To think the NHS was completely useless for this.

[cuckoonut]

My daughter has severe depression and a potential diagnosis of BPD in January when she turns 18. Recently she's been in an extremely dark place. She's been in and out of inpatient units since she was 14 so we're kind of used to the process of what happens when she attempts to end her life. Two weeks ago she took an overdose, she was taken to a&e, checked over and had a mental health assessment. They deemed her fit to leave and sent her on her way. She has been given no extra support since then despite us asking multiple times. Last night she attempted again. She took 16 Paracetamol with half a bottle of wine and intended on taking another box if we hadn't have stopped her going out. She almost collapsed about 3 hours after and we put two and two together. We called the ambulance and they said they'd send somebody out within 2 hours and to call back if anything changed.

We sat up and waited with her for about 45 minutes when her breathing became very painful, and she said if she didn't force herself to breathe she thought she would stop altogether. She was struggling to stay awake. My DH called the ambulance again to tell them. They said 9 minutes and to hold for a clinician. When we were put through to the clinician she said, quote "from a medical stand point there's nothing wrong with her. She doesn't need to be seen" despite her not being able to breathe and taking an overdose just hours earlier. She kept insisting DD was fine and that she would cancel the ambulance. We asked to talk to somebody else and she kept refusing. We hung up and called again but they kept saying we had to speak to the lady. The ambulance arrived as she was saying she would cancel it. The paramedic checked DD over and said it was best if we went to A&E because of the dose and it was an attempt to end her life. Then her radio buzzed and they asked "why are you still there?" She called up the lady we had been on the phone to and they had a long conversation outside. She then came back and said it was unnecessary to come to the hospital and that DDs mental health team would be informed on Monday. DD has been up all night vomitting and wanting to hurt herself. They didn't even give her a mental health assessment like they're supposed to when somebody tries to commit suicide. She's a minor for God sake!!

But they did two weeks ago, and before that and before that and before that. What help would another assessment do? Nothing.

Indeed. That's the problem isn't it. Suicidal children and teenagers with zero/very little support or help. Yanbu OP. The NHS is rather rubbish at helping kids with mental health issues, hence why they end up in these situations.

I doubt op had the time to look up whether paracetamol overdoses affect breathing or how much needs to be taken to cause liver damage at the time, so telling her she's unreasonable because of that is ridiculous.

As for the triage system, one day 111 will send someone an ambulance for a mild chest infection despite then saying it's not necessary because they know they need a GP and not an ambulance and another day the 999 team tell you to wait hours for a call back when you have someone in severe pain, sweaty, obviously very unwell and when you DO seek other medical assistance the first thing they is why you didn't ring an ambulance. So that doesn't always work well does it.

I think the OP is referring to Bipolar Disorder not borderline personality disorder when she states BPD.

Why? Everything the OP describes would be indicative of borderline personality disorder, including a reluctance to confirm diagnosis before the 18th birthday.

The NHS guidelines say go to A&E rather than dial an ambulance so I can understand why that has been the advice but I feel like there has been a lack of compassion for the OP. Having dealt with shit mental health service provision for my mother, I can only imagine how awful it must be when dealing with a child. There needs to be better help from crisis teams for dealing with deteriorations and risky behaviour. Too often families are left to deal with sick people with no support or help.

Secondly, if she has attempted to take her life various times before, as recently as 2 weeks ago, why does she have easy access to paracetamol, wine etc? Or free reign to go out and buy whatever she likes?

She is 17? How do you suggest she keeps her indoors? You think it is acceptable for OP to lock her up? Do you have any idea how difficult it is to keep someone safe when they are suicidal unless they are in a secure setting? Do not put guilt onto a parent who is trying to do their best. You have no idea.

People have also mentioned 'cry for help'. I just want to say that the more attempts someone makes the more likely they are to eventually complete. Always treat any suicide attempt, no matter how 'mild' the attempt very seriously.

I agree OP should have taken her to A&E herself. Unfortunately, sometimes that is the only way to be seen by the MH team urgently. BTDT many times because there was no other option in a crisis.

OP

Secondly, if she has attempted to take her life various times before, as recently as 2 weeks ago, why does she have easy access to paracetamol, wine etc? Or free reign to go out and buy whatever she likes?

Do you feel better after writing that? Because you shouldn’t.

Unless there's a huge backstory, this would be nowhere near yhe threshold for an inpatient bed

Yep, sadly not.

Another Dr here. I agree with wineandtiramisu that going to A&E would have been a reasonable thing to do, but an ambulance was not required. I also agree she seems unlikely that OPs DD will have taken a toxic dose, but as we don't know OPs DD weight and other health issues it is impossible to say. An assessment in A&E is, therefore, not unreasonable.

As for Sounds like she needs to go back into inpatient care, it is a common misconception that everyone threatening suicide, or making any attempt at suicide, need to be admitted to an inpatient unit. Clearly, OPs DD has required inpatient treatment before and may need it again, but this particular incident does not automatically mean she needs to be admitted. I am unclear if OP means bipolar disorder or borderline personality disorder- this is an important distinction in the current context.

I just wanted to add that sadly for someone with ongoing mental health problems, there are no quick easy fixes.

As for Sounds like she needs to go back into inpatient care, it is a common misconception that everyone threatening suicide, or making any attempt at suicide, need to be admitted to an inpatient unit.

Having vast experience caring for someone with BPD. Relentless suicide attempts needs a secure place where it can't happen. Home isn't that secure place. The more they do it, the more likely they'll succeed by accident.

But no one is admitted to a secure unit for ever.

Also, if we are talking about borderline personality disorder an inpatient setting is not appropriate and can in fact be detrimental.

Also, if we are talking about borderline personality disorder an inpatient setting is not appropriate and can in fact be detrimental

Or it might not be. The girl I care for has been in a secure unit for 2 years and is actually starting to recover after a LOT of therapy and jiggling of medications. At some point shell be going into a PD unit to prep her for RL.

She would be dead now if she hadn't have gone in. Or rather if I hadn't fought for it to happen. More like it's not appropriate because it costs so much

gamerchick

Having vast experience caring for someone with BPD. Relentless suicide attempts needs a secure place where it can't happen. Home isn't that secure place. The more they do it, the more likely they'll succeed by accident.

I am not a psychiatrist, but do have some experience of working in a mental health unit as a junior Dr. The psychiatrists who I worked with did not advocate recurrent admissions for patients with borderline personality disorder (if that is what OPs DD has) as the evidence does not support it. There is evidence that recurrent admissions are actually detrimental. A psychiatrist friend has told me similar in the past.

Also, in my experience that patients are free to come and go from the ward unless held under section so they cannot "be prevented" from doing anything unless they are deemed so incapacitated by their mental illness that they can be detained under the mental health act.

I can appreciate, from a carers perspective, that being left to cope is a very frightening prospect. I suspect the real issue is that the support at home via the crisis teams and community mental health teams is inadequate (largely because of lack of resources).

If I'm honest I couldn't give a fuck about any opinion coming from a psychiatrist. Not after 6 years of dealing with mental health services. If each sufferer had the resource they need poured into them recovery rates would be far better than they are. Early intervention should be focused on rather than waiting until something actually life-threatening happens. Care in the community sucks and doesn't work.

This is a money issue. Services are spread too thin and 'difficult' desicions are made rather than the right ones.

gamerchick

The girl I care for has been in a secure unit for 2 years and is actually starting to recover after a LOT of therapy and jiggling of medications. At some point shell be going into a PD unit to prep her for RL

That is very unusual and suggests that the patient you care for does not have a straightforward, stand alone diagnosis of borderline personality disorder. It is not, from my understanding (and I freely admit that I am not an expert) supported by the evidence for the treatment for borderline personality disorder and is believed by many to be unhelpful.

Yes, repeated suicide attempts increase risk of completed suicide- though often by misadventure, rather than real intent to end their life. Clearly, if a person does end their life then whether it was misadventure or intent doesn't really matter given the outcome, and so does need to be addressed. But that doesn't mean a patient necessarily needs admitted to an inpatient psychiatric unit.

gamerchick

I have some sympathy with what you are saying re resources, but that is true of almost all aspects of healthcare. I work in a different field, but things could be a lot better if we had more money, more staff and more physical resource. Mental health services are more chronically underfunded than many. The reality is that it is not going to happen unless we pay A LOT more for health services.

I find it difficult to believe that everyone in the field of psychiatry is wrong about everything though. So, I'll respectfully have to disagree with you there.

Extra resources that no one wants to pay for... Pie in the sky!

Honestly what happened 50 years ago to people with mental illness? Obviously there were asylums but not everyone went in one. Did people work? Just crack on with life?

Mental illness is rife and I personally think that a lot of mental illness comes within the realm of normal. It is normal to live with some stress, some anxiety and some level of depression.

Honestly what happened 50 years ago to people with mental illness? Obviously there were asylums but not everyone went in one. Did people work? Just crack on with life?

Seriously? There was little or no understanding of MH many years ago, that wasn’t a good thing!

Aye the system now is fucked, but it’s better than no system at all.

People probably completed suicide before then, or were locked up in asylums. Neither of which are anything other than inhumane.

Of course asylums are inhumane. I'm not advocating them. But of mental illness was as prevalent then as it is now there would have been swathes of the population not treated at all. What happened to them?

Extra resources that no one wants to pay for... Pie in the sky!

Many of us would pay extra tax for the NHS.

Many more would advocate raising corporation tax and a massive clampdown on tax avoidance.

Fifty years ago people were on medication and did the best they could. In general over the last 50 years female suicide rates have fallen, and men's have risen. The biggest drop in suicide rates has been amongst older and middle aged people.
There was less support in the past for people with mental health problems. No 6 sessions of counselling available on the NHS for example and no crisis team.

But of mental illness was as prevalent then as it is now there would have been swathes of the population not treated at all. What happened to them?

We had much stronger family and community networks in years gone by, people would have the support in the first place so less likely to become ill, and if they did they would have family to care for them. If they didn't there were workhouses. They didn't fully shut down until the 1970s.

I have no answers for you, @cuckoonut but I'm very confused as to why you didn't get a taxi/drive your DD to A and E to get her bloods checked.

But of mental illness was as prevalent then as it is now there would have been swathes of the population not treated at all. What happened to them?

Well my dad and his dad before him were both left to get on with it and take it out on their families continuing the cycle of poor mental health. I have broken the cycle but no thanks at all to the NHS.

Thank you for your answers all. I find it fascinating the good and bad points of mental health treatment.

Better support networks makes a lot of sense.

I didn't know that about suicide rates either. I assumed they had risen