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.

What an elderly person wants, and what they need, are often two very different things - whether they have capacity or not. If relatives are not willing or able to care for them any more, and the person can’t possibly manage on their own, then ‘home’ is no longer an option.

Unfortunately, even when they still have capacity, some old people seem unable to consider anyone’s wishes, needs or welfare, but their own.

Your DH should talk to his dad about what they both want to happen. In the meeting it may help FIL if your husband takes the lead & speaks for them both. The hospital may try to pressure them to let MIL return home, they need her space. They may promise all sorts of support that may not occur, to sugar the pill. They cannot force FIL to allow MIL to return home, but he may well feel under pressure. Help your husband to make a list of points he wants to express to explain why it is inappropriate for MIL to return home.

Incorrect. Because it isn't his house, it's their house. He can't be forced to care for MIL however if it's also MILs house then he can't refuse to allow her in it. He can simply refuse to do care and then other arrangements will have to be made.

I’m going to assume that MCA assessments have been done abc that social services/NHS can demonstrate capacity to make the decision on returning home or not.

So, whats their plan? CTO (you mentioned non compliance with medication) and s117 aftercare? If yes, and FIL really cannot cope, then you need to push this fact, shout unsafe discharge’ from the rooftops and if no joy ensure a water tight s117 funded aftercare plan that doesn’t involve your FIL.

Actually, yes they can ‘force’ a person to be allowed to live in their own home if said person has the mental capacity to make the decision to live in their own home.

Are you able to say (and not actually do this) "fil is going to live with us. If mil returns home, then she will be by herself. I'm not taking her in"

As PP have said, it firstly comes down to her capacity. If she has it, and wants home, SS will need to try and get her home.

If this is the case, you must remove her husband from the property. You can't risk them finding that he is capable of providing all/some of her care needs, if - as you say - that is the case.

If there is such a conflict the assessment of capacity needs to be carefully conducted. These are frequently not done rigorously.

Yes I suppose if MIL had capacity it wouldn’t be possible to say she can’t access the house. The only option then is for FIL to move in with OP at least temporarily and tell hospital they would be discharging to an empty house and that would be unsafe. Seems very unfair that FIL is being driven out of his own home though.

Fil needs to refuse to have her home and then let dh speak on his behalf stating the reasons.
Id also be tempted to get legal advice before heading into meeting.

If she is currently on a section this would be changed to s117 aftercare which means her Care coordinator is responsible for providing suitable accommodation( and almost everything to benefit her MH)
im guessing it is a communication problem( usually is) and whoever called to arrange discharge home simply doesn’t know the whole situation
Does MiL have capacity?
There is a visiting mind advocate( every time I’ve been an inpatient) who might be helpful
Personally, I wouldn’t be arranging any carers assessments or indeed a care assessment for FiL as he is simply not able to look after her, however much MiL wants to return
its really difficult to see Parents age and become frail and unwell, so I do sympathise.

This will all depend on whether your MIL has capacity. Make sure you ask to see the capacity assessment and ensure it has been completed and by whom. I would argue that if she is already saying she wants to come off medication she is lacking insight into her condition.
If she is deemed to have capacity there is little to be done to prevent her coming home to her own house however FIL and family have to be clear they will not be caring for her and that the NHS and local authority have a duty of care under section 117 (if she has ever been detained under a section 3) to meet her care needs. There will need to be a detailed risk assessment and aftercare plan in place to outline her care and support needs and identify any potential risk to FIL. I would also request an assessment for his needs by the Local authority to run alongside this.
I'm sorry you are going through this.

FIL needs to refuse to be her carer at all. They're talking about supporting him so he can support her and also possibly giving her carers a few times a day, but mainly it'd be FIL providing care.

If I was FIL I'd tell them that if she's discharged home, he'll be moving out. That will make it crystal clear to them. If it comes to it can FIL stay with one of his DC? It probably would not be for long because MIL would inevitably end up back in hospital sooner rather than later. I'll bet if FIL isn't going to be home with her they'll not agree to discharge her anyway.

It's not ok for MIL to expect to run everyone else into the ground trying to care for her just because she doesn't want the suitable care being offered. They wouldn't be offering a care home if there was any chance at all that she didn't need it. They'd be discharging her into the community and seeing how it went.

Likely to go on a period of 'leave' first so if it goes wrong she may be recalled to the ward (however sometimes the bed is allocated to an emergency admission).

Falls, refusing meds and poor intake can all happen on the ward/care home.

It's hard to get a care home placement and often they will aim for the least restrictive option, usually home with POC and CMHT. If the MH crisis is over then the recovery can happen in the community.

They might push for trial with QDS POC and daily CMHT/HITS to 'see if it fails'. If the person wants to go home and has capacity (and sometimes even if they don't) it is difficult to deny them a trial period.

There may be an option for day hospital, day centre placement or respite for carer. Lots of options before care home will be considered.

Lots of people who live alone are discharged home with a care package.

In this case, it's clear the care package they want to use involves FIL being main carer. Otherwise they wouldn't be talking about supporting him, only about supporting MIL. Also if someone can reasonably be discharged home alone with a care package, they don't offer a care home placement instead. Care home is a last resort when all else is unsuitable.

could fil just not run up to meeting. Say he lives with you know due to ill health.

*turn

I think this is the key here: they wouldn't be offering her a case home at all if she didn't need it.

Stand your ground OP.

Hi, it is really not as simple as you state.
The hospital want her discharged, understandably. However having been detained by the state under S3 (?) Mental Health Act and treated there, there are responsibilities for her aftercare, which the state (NHS and Social Services) need to comply with. First of all, if she is under S3 then her aftercare, treatment and accommodation in a care home or similar, is free to her. The discharge plan must be tailored to her needs (requiring an assessment) also, the detaining authorities and the medical team have a requirement to draw up a plan to prevent her returning back to hospital ( or at least attempting to achieve this). There also needs to be a recognition of what she expresses as her wishes and an assessment of her mental capacity to understand the consequences and the pros and cons of what she is asking for. A repeated statement of "I want to go home" is not a capacitated statement, unless it is made clear to her the potential consequences of the action and she understands this. The person will probably need quite a lot of explanation and discussion to enable this. From the information given I doubt that this lady would be able to undertake this. The discharge planning process must acknowledge previous behaviours or she will most likely be back in hospital again.

Psychiatrists do not assess legal capacity, in this case it would be a best interest assessment. Psychiatrists state if the person has a mental health diagnosis and what that is.

@OnGoldenPond two separate issues

If MIL has capacity and wishes to return home, then she's entitled to do so, however unwise / dangerous

But FIL under no obligation to care for her. And if that's his position, it needs to be clear in care plans

OP are you in England? If not please say where you are as advice will be different

What happened @crunchycrispy? Did they have the meeting ?

Make sure you get full care assessment and presuming that she has been in a section 3 - after care MuST be provided as 117 aftercare.

you are totally within your rights to refuse for her to come home if you don’t feel able to manage her.

There is a treatment order that can be given in release of a section - which if the person breaks by not taking meds etc they can be immediately recalled to hospital.

charity - mind - is your friend - whilst she is still sectioned she can get free legal representation under my legislation

Do not be pressured into taking on more than you can manage - absolutely insist on a full care assessment of her and carers assessment of fil . Do not let her home until section 117 aftercare is written and allocated as otherwise you may be left in your own

Good luck