To make a complaint about my treatment on a psychiatric ward?

[dontrunwithscissors]

I was recently admitted to my local psychiatric hospital for a psychotic depressive episode. (I have bipolar). Overall, I got excellent care. With the exception of the occasion I'm about to describe, the nurses were wonderful. I apologise for the length of this post, but want to include all details.

When I was first admitted, I was put on constant observations due to the level of suicide risk. I was getting 'messages' instructing me to strangle myself (bag straps, clothing). By day 3, my psychotic symptoms had improved, but not resolved completely and I was still deeply sucidal and getting incredibly powerful urges. They took me off constant observations that morning after asking me 'if I can keep myself safe'. I said yes (genuinely thought I could). On reflection, I was still a risk to myself. They had still left me with some items of clothing that could be used as a ligature. I was put on the normal hourly checks.

That evening, I attempted to strangle myself. A nurse walked in on me, but didn't realise what was happening as I was on the floor, on the opposite side of the bed. A few hours later, I went to one of the nurses (night shift) and told her I felt unable to stop myself following the messages, I was very distressed, and said I needed help. She told me to go sit in the TV room. I didn't want to sit there sobbing so I went back to my room.

Ten minutes later, I returned to the nurse and said I needed help. She asked me why I had said I could keep myself safe that morning, but was now telling her something different. I said I didn't know, but I was really struggling now. (Night times are always my worst.) She walked off from me. I returned to my room. By this point, I figured they were not going to help me and seemed to be suggesting I was lying. I returned to her shortly after and said I needed help and asked to see the duty doctor. She threatened me that if I insisted on seeing the doctor 'they will section me'. (I was an informal/voluntary patient. I was asking for help not to leave at all.). She again walked off from me.

I again returned to my room and again started to strangle myself. I was very, very distressed by now. I approached the other nurse (male) who was on duty and again asked for help and to see the duty doc. He said 'you've already been told you can't do that.'

I was desperate by now. I rang my husband, sobbed, explained what had happened. He rang the ward and spoke to the male nurse. This nurse came to my room, asked me why was i behaving that way, and told me to go to bed. I told him I felt unable to keep myself safe. He left me with clothing. I ended up speaking to DH on the phone until I fell asleep (with him still on the phone.)

The next afternoon, I knew those two nurses would be on duty that evening and I again felt that I would deteriorate that night so I spoke to a 'nice' nurse and she immediately came to my room and took everything away that I could use. She highlighted the need to increase obs.

I've been out of hospital 1.5 weeks and thinking about how I was treated that evening. I was clearly distressed and communicating that I needed help, but they did nothing to intervene and ensure my safety. The threat that they would get me detained if I insisted on asking for a doctor seems particularly cruel (or maybe illegal?)

So, WIBU to issue a complaint about the treatment? Should these nurses have behaved differently? I'm caught between feeling this should be highlighted, but I also know that at some point I will be admitted again, and I will have to 'deal' with these nurses again. FWIW, the hospital has been in the news recently for allowing a sucidal man to leave and he subsequently killed himself--the ruling was they should have detained him, but he was assessed by a trainee pdoc who failed to recognise the dangers.

I definitely think you should complain. I'm really sorry you had this experience. Maybe have a chat to Mind, think they have a legal helpline you could try.

Those nurses appear to be in the wrong job! Their behaviour was appalling. Yes, please complain and the suggestion to contact Mind is an excellent one.

Not sure how to respond, but I know there are a lot of MH professionals and lawyers on MN so I'm sure someone will be along soon to advise you.

If your not happy then make a formal complaint.

Perhaps as a first step request all your hospital medical records to see what is noted about their contact with you, observations etc. And then seek advice. But it does seem very wrong to use 'sectioning' as a threat.

It's always OK to make a complaint if you are unhappy with your care.

But it's difficult to judge the situation only knowing one side. There is a clinical evidence base for encouraging patients to recognise their own responsibility in managing their safety in some disorders. So while using eyesight observations or removing potential ligatures may feel in the short term like you are being looked after but may not actually help in the long run.

I do wonder if the nurses were keeping a closer eye than you were aware, ready to intervene if required. But it's impossible to know, maybe they were just very unprofessional.

I would also say that identifying 'good' and 'bad' nurses can be a typical symptoms of some disorders too.

YADNBU.

I know nothing about psychiatric wards, but it seems that asking a patient to assess their own level of risk, and abiding by that seems a little odd?

It seems to me that the "nice" nurse was just doing her job correctly.

X-posts with atheendoftheday who sounds knowledgeable, ignore what I said, and listen to her...

Thanks.

chapsie, yes, that's a good point. I've requested my notes in the past so know the procedure.

Difficult to comment as not there BUT I would never move someone from 1:1 to hourly obs - it would be 5 or 15 minutes. You sound like you needed some prn medication. Any ligature risk items should be removed (however I've seen people ligature with knickers or anything they can get their hands on. NOBODY. Should ever be threatened with section in and I want to make it clear to anyone who may need help that it us very difficult to section someone. It is not a process taken lightly - sadly I have heard people communicate in a manner which appears to give the patient no choice... Do this or I will section you/ inject you. Please complain. It gives the staff a chance to feedback to you and also if at fault some action can be taken

The treatment you received from the 2 nurses in question sounds negligent and definitely amounts to bad practise. You were asking for help to keep yourself safe and deserved a professional, caring response rather than the apathetic one you received.

I'm glad you're feeling somewhat better and hope you have the strength to complain

It is normal these days to include service users in all decision making including risk as it is meant to be a shared process. However the healthcare professionals can over ride anything deemed risky . Most people with mental illness retain some ability to make choices but we have the power to make choices for the person to keep them and others safe

did they offer you any PRN [as required medication] ?,did you say you wanted to leave? the duty dr probably couldnt have done much other than reveiw your PRN medication and they are extremely busy at nights du to being the ony dr on duty so even if they had been called they would have probably taken hours to see you i,m an RMN [ although not working now i have spent years working on the wards you describe] i would have taken you into the quiet room and had a chat or if i was very busy right then i would have asked one of the HCA,s to have a chat to see how we could have managed your distress and probably offered you some medication as it might have alleviated your immediate anxiety.

X-post. No where in my OP did I classify nurses as good and bad. I used the term 'nice' (deliberately in '').

I absolutely understand the value of encouraging people to take responsibility for their safety. That's exactly what I did when I said to them that I needed their help and to remove the remaining dangerous items because the situation had changed.

Their response to me asking for help was at odds with every other occasion where I've turned to nurses and said I was struggling. They consistently say 'what can be done to help you and minimise risk'?

I told my CPN about this and she was at what I told her and said she didn't understand why they took me off constant obs so quickly. I didn't pursue with her whether I should make a complaint. I think that would put her in a difficult position.

Absolutely complain. What a horrible way to be treated. Well done on keeping yourself safe OP .

From what you describe you didn't need the duty doctor... you needed the nurses to actually nurse you, as in do their job. If any nurse I worked with behaved as they did the rest of the team would call them out on it... providing support, reassurance and sometimes constant observation is our job (one of my favourite parts to be honest, it's how we get to know patients and how they come to trust us)

i do agree with wheretheresawill1 nobody in the trust i worked for would have gone from level one obsevations [within arms reach] to general observations they would have gone to level two within eyesight and then probably fifteen minute checks.

Sorry, more X posted. I'd already asked for PRN medication (had lorazepam and extra quetiapine). I'd explained when I requested it that I was really struggling with the intensity of the messages. This was before the night shift had started.

I only asked to see the duty doc as I felt so desparate. I felt I'd done everything I could at that point and couldn't understand why they weren't doing what I've always experienced--speaking with someone about what was happening. I certainly never asked to leave. The threat of detention confused and scared me.

Yes do complain. Tbh, if overall your care was good, then this is so much better than mpst people experience in a psychiatric hospital, but most people don't complain, and so it continues.

Night shifts are often a law unto themselves, with neglect and abuse being shrouded in half-baked rhetoric about 'personal responsibility.'

Best of luck. But yes definitely make sure that this is investigated.

YWNBU but it won't help I was traumatised by my treatment from our local mental health team and my health is now worse than it was. I've complained. They've said they were wrong on parts and are 'sorry', denied others and overall it's got me nowhere because they have just completely ignored my question of how I can get help so I have no assistance in recovering from what they did to me or from the original problem.

you do get good and not so good nurses i,m afraid i cant understand why they were threatening to have you sectioned though if you werent trying to leave or making any gestures to leave did they give you the prn [sorry i,m not clear and if they did ,did it work did they check you were feeling calmer?

I forgot to add that I think they were short staffed that night. There was only 2 people, whereas there generally seemed to be 4.

Sorry, I forgot to add that once DH rang the office, the male nurse finally came to speak to me in my room. He took some clothing that I gave him away. By this point, I was distressed, confused, and scared.

I don't think you'll be able to get an answer from anyone here as to whether the nurses were reasonable in their actions or not. As a PP said, you only have your own viewpoint on the situation, which is obviously skewed somewhat due to your state of mind at the time.

From my experience as an inpatient, they remove everything that is an obvious potential ligature - belts, phone chargers, scarves, leggings - but on a regular psych ward they can't take all your clothes away from you. You have jeans, jumpers, socks - a determined person will make do.

I'm surprised the nurse left you lying out of sight on the far side of the bed without a visual check you were OK. You should ask to see your notes - if she wrote down that you were visible in your room when actually you were mid strangling yourself then she should be in trouble.

Hospital sucks - I did 4.5 months in one stint - hope you can avoid going back in for a while.

Yes, if you feel able I would definitely make a complaint.

Sorry you had that experience OP, I think it's terrible that your husband was the only one to be relied on. The hospital failed their duty of care IMO.

X2boys in my trust they've done away with 15 minute obs, the rationale is that if some is determined then 15 minutes is more than enough time (as I've unfrotuantly seen in a previous role several times) we would go from arms length to eye sight to general. They can be placed on general with certain restrictions though such as no closed bedroom doors or to go to the toilet near the staff office so they can be closely monitored.