Should a nurse be lying to a mentally ill patient in writing?

[l39]

My mother is a voluntary patient in a psychiatric hospital. She is depressed and suicidal. I know that the staff are all trying to do their best for her, and I do believe she will recover, because she always has before.

The consultant is thinking about sectioning her next week if the newest drugs don't work and she doesn't agree to ECT voluntarily. He told us so himself.

I have been to see my mother this morning and she is carrying around a sheet of paper which she says a nurse wrote and printed out for her. It is supposed to stop her worrying (ha! enough Diazepan to stun an elephant isn't stopping her worrying). Among other things (in really shocking grammar from an educated person) it says that she will 'never ever have to go to a locked ward, be sectioned or have a nasogastric tube'.

(The tube bit is because she wants to starve herself to death and doesn't want to be fed through a tube.)

Mum already distrusts the staff and thinks they are plotting against her. The promise on the paper is a load of rubbish as her consultant is thinking seriously about sectioning her and we hope he will - she's been sectioned before and treated with ECT without her consent and it WORKED. She was well and happy for years afterwards.

We have been trying so hard to reassure Mum for weeks now while being truthful with her. It's very hard work and now I find a nurse telling her a pack of lies IN WRITING. When they do section her this is only going to confirm her belief that she can't trust anyone! Is this really the proper way to treat an irrational and very distressed patient?

[solidgoldSneezeLikeApig]

It's possible that a nurse didn't write the letter at all: maybe another patient did (or a visitor who means well but has no professional training). TBH I would let your mother keep it if it comforts her: once she has been treated and is recovering she won't mind one way or the other - or even remember, necessarily, exactly what was said to her when she was ill.

[Robespierre]

It seems wrong to me. It will undermine her trust, as you say, and it also confirms to her that sectioning, ECT, etc are things to be srhunk from -- instead of attempting to tackle her fears about them.

It must be extremely terrifying to have your autonomy taken away, and one of the few things to reduce the fear and rage at that loss is an attempt to treat the patient with continuing respect.

[Amapoleon]

To me it doesn't sound as if a nurse has written it and it would be very unprofessional to so.

When my sil was in a psychiatric unit, she and the other patients used to concoct all sorts of stories, provide evidence etc and it all seemed quite plausible. In fact sometimes it was hard not to get sucked in to the paranoia of the place without realising.

Wishing you and your mum the best of luck.

[Surfermum]

I would phone the ward or go in a speak to them and discuss it with them. Like solid says, it may not have come from a member of staff. Or if it did they may be able to explain to you why they've done it or take action if they feel it's not appropriate.

[l39]

Thanks for the answers. Would still be glad to hear from anyone else who wants to add a message. I did wonder if it really was a nurse who wrote it but among other things it lists the drugs she is currently on and how many mg of each she is taking. That inclined me to believing her in this case.

[gussymooloo]

I would speak to staff and clear it up. It could of been written by any number of people for many reasons.

Im sure the staff would be happy to resolve the issue, i know i would.

hope your mums ok.

[l39]

I know she won't remember much of this when she recovers, solidgold. I'm not thinking of her remembering this months later from a position of sanity, I'm thinking of her next week when she's sectioned (and obviously, still ill.)

I wondered if someone would pipe up to say that they're trained in the area and it's advised to calm the irrational person down by saying what they want to hear, even if it will soon be obvious you were lying.(Much more obvious if you actually wrote it down!)

I generally try to be honest but it would actually be a big help to me if lying was officially approved in the circumstances as Mum doesn't think visiting every other day is enough. Every visit we face at least 15 minutes of 'Why can't you stay overnight? Why can't you come back tomorrow?' It would save a lot of tears and pleadings to say 'OK I'll be back tomorrow' (I have 4 children and another on the way and my husband works away a lot) but I don't say that, obviously, because I thought that I ought to stick to the truth and not disappoint her.

I think I will mention it next time I go if it's still there. (There is another copy on the wall of her room. Visitors aren't allowed in patient's rooms but we saw it while the door was open.)

[scottishmummy]

keep a copy of the letter take to ward round query it-with the psychiatrist and key nurse

the composition and tone sound completely unorthodox.could someone else have written it?

and to clarify it is not good clinical practice to lie to calm a pt down.not the done thing at all.in fact usually it is the impact and immediacy of hearing a contrary opinion that can make pt agitated.so no lying is not a strategy at all.ethically or practically

it is really stressful that your mum is unwell.hope this resolves

[Devendra]

I would just ask them.. I am a psychiatric nurse and would definately not have written that stuff.. Its unhelpful and unprofessional..

[l39]

Thank you. I was unwilling to bother the staff at the time because I know that they are busy and my mother spends a lot of time grabbing them and rambling. Perhaps it was another patient after all but how did they know what drugs my mother is taking? She probably couldn't tell them, she's pretty scrambled.

Oh well. If the copies have both vanished when I return (which is what I expect) I won't follow it up.

[ThePellyandMe]

I'm a psychiatric nurse and would never do anything like that, nor would any of my colleagues I'm sure.

It's very unprofessional and so likely to cause huge distress and undermine the nurse-patient realationship, I can't imagine why any nurse would do that.

[l39]

Thanks, Thepellyandme.

I have just had a phone call from the hospital and they are not waiting until next week after all. They are sectioning her right away. The consultant certainly changed his mind quickly. I wonder what she has done since yesterday.

Well, if it was a nurse, he or she is hopefully feeling a bit stupid for making such a promise on Sunday (at the earliest) and having the patient sectioned on Wednesday.

Still, what really matters is that Mum is getting the help she needs. I am hugely relieved.

[PeppermintPatty]

I agree with ThePelly.

Something like this has happened to me when I was in hospital. I DID remember it afterwards and I was (and still am when I think about it) very angry about it

It doesn't matter how ill someone is, they deserve to be treated with respect and this includes not being lied to.

[ThePellyandMe]

I'm glad she's getting the treatment she needs l39. I hope her mental health improves soon.

[staggerlee]

Hi 139

When I first read your post I assumed that your mum had written an Advanced Decision with the help of the nurse. Its perfectly reasonable for mental health staff to help patients to write what they do and don't want in terms of treatment. However in practical terms Advanced Decisions would only apply to patients not subject to the Mental Health Act i.e sectioning as the Mental Health Act could override any advanced decisions about treatment for a mental disorder.

However if this was written by a nurse to placate your mum its very unprofessional and frankly untruthful. I'd ask for clarification from the ward staff.

[ladylush]

Could it have been written by a bank N/A? Not running down nursing assistants but if it was an agency worker who hasn't got much -common sense- knowledge/experience, it is feasible it could have been written by staff.

I think you should ask to speak to the Charge Nurse or Manager and show them the letter. It can then be investigated.

I am a CPN and find it shocking that staff could lie to a patient. It breaches trust, ethics, code of conduct etc.

[ladylush]

As you can gather my striking out of "common sense" didn't work!

[l39]

After everyone's kind reassurances I was almost sure the list had not been written by a staff member........

but today I have been told that it was! And not just a stand-in but the psychologist!

When I saw that Mum still had the printout I took it to the office and said
"Mum says this was written by a nurse, is that the case?"

The nurse inside took the printout and said "It was probably written by the psychologist, to reassure her."

"But it lies," I said, "it says she'll never ever be sectioned, and she is being sectioned. Look how badly it's written, surely this can't be the psychologist?"

(It doesn't say nasogastric tube, it says nasal gastric tube. It says "the nurses will never forget not to give me my medication" when I assume it means the opposite. It refers to mum as both 'I' and 'you' in the same sentence. And as 'she' in the next sentence. Generally it looks like it was written by a semi-literate person.It says 'ECT is not important' when we've been telling mum for weeks it is important to have the ECT, because it will make her better.)

The nurse read the list. She said she had to check mum's notes to see if the psychologist had written it.

To see if it was down in the notes that the psychologist was lying to mum this week, I suppose, or if it was someone else's turn. If the psychologist really did write this, I'd hope he would be too ashamed to record the fact.

So I left her to it. A few minutes later a different nurse came and gave the printout back to mum. She didn't tell me anything, and nor did anyone else.

Mum still thinks she can get out of being sectioned somehow.
I'm not happy about this. Am I being unreasonable?

[ladylush]

No you are certainly not being unreasonable.
When will you find out?

[l39]

Well, I'm visiting again Saturday morning. But if the sheet has gone missing by then, I won't have anything to prove it existed. I was going to try to take a photo of it, but it was raining so couldn't do that outside, and inside I thought the staff might stop me.

Should I keep asking? Mum has much bigger problems than this after all. I want to get a proper answer, though.

[mollyroger]

So sorry you're going through this. Have nothing useful to add, but wantd to send you best wishes..

[ladylush]

Ask for a photocopy to be put in an envelope for the manager's attention.

[gussymooloo]

It sounds terrible. Ask for a copy. Put your concerns in writing to the ward manager.

If the psychologist was doning some kind of "work" with your mum he/he can explain the letter, if it was written as reassurance or a promise than the psychologist needs some competency management and supervision.

[scottishmummy]

discuss in ward round.if you feel anxious take a MIND advocate or PALS

this has caused you and your mum considerable anxiety.acknowledge that to them

-ask who wrote it

• why
• what outcome where they hoping to achieve

hope this can resolved

[l39]

Thanks for the advice and good wishes.

I didn't find out anything today though. Although mum still has the paper, she's in such a state at the moment that I couldn't really give it any thought while I was there.

I know they are doing their best but when they rang to tell me about the section I thought they'd soon be doing something! But no. The section still isn't achieved and according to mum ECT won't be until Tuesday. (Not that she's exactly a reliable source of information.) She's positive she'll be dead by then and is just pleading with us to save her life. Over and over. And clinging to us and begging us not to leave... And threatening to kill another patient , which I don't think she's ever done before. Are murder threats a really bad sign? It is scary to me, much more than all the suicide threats.

I wonder if she's now more ill than she was in other attacks. She's still eating and walking - she's been totally unresponsive, years ago, just sitting there not saying a word. For weeks. So this doesn't seem as bad as that. But she's saying she will have to kill this other patient! The new person follows her around all the time and - according to mum - threatens her. I asked the staff if they could keep the two of them apart but they say no.

I suppose I should keep my questions to ask the staff but they are just so unhelpful. They just seem to fob us off as though they have to keep us calm or WE'LL start causing a scene! They tell us things we already know and never mention stuff I would think was important - like the murder threats, or the cuts she gave herself on her hands smashing crockery, or whether she'll go to the locked ward if she strikes this other patient. Who is less than half her age and looks much stronger, so mum probably won't do her any harm if they come to blows, but still... Won't she be crossing a serious line if she attempts to hurt someone else?

Thanks to anyone who's able to answer!