To think this psychiatrist neglects their patients

[User5373839]

I’m on a support group for people suffering from mental health problems in my local area. The main point to to offer support and signpost people to support groups etc in the area. It’s been mentioned on there recently though about the local unit and the consultant at the unit. He removes people of a section within a day usually if they have a particular condition. Aibu to think this is dangerous and if someone meets the criteria to be sectioned less than 24 later you don’t remove the section? Surely it undermines the decision of two other senior doctors and a amhp.

I think the 28 days is standard to give enough time to stabilise the patient.

Police and gps aren’t psychiatrists

What’s surprising at how easy it therefore seems to be sectioned if people are let go so quick... I thought it was nearly impossible to have somebody sectioned!
(Might be wrong. About everything.)

That what I thought. As surely someone decided that 28 days was an adequate amount of time to needed to assess people.

If someone agrees to stay on a unit then there is no need for them to be detained under a section. Or perhaps they just don’t meet the criteria anymore, one night on a unit may be enough for people to accept community support etc

This psychiatrist just discharges people. They don’t allow them to stay informally.

It’s pretty widely excepted that the best place to recover is at home, there are teams who can offer intensive support. There are also some conditions where guidance says only admit for the shortest possible time. It’s hard to say isn’t it without knowing everyone they know.. I certainly wouldn’t be jumping to the conclusion they are neglecting

Is the condition EUPD/BPD out of interest? I know that some health professionals believe that it's better to treat those kind of conditions in the community rather than in hospital.

My friend's son was sectioned and discharged to the care of a Home Treatment team after 5 days. He'd had a psychotic breakdown and, after being put on anti-psychotic medication, he wasn't experiencing voices and wasn't considered to be a risk to himself (or others).

Psychiatrists are primarily involved in the medication side of things but will do an out-patient referral for psychological therapies if required. It is often not until you have started to recover that you are in a position to benefit from therapy.

It depends on a lot of things if the patient is compliant and agreeable to staying informally and to treatment then the Psychiatrist might not feel the patient needs to be on a section, also what section is the Psychiatrist rescinding it it's a 5/2 for example ,this is a an emergency section and the Dr,s holding power it lasts for up to 72 h rs and often patients are made informal patients very quickly ,maybe it the Psychiatrist has known the patient for a long time they may not feel inpatient treatment is the best treatment .

If the condition is BPD, then the current thinking seems to be that it is best for people with this disorder to be kept out of hospital, in order to help them get well/stay well.

People who have spent a lot of time in hospital previously, as inpatients, may have an underlying desire to be admitted again - even on an unconscious level - as there is a certain level safety and familiarity in that environment.

To keep detaining people might encourage them to behave in a way that has caused them to be sectioned in the past, and therefore set up a repeated cycle of behaviour.

So by discharging people as soon as possible, every time they behave in a way that causes them to be admitted to hospital, the theory is that the cycle will be broken and that the person will learn to use other support networks and resources, so that the habit of returning to hospital is reduced.

I've been sectioned before. Hospitals are awful places. If there's another option I'm glad he's taking it. I really think the ward is also not a good therapeutic environment at all. It's a holding place to keep you alive if you're in real danger but it's a grim place to be. Home treatment team are much better.

Yes the condition is eupd. I did think that about it not being suitable for some people but the reviews online about this consultant also show that people with eupd get discharged very quickly. If it’s best to keep people with the condition in the community why do they section them?

More info needed. Every person and situation is different and complex to unravel. Keeping someone else 28 days could be equally difficult as discharge after 24 hours.

It’s solely people with eupd they discharges within days. People with other diagnoses are often in there months.

The guidance for EUPD is to keep people in hospital for the shortest time possible so that explains things

Yes but surely people with eupd are still at risk if they are engaging in certain behaviours.

Of course there is a risk, however you can not and should not lock people up for ever so the risk needs to be managed at home eventually

however you can not and should not lock people up for ever so the risk needs to be managed at home eventually

this - 100% - for conditions where there is no 'cure' then management is the only option - fair better to manage at home than be locked up

I just don’t understand why they are not just kept at home if they are going to be discharged within a day anyway.

I'm not a psychiatrist, and even if I were, I'm not dealing with these individuals patients, so I can't purport to know whether this action is neglectful. But based on what PP have said, it seems these actions are in accordance with current guidelines. If you feel you've been neglected, I'm sure there's a professional body you can report this to.

I know it is hard OP, when it seems like people aren’t getting the help they need.

There is only so much that can be done to keep people safe though. People with BPD/EUPD are always at risk while unwell

But it is about giving people some autonomy and quality of life (as well as the fact that there simply not resources to offer inpatient treatment to everyone at risk, even when the risks are very serious.)

Being on a locked ward, with 24 hr one to one supervision, and no access to sharp objects etc... as the poster above said, it is not a good place to be to help someone get well long-term.

People with BPD need to learn to use their own inner resources - as well using outside support that is available- so that they can learn to stay safe in their own homes. To someone in distress who is begging for help, being discharged from hospital may seem like negligence, but the decision will have been made in the patients best interests, even if they don’t agree with the decision.

Well, you can have a MH crisis which is only acute for a short period of time. I remember once reading that people are often only actively suicidal for a short period of time (less than an hour) which is why the law around how much medication you can buy at one time has been relatively successful since it was introduced. Obviously not the case all the time but it's certainly true in my experience that if I can get through an immediate crisis which may last for as little as half an hour, the risk is much lower.

Well, just because you are sectioned doesn't mean you need to stay for the maximum possible time allowed. Responsible Clinicians are mean to remove a section as soon as they feel it is safe to do so.

I have seen this happy in a mental health unit before, but the context was that someone was repeatedly sectioned by doctors who did not know them well, but when reviewed by the Responsible Clinician who knew them they felt it was safe to manage them at home.

Is it anything like that?

I have bpd/eupd.

I've been sectioned on the motorway for running away and driving to the sea to kill myself. It was a section 136 (48hrs so you can be assessed to see what should happen next). I was spat out the next day without my car 100 miles away from home. I tried to kill myself again that night and woke up in hospital on a drip etc. Took my own drips etc out and ran away once I wasn't disorientated. Went home, changed out of my hospital gown and tried to kill myself again in a field via use of a ligature but was found by a member of the public. THEN I was sectioned for 16 days and stabalised on meds and the like.

It was terrifying. I was very honest and told any professionals that asked that I wanted to die and would make it happen. You could see in my notes that despite the diagnosis I'm not prone to threatening suicide if I don't mean it. But because these people went off the diagnosis and not e or my family or our personal experiences of my illness I nearly died. How I didn't still amazes me and I'm so grateful life seemed to want me to stick around but the system is a bit broken. Yes some people with bpd form unhealthy attachments to hospital and should be discouraged from seeing it as their saving grace.

But to use a diagnosis as a sweeping generalisation when people can present so differently is extremely dangerous and unprofessional in my humble opinion.