Inpatient care on NHS mental health ward

[0vertherainbow]

My Autistic DS is currently and inpatient ... severe mental health issues (depression , paranoia) but no learning difficulties.

What I'd like to know is: what level of consultant input is considered necessary, or with due care? and how might it be possible to understand whether he is getting all the necessary input that he needs? He had been under a care plan in the community before this admission... Stayed with same consultant but has seen them twice in three weeks while on the ward, despite rapid decline in his mental health.

I'm so sorry for you and your son. I don't have experience of inpatient but suggest that you join (if you haven't already) a private Facebook group entitled Parentling Mental Health. They have a sub-group for parents of those who are inpatients.

I’m an inpatient MH nurse. Consultant rounds on psych wards are normally once a week. Twice in three weeks is a little less than normal, but might happen depending on when in the week he’s admitted or consultant holidays etc etc. On inpatient wards, nurses do the vast majority of the care including writing care plans and doing risk assessments as well as planning day to day support. Consultants mostly do diagnosis and medication. Have you tried contacting his assigned nurse? If he was my patient, and he’d consented to us speaking to you, I’d be happy to have a full discussion about his care. Is he under a section and are you the nearest relative? As nearest relative you would be entitled to some information legally.

I came to say something similar, I’m an RN but not in MH but have done some work on a unit.
But commenting as someone who a long time ago was a patient (talking over a decade ago) & someone who’s close relative was a patient (I was next of kin), like mentioned it was weekly consultant rounds.
The designated nurse was the wealth of knowledge and always happy to talk to me.
There was a less senior doctor for any medical tests ie blood tests/ecg readings/medication on call but yes in essence the nurse would be my first point of contact.
Also have you thought about using advocacy for your DS? They helped my relative a lot.
Sending hugs at this tough time

Thanks very much for replies.
Yes he is under section, and I am nearest relative. I have been able to speak to nurses on the ward extensively about his care.
They say his care is directed by the consultant's instructions. So e.g. meds as instructed ( PRN and otherwise) whether or not situation seems to suggest he needs more ( e.g. sedative when severely anxious and kicking off).
So while the consultant is not available regardless of distress my son is in nurses are not able to do anything more than physically restrain/ monitor/ safe keeping.
Does this sound correct?

Yes he has an advocate- so far limited in affecting significant change for him.

So sorry to hear this. My asd son has been an inpatient too and sadly for him it made things much worse. He is now back home but incredibly traumatised from hospital. Hope you have a better experience.

There are weekly ward round meetings which are on Teams or similar you should be invited to which give updates on progress - ask if can join if not been offered. If you want him back home, home visits are the way to go and show he does better there. There are CETRs you can have and another health regular one as well as an autism keyworker and an IMH advocate, none of these were especially useful and there were endless meetings but they are supposed to plan way forward.

On Facebook there's a group called Parenting Mental Health, join that then there's a subgroup PMH Inpatient and join that and there's other parents in the same boat. I could also phone psychiatrist and she would talk to me.

@0vertherainbow On most wards there's a morning team meeting in which the consultant, a senior nurse/ward manager and any representatives from the therapy/psychology staff discuss the patients individually, including whether there's been any changes or if anything, including medication, needs updating. There should also be a doctor available 24/7 who can prescribe/assess on the nurses' request. Necessary immediate medication should never be left from one consultant round to the next.
This does all sound very medication focused though. What is the ward doing to support him therapeutically? Most wards have a lively OT program (cooking, art, yoga etc) going on plus opportunity for psychological support, both from the nurses (many, including me, are also therapy trained) and psychology staff. Inpatient stays are about improving people's functioning so that they are able to successfully live in the community. How is that being supported?

I would ask if the psychologist is able to work with the team to provide a psychologically informed care plan that they can all work with. At the moment if he's getting worse, their current "treatment" isn't working.

@JennieTheZebra I know about the team meeting...His assigned consultant is on the ward once a week. My impression is that his input is via email otherwise, since he is based in the community. I don't think that happens daily though, and definitely not over weekends.
The doctors on the ward do not prescribe / change any medications without the consultant's authorisation. I agree that meds are a focus in my head... mainly because in the past being on different meds enabled my son to stabilise to the extent that he could engage with therapy, and eventually even carry on with his life.

@5475878237NC Every time I have spoken to staff on the ward I've been told that the consultant makes the decisions about his care plan. Even the psychologist involvement seems to be subject to consultant's direction.

Right now he is only lurching from one crisis to another, and I don't understand why there doesn't seem to be a clear, directed plan from anybody who is looking after him- especially given the replies from @JennieTheZebra