Does anyone work in mental health? Informal patient on run

[YouCantCenaMe]

Hello, have name changed for my privacy.

My sister has been in a psychiatric hospital for a few weeks following a breaking down and 2 suicide attempts (One on hospital grounds)

She has now gone AWOL from the hospital after telling them she wanted a walk.

She was self admitted, so informal and not sectioned so she was allowed out (despite buying the tablets she ODd on whilst being let out)

I called the ward and the basically said she's allowed to leave.

She's send me multiple messages saying she wants to kill herself/buy razors.

Any ideas what I can do?

I feel she needs to be sectioned buy no one seems interested :(

BPD is really difficult for the individual because, unfortunately, some (most?) Trusts do not have treatment pathways for PD. Hospital admission is ineffective and not recommended by NICE, other than for v short stays. Can your sister stay with you? There are Home Treatment Teams that are able to offer support. Ask the ward for the Crisis team's number also, as they may be able to advise you if she has consented to share information. Most suicidal patients are managed in the community these days, not on wards. I hope your sister gets the help she needs

She can't stay with me as I have children and in the past social services have been involved because of her self harming with them in the home. I can't have them around that again.

Plus we are in different areas and she needs to have access to her Gp/ therapist

Holding your hand OP

Just to give a perspective, one of the best things that happened to me mentally was being sectioned on admission, I was a voluntary patient and I walked out of the unit, past 2 Drs and a nurse, crossed the car park and made an attempt on my life, I was sedated (for my safety) and returned to the ward and then was sectioned as I wouldn't stay, I then made another attempt on the ward and I spent the next weeks on a 1-2-1 then stepped up to a 2-1 with talk of going to the psych intensive care unit.

While I was on observations and the section, I didn't get a choice re medication, it was given by injection in the early days as I was constantly resisting. Looking back, I wasnt able to see that it might help me and saw it as fighting the system and they were trying to stop me dying when I thought it would be best.

I broke my mother's heart as she wanted to come and see me and make everything alright, the staff advised her not to as it would make things harder for both of us. She rang the ward several times a day to speak the staff instead as I was oblivious as to where I was and she was worried sick. Her first visit was cut short after a couple of mins as I wanted to go home and was very distressed and she was too.

I was kept in a sedated state for the early days to give my mind time to settle down and so I could potentially start working with them. As the medications started to calm things for me,

I did engage with them and honestly, I can say now, it was one of the most therapeutic things ever happened for me. I was given outlets to express my feelings and even when my 28-day section was over, I was given the choice if I was going to go onto another or would I become a voluntary patient again,

I was there for another couple of months but as the medication helped me and I was given support to leave and moved home upon leaving the hospital, I was linked into a network of supports and it was one of the best things for me.

20 years later I still have some of those supports CPN, support groups and now a specialist practitioner as well.

Yes to them avoiding sectioning due to aftercare, try speaking to MP definitely as your sister is vulnerable and currently a risk to herself (evidenced by very recent attempts) and isn't getting the help she needs and is a risk to herself.

Also link in with the mental health charities in your area for support Mind, Rethink,

Remember to look after yourself in the midst of all this, speak to Samaritans if you need to

If she would be agreeable, there should be a ward round possibly Friday or Monday before she is planned to be discharged, if at all possible and if she might agree, go to the ward and with her permission sit in on her ward round,

This will give you a chance to say how things are and if needed that they are being neglectful in discharging her to her own devices when she is actively suicidal and that if they discharge her that her death will be at their hands as they have failed her.

Ask for a discharge plan to be formulated with supports and contact numbers and planned follow up crisis numbers - sometimes you have to push like hell

They'll do anything they can to avoid sectioning because it is more costly, especially because of the right to aftercare (there's no right after an informal admission).

117 aftercare has little impact on the decision to detain or not.The least restrictive option must always be applied. The assessing team will need to weigh up the patient's capacity, what is in their best interests etc. I agree with PP that long term admissions to hospital are not helpful and actually get in the way of recovery for BPD. OP if she is detained, push for clear objectives for the admission such as doing orientation work around her diagnosis and assessments of her commitment to a therapy. It must be really scary for you at the moment, make sure you have support too.

Call your MP or find the address of their offices and beg for mercy.

This sounds horrific.

Can you contact PALS and give info and say you feel she's not being given appropriate medical care?

Where possible put a drain on surrounding services, if she is released and goes quite/missing - call the police.

Take her to a&E if you feel she is at immediate risk. Ask your MP team for support.

Where possible emphasise she is at risk of likely significant harm.

Just awful, so sad for you. And her.

Big hugs and cups of tea.

The thing is, leaving the hospital and the self-harming in a public place are probably not seen by the professionals as signs of real suicidality, because she she made choices that meant she was very likely to be found. And an inpatient unit is far from the best place for many people to get treatment.

I've never met someone in mental health who wanted their patients to be harmed, but sometimes there is a need to make decisions that seem harsh from the outside but we know are for people's long-term good. Often discharging people who want to stay an inpatient is one.

@WonkyDonk87 Nice theory, but the reality is they'll do what costs least. The OP's sister is actively suicidal, you can't suggest that letting her wander off to buy knives is in any way appropriate.

OP can you try Mind? I hope you manage to help her get the help she needs

Stompy... And the overdose in a locked toilet?/ being found by another patient. Was that attention seeking too?

@YouCantCenaMe Hi, I am mostly sending you a hand to hold. I do have a sense of how stressful the situation is.

You are wise to hold the boundary on not having your sister to stay at your house.

Do you have any support for yourself in all of this?

I work in MH in the community with people who struggle the way your sister is and I would say that if inpatient treatment hasn't worked this far, it's not going to moving forward. However, I think the main issue here is lack of stability and discharge care plan - they should have assigned a care coordinator and found a place for her to stay temporarily, as well as providing her with Crisis contacts. It is sad that this hasn't been done - I would call the ward and ask for advice on this personally.

You can request for her to have a mental health act assessment. (Google it, mind website is very good). They can't refuse as she meets one of the three criteria in that she's a danger to herself.

Ring the hospital and request that now.

I'd advise you to read up as much as you can on the mind website and also if she is discharged from hospital, the hospital has a duty of care to ensure her wellbeing on discharge.

I'm afraid you're in for an uphill battle. I've used the "if xxx kills their selves after discharge I'll be holding you responsible, please record this in their notes as I've said it".

You have my sympathy.

Stompy... And the overdose in a locked toilet?/ being found by another patient. Was that attention seeking too?

I didn't describe anything as attention seeking!

I said that not every self-harm act (or overdose) will be perceived as having a genuine intention to end your life. Obviously I don't know your sister so I can't comment on her case.

But you seem determined to see professionals as the enemy (we are honestly not).

Asking to have it recorded that you will blame professionals if she ends her life will not make a difference to the decision making.. But it is probably a good idea to communicate your concerns to the staff. They will be able to explain their reasoning (assuming your sister consents to them talking to you) and they might even be able to reassure you.