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A relative has been sectioned after an attempt on his own life and psychosis (he’s convinced that people are after him). He’s in his early 70s and lives alone with no immediate family other than a sister who can’t look after him.
Presently he has been admitted to mental health ward that is miles away from his home or his closest family, a 3 hour round trip on public transport.
Nobody in the family has the space to take him in. He has his own house, but as recent events have proved, he can’t look after himself.
This has only happened in the last 24 hours and as his nearest able-bodied relatives I suspect that we are going to be getting involved.
What happens next?
Used to be 28 days of staying their to be 'assessed' I don't think we were even allowed to visit in that time period... Although this was all 25 years ago.
I had someone sectioned once, for not wildly dissimilar reasons. They let her out after a few days as though nothing had happened.
Good luck. What a horrible situation.
My brother in law was recently sectioned. He spent 28 days refusing to engage with the mental health counsellors and was then released to go back home without any medication or support. It's been a total disaster and I really don't know what the answer is. We called round to see him last week and found that he'd ripped the toilet out of the bathroom and placed it in the middle of the lounge as it apparently looked better there. Each to their own and all that but I wish he'd turned the water off first.
No direct experience of this exact situation however some experience of something close. Don't wait for call backs. If someone says two days. Phone them in two days to check. They will be too busy to phone you. Some services are outsourced to charities. There can be gaps between responsibility of different agencies. You will need to keep track of things and chase people. You will effectively need to manage his care. Good luck.
As above after the initial 28 days they can extend it.
We are going through this with the FIL at the moment - sounds like a similar situation. THis has been ongoing since June last year. They have extended the section a number of times.
The services have been very good. It is difficult to get information about what is going on sometimes and it has been a very slow process. He is currently having ECT and it seems to be having an improvement but it is a last resort.
Even though he cant look after himself I doubt that you or other relatives could look after him. I think my wife feels guilty sometimes but at the end of the day we have a 9 year old at home and we wouldn't jeopardise him living in an environment with someone with those kind of issues. If he isnt able to recover then it would a care home unfortunately that will likely specialize in people with mental health issues.
You have my sympathy, my brother in law was sectioned quite a few years ago, he phoned the police and told them he was going over to his mum and dad's house to kill them . He changed from being really placid to really aggressive we think due to drug taking . The things he used to say to my wife on the phone would make your blood boil .
One day he phoned her and said " It's your brother, not the one who killed himself as that would be scary " ( That actually happened)
Though it's been a long time and he seems stable through medication I still can't have in him our house he just unnerves me .
He missed his father's funeral even though we called for him , when we did finally find him a few days later he laughed and said " Oh I missed dad's funeral didn't I I overslept" 😡😡😡😡
Section 2 or 3. There is a BIG difference and huge future implications between the two. Good luck.
Thanks for the feedback.
Waiting for more information from the hospital then we'll see where we are.
The other thing is being older he is a vulnerable adult. I don't know english law on this but basically he should be properly assessed prior to any discharge - not just sent home again to an unsustainable situation. There will be social work input
A relative was sectioned 25 years ago for a bi-polar related breakdown. Relatives were allowed to visit after the first day or so. While in hospital they managed to get medication regeime sorted out. Thereafter stable with a home visit from a CPN every so often. More frequent at first then down to something like monthly or bi-monthly. Pretty normal family life after that. Working. Etc.
Had another episode last year which was sorted out after a voluntary admission for a couple of weeks. Obviously every patient is different and services are different in every area but there is no reason why with the right care mental health issues can't be sorted out. Every case being of course different. My relative was living with a partner which is obviously different from a 70 year old living alone. It may be the case that a 70 year old with some mental health conditions would be better of in residential accomodation. This would mean council/social work involvement as well. I have no experience of this side of things.
Longer term. if this episode is controlled any you are the next of kin that may become involved a power of attorney (medical and financial) would be very handy. Won't help now but he returns to living at home and has a further relapse it would help then.
Is this his first "episode"?
Big difference in potential outcomes between 1st and Nth episode. ie, much better if 1st. Little hope of recovery for a 70+ yo that's experienced several episodes (sorry); it just becomes a revolving door situation.
He will be on a Section 2. Would he stay voluntarily if not sectioned? Will he accept medication? Will he accept support?
MH services are so stretched. I fear he'll be discharged back home, assp, without a sufficient support package in place.
I've been involved in these situations as a carer, as a professional, and have been very close to being the patient. My heart really goes out to anyone in this situation.
@stanley. He's tried twice in the last week, but this is his first episode. The decline has been over the last three or four months.
He was sectioned because he wouldn't stay voluntarily, won't take his meds and probably won't accept help. As far as he is concerned he's ok.
Dont panic. He is where he needs to be at the moment. He may well improve with medication. They'll do a full range of health checks to rule out possible physical causes. Ward should welcome any info you can provide about his social circumstances and recent changes or stressors. Next of kin (his sister?) should have been consulted re section. He has right to appeal against his section. NOK will be asked again for opinion. Any info you can provide re his past and recent history, and support network, or lack of, will be valuable. Find out who his key-worker / care coordinator on the ward is, and liaise with them. If they are unavailable / useless, ask for the ward manager. Your relative has the right to decline to give "consent to share information," which means that the ward wont be able to tell you much / anything about how he is doing, but dont let that stop you from communicating with them. Given his age / vulnerability / risk, the ward are unlikely to rush to discharge. When things have improved there will be a discharge planning meeting, this is a legal requirement, its called a Section 117 meeting.. Community mental health team will be involved for ongoing monitoring and support. Crisis and home treatment team may be involved initially to facilitate early discharge and provide closer monitoring after discharge. Consideration may be given to a funded care package if he needs practical help at home. The fact that he has been sectioned may make him eligible for some funding re social care, but only if Section 2 is converted (extended) to section 3. Apart from medication, he may benefit from psychological interventions, but this is unlikely to be offered whilst he is in hospital. CBT has good evidence base for both depression and psychosis. I don't know much about dementia assessments and care, but given his age, I'd expect this to be considered, and he's likely to be followed up by older people's community mental health team, who will be consider.
You aren't under any obligation to look after your relative, but you may be able to nudge / steer / request / challenge if you don't think he's getting the care he needs.
Easy to shpeil stuff this as a mental health professional, but I know it feels very different when its your friend or relative who is suffering, and you're dealing with a buerocratic system.. If you or his sister are feeling stressed, ask about carer's support.
He may really appreciate a call or visit from you.
I hope your relative improves soon, and take good care of yourself
For us a stay until ready to leave is normally followed by a return home with Crisis Team support until can be handled by regular MHN.
This is long term and regular contact with MHN generally avoids admission but things get too much or out of sink every few years.
Section 2 for assessment and section 3 for treatment. Can't remember the name but you can appeal against the section but if he is actively suicidal with a plan and no supports they're unlikely to release him. Or at least, I wouldn't like to be the Duc who signs his discharge paperwork. Sounds like community older adult team needs to be involved.
I think a lot will depend on if/how well he engages with the support. An ex was sectioned a few times (bi-polar which led on to other issues, including psychosis with hearing voices etc.), she would take the meds whilst at the unit but after discharging would stop (as they made her pretty lethargic/zombie-like) and she answer the door to the crisis support team so after a few months she'd end up in a bad way and sectioned again. I think one time they gave her slow release meds via injection which at least meant it wasn't relying on her voluntarily taking pills each day but after the effects of that wore off it was back to the same cycle. All the while she'd refuse to engage with counselling of any sort (although very little was offered anyway) so sadly I couldn't really see how she'd ever improve (we'd split up after a couple of years of me trying to help but eventually becoming the person her psychosis caused her to target so I couldn't be around at all).
Great post Balfour
@Balfour
A really great post. HtS, worth printing that out as a nice little road-map and reminder.
Precisely why I started this thread!
You've got to love the knowledge, care and support this place offers when it's needed
Update:
He’s been diagnosed as suffering from severe depression but isn’t unwell enough to be kept in, so they are discharging him.
The options are:
1. Send him home. A non starter as the state of his house is what brought on the depression.
2. Get him in a care home, and ultimately sell his house and raid his saving to cover the cost.
3. Move him in with his sister and husband (both registered blind) who are the only ones with a spare room, but on a strictly temporary basis. In the meantime buy a flat close to family for cash with his considerable savings. Then sell his house and put the proceeds back into his savings.
His sister agreed to Option 3 without discussing it with anyone, so our hands are tied. We can’t have him staying with her for too long because the stress will kill her. Fortunately there is a flat on the market about 5 minutes walk away, but the estate agent says that there is quite a lot of interest. The wife’s brother has declared that he is too busy to help, so it is down to us.
He agrees that buying a flat is the best option. He’s obsessed with not spending any money, so a flat should at least hold or grow in value whilst paying for a place in a home will drain it away.
Stressful! But I suppose that we are in a fortunate situation that there are funds available. Just hope that we can get the flat!
He should not be discharged anywhere without a proper formal assessment of the suitability of the place as he is a vulnerable adult
Again I do not know the English rules precisely. In Scotland a SW and OT assessment is mandatory IIRC
ASk on the ward who is making the discharge arrangements and who is the responsible social worker and what the discharge plan is. don't be fobbed of with "its a simple minimal discharge"
That sounds crap Harry... humans are at times selfish bugger and it's great to see you don't fall into that catagory.
@tjagain Thanks for the advice. We are going to hospital on Sunday and will talk to them armed with info from this thread.
His sister is a bit of a soft touch and they have dumped him on her. We told her over and over again that she isn't capable of looking after him, but she still agreed to it. Before his section he was turning up at her house daily with stuff (an hour away on public transport), angling to move in. Looks like he has got his way!
I think that they could cope for a week or two, but anything longer than that would be too much.
We need to get him into a place of his own that is small enough to cope with, warm and near family.
Check what discharge rules are for a vulnerable elderly adult as he is.
TJ - ‘Adult at risk of harm’ is the term now for ‘vulnerable adults’ in Scotland. Three point criteria would need to be met to confirm this - Social Work assess this.
Also, no mandatory right to an assessment. At local authorities discretion.
Sorry to digress. He should be followed up at least and you are right to seek clarification of what will be offered.
Ta Dander
IIRC all adults at risk must be assessed before discharge by the hospital team for suitability of discharge arrangements but its been a while. Certainly all our patients were. thats not a local authority assessment but a healthcare one
Yep sounds right TJ, sorry misinterpreted your point somewhat. I have known wards to make referrals to Social Work but it not to accepted due to eligibility criteria etc. It’s different all over the country though.
No worries.
After a manic weekend we’ve made some progress.
I saw somebody in the hospital yesterday and they informed me that there was no way that they would discharge a vulnerable man into the care of a couple of blind pensioners. Then we got home to find that a “carer’s pack” had been delivered to my MiL’s house! That went straight in the bin.
When I did see him I thought he looked like a beaten man, but other members of the family who saw him earlier in the week and speak to him on the phone every day said that the improvement was huge. He wasn’t raving, he just looked tired.
We’ve put in an offer and had it accepted on a flat that is minutes’ walk away from family and small/modern enough for him to cope with.
Let’s hope that this is the start of getting him comfortable and safe.
Right then, time for everyone to put their feet up for the rest of the weekend… oh… hang on…
I saw somebody in the hospital yesterday and they informed me that there was no way that they would discharge a vulnerable man into the care of a couple of blind pensioners.
Any chance of getting that in writing or even an email? Anecdotaly I have heard of totally unsuitable discharges being done. against the advice of professionals
@tjagain MiL had a phone call with the hospital yesterday and they confirmed that the notes had been changed to say that she wouldn't be having him.
Good. The pressure on hospitals especially psychiatric hospitals to discharge is huge. this can lead to poor discharge arrangements
Well, after all of the bullshit that we have been fed, on Monday they are going to stick him in a taxi without giving a single solitary shit where he is going to end up.
We've got him a bed in his nephew's spare room until the flat is ready.
Bloody hell, sorry to hear that Harry... I'm not entirely surprised though.
The safety nets that used to be there are gone or full of holes.
He's very lucky to have you guys doing all this for him.
Yeah. Not best chuffed.
Luckily my brother in law and his wife have stepped up otherwise he'd be couch surfing.