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Leaving psychiatric hospital when unwell

(84 Posts)
EmeraldIsle100 Wed 10-May-17 01:52:14

My DD early 20's has bipolar, depression, and bpd and is currently in hospital. She was in our local hospital but got moved to another hospital about 100 miles away because she needed to be on observation and our local hospital didn't have the resources to put her onto observation. She has subsequently been taken off observation.

She is awaiting a transfer back to the original hospital but there are no beds available there. She is really scared and incredibly lonely in the new hospital which is nothing like the original hospital and her mood is going downhill badly.

She is telling the doctors that she is improving so that hopefully they move her back to the old hospital but in reality her mood is low. She feels incredibly low and thinks she needs to change her medication. If she tells the hospital this they will most likely keep her in for at least 3 weeks to supervise the change of medication.

She cannot cope with the thought of 3 weeks at the new hospital. She is struggling to get through the day and I am really worried that she will take her own life which she has tried to do on several occasions by paracetemol overdose.

Given her terror of the new hospital I think that thing she would be better off wcoming home, seeing her key worker, GP, psychologist, friends and family than being miles away from home and lonely and isolated. She could maybe get a bed in the old hospital sooner rather than later. I hve taken time off work to care for her and she could also see the Crisis Team if necessary.

I would appreciate any advice, thank you very much. She is completely terrified in the new hospital.

TitaniasCloset Wed 10-May-17 02:00:44

Not sure what to say but I would lead by whatever ds wants and thinks is best for her. Are you able to discuss the problem with her care coordinator? Will your home be a peaceful structured environment for her?

TitaniasCloset Wed 10-May-17 02:01:13

Dd I meant sorry.

EmeraldIsle100 Wed 10-May-17 02:16:13

Titanias, thank you very much for replying. I honestly thought that if anyone replied they would say I should make sure she stays in hospital.

I have taken time off work and will be here every day to keep an eye on her and take her to various appointments. We are very lucky that we can access regular support outside hospital. Our GP is fantastic and if her health declines we can call the Crisis Team.

To be honest if I asked the staff in the new hospital they would most likely say that she should stay in hospital and if she leaves, they would deem her to be absent without their approval. I don't want to fall out with the hospital so I have to be very careful.

I think it would help her enormously if I let her lead things. She isn't reckless. At the moment she is utterly terrified of the new hospital and as it is so far away I cannot visit her often and the loneliness is overwhelming for her. She is allowed out on home visits and I can see a big change in her when she is home.

Thanks very much for your thoughtful response which is hugely appreciated.

TitaniasCloset Wed 10-May-17 02:48:05

Good. Luck op. Just wanted to add that if she does come home writing out a care plan for her with the care coordinators help would be useful. Also, as I said keeping a sense of structure in the environment like a hospital, meals at the same time everyday and planned activities that she is capable of, so that she eats and gets dressed and isn't sleeping all day up all night and making herself worse.

If she is having a really bad anxiety attack often breaking the day or the hour ahead even into sections and writing out a plan or to do list can help. Eg, make a cup of tea, watch TV program, walk around garden, try breathing exercise, lunch, etc etc that sort of thing.

EmeraldIsle100 Wed 10-May-17 02:55:24

Great points Titanias, thanks again for your advice. You're so right, a sense of structure is crucial. I honestly think her original problem was a sleeping disorder which sparked off a lot of problems.

Really great tips, thanks again. I can go to sleep now LOL

erinaceus Wed 10-May-17 09:28:24

Hi EmeraldIsle100

I hope you managed to get some rest last night. Is your DD a voluntary patient, or is she detained under the Mental Health Act? In my opinion this makes a difference to what I would do in your situation. I've been in a situation somewhat similar to that of your DD and am much better now. One of the things that helped me at the time was a realistic plan that took my wishes into account.

Is she sleeping any better in the hospital? I found the hospital played havoc with my sleep, which was not helpful. One thing I will say is that I did spend X days in the hospital waiting for a bed to come up somewhere else, and whilst it was hellish at the time, I did get through it, largely using the strategy Titania suggests even though I was on the ward. One hour at a time. It was pretty hellish and if you and your DD agree that she will be safer at home it is worth discussing this with the consultant in charge of her care at New Hospital, who may themself be difficult to pin down. (My consultant when I was on the ward was lovely but incredibly busy.)

Not sure that is of any use. Does your DD have someone whom she trusts? You mentioned that she is telling the doctors she is improving and telling you her mood is low. If I were you I would feel back to the ward what she is telling you. Does she have a ward round coming up that you can get to? Apologies if this is teaching you to suck eggs. I found the whole ordeal Kafkaesque myself but I did get through it, in part with the support of lovely people on this board smile

EmeraldIsle100 Wed 10-May-17 12:22:09

Erin I did get some sleep but woke in the early hours. Thanks so much for taking the time to reply and I am delighted that you are feeling better. Believe me this is not a case of teaching me to suck eggs, I need all the advice that I can get!!

My DD has been detained but I heard this morning that has been given authorised leave for the next 3 days.

She is medicated so that she can sleep but her sleep is broken and I wouldn't say she is really refreshed and she tends to snooze throughout the day.

She is finding the wait for the bed in the old hospital hellish and the new hospital is a completely different kettle of fish from the old one. She honestly is not coping with it. I have tried everything to support her including one hour at a time but she is just terrified and extremely lonely. It is a round trip of 200 miles from our home.

Both my DD and I agree that she would be better off at home and the nurse I spoke to this morning agreed that being home would be good for her. The nurse also mentioned that the view is that going back to the old hospital is not a good idea for DD as there are some bad influences there which I agree with wholeheartedly. I take it from this that going back is no longer on the cards.

The reason she has got the leave is because she is telling the doctor that she feels better than she is. She thinks her anti depressant is not working but is terrified that if she tells the doctor this she will be kept in hospital so that they can monitor the change of medication which can take up to three weeks. This worries me as she absolutely hates it. She is prone to exaggeration at the best of times but this is different and it is not just a case of her wanting her own way. She is 20 but acts more like a 16 year old because of her illnesses.

If I feed this back to the hospital I am very worried that they won't let her out for a few days. On the other hand I am not a medic and what if I do the wrong thing??

She doesn't trust anyone at the new hospital because she has serious trust issues which are documented.

My heart tells me that home is the best place for her now and if she gets discharged she will see her key worker and psychologist a couple of times a week. We can see our GP about changing medication and and can do Recovery College courses which she likes. She can also spend time with her dog and go to the gym.

Apologies for the length of this post and again, thank you so much for posting. I really hope that your health continues to improve. I am sorry you had to go through such a tough time but am so grateful for the knowledge you acquired that you are in a position to help us. Take care of yourself.

erinaceus Wed 10-May-17 18:40:30

Hi EmeraldIsle100

There's no need to apologise for the length of the post. It's what MN is for.

If your DD is detained under the MHA, she will be entitled to an Independent Mental Health Advocate. This is a person who is on her side - here is a description.

The other thing that it might be useful for you to know is that the person who is in charge of decision making about your DD's care is known as the Responsible Clinician. She may have multiple doctors involved in her care but there will be one who is responsible for decision-making around leave and discharge. Your DD should have some paperwork with this person's name on it, or be able to ask the staff who it is.

If I feed this back to the hospital I am very worried that they won't let her out for a few days. On the other hand I am not a medic and what if I do the wrong thing??

If she stays in hospital is that so terrible? They are terrible places, I agree, but they are absolutely the last resort and no-one will keep your DD in hospital if a better alternative exists for her.

It is worth, if you can, having a three-way conversation with your DD and her RC. If you are not able to physically make it to the ward round, you could find out if you could dial in. My experience is that everyone involved in my care - including me and my relatives - being on the same page was important to me, and I did my best not to say different things to different people involved in my care, but I did experience my opinion of what might be best for me changing rapidly and sometimes abruptly. If your DD is saying one thing to you and a different thing to her RC and you are comfortable with that, that is one thing. If you have doubts, you could discuss those doubts with someone involved in her care.

An important thing to remember, in my opinion, is that Doctors are not Gods and the power that they have to "do things" to patients is in law and medical ethics extremely limited. If your DD feels as if her medication is not helping her, she would be ill-advised to stop taking it without the guidance of her doctor. If the doctor would prefer she be in hospital to monitor a change of medication you could negotiate whether this transition could instead be handled at home with the support of the Crisis Team. In general, one is not obliged to comply with medication in order to escape the clutches of the hospital - that is not quite how it works, for all that it might seem that way.

The nuts and bolds of the whole enterprise can seem mythical from the outside but they are what they are and in my experience working with the system instead of against it is in general the less painful route. I did only learn all this by experience though.

I hope that a little of this helps. For what it's worth, I am also a fan of Recovery College.

Lastly, do you have support for yourself in all of this? Being a carer is a real burden. Have a think about you. Will you feel better if your DD is at home, or worse?

Sending flowers

EmeraldIsle100 Thu 11-May-17 19:54:47

Thanks again Erin. I took your advice about everyone being on the same page and told the hospital that DD wasnt as well as she was making out. You were spot on about negotiating how best to manage the change the meds and have given her 3 days home.

Thanks again for posting, I really was panicking. Your post made things clearer. Thanks for flowers. Things are looking brighter today!!

EmeraldIsle100 Thu 11-May-17 19:57:38

I meant to say my GP is an incredible support to me. I am also lucky to have a loving partner who is great. I have to remember to focus on him and my DS 18 because my focus is so much on DD. Take care of yourself

erinaceus Fri 12-May-17 08:30:39

I don't think I really gave advice! I was trying not to blush I am glad that sharing my experiences helps you though.

Having been somewhere where your daughter is, when I, my relatives, and the professionals involved in my care start actively working together, the whole enterprise involves less suffering than when different people are pulling in different directions. We didn't all get it right all the time but we did and still do our best. Ultimately when your DD is detained, the RC has the final say, but you and she can both give significant input. Sometimes, masses of patience is needed. In my view, hospitals are not therapeutic places. Is your DD still there, or is she home on leave at the moment?

I can make suggestions for how to make her time in hospital more bearable. I posted on here all through and it made such a difference.

I am glad you have support for you. I hope that your partner and DS are alright. Trying to find other parents in your position might also be helpful. You might find that your DD's local team or the one at her hospital can connect you to resources for carers. If you know which Mental Health Trust your DD is under locally then you could look on their website to find out about support for carers. There are other parents in your situation; your DP and DS might find more information helpful too, depending on where they are at.

I'm glad that things are looking brighter today. If you become concerned for your DD's safety at any point, stay with her, phone the ward, take her to A&E (if she will go), or phone an ambulance. My parents have done all of these for me at different times, I am still here, they are still here, and we are still talking. These things can be gotten through, but they are hellish at the time. If you like flowers, maybe buy yourself some, or ask your DP to? Here are some virtual ones in the mean time flowers

HTH

EmeraldIsle100 Fri 12-May-17 08:50:16

She is on home leave now until Monday. She slept in my bed and I am hoping she sleeps on for a while. She cried and cried all night until the sleeping tablets worked. She just keeps saying she wishes she wasnt here.

It completely breaks my heart and I am hoping things change. I am nervous about her waking up. The hospital said leave was about her gaining positive experiences to replace negative emotions.

She has promised me she will keep herself safe and she won't be far from my side. When she goes back on Monday they will discuss medication.

I would be very interested in suggestions for things to do in hospital. She is bored senseless in hospital and hates it because time goes so slowly.

erinaceus Fri 12-May-17 09:39:09

Here are some suggestions:

- Does the hospital have an Occupational Therapy department? The one I was in, did, but as a patient I had to ask to be referred to OT, which none of the staff told me(!) Another patient told me. OT gave me access to groups. There were only a few that I liked, but they did help to break up the day.

- Does she talk to the other people there? I got on well with some of my fellow inmates. It didn't seem to make much difference whether the other person was a patient or staff. Some staff had more time than others. Student nurses were quite often bored because they couldn't be given any real responsibilities so were good for a chat! With fellow patients some were easier to talk to than others, and I had a couple of quite distressing interactions, but overall a conversation with fellow patients was a good way to pass the time.

- Board Games, either alone or with others. I played solitaire during one admission, Jenga during another.

- My concentration came back part way through my admission so I read a novel.

- I did loads of art. I have lovely art materials at home and got someone to bring them all in for me. I drew and painted a lot. The ward had some art materials but they were crap and I am a bit of an art material snob.

- I used to call The Samaritans from the ward if things were getting really bad and there was no-one to talk to.

- Taking up knitting is a mental health trope but loads of people like it. I don't, but lots do. Your DD might have to leave the needles with the staff when she is not using them though.

- Does she have access to the internet? I watched iPlayer and listened to iPlayer Radio. One could do a Coursera course. Some people like Ted talks. I Skyped friends. I forked out for loads of mobile data as the hospital wifi was crap.

- Can she go outside? Before I was able to go out unsupervised I used to go outside with staff for walks. The ward I was in also had a sort of patio which was something like a prison yard. One could sunbathe.

- The food on the ward was dire so I had visitors bring me snacks.

- Lots of cups of tea.

You could start a thread in this topic asking for more suggestions. There are a number of us here who have done time as inpatients. It is hellish, but it is survivable. I hope you and your DD have a good weekend and that between you you can keep her safe. She is more likely to be discharged if she is able to stay safe at home.

EmeraldIsle100 Fri 12-May-17 15:31:11

Thanks Erin all going ok. She is moaning a lot about new hospital and texting a friend from the old hospital. She is watching Friends re-runs and smiling a bit so that's good.

erinaceus Fri 12-May-17 16:37:56

Complaining about hospital is valid IMO. They are, in general, shit places to be. Friends is good though! Hope your weekend continues to go well.

NolongerAnxiousCarer Sun 14-May-17 22:28:24

Hi Emerald,

Are you your daugters nearest relative? This is a legal term under the mental health act and gives you certain rights/responsibilities. One of these I believe is that you can apply for your DDs discharge from hospital into your care. The Mind and rethink websites have more information on nearest relatives. If you are going to do this though think about what support you will be able to offer and what proffesional support will be available. Them letting her have some leave sounds positive though.

wtffgs Sun 14-May-17 22:39:53

Nothing practical to add - just brew and flowers

DC1 is a (younger) troubled soul with no MH diagnosis yet although we continue with CAMHS. She has been deeply unhappy for years. It is so hard to see them suffer.

EmeraldIsle100 Mon 15-May-17 13:53:21

Thanks very much for posting Longer. I am her nearest relative. She is legally detained and I think I would have to go to Court to have section overturned.

She is getting day leave but desperately wants to get back to original hospial and away from new hospital. I am worn out listening to her fixating about it.

The hospital is ringing me later and best news for DD is for her to get bed in old hospital.

Thanks wtf. Its an incredibly painful illness and awful to see your child go through it. I really hope your DD gets tbe help she needs flowers

erinaceus Mon 15-May-17 14:59:00

EmeraldIsle100 If you are worn out listening to her, are you able to make some space for yourself? For example, when she is at the hospital she is probably as safe as she can be. Are you able to get any rest? If her RC is not prepared for her to be discharged home, that is not a decision that will be made lightly, and appealing the section legally does not look from the outside like a fun journey although I have no personal experience of the process.

flowers

EmeraldIsle100 Mon 15-May-17 22:48:14

The hospital rang at lunchtime to ask if DD could come in to see doctor so we hit the road. Long story short but the doctor said that given her feelings towards new hospital it is unlikely she will gain much by being there. Myself and DD said being at home helped and although she has suicidal ideation and had the chance to buy paracetemol she didn't.

She didn't self harm (despite having the urge) she just made one superficial barely there burn. All in all she did well and has got one week's leave. We can ring anytime if problems arise.

It's going to be a LONG week for me. It will be like having a newborn, but an unpredictable 5' 8" one. Here goes, wish me well.

I really appreciate everyone taking the time to post. I honestly felt less alone knowing I could post. I kind of protect my parents, both 82, as dad is just out of hospital and mum is minding him with help from my brothers & sisters. I live 4 hours drive away. My mum does the lion's share.

I am exhausted after drive today and appointment which was intense. I never imagined I would sit in a room and discuss whether I could keep one of my children safe.

I hope I haven't upset anyone. Thanks again and I hope anyone going through similar knows they are not alone.

erinaceus Mon 15-May-17 23:20:12

I never imagined I would sit in a room and discuss whether I could keep one of my children safe.

Life sometimes throws situations that we never imagined at us. There were times when I sat in such a room with my parents and their answer to the above was "no". Those times, I did not go on to live under their care. In my opinion, it took them some cojones to admit that they were not able to keep their own child safe. I am trying to say that really you are not the only parent to go through this. If you have elderly parents of your own as well, you only have so much to give and it is no good to your DD if you run out of resources.

Sending flowers keep posting if it helps. Sending flowers to your DD, too.

EmeraldIsle100 Tue 16-May-17 00:14:07

Erin I said I could try but as I was saying the words I wasn't 100% convinced. I have a conviction that if she wants to end her life she will and as much as I try if she wants to she will do it. There is no way I can watch her 24 hours a day.

I admire your parents for saying they couldn't keep you safe. My DD is very impulsive and has strong opinions and staying in the hospital was never going to work.

She is upset now and I need to go. Chat soon and thanks to everyone who posted. Your posts are really helpful.

EmeraldIsle100 Tue 16-May-17 00:26:09

We have just had a discussion which went nowhere and she said I don't understand. She is talking about the same things over and over that have no basis in fact. I am out of my depth and beginning to wonder if she should be re-admitted as nothing I say is helping.

Thanks for reading and sleep well x

EmeraldIsle100 Tue 16-May-17 00:29:30

Erin did your parents saying they couldn't keep you safe result in an improvement in your health?

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