To find a lot of psychiatrists uncaring

[Sevendaysaweek]

Dn 19 has been admitted to a mental health hospital. I’ve found out today that she told her community consultant how low she was and that she felt at risk. He dismissed her feelings told her she had got through it before and that he was fond of her. Then told her she would see her worker the next week. The worker left suddenly and didn’t even tell dn she was leaving. I’m thinking to complain to pals as this could have been prevented and I feel so sad for her that it hasn’t been.

*spy (in quote)

It's not an easy profession to be in. You've only got your neices side of the story. It's so hard with mental health (suffered myself) I found only I could 'rescue' myself. There's no magic pill or cure. Is your neice saying she thinks she would harm herself if left alone?

My son is diagnosed with eupd and is struggling to get therapy but that’s another story. Dn is diagnosed with depression and ocd.

[quote AwaAnBileYerHeid]@Sevendaysaweek I'd be surprised if there wasn't a bit more of a backstory. If there is a diagnosis of EUPD (you say there isn't but there are other posters contradicting that based off other posts of yours so I don't know) then perhaps the conversation went something along the lines of your DN getting upset and stating that no one cared about her due to her not getting the support that she wanted. And the psychiatrist responding that that wasn't true at all and there are many people who are fond of her/the team are fond of her/he is fond of her. And then the conversation has been mis-reported back to yourself. Kind of like the 'I hate you, don't leave me' narrative that we often get from people with EUPD.

If your DN does have a diagnosis of EUPD then often it's not in the patients best interests to be admitted to hospital. Often problems become worse while in hospital and maladaptive behaviours are learnt from other patients. Many trusts are piloting 'PD Pathways' as a way to stop admissions for people with a diagnosed PD and form other clinical routes ie community support, group therapy work etc.[/quote]
I absolutely agree with this - my psychiatrist has told me before that he's fond of me. His reasoning is that he won't be able to convince me that my family would care if I died because a I can just argue with him that I know them better than he does etc. But I can't argue so much when he says it about himself because I'm not in his head!

[quote AwaAnBileYerHeid]**@nc1962* Someone should be sectioned if they're begging for it? No. Someone is only sectioned if they are a danger to themselves or others and not being treated would be of detriment to them and* they are unwilling to accept help/go into hospital. If someone is "begging to be sectioned" then they don't need to be. They will come into hospital and be treated informally.

The general public have a massively high (and quite frankly unrealistic) expectation with what psychiatry can and can't do. A psychiatrist can't just section people willy nilly, there are laws (the MHA) to follow and each action needs to be justified and proportionate.

The problem with mental health services these days are yes, lack of funding but also huge misuse and abuse of mental health services. Where I used to work, a 20 bedded unit, I'd say only about 6 or 7 of those people needed to be in hospital. Less than 50% of them had genuine mental illness. We are seeing more and more people coming in with normal life stressors being self diagnosed as 'depression', 'anxiety' etc and demanding therapies etc ie a magic wand to make everything better.. However psychiatry cannot do anything with issues such as situational stressors. And many people do have quite frankly shit lives due to poverty, lack of social support, relationship breakups, lack of a meaningful life etc. Psychiatry is there to treat and manage mental illness, not to fix the aforementioned problems. It just can't.

The majority of the people I've met who are genuinely, chronically mentally unwell would do anything to get out of hospital or not be admitted in the first place. They are so ill that they don't understand or appreciate why they need to be in hospital.

I'm sorry to hear of your sisters struggles and I genuinely hope she's in a better place now.[/quote]
As a service user who is now stable I agree with everything you are saying.

It's when I become a service user, like the ops dn that I see you all as uncaring twats!! I tell those around me what I want them to hear and will miss out vital bits of info because to me, they are being unfair and I am right.

I've had to hold back saying things in group therapy because the other users are there for just that - mh team to sort out their shit for them - I knew the intricate mundane life issues of random people, but how to deal with the actual MH side not so much. The facilitators try as much as possible to try and skew back onto topic.

And yes to the hospital admission, the thought frightens the absolute shit out of me. It is THE worse place you can possibly imagine to be in. No, no, no. Not a chance.

People think normal hospital wards are bad enough, or how it's unfair you cannot have your bestie or whatever sleep over. Try one of these wards. The patients aren't all walking around almost asleep and nice happy polite people to be around. No visitors and when you finally can, it's all limited. Depending on why your there, no 24 hour access to the outside world via the phone/internet. The monotony of a very controlled environment. Cannot just go for a walk outside depending on the ward.

It does feel a bit that the guy can't do right for doing wrong

He is accused of being uncaring for not immediately admitting her but equally of being unprofessional when using a kind word about her.

Yes one has patients who one is more or less fond of but professionalism is not allowing that to prejudice the care you provide. I have looked after patients who were rapists, child abusers, wife beaters and murderers but I treated their mental illness just the same. Therefore I don't tell patients I am fond of them or not as it makes no difference to how I'd treat them.

However if you aren't in the room then relying on a 2nd hand report from a person who might be experiencing cognitive distortions due to being unwell isn't likely to be reliable. I would probably try not to say to a patient that I am fond of them but commonly you would get thrown at you 'you don't care about me. I may as well just kill myself as nobody cares.' What do you say to that? Usually something along the lines of 'well yes we do care but in a professional way' I am strongly suspecting it will have been something like that.

@Sevendaysaweek regardless of the diagnosis, I'm not sure I would go on solely what your DN has said. For a psychiatrist to come out with "I am very fond of you" is....unusual. However in one sentence it seems like psychiatrists are vilified for being impersonal and dismissive. On the other hand, we have a psychiatrist who has allegedly said that they are fond of a patient who they've worked with for quite some time, an attempt at reassurance or just to be nice, and they are also being vilified for that. I'm genuinely not sure why you are making such a big deal of the psychiatrist allegedly saying that he is fond of her? Is there a backstory?

Has she been admitted or has she been sectioned? They are two different things. It must be a great worry for you that she is going through a difficult time however the fact that she has always been able to keep herself safe in the community is a massive positive. Has there been voicing of self harm?

Co dependence on MH hospitals isn't just limited to those with EUPD. This can happen with other PD's and I believe certain depressive disorders?

@canigooutyet Yes but mainly I'm talking about personality disorders, specifically EUPD. There can be a co-dependence for anyone with any diagnosis however actively wanting and seeking hospital admission is much more prevalent in those with EUPD. Hence why NHS trusts up and down the country are pumping millions of pounds into pathways to deal with individuals with a diagnosis of EUPD.

Well obviously I’m wasn’t there so can’t be sure exactly what happened just what she said. She didn’t want to be admitted when she saw him she wanted the crisis team which he didn’t want to offer.

Im a consultant psychiatrist. I work in CAMHS.

I certainly don’t think I’m uncaring or feckless. I wouldn’t have gone in to mental health, or medicine in general, if I didn’t care about people. I care a great deal.

What I am, though, is exhausted. Exhausted by the high numbers of cases, the limited time I can give my patients, the limited resources available. The hoops I have to jump through to get intensive support or in-patient treatment or specific therapy. The constant changes in processes and referral pathways and risk assessments. The parents who have fucked their kids up. The ones who take no responsibility. The traumatised vulnerable families for whom it is difficult to find hope. The reality that social factors are likely stronger than biological or psychological ones. The mounting trauma-by-proxy of working with hundreds of cases of abuse and neglect.

So yeah, reading that we’re all just lazy heartless arseholes grates a wee bit.

Sorry if I've misunderstood but haven't you said she is in hospital already and you posted a few days ago to say she was sectioned under a section 2? If so why does she need the crisis team, aren't they there for support in the community not whilst an inpatient?

I don't mean to cause offence by these questions, I'm just not sure what the issue is if she's already in hospital then surely she'll be receiving support? Not sure how these things work tbh.

What does she want the crisis team to do? They're not a substitute for the support worker who has left.

I don't think that mental health workers should take out their frustrations on the vulnerable. It is not their fault that in-patient care is reserved for cost purposes for people who are so ill to present a risk to themselves and others.

It should not be the accepted norm that hospitalisation or non-community care makes things worse. If it wasn't so hellish, respite care could be beneficial. It could provide a needed break and therapeutic space to learn coping mechanisms.

It should be possible to receive care before a crisis point is reached just like for physical health. For example, someone with anorexia should not be expected to hit a certain BMI before qualifying for treatment. The notion that you have to meet x, y and z criteria to qualify is counterproductive. The 'fact' that things weren't bad enough increased my son's desperation - i need to attempt suicide- and fed into his belief that no one cared.

The perspective of health care workers is useful in determining how health policy needs to change. The perspective of service users is useful in determining how the experience of care needs to change. Both need to change.

But if you think it is all about the feelings of health care workers, you have things arse about tit. Sorry to say but psychiatrists prioritising their feelings and feeling misunderstood because they are just about medicating the severely psychotic have lost their way. Or maybe that's what they thought the job was?

Yes she’s currently in hospital but if she had crisis team input when she said she needed it weeks ago she wouldn’t have needed the admission.

*if she had crisis team input when she said she needed it weeks ago she wouldn’t have needed the admission.

In my experience most admissions are patients currently under the crisis team.

What did she want the crisis team to do, and what help does she want now?

They would have provided her with someone to vent to. She’s been left all her own.

When you talk about parents who have fucked their kids up do you mean deliberately because the way I see it, all parents fuck their kids up psychologically and physically when compared to an ideal. Didn't provide consistent boundaries or insist on 5 a day. That's why their psychotic/diabetic and I'm so overworked.

My son was distressed because of policy failures of SN education. His parents didn't cause the problem, CAMHs could not help beyond a visit every two weeks and parents provided the lifeline and daily support.

If a system is working perfectly there are a minority of parents that fuck this up - an even smaller minority if you exclude parents with impacting domestic abuse, drug and alcohol issues and mental health issues for which they haven't been able to access help. In a bankrupt system there are also parents with none of these issues.

It is sad that you appear to give equal if not greater weight to problems (allegedly) caused by parents.

It is always the same. Teachers blame parents. Mental health workers blame parents. Denial of responsibility.

Who steps up - parents.

And for those with crap parents - no one. And when your an adult - no one (unless you are a risk)

But the problem is that you are not appreciated ...

I don't have any first hand experience although suspect that like any profession you have those who are excellent and those less so

I will say anecdotally that a friend who is a clinical psychologist working with vulnerable people (I realise it's different so probably not relevant!) is the worst to speak to in terms of making you feel better. I don't mean that we go to her with our problems to fix but just by way of daily conversation like if she were to hear about a pregnancy loss for example she'd invariably bring out all the things people often don't find helpful like "you can always adopt" or "you're lucky you lost it early" and I'm always surprised how insensitive she seems!

The fond of comment was apparently made in the context of don’t do anything harmful we are fond of you. I would assume psychiatrist don’t tend to either like or dislike their patients as this would be unprofessional surely?

I think you’re reading too much into the word ‘fond’. Maybe your niece told the psychiatrist he doesn’t care about her/nobody cares/she feels a burden/wants to harm herself because nobody cares etc and he disagreed and said he/they are fond of her and want the best for her, want her to keep herself safe. Are you sure niece told you the full story?

Many staff in MH get fond of certain patients, especially patients who are regulars or are young (eg from CAMHS with lots of rehab potential) or those with very low self esteem who rely on MH staff to reassure them.
It’s hard not to get fond of some patients, we’re not robots. I agree it’s a bit unprofessional for a psychiatrist to voice it but maybe your niece accused him of disliking her and that was his way of reassuring her he cared and didn’t want any harm to come to her.

Where I used to work, a 20 bedded unit, I'd say only about 6 or 7 of those people needed to be in hospital. Less than 50% of them had genuine mental illness. We are seeing more and more people coming in with normal life stressors being self diagnosed as 'depression', 'anxiety' etc and demanding therapies etc ie a magic wand to make everything better

Yes this is an issue on many acute psychiatric wards. We do have patients who are severely clinically depressed or have psychotic depression and need to stay in for treatment. But a lot of patients on the ward have fluctuating anxiety/depression or housing issues or are just very isolated. I can understand why they want to come in as many view hospital as a safe haven. No responsibilities, all meals and meds provided, attention and 1:1 time with staff, group therapies like art, gardening, music, yoga, pottery. Some patients seem not to realise they are being monitored all the time, so if they claim to be severely depressed in ward round with the psychiatrist, yet are observed socialising and laughing with other patients and upbeat and enthusiastic in groups, all that gets fed back to the MDT.

Then you get patients who are clearly malingering or have some sort of fictitious disorder, as they put on a show of responding and being very unwell, but when they think they’re not being observed by staff they act completely differently.

Staff can signpost patients to community services and groups (though many groups are virtual due to covid) they can help fill in PIP forms and UC applications, they can help with housing to some extent by referring to community services that specialise in things like housing, budgeting, life skills. They can recommend a period of MH rehab at a less secure facility if patient meets the criteria and a bed is available. They can recommend specific community based therapies on discharge and make referrals. A patient on a Section 3 is entitled to extra (free) aftercare and regular follow ups.

But unless a patient is severely unwell, hospital admissions tend to be short. Psychiatric wards tend to be busy, non therapeutic places as lots of unwell patients scream/shout/attack staff and/or other patients and disturb others sleep.

Staff are often very stretched and may appear to lack patience, when really they’re just exhausted and stressed.

Great posts, DougRoss and PaddyFodder.

KeepOn, there are, sadly, parents with none of the challenges you mention who, borderline-deliberately, fuck their children up, and then refuse responsibility. There are many fantastic parents, of which I am sure you are one. But that doesn't mean there aren't also the others.

They would have provided her with someone to vent to. She’s been left all her own

Does she not have family she can vent to? Helplines to call eg Shout or Samaritans or a local phone service?
It’s a shame about the lead practitioner, but staff do get sick or go on leave. Hopefully a new one will be appointed ASAP.
Did they give a reason why Crisis Team won’t take her on?
Has she asked about the possibility of a ‘half way house’ or even a day centre, where she’d get therapy and support for a few more weeks?

A Psychiatrist is there to determine if you need medication and/or counselling services. They ask the same ticklist of questions every time about sleep, concentration, motivation, whether you have thought of harming yourself etc. That is it. They will medicate you and adjust your medication.
Help probably comes more from psychological therapies but there is such a waiting list that often patients don't get it when they need it, if at all.

OP, if your Dn feels suicidal then she needs to spell that out. If she did and her feelings were dismissed then, yes, you are right to report them to PALS. However, be sure that your Dn did express themselves properly. On that thought, does she need someone to advocate for her? I often have to be quite forceful with my relative's psychiatrist because they are utterly crap don't do things they say they will and their consultation reports are works of fiction.

Mental health is such a hard profession

They can only really admit if you try suicide.

It's a fucking disgraceful. But there is literally no money. Not enough resources. Friend is a psychiatrist and says it all the time

How she became a dr to help people and can't.