The inadequacy of A&E in a mental health crisis …..

I have blogged a few times on my personal experiences when attending accident and emergency departments in a mental health crisis. Every time I have attended, the experience has been hugely unhelpful and in some cases worsened (if that was even possible) my mental health distress.

This week I have seen again many cases of people on Twitter who have been turned away at accident and emergency, spoken to people who have no knowledge of mental health or even sent away with tablets whilst being suicidal.

As I understand it not all accident and emergency departments have liaison mental health teams attached to them and there is also the added problems of different NHS Trusts operating different services in the same area. In my trust for example the accident and emergency is run by one trust and the mental health services run by another. This setup only seems to add to the poor experience and creates a culture of relinquishing responsibility by both parties involved.

I don’t really have any answers but a few things I try and do when I am out in the impossible position of having to go to accident and emergency are:

1.) Try if possible to go with someone – I do though understand that this is often not possible and so apologies that this is just another unhelpful suggestion.
2.) We have triage system at our accident and emergency – I always try and ask at this point what the mental health liaison care is and also whether there is a dedicated area to wait. It is important that the staff realise how distressing it is to wait in this environment when mental health distress is so high.
3.) I ask for a waiting time – they will know one if you went in with a broken arm so this should be no different.
4.) if possible I always take with me a copy of my crisis plan which is useful when by the time I get to see someone I am past being able to coherently manage to communicate much.
5.) During this last episode I have made the decision that I am not going to go to accident and emergency unless it is absolutely necessary so therefore my GP has referred me back to CMHT services. It is worth getting to grips with the system within your trust so that maybe some other care options can be investigated.

Sounds simple!!!!! BUT …….

The problem with all I have said above is that by the time the need for accident and emergency arises the possibility of being able to calmly put in place any or some of the above is pretty small. This therefore illustrates my point that the system as it stands isn’t right. It is putting more lives at risk, hugely endangering patient safety and going nowhere to improve parity of esteem which is supposed to be a priority.

The staff in accident and emergency often do try and do their best but don’t have the knowledge, resource or time to be able to help. With Mental Health beds being cut so drastically this situation can only get worse. Even after 4 hours or so in accident and emergency this hasn’t always led to me getting to a place of safety. In some cases even the crisis or Home treatment team I have referred to have been full and therefore I am left in a worse place than before.

I am unsure of where to go from here in drawing attention to this situation but for my sake and thousands of others something needs to be done.

So A and E in a crisis doesn’t get any better at all

My care coordinator called me earlier today after 48 hours from when I first called my GP. Not sure what the delay was but she said that she would refer me to the Crisis Team also known as Home Treatment Team (HTT). She then called me back and said that she had been told that she would have to see me first before the HTT could. I didn’t understand this & wasn’t happy to accept this because a) I couldn’t get to see my care coordinator when she could see me and b) I needed to just be assessed once and not twice which is what would happen. I couldn’t understand why they don’t realise that if I ask for help and kick start the crisis plan then I need to be taken seriously and certainly not given 2 assessments unnecessarily. The other problem of getting somewhere was also not understood which was frustrating.
I was therefore told that there was nothing else that could be done apart from a and e.
At 3pm my friend and I agreed that I had to go to a and e as so unwell but I was very frustrated by this. We were seen firstly by a nurse who points people to the most appropriate area and then we sat in a quieter area of the waiting room. I was seen by the triage nurse very quickly however she didn’t fill me with confidence. She called the mental health liaison worker whilst I was there and even said ‘I’ve got another one for you’! I just don’t understand why people think that is an acceptable thing to say – you wouldn’t say it about a cancer patient? She also commented on my anxiety and instead of being sympathetic she said I didn’t need to shake! Couldn’t make it up really!
By this time it was only about 3.40pm and it was stressful and exacerbated my anxiety & paranoia. We stayed in the same place the entire time and I probably lost concentration to have a panic attack but no one called us at all. About 6pm I asked whether there was any update and shortly afterwards the mental health worker (which we didn’t know who he was at the time) came and asked for someone calked ‘Helen’. It transpired that she had also got fed up with waiting.
Even though I was still waiting we witnessed the mental health worker having a good long chat and laugh with the security guard for over 10 minutes and then he disappeared. It was only when the original nurse that we saw when I walked in the door saw us still waiting and actually went and found the mental health worker that we realised what had happened. Apparently the mental health worker had been ‘looking for me’ since 6pm – it was now nearly 7.30pm. As usual it seemed that it was my word against his – thank goodness that my friend was with me so I knew he hadn’t.
I was eventually seen and he was quite an amenable man however it is so hard for me to talk to strangers and also he asked me why I had refused to attend the HTT team earlier today! I couldn’t believe that had been put in my notes when I hadn’t refused at all.
I now have a referral to HTT and they are seeing me at 5.30pm tomorrow and will be able to help with PRN meads and support over the weekend. Just seems a completely ridiculous and time wasting way of doing things. When will crisis care change.