Page 3 | Sectioning (help/experience)

FlatOutAgain · 2023-01-08T10:28:32+00:00

Asking on here in case someone has experience or any answers. Those who have followed my threads know the issues with mum. I am typing whilst waiting for a call back but as I have no knowledge of this someone else might. Mum smashed up her room last night (again), has bitten and punched staff and has poured water into electrical appliances. She is a danger to herself and other residents as she has been going into other rooms and hiding etc. She has caused so many issues in only 9 days. The care home have said they cannot cope with her and we have to pick her up. I can't just pick her up and put her with my 85 year old dad. I called 111 and they called the care home to assess. We are now waiting for a nurse/paramedic to call the care home to assess. All of the mental health services are not available on a sunday. Anything anyone else can think of? I will pop back now and then to see if there is any advice. Sorry to ask on here but I am just trying every option I have thank you

Original poster

FlatOutAgain · 12/01/2023 16:00

Thank you again for your replies. Sorry I have not responded sooner but it has been a very busy time.
Mum was going to move to the Dementia ward yesterday but it got cancelled due to the ambulance strike as the ward is on the other side of the road. Instead they moved her to a geriatrics ward and today whilst I was there with Dad, they moved her to the Dementia ward. That is good news.

I have a care worker allocated by Social Services for when mum is discharged from hospital. I thought they were called Social Workers but maybe there is a distinction or the name has now changed?

Care Home Select are also involved and will help look for a suitable home if/when mum is discharged although the psychiatrist said they will do that after they have assessed mums needs whilst in the dementia ward.

I can cope with mums situation now it has calmed down. Dad is another story and I have had to visit everyday to sort him out. Have a pre-assessment meeting tomorrow with the 'home help' as he is self-funding. They will clean, do washing, pop to the shops etc. Have also sorted out meals on wheels although not spoken to him about that yet. Care needs assessment in progress but will take between 4 and 6 months. Careline in place which is an emergency button should he fall. I do his shopping and will continue with that as I can do it when I do mine. Its just the time to do all of his washing, bed making, cleaning etc. I just lose whole days at a time and it really is not sustainable. I cannot think about the future just getting through the 'now'.

I start back at work next week so need to do as much as I can to help make him independent although that will be a massive stretch as he really is all at sea.

Thank you very much

OP posts:

CrocodilesCry · 11/01/2023 21:07

My DGM had episodes like this - not as chronic as your DM but there have been times she's behaved similarly.
Sounds like she needs anti-psychotics. I know DGM is on one and it hasn't happened since.

Mum5net · 11/01/2023 13:00

OP, the MHU that I have experience of and one of DM's care homes had a 'race track' layout. It was so clever. 'Wandering' patients/residents literally walked in circles but never came up against locked doors they needed to fight their way out of, they just kept doing circuits. It just tired them out and then they needed to rest. Hopefully the dementia ward has this ' race track loop' as it makes for much less stress.

DahliaMacNamara · 11/01/2023 11:33

Actually, we've found that being able to visit MIL on her locked ward isn't very much trickier than when she was on a trauma ward in a general hospital last year, in that we weren't able to gain access to that ward without being let in by staff either. Getting out was easier than on the locked ward, for obvious reasons. However MIL is apt to become agitated if she tries to go through a locked door, having no capacity to recall where she can't go, or why. This would be difficult for OP to manage, but not nearly as worrying as knowing the possibility of escape is very real.

JennieTheZebra · 10/01/2023 20:07

It does sound like she needs to be on a locked ward (a ward where you need keys to get through any doors and only the staff have keys). It’s almost impossible to escape from a locked ward; in the building I work in (a MH hospital) you need keys to get absolutely anywhere, especially outside. Locked wards can make visiting more tricky though.

josephjohnson · 10/01/2023 19:10

Peoniesandcream · 10/01/2023 16:54

I struggle to understand how a care home can't cope with her behaviour despite being trained, yet a hospital will? I've been a senior nurse in both, atm a hospital ward and unfortunately it's so difficult with all these social admissions. There just isn't the staff for all the 1 to 1's needed which is when falls happen.

She needs medical assessment and intervention, she won't get that in the home.
And you say the home is trained for this, but it's unlikely that they are trained to manage the extreme behaviour that the OPs mum was displaying before she was admitted.

Original poster

FlatOutAgain · 10/01/2023 17:17

Sorry its been a very busy day and I have a few mins for an update. Thank you all from the bottom of my heart for replying. Although I haven't answered individually I have read through and I have put further actions into place.

Last night mum saw a psychiatrist from the OPMH. We were unaware of this until this morning when she called. She was utterly utterly lovely and explained that they are trying to get mum into the dementia ward but there are currently no beds. They may move her to an interim geriatrics ward as the noise in the current acute ward is disturbing her and making her restless.

The psychiatrist explained once they get her onto the dementia ward they will assess her over several days to work out what the best medication and care is. She went onto say that they will do what is the best for her and even asked how I was and it threw me as she is the first person to ask, apart from Dh who is living through this with me.

The care home had not packed anything for her at all so she had nothing. I went to the care home today and discussed things with them and asked if they had insurance and was surprised when they said they 'will look'. I saw mums room and it was not as bad as they made out. The wardrobe doors were pulled off but it was not smashed up as they said. Anyhow that is a battle for another day but I was not thinking and did not take photos.

I then went to dads, sorted out his shopping and a bit of cleaning and took him to the hospital. It was awful. I was there for around 4 hours with dad. Mum was in a heightend state and was shouting that everyone was trying to kill her. She ran at dad and tried to drag him from the ward saying they would kill him as well. The nurses asked if I would try to calm her down. She refused to believe she was in hospital and kept pointing out people and saying things like 'that man has walked past 3 times and he is going to kill me'. It took a long long time to calm her and trying to leave was difficult as she would not let us go. I promised to pop back later and pick her up so that placated her.

They have put her onto memantine. She has been refusing this since it was first prescribed by the OPMH which is why they discharged her from their care. I think honestly it is far too late for this drug.

Have asked for a care needs assessment for dad and the waiting list is 16 weeks. Have sorted out a home help but need to organise it with dad. Have filled out a form so he does not have to put his bins out, someone else will. Chased up the social worker but no go as yet.

Just to point out when I say 'I' this means dh and me a lot of the time.

So ups and downs with the psychiatrist being the high point. She said that when she chatted to mum that she had no recollection of the care home at all.

I have explained to the nurses that mum will keep saying she has breathing and chest pains. They did not know this and said they have to keep giving her and ECG. After speaking to me they have put a stop to it.

She still has DoLS but my worry is she will escape. She knows where all the doors are and which ones are locked etc. She is on high alert to escape as she has done it before.

Thank you all again for your lovely kind words and advice. It truly truly makes a difference

OP posts:

Peoniesandcream · 10/01/2023 16:54

I struggle to understand how a care home can't cope with her behaviour despite being trained, yet a hospital will? I've been a senior nurse in both, atm a hospital ward and unfortunately it's so difficult with all these social admissions. There just isn't the staff for all the 1 to 1's needed which is when falls happen.

SinisterBumFacedCat · 10/01/2023 00:44

My DM has Alzheimer’s and suffered badly with paranoid delusions at the start, Risperidome really has helped, the only problem is due to the dementia she forgets to take it and I can tell when because she starts accusing me of nicking notepads and socks etc. I don’t understand why they aren’t trying them with your DM, even with potential side effects, which she might not get, this has hit crisis point and needs to be addressed so she and all around her are safe. She must be in a very scary place and it’s cruel of the doctors not to try and help. Best of luck OP, been here with both parents relatively young and it’s horrendous.

Xrays · 09/01/2023 22:17

My Mum had severe mental health issues and physical health issues in her last few months - she died of bowel cancer but also had Crohn’s and copd and a diagnosis of schizophrenia which was at its worst when I was 4-10 and then she was effectively medication free from when I was 10-37 (when she died) with no relapses that required sectioning (she did still have “moments”). When she became very physically unwell towards the end it did exacerbate her mental health issue and we ended up having her assessed through the continuing health care scheme and she was admitted to a secure nursing home for people with severe dementia (although she was only 70, a “young” 70
too, and didn’t have dementia) - they were the only place that could cope with her. I am wondering what other options you might have as it really doesn’t sound like the nursing home is suitable?

I am also wondering if it’s some sort of medication issue - ie taking medications at the same / wrong time (?) or an unresolved UTI as it does seem odd that she’s only like this at night…?

Raspberry290 · 09/01/2023 22:07

Hi,

Another mental health nurse here. Agree with the PP MH nurse poster that this is very unlikely to be psychosis though sounds as though a low dose antipsychotic medication may be of benefit.

In your position I would be pushing for this above anything else.

Have the hospital ruled out a UTI?

maryofthevirginkind · 09/01/2023 21:58

@FlatOutAgain also If you are a designated carer for your mum you may be entitled to a carers assessment.

maryofthevirginkind · 09/01/2023 21:58

Can you request she has a mental health act assessment, you are entitled to ask for this as her next of kin.

I have had a 12 year long experience of this due to my son. Very similar behaviour. Firstly the care home should not have discharged her to anywhere without a proper care plan being in place. Put in a formal written complaint and also let the CQC know. They had a duty of care to your mum and failed there.

They should have been the ones calling for help and escorting her to hospital and staying until a solution is found, that's what they are being paid to do.

Email your mums consultant with as much evidence as you can in support of her receiving the correct help and stating that you cannot be held responsible for her actions if she doesn't have her mental ill health treated.

You need to find out if she has a:
Named nurse
Psychiatrist/psychologist
Social worker
Care co-ordinator

Does she need to be held under a Section for a 72 hour assessment. As she sounds like she lacks capacity press for her to be sectioned. This then entitled her to certain care and means if and when she is discharged she comes under section 117.

Good luck. It is heartbreaking.

josephjohnson · 09/01/2023 21:48

@FlatOutAgain lots of older people are on long term anti-psychotics. It needs to be carefully monitored to ensure that it sits them and isn't being used as done kind of chemical restraint. But it's a common course of action when the situation demands it.

JennieTheZebra · 09/01/2023 21:33

Yes, many people take antipsychotics permanently. Someone with, say, schizophrenia may be on an antipsychotic for the rest of their life to prevent relapse.
Which antipsychotic is right for your mum depends on her exact symptoms and the rest of her health conditions. The side effects can vary a lot; tbh a low dose taken at night of any of the modern ones (risperidone, quetiapine etc) may just calm her down and help her sleep, without any other real side effects, other than her maybe being a bit more sleepy during the day. I’m surprised it hasn’t been suggested already tbh, but NHS MH is very snowed under right now (not an excuse, I know…).

Original poster

FlatOutAgain · 09/01/2023 18:19

@Nimbostratus100 The GP has said the same thank you.

Thank you all again. Mum is on the same ward as there are no beds on the Dementia ward. She tried to leave (as expected) today but there is a DoLS on her so she was stopped. She became very aggressive with the staff. They have calmed her down (no mention of medication but they will 'tranquiliser' her after we agreed) and she is now ok. If the normal pattern is followed then she will be a handful tonight.

thank you

OP posts:

Nimbostratus100 · 09/01/2023 18:04

I have never heard of the family of a patient suffering from psychosis being billed for the damage they have caused.

I sincerely hope you dont end up paying this, I cant see how you are liable for it at all, surely the home should be insured?

Bobbybobbins · 09/01/2023 17:38

My DM was on anti psychotic drugs for her last two weeks as she was hallucinating and became a safeguarding issue. However it was very short term as she was terminally ill anyway. We ended up having to sleep in her room for a few nights to stop her getting up in the middle of the night- we found her about to get into a cold bath at 4am one night. My sympathies OP.

Original poster

FlatOutAgain · 09/01/2023 16:56

@JennieTheZebra sorry to ask but do you know if psychotic drugs can be taken over a long period? I read that 6 to 12 weeks would be the maximum and the side effects are dreadful. Are there milder ones that the person can be on permanently?

thank you

OP posts:

Original poster

FlatOutAgain · 09/01/2023 16:47

@JennieTheZebra There will be a lot of stress associated with mums condition based on the different environments. In hospital she believed that the woman in the bed opposite was conspiring with the nurse to steal her money. She absconded from hospital and was picked up by 2 men in a car and by a sheer stroke of luck they were good people and got her home. She left hospital because she believed that a man had stolen their house and she even described the man despite being in hospital. She ended up in hospital because she called an ambulace as she believed she was dying from heart failure and would not make the morning. So paranoia, psychosis, halucination etc. but she is living in a different world and truly believes these things are happening.

Yes you are correct it needs the proper intervention from a trained professional who can hopefully find the right meds for her. This have never been done and we have everything crossed she will get that help. The OPMH saying give her diazepam is not good enough. In fact it was me who first went to the GP to ask for diazepam so my dad could medicate mum when she got too much. Dad found that the tablets did not work and the care home found the same but OPMH would not listen.

thank you

OP posts:

JennieTheZebra · 09/01/2023 13:34

Have you spoken to a psychiatrist? The clinical psychologist sounds helpful but they’re not clinicians (medically trained) and so not familiar with the different drugs available, while GPs have had very limited psychiatric medication training. Not all antipsychotics are created equal and it is possible to prescribe them in such a way that the side effects are relatively limited. I presume your mum has heart problems? Cardiology can be involved in prescribing as necessary.
In terms of the fight/flight, this is a stress response. Is it the stress causing psychosis or the psychosis causing stress? Either way, keeping her as calm as possible is key. You mentioned diazepam? Has this has no positive effect at all? If not, other benzodiazepines (temazepam, lorazepam etc) are available that might work better.
It does sound very difficult. I suspect that a short admission to an acute OPMH ward is probably a good idea, even if it’s just to get medication straight.

Original poster

FlatOutAgain · 09/01/2023 13:14

@JennieTheZebra thank you

Yes she is having psychotic episodes. She believes that young boys with sticks are trying to get into her room. She put water on the floor and hand cream all over the window so if they got in (first floor) they would slip and this would give her time to escape. She also said they were on the roof and smashing up roof tiles. We spoke to a MH professional who said mum was in a permanent flight or fight mode and as flight was not an option she was fighting as she was terrified. This was a clinical psychologist who gave us time and explained what was happening in mums head.

We have spoken at length with the GP about anti psychotics and she said that mum may need to go on them but given mums health and age then be prepared that with the side effects, especially chest issues, it could/would like bring her demise.

Thank you

OP posts:

JennieTheZebra · 09/01/2023 13:07

I’m a MH nurse, although working age adult. This might be a silly question (and I’m not sure of your DM’s history in terms of dementia etc) but, if she’s lucid during the day, have you asked her why she’s behaving the way she is at night? Are you absolutely sure it’s psychosis or could it be extreme anxiety or nighttime confusion caused by dementia? Has anyone mentioned a small antipsychotic dose at night (eg risperidone) which would help her sleep and keep her calm? If it’s nighttime only then sectioning might not be necessary, especially if the cause of the behaviour is known.

Original poster

FlatOutAgain · 09/01/2023 12:54

Sorry I can't answer all of the questions individually as I am up against it time wise.

When you think you have hit rock bottom there is always further down to go.

Yesterday was truly awful and fortunately my Dh took charge of it all. The care home needed to 'get rid' of mum and I fully understand their position. She had done so much damage and with the violence and trying to start a fire it was too much for them.

As someone correctly pointed out we could not use Section 136 as she was not in a public place. We spent at least 30 mins on the phone to the paramedics to try to find a solution other than take mum to A&E. Mum has a safeguarding plan in place at the hospital and we stressed again and again that the paramedics had to make sure the hospital picked this up. My Dh then went to the hospital only to find mum in a bay on her own. He got the nurse to look on mums record and print out the safeguarding plan which is a 1 to 1 care.

The local MH hospital had not beds and would not take a patient directly only via A&E.

OPMH had an answer phone as it was a Sunday

111 wait was 45 mins despite the advert on the radio saying 90 seconds.

I fully understand that the hospital are stretched for staff so my Dh sat with her through the evening. The Dr. assessed mum and said that without the background from my Dh they would have discharged her (unbeliveable).

Dh then spoke with the consultant and they admitted mum to the acute ward under DoLS.

Called everyone I could think of this morning. The hospital are transferring mum to another ward and are awaiting a psych review. The issue here is that during the day she is lucid and no-one seems to look at the history before declaring she is fine. She is far from fine and needs real help and a secure place.

The OPMH was utterly utterly useless and said give her diazepam. I kept telling them this was not a solution and she had had diazepam all week and every night had had psychotic episodes. For heavens sake

GP said she had also contacted the OPMH and been told the same.

Adult Social Services are trying to allocate a social worker but this has to be reviewed by the internal connect team.

The rest home said they will not take her back until it can be shown that she is recieving the correct medication and is no longer a danger. They have said we have to pay for the damage which is extensive.

I could go on but I know we are not yet at the bottom. Mum has decended into a psychotic hell and the system to keep her safe is broken. I have no other words.

thank you all again

OP posts:

Dogsarebetterthanhumans · 08/01/2023 21:08

In the last 9 days has your mum’s medication changed at all? Just wondering what changed for her to behave as she is currently. Might give you some clues if you can find out. Side effects in the elderly can be different to those seen in younger people. I really hope it works out xxx