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.

Unfortunately not her dad is currently in prison. My dad lives in the town we have just moved from but he’s not particularly kind at times and don’t think it would be good to leave him with her at the moment. Thank you for all the support on here.

Can someone on her current team intervene and recommend the hospital close to you?

I don’t think she will be fine if I’m honest. I believe she will do it again she always says she won’t then does.

We’ve now been told these no space in either of the day hospitals.

Sorry to hear that, Have they said when there will be a space they should have sorted that out before discharging her.

That’s what I thought was the plan but clearly not. They threatened her with another mental health act assessment today and said that will be what they do if she carries on feeling the way she does which I don’t think will be the right thing at all. They are still going on about her changing teams which I don’t think is helpful for particularly at the moment.i found this guidance on it www.england.nhs.uk/wp-content/uploads/2018/02/choice-in-mental-health-care-v2.pdf.

Sometimes it not the right thing but from there point of view they have a duty of care and have to make sure she is safe, the one thing I will say is that you said you were worried that if you weren't there you were worried she would do something again which means she does need a higher level of care at the moment that you cant give her and shouldn't have to. Sometimes in the long run it's for the best they might be able to get her stable on medication and work with her to deal with the thoughts. I know how horrible the wards are and how scary they can be another patient really scared my mum one time she came to visit me but sometimes it's the right thing even if it doesn't feel like it. If I am being discharged into day care I normally know when I am starting before I go home, they really should have sorted that before discharging her.

Chocolatethief Thank you for your advice. She’s got a place in the day hospital tomorrow. I’m still very concerned about her though. From what people have said on here she’s unlikely to be admitted again due to the fact she found it so unhelpful? But her care coordinator mentioned a mental health act assessment so I’m unsure really.

That's brilliant that she has got a place, hopefully it will help I have done things like day hospital and you do get some useful things out of it, it's just whether she can put them into practice which is really hard. They will look at what's best for her mainly but if the risk cant be managed they may have to go down that route but from my experience they try their hardest not to. Obviously it will be different for your daughter than from me as everyones need is different.

As somebody who has been sectioned but I will deny this under oath and to anybody who askes me about it. I can guarantee you that it is NOT done lightly.

She’s been to the day hospital today and was told by the nurse these no point in here being there as she didn’t engage with the groups. It’s the first day and she has autism she needs to be given a chance to engage. ):

I can see both sides of that though OP - while you think she needs more time, the hospital will be aware that lack of compliance is already an issue and it doesn't seem to have improved if she isn't engaging with the groups.

Have they said what will happen next?

The problem is that if the places are limited then they may not have time to wait for her to engage (which may never happen) when their are people who would engage. I'm not saying its right but that's the reality when mental health services are so underfunded.

Sadly mental illness is one of those things that people can help you with but ultimately recovery is only truly possible if the person engages with the process and treatment and actually believes themselves that they can recover. Obviously your daughter's issues are.complicated more by her autism but even taking that into account your posts dont paint the picture of someone who is currently wanting to engage in recovery. It's hard on her and on you, I wish there was a.magic pill that would make it all better but there isn't.

If she wont engage with the day services and as you said in a previous post may attempt suicide again then she may well end up back on section.

Are you getting any support through this? Her care coordinator should arrange for tou to have a carers assessment and signpost you to appropriate support.

I agree she could end up back on a section if they feel it is necessary however I dont think I have ever engaged on the first day and I have been quite a few times. Its daunting it's new people and new staff and that takes some getting use to and that doesn't take into account her autism. It takes a few days to get use to it, how long is she suppose to be going there for?

Oh I agree it takes time to engage but theres a difference between not engaging becasue you're nervous and it's all a bit much and not engaging because you just dont want to be there. I work in rehab forensic services and believe me it's usually very obvious which is which. Thankfully my patients dont have much choice given their forensic status so they all eventually engage to some extent anyway.

OP did she engage much in hospital? What about with her community team? If she historically doesn't work with her team the day hospital may be making an assumption (wrongly, each new admission/referral should be treated as a fresh start) that this isn't going to work. Did they give any indication to a plan going forward?

It’s not done lightly. My DSD stole a knife and stabbed herself/ said she was hearing voices/ went at her parents with a kitchen knife and still no sectioning.

You do t say but I wonder if your dD has similar diagnosis to my sister. She was released yesterday after being sectioned on 121 for 2 months.

I suspect they have released her as they do t have resource to watch her at that level anymore.

She overdoses daily and doesn't always take the treatment. She also won't engage with treatment which given her condition requires therapy not medication based treatment is not great.

She was discharged from one treatment programme in January for not engaging.

She spoke to the nurses in the hospital when they spoke to her. She’s a bit hit and miss with engaging with the community team sometimes she does and other times she doesn’t. She’s diagnosed with bpd, anxiety,asd and depression. I also suspect she might have a eating disorder she’s dropped from the low end of healthy to about 10 pounds underweight the last few months.

My sister is bpd/eupd. Also has anxiety.

Whatever trauma is the root cause of the bpd she won't open up in it at all.

Have they looked into more specialist units for her? Seems like the acute wards aren’t really helping her

@User5022

It's been discussed but apparently you generally need to be admitted from home address not hospital. You also need to be engaged and quite frankly she is not so not sure they will take her.

In all honesty I think she will accidentally kill herself before anything happens.

She was self harming even while in hospital and her heart did stop after she strangled herself.

So I think it's only a matter of time.

I would keep phoning them and explain what you think etc. That you say you fear she might do it again, means they either need to change/up her meds and/or send her for some different type of therapy to prevent this.

You could also call the day hospital and say to them that it isn't that she's not going to engage, it's that she might need some more time to interact fully because of her ASD.

Best wishes xxxxx

whatohwhattodo It’s so worrying isn't it ): does she live alone to? Dd has known people admitted from acute wards to personality disorder units but I guess it varies in different areas and Commissioner’s etc. I think I will get her care coordinator to contact the day hospital to explain about her condition. I think I will talk to her care coordinator about asking if she can see her psychiatrist to though these usually a wait for this.

Thing is a lot of PD units will be locked door. If she's not detainable and won't agree to be there they won't admit her. Residential services might consider her though. Like you say though depends on area and services available.

I clinically manage a PD service and have worked in PD most of my career. What I manage is a very rare service and we have a long waiting list and are not cheap to commission, so we get referrals from services and the client is engaged and motivated for recovery work. They wouldn't refer someone to a service at the cost and general intensity of our service if they weren't. We have PD/ASD clients and work with them just fine.

She will have to show she is engaged if an "inpatient" or residential service would ever be contemplated.

To put it in perspective, the reason for this is that a locked door service would be charging around £400 a day for the service, residential open service around £1200 a week. That provides a full package of care and support 24/7, room and board. Commissioners don't spend that kind of money for people who aren't going to use the service.

Thanks for the information. She’s still struggling with eating at the moment don’t think she’s self harmed since she’s been home. Do you know if we can get her supplements prescribed by a gp or will it need to be via her psychiatrist?