Woman evicted from NHS hospital ward after being stuck for 18 months

[SerendipityJane]

https://www.bbc.co.uk/news/articles/c897ew0ekp4o

What should be done is a total revamp of social care where the best option is always supporting people in their own home with dedicated staffing teams, subsided by reducing disability benefits to people needing that care - if 2-4 people can share a home then great, but if needed it should be single person housing. That should automatically be the case for anyone with complex needs including mental health, forensics, learning disabilities, etc - focusing on independence, support, education, etc with full community team support.

Sadly however, no one wants to work in any of those services because they’ve been defunded and battered by successive governments, underpaid undertrained and undervalued and overwhelmed by a massive demand.

So until the staffing and infrastructure is there we will always see problems like this.

You still get long stay wards/hospitals - albeit much much smaller - but I think a lot are now run by private organisations that can charge the NHS a fortune.

I think this is more likely the case

If you are managing a mh residence one person can totally change the dynamics and a calm placement can change to a chaotic placement and they will then be moved on over and over again, and their reputation will be known

it’s not as simple as finding a placement it’s one that can manage very challenging clients, many places will all ready possible have a few one more is just too much to manage and teams will not take that risk

it’s a very sad state of affairs

There should be more inpatient MH provision (the current level is inadequate to meet the needs of the acutely ill people who need it) and more provision of all kinds to help ease hospital discharges. It will cost but the system currently is not fit for purpose.

But...I'm not sure any of this will really resolve situations like this. This lady's case has made the news because of the hospital angle, but there are many, many complex and intractable situations that don't. They don't because social services and medical teams are committing vast amounts of time, money and other resources trying to make sure they are maintained at home or that residential placements don't break down.

People ask what would have happened in the past. I think many would have gone under the radar and possibly lived in very poor and limited conditions, maybe street homeless. Some would have been sectioned longterm and others imprisoned. Lots would have died very prematurely.

Things have changed and while every attempt is and should be made to meet people's needs and keep them safe, there are always going to be instances where it is nearly impossible to do that without constant firefighting and effort.

The hospital should be given power to do so. Just like patients who refuse to go into bays, or refuse to move wards, they are told this is not a hotel and unfortunately you arent entitled to stay in a side room when it is no longer necessary and you cannot dictate which ward you stay on. In A&E you may be assessed and seen in a nice little side room, a decision to admit made, but then you are safe to wait on the corridor for a bed on a ward. Do people want to wait on a corridor, absolutely not, but it is not their choice, a medic or nurse makes teh decision you are safe to wait on the corridor and you are moved whether you like it or not. Patients are moved for a whole host of reasons. We transfer between sites too, if you no longer require the acute care given on wards on the main site, then the base a few miles out that is nurse led not dr led is appropriate and you are transfered, you do not get a say over this, it is a medical decision. The same can be made with social care, it needs to be made wih social care. Hospitals across the country are at capacity due to social care, at this point in time, with the bed crisis as it is, the patients voice cannot be the priority. Is it shit? Yes, absolutely, but hospitals are full, and those hwo require the beds cannot get them due to those who dont require impatient care. Those who NEED the bed HAVE to be the priority.

@LolaLouise There does need to be some safeguarding in place so people are not discharged to go home who are not capable of it.

200,000 she costed the NHS. And being offered place with 2, 24 hour carers. She refuses. Council spend time and money looking for 120 places for her. Cos she has personality issues. Wow... Sorry I have zero sympathy.

As a teenager I lived in a hostel for young people - There were some lovely kids there but then a really disturbed older (22) woman came in who did exactly that.

I won’t go into what she did as not relevant- but it upset the whole hostel. ( She was given umpteen warnings, too)

She was evicted, everyone breathed a sign of relief- and I heard a year later she had died .

I hope she is at peace now- She was clearly very disturbed.

At the time I found her scary, but now I’m much older I see exactly why she behaved as she did.

Obviously. Thats why we are in crisis because these patients arent being discharged to an unsafe environment. But there are options, the lady in question refused the option, she should never have been allowed to refuse it. They should have just removed her there and then and any disagreement over the facility be had once moved out of an acute hospital bed in a medical facility. It never should have been allowed to get to the point it did.

I actually feel sorry for this woman, as it sounds like her life is pretty shit. And I worry that if she could not properly engage with the process of being moved out, does she truly comprehend the ramifications of being featured in an article like this.

But I also feel for the scores, maybe over a hundred patients who in that time should have had use of that bed, and instead may have been stuck on a trolley in a corridor, waiting for one. Maybe even dying there.

It does demonstrate that you can't solve the problems in the NHS without also sorting out social care. We all have such stories we could tell were it not for respecting confidentiality.

I have several people like this in my family and it is heartbreaking. The core of their condition is that they reject all the (considerable!!) care and help and love and support offered, making it completely impossible for anyone to help improve their situation, and then they will lash out violently (often physically) because they feel nobody cares enough. Often post on social media - crying photos and videos about how utterly alone they are in the world and how they’ve been abandoned and betrayed, when actually about ten of their closest friends and family have been entirely financially supporting them for decades, advocating with doctors on their behalf, coming and staying with them and helping them to eat, finding them therapies (that they won’t engage with in good faith or at all).

I’ve eventually gone NC as the alternative was to be bled completely dry emotionally, financially, and practically - and still never be perceived as doing anywhere near enough to help them. The more we gave the more tirelessly they would work to perceive us as abandoning uncaring arseholes. That is the dynamic unfortunately with many people who are extremely severely affected by this condition.

it is different for people who are less severely affected - which is why I think we need different terminology for those with EUPD diagnoses who have insight and lower care needs and are able to live independently, and those who really do need the on-call support of an interprofessional team.

Perhaps if you refuse a suitable care home the hospital should charge for rent and meals.

Often in these cases the parents can be the cause of the original problem rather than the solution.

Surely we have to come to a point in society where we prioritise the many over the few. It's not a case of saying that people don't matter but this lady has effectively prevented many people from getting treatment and help. Who knows the impact this has had on people's lives! Their stories will be untold though and this woman will dominate headlines where some will believe that her needs and wants should be prioritised over everything else.

The general public do not appreciate how difficult this type ot patient can be. I think in time Gov. Will have to open up ward facilities similar to institutions in 1900s.

Well she seems as nutty as a fruitcake and extremely difficult and intransigent to boot. Ditto the mother. Meanwhile a bed is being denied to someone who wants and needs actual medical treatment. What the answer is I do not know. Obviously her original ‘home’ was at the end of their tether.

those who really do need the on-call support of an interprofessional team.

Totally agree with this @VoltaireMittyDream . Multiagency teams with medical/mental health/social care practitioners (etc) with advanced training are not a total solution, but would help. Currently such cases tend to be dealt with by one person, until they can no longer cope (the toll it takes on the rest of their considerable workload is big and because of the complexity it is usually a senior/very experienced worker) It would give more continuity for the clients and their families, for a start.

Absolutely ridiculous. If you do not need a medical bed then you should not be in one if you have been offered an alternative

Yes I agree

Obviously far more comfortable conditions with therapeutic support

some people just can not live in a community setting, I’ve seen so many in and out of hospital it’s very sad for them, it’s hard on their families, puts extra work on their teams and unsettles other residents

I thought it was because the Tories under Margaret Thatchers rule thought Care in the Community would be cheaper. I think institutions to house violent and challenging mentally ill people like the Nottingham killer who refused to take medication and murdered 3 people would be beneficial to save the devastation to society they have caused.

Tell me that you have no idea at all about personality disorders without telling me...

I agree that such institutions would be best. It was stupid to shut them IMO. A Home would be ideal for this woman. It could have an enhanced unit for people like her who need extra care and are prone to causing harm to themselves or others. I also think that they’d like it (although they’d never admit it) as it fulfils their need to be looked after and have everything done for them.

The person I know craves being looked after and babied basically. At the moment, due to recent events, they actually are in a home of sorts and seem to be ok. They’ll never be content but they seem more settled.

Social care is commissioned by councils but provided by 'entrepreneurs'. How will market forces ever induce them to provide what this woman needs? She's not the kind of business they want.

In most cases people like that are in hospital - forensic or secure - but much smaller hospitals with eg an OT, physio, etc.

Anything larger you’d end up with a death rate through the roof and the wrong sort of people working there (ie people with a punishment mindset) - no one in their right mind would want that sort of job. People will work in smaller institutions and bigger trusted ones like Broadmoor and Rampton etc, but if you open up just general ‘massive mental illness’ housing for no real reason other than to stop them being society’s problem, very few genuine people will want a job there.

Not knowing how to communicate effectively can manifest as abusive wording.

I'm autistic and literally having to be coached in how to communicate frustration to others in a way that isn't rude, sarcastic, or abusive.

Speaking of autism, EUPD is a common misdiagnosis for autistic women.