A&E was a complete shock - MH crisis?

[Longtimeteacher]

In the very early hours of yesterday morning, my DH woke with excruciating pain in his side and across his lower back. DH is not a complainer and rarely poorly, therefore I knew it must be bad, so at 1am we set off for A&E.

We arrived at about 1.30am (Wales) and DH proceeded to have his bloods and other samples collected etc and then came the wait…15 hours. We finally arrived home at 5pm this afternoon.

Luckily DH is fine. It looks like a stomach ulcer from Ibuprofen use, but I was shocked by what A&E is dealing with. Just last night there were 6 people brought in due to suicide attempts or threats, often with 2 police officers per person.
I was sat near the reception and there was no attempt to promote confidentiality, I suppose it was impossible being as busy as it was. Phone numbers and addresses, full names etc said aloud.

So in the space of just a few hours there were six poor people in A&E due to threat of suicide; held by police or security all night until the MH team came in this morning; another 4 or 5 people were in, clearly for other severe mental health issues - panic attacks; types of personality disorders etc There were only a few people with breaks or falls or bad tummy’s. The majority, were MH related. And seeing those people was a real eye opener too - the MH issues were blinding clear bless them and not at all mild.

Is this a sign of the current times? We clearly need so much more time and money put into MH. Was it just a particularly bad night, or is it always like this?

The staff were amazing with these people. Real professionals with compassion and understanding, but there were sooo many people to try to deal with, taking up a lot of time and resource.

I really was shocked by the extent of the issue last night. It’s seems such a very big problem.

Yes, it's a sad indictment of the lack of funding available for mental health support. The only way most people can get help is by going to A&E.

Yes, it is like this all the time.
Police get tied up for hours to deal with such patients. Not their fault at all, as it is their job.... but a sad sign of the times.

I agree. I work for a charity for over 50's helping with benefits etc but just recently half my time has been spent making referrals to adult social care or safeguarding because of people with mental health issues that just don't seem to be getting any help. I went on one visit this week and was so shocked at the conditions one man was living in clearly with mental health issues, not taking his own meds and taking very strong prescription medication that was prescribed for someone else etc, did not seem to have anyone monitoring him etc.

@Amiable

I can confirm that. As a long term sufferer of many mental issues trying to get help is impossible. For me, the lack
of communication between the access and assessment team and my GP is outrageous. I've been waiting for months and months for a referral for secondary care from my doctor as per the recommendation of the mental health team (I'm too complex for 'normal' therapy). I am yet to receive that referral. I have never been to hospital for my MH, I've felt on the verge of ending my life on more than one occasion, most recently only last week. I've now opted for not telling anyone how I feel, no point. I think the lack of support makes me feel 'what's the point?'.

My son was on a bridge wanting to end his life, the police went to him they called an ambulance only to be told it would be TEN HOURS! He was temporarily held at the police station to be assessed then let home. He was seen by the crisis team the day after.

I work in MH and it is very under-funded. It’s awful and we all wish we could do more.

That being said, confidentiality should always be paramount. You shouldn’t have known their names/addresses/phone numbers/reasons for being there. There’s no excuse for that.

I'm surprised you didn't know about this to be honest. Police officers I know say they now they spend a large majority of their shift dealing with people with serious mental health issues. The problem is there just isn't enough mental health support. The police will take them to a and e if at immediate risk. They will then be seen my the mental health team and discharged home as not severe enough and told to wait to hear from the crisis team who then visit and do bugger all. The wait for cbt, counselling etc is months if not years long. The pandemic and cuts to NHS funding has exacbertaed it.

I'm a mental health nurse. Services are so under funded and every team is carrying vaccancies pretty much at the moment. So many people end up at A&E as they are just not getting the support they need elsewhere. I've been nursing 22 years and this is the worst I've ever seen it.

I would suspect a huge increase in mental health issues across the globe is down to the collective trauma of what we experienced over the last 2.5 years in terms of Covid. I can see in the older people in my life, especially those who live alone, how utterly damaged they were by the lockdowns. No doubt older children and teens are the same (if I had experienced a lockdown with my family at 14 I genuinely am not sure I would still be here today) as well as those in difficult living situations eg relationships deteriorating under the pressure of lockdowns, home schooling etc. Then of course there are those who lost loved ones, those who had anxiety or OCD or other condition triggered or excarebated by the constant death counts, fear of catching it etc and then even those who were “least” affected found their lives turned upside down.

We are now seeing the effects of all of that.

PS That makes me sound very anti lockdown - I’m not but it would be a lie to claim they didn’t have a massive impact on people.

Mental health services are telling people to go to A&E because there's nothing else they can do.

Personally, I think it's a terrible idea. The waiting room in A&E is enough to send me over the edge, not least people at the lowest point of their lives.

The teens are really struggling too, so many going in to A&E and so many admitted on the wards with no specialist beds available. There is a lack of provision for children and young people for MH across the country.

I had to tell someone I know that it was ok to have their adult child back home after they attempted to end their life during lockdown, because they were so worried that they would get in trouble with the lockdown rules over households meeting.

So many elderly people I know locally have been affected too, not seeing any family for months and now struggling to get their confidence and independence back after being mostly inside their homes for so long.

The knock on effects of the last few years are very apparent.

In terms of mental health, I’m in Australia and have two children. The mental health issues associated with lockdown have been huge over here too. I have three friends working at three different schools and the number of children suffering from anxiety, OCD, depression has been “an explosion” according to one school counsellor and “unprecedented” according to another.
And this is in a wealthy, comfortable area, and these friends work at well provisioned private schools where (IMO) lockdown was done as well as possible with online classes and loads of contact.
Anecdotally, so many friends of mine talk openly about the difficulties their children have had both educationally and socially.
My two children have escaped relatively unscathed although both of mine have been more worried and fretful about things that wouldn’t have bothered them before - like daddy going overseas and them worrying about him getting stuck there, plus big worries about school camps, much more home orientated than before.
Extrapolate that across countries and people who were mentally fragile to begin with and I believe we haven’t seen the size of this problem yet.

I believe both of mine see the world as a more dangerous place now than they did before. Luckily they have many years before they’ll have to leave home (oldest is 12) but I can imagine that for children going through this when they were 13-16 it would have made a huge impression.

At this point, mental health services are the equivalent of putting a plaster over a severed artery - completely ineffective. I’m on a load of drugs, and have been left to get on with it. I’ve kind of accepted that if I hit a crisis point, I’ll end up just another suicide statistic.

Sounds about right, but I don't think it's anything new and it really depends on area. Bit of a ramble but this is my experience with the NHS mental health services 10 years ago:

I'm completely fine now luckily, but I went through two years of grieving/PTSD when I was aged 17-19. I was completely catatonic for most of those two years, spending days on end lay staring at the ceiling, not eating or drinking or doing anything really. I didn't leave the house, I didn't shower, I didn't see other humans. I did visit the GP about it regularly but they kept telling me that there was a two year wait for help. I went to A&E on 5 different occasions and very politely explained to them that I was going to attempt suicide because the pain was too much to bear any longer, but each time they sent me away and told me to contact my GP in the morning. The GP would tell me that there was still well over a year left to wait for any help, so I'd very seriously attempt suicide. Thankfully I wasn't any good at it! It would just result in me spending a few days swimming in and out of consciousness with awful diarrhea and then feeling groggy and kind of hungover for a few weeks afterwards. After two long years I finally got my appointment to see somebody... And they told me that my mental health was too unstable for the therapy that they offered, and I was put on another list with an estimated waiting time of 9+ months😂Eventually I began feeling better on my own as the grief passed and the trauma faded, I moved to the next town over for a fresh start and only had to wait 6 weeks to start counselling in the new town. Such a massive difference a mere 10 miles makes! But yes, some places have been absolutely drowning for years now. A few of my friends had similar A&E experiences to mine as teenagers too.

Undoubtedly Covid has had a huge impact on people's MH and wellbeing but many of the problems regarding services predate that. Around four years ago my BIL was going through major issues with his MH and his wife was told his suicide attempts weren't serious enough yet to warrant extra help. He was constantly sectioned and discharged and it always felt like he was lurching from one crisis to the next without things really bring addressed.
There are other factors affecting A and E too, like alcohol and drug abuse, as well as people there because GP services are failing. It's a mess.
It also seems to me that nobody is looking at the root causes of the explosion in MH issues. Of course Covid is one but there must be many others and we don't seem to be looking to seriously address what they are.

This truly is devastating. I thought my MH was low at the moment, but I really learnt the difference between feeling low and mental health on Friday night.

Surely this cannot be left to continue. Many of the people in A&E were young people, perhaps 14-30 age range. Not all, but the majority. These people will have families and children who they are unable to care for properly and the problem gets worse still.

And we have a cost of living crisis to boot.

I did wonder the benefit of attending A&E as a person on suicide watch, and being deprived of sleep for the next 8 hours? But I guess there are no alternatives.

I’m sorry to anyone going through these serious problems right now. I hope we can figure out what to do as a society as soon as possible.

Wow, thats dire. MH is a mess but tbh the whole NHS system is broken and the government who want to continue privatisation process won't fix it. Its only when you have a need to be there you really see the tsunami of problems. Nurses definitely need a pay rise!

That’s normal numbers really. About 8 people in a 12 hour shift is average so 12 in 15 hours wouldn’t be unusual. It’s not a recent increase. I’m very surprised if there was no MH team in overnight though. It could be they were waiting to be medically cleared post OD or for alcohol to leave their system first though before being seen: you can’t plan for support until you know if Someone is being medically admitted and can’t assess MH if intoxicated etc.

NHS under the Tories? We can you expect? They simply don't care.

Back in the 90s all the mental hospitals were gradually closed and all the patients discharged into the community. There is no mental health care now.

I recently spoke to several people (all age 60+) who have been to A&E in last 18m who commented spontaneously on the heavy presence there of people in MH crisis. They had been to A&E for other reasons in previous decade & said they hadn't noticed such MH needs previously: they felt either the actual need is greater or the need has become more obvious.

There's been a staffing crisis for many years in mental health, yet the government hadn't bothered to try to do anything about it. A&E has always been seen as well if everything else fails ie early intervention, community support etc because of lack of staff then they can just go to A&E at least (same for many physical conditions too); but now A&E is fucked so its not as easy to paper up those cracks or let hospitals deal with the fallout from the systematic underfunding and neglect of other parts of the system. Its not even about money at this point, my trust has been offered millions by the gov for enhancing mental health services, but no point as there's not enough staff (even locums on ££££ per shift) to run what we currently have.

I have thought for a while not that there needs to be a completely different a&e for MH crisis. An entirely different system and atmosphere is required. But then a different system is required for a lot of things these days.

It’s incredibly sad and right now there is no change on the horizon that I can see which will improve it.

It's nothing overly new to be honest. The reason for keeping them in A&E is yes partly to try and ensure their safety, but also they have to wait for the correct HCPs to be available to do an assessment which can take a long time.