To think sectioning shouldn’t be done lightly

[User5022]

Eg used because an adult decided they didn’t want to rest of a treatment. I always assumed it had a really high threshold.

@doublebarrellednurse

That's really interesting. In your experience what is the answer when they won't engage? The only end I can see is accidental death?

How do you get them to engage if they don't want to?

My sis basically wants to be left alone to overdose daily (and call an ambulance each time) but then doesn't like the consequences of that of being sectioned and thinks everyone is being unreasonable and should just let her get on with it. (Not admitting that if she didn't call the ambulances each time she would be left to get on with it!)

we are talking 20-40 tablets per day every day at times.

My sis basically wants to be left alone to overdose daily (and call an ambulance each time) but then doesn't like the consequences of that of being sectioned and thinks everyone is being unreasonable and should just let her get on with it. (Not admitting that if she didn't call the ambulances each time she would be left to get on with it!)

Pretty much my experience, it was relentless and it wasn't just overdoses. Took attempts into triple figures and heart actually stop and having to be resuscitated before we got her into a closed hospital. I think some people just like the attention of being in hospital who are cursed with this illness. It's exhausting for the carers.

It's knock on effect of seeing what the body can tolerate, someone taking an overdose doesn't really register much. It's like meh.

Bottom line, if they won't engage then they either won't get the help they need or they get sectioned for years and forced to engage to break them out of the overdose/hospital habit they've got themselves in.

@gamerchick

She moved away from
Overdoses in hospital as obviously could not get the tablets. Tried drinking vape liquid a few times, cutting, strangulation (which did require resuscitation) but she shrugs it off.

The strangulation was while on 15 minute obs. The rest while on 121.

Frankly I feel like if you want to do that at home get on and do it but don't then keep calling us expecting me to bring up all your belongings that instant.

I was really struggling with the stress of earlier this month - was getting calls in middle of night as she absconded form a and w whilst awaiting transfer.

She does seem to enjoy being ill - comment from many staff has been that she wants to be ill and gets upset if she is not. She currently has very low haemaglobin (under 8) and is refusing any investigations into why.

She doesn't want to be dead but at the rate she's going she will be. She just laughs everything off.

Something needs to happen one way or the other because honestly it puts so much stress on the rest of the family never knowing if the reason she doesn't answer or phone is because she has taken it too far. Or waiting for that phone call.

Yep and I hear every single word you're saying.

It's not palatable and I've been judged harshly. I'm also not recommending it either but the only approach that worked for us was to bring up the drawbridge. No running about, no more phonecalls, tell the authorities that she was totally on her own and anything that happens to her is on them. It was a risky gamble but it worked. They were forced to act and put her where she couldn't hurt herself and draw on resources anymore.

It's a horrible, horrible situation to be in.

I dont think it's fair to discuss this on pop's thread she is worried about her daughter and I'm not sure your comments are helpful towards the situation

I'm all ears for your experiences and workable solutions that are easier on the eyes. I'm sure your surefire tried and tested will be the holy grail to the nightmare this particular thing is.

There is no sugar coating the state of MH services. The sooner people get on the beam the better.

I'll post where I like thanks. The report button is right there. When you've done this as long as I have, it becomes your normal

I honestly don’t mind other people talking about their experiences or professionals talking about the treatment for patients similar to my dd.

@whatohwhattodo

It's difficult but whilst they still have capacity (by the letter of the law) there is very little that can be done. I worked for the ambulance service for a while and your sister is not alone in doing what she's doing.

Largely people do engage eventually. It just clicks. Or they become physically unwell and it hits them they need to make a change.

Sadly with PD you're 8 times more likely than the general pop to end your life. Which is a scary statistic and why I end up in coroners semi regularly.

In the grand scheme of things, and sorry to be so clinical, overdoses that are self reported mean she's a moderate risk. It's a very push/pull thing she's doing - help me/don't help me. I'd be trying to get to the bottom of what function o/d has for her and finding alternative strategies and also laying out what things like dialysis are like. Unpleasant, painful, life long, transplants, rejection etc etc. Also meaningful activity like work, education, volunteering is often a big help.

Sometimes it just takes a long time though. Sometimes it takes simple maturity.

Services need to do more to engage people but it's excessively challenging at times. Most CPN in our area have around 40 people on their caseload in the community to manage.

@User5022 most GPS will prescribe but again some won't 😣 they'd be your first port of call

@gamerchick is spot on. I've had to have this conversation around setting boundaries with many many families. It causes immense pressure for everyone and generally just "feeds" the behaviour. Sadly sometimes you have to make people stand on their own two feet and take some responsibility before they realise that life isn't going to fix them they have to do it themselves.

@doublebarrellednurse

What you say makes sense. She has hoarding issues and has long standing anxiety. This has lead to a situation where she spends all her time in a very cluttered flat. I feel depressed just walking in there so I am not surprised she feels so down however as you know hoarding is not something else that can easily be solved and she won't accept any help to sort it out.

They have transferred responsibility for her to another team for a fresh start and they have mentioned volunteering (which she used to do for a while after stopping work) which I think would be a good thing as when she is out and in her comfort zone with people she's knows / trusts she is very social.

She is mid 40's so not sure there is any maturity to come. She has stayed with my parents previously which went well but the last few times not good as I think she obviously could not take the tablets there.

I am it's dreading the next few weeks now she is out as to what happens.

It seems the case that there is a noticeable deterioration in her mental health if at any point it seems like she might have to address the underlying cause of the problem.

@doublebarrellednurse @gamerchick

Forgot the reply to this one - the magic pill makes sense. Her neighbour does a lot of well-being type stuff and has offered to spend some time with her and work on it. This was refused and her comment was she thinks my sister just wants a magic pill to solve it all.

That must be hard what, when I worked in acute psychiatry we had a lot of patients with similar injurious behaviour to.your sister ,several long term( in that they had frequent admissions ) patients had risk.assessments that stated there was a high risk of accidental death ,I don't think.bringing people into hospital works ,because it doesn't actually cure.the problem.it's just keeping someone safe in crisis but perpetuating the situation ,this has been acknowledged in recent years ,may be long term CBT,/ Psychotherapy etc but someone has to engage for that to help it must be really hard on families though

@User5022

You say your. Sighted has asd. My sister has had issues from a very young age and with the benefit of hindsight i do wonder (and her support worker) wonders whether she was / is asd and the issues with never being diagnosed and lack of support has lead to this

However obviously 40 years ago I don't think it was probably as understood as it is now.

Possibly What, ASD is much harder to diagnose in females and a lot of patients got a " PD" diagnosis in years gone by ,which possibly wasent the correct diagnosis it seemed to be a " catch all diagnosis " .

@x2boys

You are right. Any chance she got in hosp she was harming and getting more frustrated. I actually think shes possibly at higher risk straight after coming out because she will feel like she's for lost time to make up for! I think maybe for a couple of days after she was resuscitated she was a bit subdued but then back to normal.

she’s had a better day at the day hospital today however is saying she doesn’t want to go and she feels uncomfortable being around people so much older all day. I’ve reminded her if she doesn’t go she risks another mental health act assessment. She’s told me it will be impossible for them to section her so she doesn’t care. I’m at a loss of what to do really

Well.hopefully Op.as she's starting to.engage it will.get easier for you?It takes time ,she's had a better day and that's positive for now .

She’s now kicking off saying she won’t be going unfortunately

Do.you think.she might give it a week?.if she ,s aware of the possibilities of what will happen if she doesn't attend the day hospital ?

Not read whole thread. This is a rather unhelpful sensational title to a post, although think OP might not have realised that.
I am a psychiatrist with section 12/ responsible clinician status and regularly do mental health act assessments. It is never undertaken lightly.
An assessment requires two psychiatrists with section 12 approval (specific qualificiations), one of which is independent (non NHS doctor) and an approved mental health professional. A least restrictive option is always preferred.
Detention requires us to have evidence that
There is a disability of the mind to a nature and/or degree that this poses risks ( to/ from self and or others) which can not be safely managed in a less restrictive manner. The vast majority of patients are deemed to lack capacity under the terms of the mental capacity act 2005 to make a decision regarding their treatment due to the disability of the mind.

Risks are wide and varied, not just suicide or violence. e.g. self neglect , non compliance with medication in the clear historical knowledge that this will lead to a decline in health, refusal to eat and drink due to a mental disorder, inability to comply with less restrictive options already tried.

Declining treatment in a patient with full capcity to make that decision is fine. It is not if capacity is impaired due to a disability of the mind.

No she’s saying she won’t be going as she believes they won’t do anything about it and she was only going as she’s didn't want to be sectioned):

dairymilkmonster I apologise for the way I’ve written the tile. I wrote it in a time of stress and I acknowledge that it wasn’t the right way to word it.

@dairymilkmonster you might want to read the full thread. That point was made and accepted some time ago...

I was sectioned for threatening to cut my wrists, in tears, family called polie. They were gonna arrest me for something idr now what, but when in the back of the car I just bashd my head against the frame, they said if I carried on doing that they'd ask for me to be sectioned etc, so I carried on because I'd rather be sectioned then be "at fault" for beech of peace and spending a night in the cell. I got like two weeks at a Priory hospital that my family didn't have to pay for because there were "no other beds anywhere available". It was actually OK there you know, I made a few friends, had a lovely big room and en suite (sure they do watch you sleep etc first few nights but if you prove you won't do anything they stop). One of my best memories from there was setting the fire alarm off just before lights out with 2 other girls, it opened the locked doors to the ward automatically for escape, so we legged it in our pj's out into the night, security guy chasing us...one of the girls he caught but me and the other girl "escaped", when we came back the security guy started calling me Bolt because I ran so fast haha. Miss it sometimes, but that was many years ago.

Tbh that didn't seem like a high threshold to me, I stopped banging my head when they sectioned me so they could have not.