Did the MH services let my daughter down?

[FlowPurple]

My daughter has been diagnosed with complex post traumatic stress disorder and cyclothymia. She's under CMHT and receives weekly trauma therapy.

Yesterday she was in crisis for the first time ever, she's had fleeting thoughts of being worthless and not good enough but never actually had active thoughts of suicide.

Yesterday she was in distress, she normally hears voices but they normally just talk to her but yesterday they were frantic, she couldn't understand them and wouldn't enter her house as she said if she does go home then it's "inevitable" that she'll hurt herself and she can't keep herself safe.

Her husband took her to A&E because he didn't know what else to do as this was early evening and there was no one else to contact. He had to leave her at A&E as they have two very young children he had to come home to and he took her phone to charge as it had died.

At A&E she was a bit more settled (but still quite distressed as she hasn't felt this way before) as she wasn't going home, the problem seemed to be she thought if she went home that's where she'd hurt herself, anywhere else was fine.

She saw the mental health team and they confirmed she was in crisis but couldn't speak to the CMHT as it was evening about half 8ish so their suggestion was she stayed in the A&E waiting room until 9am when they could contact the CMHT so they wanted her to wait in the waiting room for 12 hours on her own (no one was alllowed to wait with her) in distress.

My daughter understandably didn't want to do this as people were already looking over at her crying and she felt incredibly anxious but they told her she couldn't leave and the nurses in A&E would watched her and if she wanted to leave they'd have to speak to the MH team first.

My daughter called her husband on the hospital phone and told the staff she was leaving and they just said okay, didn't talk to anyone first just waved her off.

She still wouldn't go into her house and slept in the car over night and no one's been to chase her up today.

Now I know resources are short and they probably did what they could but AIBU to think asking someone in mental distress experiencing psychosis and had plans to end their life should have been asked to wait in a public A&E waiting room for 12 hours plus (having no phone or money) and couldn't have anyone waiting for with her?

It is poor but unfortunately the NHS is broken. The hospital had a legal authority to keep her there and if they were concerned they would have had to use the mental health act to detain her which Dr's and nurses can do for a short period. Hope your daughter is feeling better.

I mean had no legal authority

I'm surprised there was no mental health professional on duty. I've taken DD to A&E out of hours after overdoses and there's always been at least a mental health nurse on site. We've often had to wait several hours to speak to them but they've always been there and they have the authority to admit her to an appropriate ward/unit if needed. I wonder if they'd called in sick?

Either way, YANBU. Your daughter was badly let down. Unfortunately, ime, this is normal. Mental health treatment in this country is woeful.

She did speak to two MH nurses and it was their idea to leave her in the waiting room until they could speak to the CMHT which would have been at least the earliest 9am but it could have been much longer and I know it was short notice and they're under staffed, and have limited resources but I just can't fathom leaving a well person in the waiting room for over 12 hours never mind an unwell person and she was really unwell, I've never seen her like that before but she hadn't hurt herself (yet) as she had avoided going home all day but was so distressed at the voices she was hearing.

I'm sorry about your daughter, it's heart breaking isn't it.

The government have let your daughter down. Not the overworked NHS staff.

That is horrendous @FlowPurple and it doesn't really matter to your daughter who is to blame, she was seriously let down.
The whole system is fucked.

When you say she spoke to two mental health nurses, did she just speak to them, or have a full assessment?

Mental Health Liaison Team are based at A&E and they assess people who have gone to hospital due to struggling with their mental health. I am surprised at this course of action, if they didn't feel she needed hospital admission, or the crisis team/the home based treatment team, I would have thought they'd have discharged her and advised CMHT, so they could make contact the following day. I've never heard of someone staying overnight in A&E to be seen the following day by CMHT, either they are safe to go home, or they're not!

Sorry your DD is struggling, feel free to message me if she'd like any information on voice hearing and I can send some useful links x

Unfortunately mental health services are essentially non existent in the NHS at the moment. I remember a few years ago unintentionally overhearing a poor man begging not to be sent home because he was there for his 2nd attempt that week and knew he'd try again once alone. They basically told him it was physical so they couldn't help at A&E.

@WickWood I think they did a bit of both, the spoke to her for five minutes and wrote a couple of things down - they then sent her back into the waiting room whilst she was crying and hyperventilating so they could discuss the next course of action and then they brought her back in and said this.

She asked if she could wait in the car as she didn't feel safe in the waiting room and they said no as that isn't safe and they'd have to discharge her and she's safe in the hospital.

I'm sure they did their best but like you say either she needed help and to be admitted or she was safe to go home in their opinion but she was kind of in limbo.

My daughter is always given a bed in A&E during crisis whilst she waits for the crisis/ home treatment ream.

Was she assessed as being in psychosis?

Hearing voices or seeing things isnt always psychosis so it depends on whether they assessed that, or simply didnt assess. Did they assess whether she was at risk from herself (or they didnt assess it at all)?

There is no MH support for either adults or children. I have heard it said by MH professionals that lots of presentation or behaviours like this simply need to be more tolerated by society, its not detainable and sometimes not treatable apparently

Years ago people having this experience would have been detained. However, there have been lots of arguments and advocation over the years not to detain people and unfortunately this is the consequence. Its also cheaper as well, how convenient for successive governments

That's great to hear, I'm glad at least somewhere people are being looked after.

I wouldn't have expected her to get a bed as they were seriously physically unwell people on the corridors waiting days for a bed so I understand why she wasn't offered a bed however I don't think 12 plus hours in the waiting room was suitable either.

I guess I don't know what the answer is and I'm just thankful she stayed in the car last night to try and keep herself safe.

That has to be one of the most appalling instances of bad practice, I think she was failed yes completely. If you have the strength put un a complaint to pals. Totally unacceptable, so sorry she was treated like this.

Threads like this make me so glad I'm well.

Almost 20 years ago I got sent home after getting caught mid attempting suicide and taken to hospital as a young adult. I was sent home as if not cut deep enough to need stitches. Within a week I had tried again and that time I did get out on a ward for a couple weeks but it took family members refusing to take me home and insisting they do something or I would have been sent home without help that time too. I dread to think what it's like to be that unwell now

Unfortunately it's likely that's the best service they could offer her at the time. I would not hold out hope the NHS will be able to do much more, they just dont have the resources.
Mental health care is extremely lacking in the UK, it's long past time the Government invested in it.

My DH has attempted suicide on more than one occasion, spent hours waiting to be seen by the crisis 'team' (one person) in A&E, been sign posted to various support services, and sent home.

If any of you can afford it, could you pay for private care for her, perhaps counselling?

She is receiving trauma therapy once a week and is on medication. This was just very unusual for her.

Sorry to hear about your DH.

@FlowPurple I'm sorry they left her in that state, I don't work in A&E personally, but if someone I was working with was that distressed I'd definitely offer them support before leaving them (emotional support, utilising breathing/grounding techniques etc), as I'm confident my colleagues would also.

It sounds like she rarely goes to A&E for support and I'm sorry she didn't get much of a response, and has had no follow up today. CMHTs are ridiculously oversubscribed, but that is no excuse.

Does she have a crisis plan to go through if something like this happens again? Ie the out of hours number to call, how she can self soothe, what has helped before, distraction techniques, staying with family etc x

@FlowPurple I'd also encourage her to let her therapist know, trauma work can very unstabilising, so it's helpful they know what happened x

God - it's like third world medicine now.

What is the point of a crisis team that does not work at night?

Simple humanity would have dictated that she could not wait on her own and afraid in a waiting room overnight.

This surprises me a bit. It sounds though like she did see a MH team in A&E and they didn't think she needed to go (voluntarily or involuntary) into a mental health hospital. They wouldn't have had anywhere else particularly to send her in that case. We do have late evening support from a crisis team but if you don't need to go to hospital it's likely to be a phone call to see how you are managing and offer some reassurance. My guess is she she said she felt she couldn't go home and was quite focused on the issue of entering her own home so they said she could sit in a&E if she wanted instead. We may have tried to find a side room or looked if someone could come and stay with the person but vary capacity dependent. I would also guess (but obviously just from what you have put) that they didn't think her suicide risk was that high, possibly she had no specific plans, offered reasons she wouldn't commit suicide etc. I'd be interested to know what you would have hoped would happen. MH services are absolutely the poor relation in the NHS though and if there is a failing it's not with individual staff but with how it's resourced and set up.

It doesnt sound like she had a MHA assessment though, perhaps she didnt meet the criteria for one to be triggered.

It doesn't improve things for your DD, and I hope the crisis passes, but this is correct.

We never know what's going on behind the admissions door of a hospital on any specific day, the staff may have had a reason for suggesting what they did. But overall the system is not there for us now, which is scary.

Well its clear what the reason was, there was no CMHT on duty and they were coming back in the next morning so she was asked to wait.

Thats the problem, that there was no one else to see her apart from the MH nurses, but they're not psychiatrists or AMHPs (or the might have been OP isnt clear) but the team she needed to see didnt have anyone there or available then.