"16 year old female, self harming, using glass, ? violent"
I'm often very critical of mental health services. That criticism is based on personal experience in dealing with staff at mental health units, crisis teams and AMPHs. In rather heated exchanges I have been told by mental health professionals that it isn't all bad and there are good staff out there. My response has always been that I can only write about what I come into contact with. If it's bad, then I will say just how bad it is but if and when I get a positive experience I will also share that. Well last night I had one. Not only with a mental health unit, but also a crisis team and the staff I met.
We were called to a private address to a young girl who was self harming. It is always sad to see someone so young suffering as they are and they are often very difficult to interact with, especially with the limited training we have. When we arrived we were pointed in the direction of an upstairs bedroom by an apparently unbothered mother. Perhaps here is one of the reasons she is was self harming in the first place. That aside we went upstairs to meet Amy. She was in her room and having some kind of manic episode. She was very twitchy, on edge and was acting rather frantically. She had the most captivating eyes, and despite her behaviour a really gentle manner about her. She was smiling and talking to herself and sadly, bleeding from her arms. I began talking to her, keeping my distance as I didn't want her to think what we were encroaching on her space. Gradually, as the conversation went on I edged in and sat down. We discussed her recent treatment and then I asked if she had a crisis team. She did. Going by past experience, the prospect of having to go through the uphill, hapless task of getting them out was something I was dreading.
To my pleasant surprise I had a very fruitful conversation with her case worker. I got a full history, a list or do's and don'ts and a promise that she would be with us shortly. And she was. By the time she arrived we had dressed and cleaned the wounds so I stepped out while they spoke. I few minutes later she emerged and said she was going to call her unit to see if she could be admitted there. I was happy with the cuts so if we were able to bypass A & E that would be better for everyone. I overheard an extremely heated conversation between the case worker and the unit.
"I don't care, I am bringing her in, make space"
No idea what they replied!
"Fine, I'll stay with her but I'm not having her sit in A & E for hours on end. The ambulance have said she if fine to come with me, we'll be there shortly"
Boom! So refreshing to see someone go that extra mile and be in a position to insist on an admission to the correct facility. We took them both and left the unit very pleased with the outcome. Normally, that would be the end of that patient for the day but clearly this was no normal day!
About 9 hours later we got a call to the same mental health unit. We started heading round and the screen updated with more details.
"16 year old female, cut to arms"
It was the same girl and amazingly we had got the job. Shortly after her arrival in the afternoon, she had cut herself again with a broken glass. Staff had cleaned and dressed it but when a doctor visited in the evening, he wanted it closed properly at a hospital. We arrived at the unit to be met by waiting, friendly staff. On the walk to their medical room the nurse gave us a full history, one we already knew but useful all the same. Amy seemed relaxed to see me. She also seemed in a much much better state of mind than before. She skipped to the ambulance and was very chatty. The case worker who had stayed with her came with us. It was so nice to see. The staff were very compassionate towards the patients that we saw.
Amy had had a troubled upbringing with huge attachment issues. Her manic depression, low self esteem and history of abuse and neglect were horrible to hear and read, but seeing respond so well to people who clearly cared about her mental well being was great to see. I was a prime example of the what benefits there can be when an ambulance looks for other options other than A & E, when a crisis teams comes out on request, when a mental health patient is taken to the most appropriate place and when staff are attentive and willing to go the extra mile for the right outcome. It also showed the results that can come from continuity of care. Far too often, people complain that they never see the same staff and information isn't passed on. It can feel like starting over, every meeting they have. Clearly, if all areas within the NHS work together, have transparency and support each other the patients will only benefit. I live in hope that these types of jobs will become common place and not a rarity.