatment. Patients are pushed from pillar to post, while every service that is there to help, tries its best to pass the buck to someone else. Until the problem is tackled head on, nothing will change. Although mental health in the work place is becoming much more widely accepted, with stress and depression being recognised as common illnesses, patients with conditions that attract a public stigma such as schizophrenia will continue to be social outcasts and while that is the case, mental health will continue to be brushed under the carpet and maybe that is what the government wants. The situation is getting worse at an alarming rate, and with the current government ripping the heart out of the welfare system under the banner of 'reform', even the most basic benefits for the mentally ill are being removed. Britain's mentally ill are being pushed to the edge, evidenced by the 8% increase in suicides this year, but maybe these suicides are the savings in benefits that the government want by reform. It certainly seems that way.