MIL sectioned, hospital want her to return home

[crunchycrispy]

This isn’t really an AIBU but I (we - my husband and I) need some help/advice today/tomorrow really.

Background:

My lovely MIL is schizophrenic - has been for 40 plus years. In and out of mental health hospitals and units on and off for years. Sectioned many times over the years. Pretty much always medicated.

Over the years she has done things to herself which have caused serious injury and are part of the reason she isn’t so mobile anymore. Various medications to stabilise mental health have also contributed to additional conditions she now suffers from too.

My lovely FIL has stood by her all of this time, looked after her when she is home (of which there have been periods of a several years at a time), whilst working full time and bringing up 3 children.

They are both now in their mid-70s and FIL has his own health conditions. He would struggle to help her if she falls again. Plus her last episode last year which saw her sectioned again and back in to a mental health ward has really taken its toll on him. His stress levels are extremely high all the time with worry. I’m not putting too much detail in so I hopefully don’t give away who I am if family members are on munsnet. But basically if MIL returns home it will probably finish FIL off - he cannot cope anymore.

MIL has been in the hospital for going on a year this time. During that time she managed to fall quite badly and had to be transferred to the emergency unit in the hospital for a bad head wound. She stayed in the main hospital for a week deteriorating and on a lot of oxygen but thankfully got better and was transferred back to the mental health ward.

For some time the hospital have been working with Social Services to find MIL a place in a specialist care home that can cater to her mental health needs. This would be a permanent place and FIL and my DH and both my BILs support this.

Then this week my FIL is informed by the hospital that they want to meet him on Friday to discuss her release home to FIL, where she/both will be supported by local team and social services! Apparently she has told the drs / social that she is refusing to go to a care home and wants to go home. She is also arguing constantly that she shouldn’t have to take her medication and so of course FIL has that worry again that if sent home she will relapse very quickly and he will have to wait days again for them to take it seriously and come back and collect her - and help him!

I believe she is still under section but we have to have a chat with FIL today and double check that.

FIL cannot and will not cope now with having her home.

DH and my instincts are that they can barely keep her stable on meds, as her condition seems to have worsened with other ‘old-age’ maladies, and want the bed for someone they can treat; and that social services are struggling to find her a specialist care home/don't want to fund it.

However, my aging, and really not in that great health, FIL cannot care for her and himself adequately now.

DH has been invited to attend meeting in person with FIL at hospital or to join via teams call. I can be with DH on teams if he doesn’t make the journey (4 hours away) to be with FIL on Friday.

I/we need the collective wisdom of mumsnet to give us the right things to say in this meeting to the Dr/care team and social services to stop them discharging MIL to FIL. He is very stressed out and we hope they are not literally going to drop MIL home in a transport ambulance or similar.

Does FIL have any right to refuse MIL discharged home to him?

Off to work myself shortly so I will say thank you now to those who answer and will check back in as soon as work permits today.

Can she be discharged to an empty house?

That is all I would ask on repeat. Inform them that FIL is now staying with family due to own medical issues and that there will be no one available to care for her.

It sounds awful and callous but it is the only way

Could FIL come and live with you for now ‘because he needs your support’, and you refuse to take MIL, so discussions about discharge ‘home’ would be to an empty house as if MIL were single? That might focus minds differently.

Cross post!

This, get dh to attend with him and hold firm to this. It's true as can't imagine the impact on his health caring for her!

CPA doesn't exist anymore.

I agree with others, the words unsafe discharge need to be used. At the meeting, FIL should also say that he is unable to provide care at all going forward. So any discharge plans the hospital have must not include him as a care provider in any way, shape or form. They need to organise the discharge in the same way they would for someone who lives alone.

As has been mentioned, they need to do a very specific mental capacity assessment surrounding her desire to return home. If she has capacity, they cannot stop her returning home because FIL doesn't want her to.

FIL can say he is physically unable to provide XYZ care, and how will this be managed at home.

Regarding not taking her medication, if she is on a Section 3 and has had multiple admissions, and a pattern for not taking her medication when going home, you could ask for a CTO (community treatment order) to be put into place. This is basically like a Section at home, so there would be certain conditions to abide by (like taking meds) and if she didn't she could be recalled to Hospital. There is specific criteria for going on a CTO, but I can explain if needs be.

Is she on an injectable medication or oral? If its oral and there are questions about her compliance, an injection might be better. Added bonus of an injection is she'd need a community nurse to administer it (at least to begin with) so someone would be able to check on her at home and monitor how she's doing.

I'm sure you know this if she's been through all this before, but just in case.

Agree with previous posters, your fil needs to move out even if it's too a care home or yours. The hospital would be negligent to discharge her to an empty house.

I would agree that your husband should be present in person at the meeting to support your father in law. Definitely be firm and insist that your father in law won’t be able to cope; emphasise his own deteriorating health and the stress that all this is causing him. What a wonderful man he is for supporting his wife all these years. He deserves to have her looked after at this stage in his life. It’s very sad for your mother in law, but really, to have her home sounds far too much for your father in law and dangerous for her if she will likely stop taking her medication. Best wishes to you all, this sounds really difficult.

yes CMHF in most trusts for community teams but still used in secure services (may be called different things in other trusts). But either way, OP's MIL should have a care plan.

Repeat your position endlessly. List all the probable and possible dire and dangerous outcomes that could result from them discharging her home. Say what you would consider an appropriate- and safe- alternative. Be stubborn. Repeat some more. Don’t feel guilty: You are protecting FIL. He needs it.

I have no special expertise in MH or elder care, but what this essentially is is a buck passing exercise with budgetary motivation. Dig your heels in.

Can he say that he won't be in, he is going to stay with a friend for a while and refuses to look after her, and that it's not safe for her to be there by herself. And he comes to stay with you for a while.

There was a similar thread a while ago (maybe a year?) Where there was some good advice. Maybe try the elderly parents board?

No.
Unsafe discharge.
Keep saying ^ on repeat

This conversation really hinges on whether she has capacity. Capacity is her ability to understand this specific decision (where do I want to live?). Her capacity is assessed by a health or social care professional when discussions about discharge are had. They will check she understands the risks of going home and can retain information around this conversation. Having capacity means she can make whatever decision she wants. It does not have to be a wise decision. So she could say yes, I understand I'd get much worse, probably fall and maybe die or be seriously injured but it's what I want and that would be that. If she has capacity she has the right to go home if it's her home too and thats what she wants. If she wont change her mind there isn't much you can do about that other than not support, remove your FIL and let it fail as fast as possible knowing she may get readmitted and this whole process would start again. So, in this scenario, I'd focus discussions around family not providing any help or support rather than battling about whether she can physically come home or not.

If she doesn't have capacity. Then the decision is made in her best interests, with input from family and care providers. This is unless someone has power of attorney for health in which case it's their decision. If she doesn't have capacity then you are much more likely to get the outcome you are after if family don't support discharge.

If she is deemed to have capacity to choose to return home and she is either joint owner or joint tenant of such home she cannot be forced into residential care. Least restrictive option, home with a care package. It will likely break down at some point and the cycle will continue. No one can force you to stay in hospital, section 3 will be rescinded if she is fit for discharge and once informal she can leave of her own accord.

As others have said the key to this is whether she is deemed to have capacity or not. If she is then she has the right to return to her own home. But this doesn't mean that your FIL needs to look after her. I agree that making it clear that if she does go home your FIL will be living elsewhere to meet his needs is the best way to go around this. This is the tightrope social services walk meeting the needs and legal rights of all concerned.

It may be hard for FIL to say no so make sure dh advocates for him.

I would perhaps advise FIL not to attend the meeting. I know that sounds terrible but it’s quite easy to be browbeaten at these things full of nodding heads that all want the best for MIL but have no regard for whether FiL can cope. I think a preprepared written statement that he can not provide care and it would be an unsafe discharge would be better.

As others have said use the words Unsafe Discharge

FIL is in hospital , there was a Discharge meeting for him , which caused MIL to panic , thinking he’d be coming home , but it basically is a meeting to discuss discharge if and when it happens , and where he’ll go

Have they done a CHC assessment?

Had a recent experience of this and the person only lasted 3 or 4 days at home on a trial basis, could not cope and they returned to hospital and then a care home at SS expence due to complex needs. Refuse to accept SS pressure to return them to home, it is not going to work.

What a horrible situation for everyone.

If your MIL has been under an S3 then she should have her care funded via a Section 117 agreement. That basically means the NHS has to pay for her after care, so they should be the ones working with family to try to source this, not social services.

As others have said, if your MIL is deemed to have the capacity to make the decision to return home and she is the joint owner/tenant of the property, she has the right to do something. Your FIL needs to make it crystal clear that he cannot and will not support her to do this. Him moving temporarily in with you might be one way round it but that will be stressful for him.

I wish you lots of luck on getting this resolved

I'm really sorry that you and your family are going through this. From experience, I know how much a family member's long term mental illness can take it's toll on everyone involved.

As others have said, if you're MIL is not deemed to have mental capacity, the process will likely be easier. Find this out first. Do you know who has Lasting Power of Attorney for health and welfare for her?

Having had some personal experience of dealing with discharge from psychiatric wards and care plans post discharge, my advice would be to put all of your concerns in writing to as many people as you can (social services, psychiatric team at the hospital, GP, community mental health team).

Attend the meeting, take minutes or record it, and be prepared to advocate for your FIL and MIL as much as possible. In my experience it can be helpful to have a couple of you there to ask questions and make notes. Repeat your concerns as much as possible to as many people as possible. Ask for the discharge assesment/plan and make it very clear that your FIL cannot and will not be responsible for ensuring your MIL takes her medication or is kept safe and highlight the obvious risk of relapse. I would think that your MIL's discharge would be considered a complex discharge and so there should be a comprehensive care plan in place for her care post discharge. I would imagine that any care plan is likely to involve multiple agencies - try to find out contact details for each -e.g. who is the community mental health nurse, who is the social worker.

In our situation, my mother (also on a psychiatric ward) had a number of physical conditions which needed ongoing treatment post discharge and we asked for a Multidisciplinary Team Meeting and attended this on teams. A psychiatrist and a consultant overseeing the treatment of her physical illness attended this and we did get some clarity on treatment at this meeting.

If anything, requests for these things may stall the discharge process so you can work out a longer term plan for care. It's such a heartbreaking situation - whilst your MIL cannot live on a psychiatric ward for the rest of her life, the model of care in the community just isn't enough for some people with such complex needs.

I would also recommend putting your concerns to PALS (Patient Advice and Liaison Service) as they can help you to raise any concerns. You can do this in writing or the hospital will likely have a PALS office on site that you can drop into and speak to someone. This might be the cynic in me, but we found that once we went to PALS (this is not the same as making a formal complaint), professionals involved in my mum's care were more likely to speak to us and it was another place to have concerns formally documented.

My experience is slightly different to yours as she did become (sort of) well enough to go home and her DH had the capacity to care for her with significant input from the community mental health team and a change in medication that we had to fight for every step of the way.

Wishing you all the best with this. It's such a difficult and frustrating (not intended as a criticism of the NHS - just my experience) system to navigate and it does take its toll on everyone. Look after yourselves.

I've never posted on Mumsnet before (long time lurker), but feel free to message me privately if such a thing is possible!

Your fil's high blood pressure may be enough, maybe his doctor can write a note recommending against mil coming home?

This. And if they try to send her anyway, he must not answer the door. You must make sure she has no house keys with her!

I know it sounds drastic, but probably the only way. It sounds as if she’s unable to understand or appreciate that your FiL simply can’t cope any more.

We experienced this with my Mother (physical illness only) - she was determined to come home but caring for her was taking a huge toll on my Father and he wasn't willing to do it anymore. Her baseline was extreme frailty and we didn't like leaving her in the house for more than an hour or so alone as she had had some falls and not summoned help appropriately. On the odd evening my Dad went out someone else would go and "mum-sit". When he had planned ortho surgery my siblings and I juggled leave so one of us stayed there for a period of around 3 weeks.

Then she had a physical health crisis, was discharged unable to climb the stairs, or get in and out of shower unaided. The hospital OT team had said she was fit for discharge which badly shook my Dad's confidence in them/ the discharge planning process. She bounced back into hospital within a few days unwell.

Then the wrangles started. The meeting with the discharge planning team was extremely acrimonious. No matter how much we explained how unrealistic she was about her own abilities and how much had be being done the staff all sided with my Mum. "But it is her house too" was one of the lines as was "she doesn't want carers"

Well, yes it was. But owning half the house didn't mean that my father was compelled to be a 24/7 carer doing physically dangerous stuff like carrying her up the stairs, no planning from the hospital side had gone into her needs at home (stairlift/ re-arranging to create a downstairs bedroom). It was very much "she is coming home on Monday".

In the end my Dad booked a holiday and told them they had to assume my mother would be in the house on her own. He did say he would sort groceries, laundry and ensure the house was clean. If he was at home he would cook her meals but he was no longer willing to be at home 24/7.

They backed down and a long term placement was being sought (against her will) when she died.