AIBU to think mental health crises should not be treated as antisocial behaviour

[Serencwtch]

TW: Some references to suicide.

In my local area Police have started a new initiative to reduce the demands & costs involved in attending to 'concern for welfare'/mental health crisis type calls.

They have issued a number of formal enforcement notices and warnings using Antisocial Behaviour legislation to people who have caused inconvenience through mental health crisis/suicide attempts in public places. These enforcements are community protection warning (CPW), Community Protection Notice (CPN) & Criminal Behaviour Orders (CBO).

I know one individual very well who has received one of these & they were very distressed by it & have now become very withdrawn & secretive. It's also difficult as a loved one as if I was concerned this person may be at risk I would be hesitant to involve emergency services as even a call to ambulance would likely result in police attendance & therefore have criminal implications for them. I also can see that it has increased their risk but in a more secretive & less public way. No doubt police consider this a success as they have not been called out to them.

I fully understand the pressures on police, I have friends & family that have served as officers & police staff. The funding cuts are every bit as bad as NHS or social care but with less public awareness.

This doesn't sit right with me at all. I think it's misuse of legislation designed to tackle antisocial behaviour & that a mental health crisis/someone attempting to take their life should not be labelled as antisocial behaviour.

https://share.google/aimode/tIeeT7jQGiNK7jDxM

I'm a mental health nurse. IME these steps are only taken when someone presents at bridges/train stations very frequently.

Some people get into a cycle of putting themselves in danger, being placed under section 136 by police, go to hospital for assessment, be assessed and discharged several times in a week. This will only happen when someone is in crisis, but speaking very generally the answer for these folk will be psychological therapy in the community, admission to hospital can do more harm than good. It also uses alot of police input without actually achieving much for the person.

Engaging with said therapy if you have experienced trauma is hard going, and then waiting lists are ridiculous. People get stuck presenting in crisis and do increasingly risky things to try and get help - some get blinded to the risk they are putting themselves in and tragic accidents can happen.

That's a long winded way of saying we need lots more funding for psychological therapy and CMHTs, but really if someone is turning up at bridges/train stations enough to warrant this it will be in their interests to use legal frameworks to break the risky cycle they are in.

It is difficult as SOME people with mental health problems have antisocial behaviours and scare others in the community.
Suicide and self harm is different as they’re hurting themselves.

Not if it is public. That's the issue here.

All these problems regarding mental health can all be traced back to 'care in the community'.
Chucking the mentally unwell back out into society with no proper care.
Throughout all of recent history we had dedicated hospitals to contain and treat them, they were called asylums, and imo they should be reinstated.(modernised and slightly less draconian, of course)
This would achieve two things. Treat and assist the severely mentally unwell in a safe and controlled environment, with all required professionals in one place, whilst putting off all the habitual and disruptive types who would soon find other means of letting our their frustration if it meant a 6 month stint for evaluation in the local asylum.
It would also protect the public from these concern for welfare dramas, and also stop the serious attacks we have seen by schizophrenics on innocent people in recent years.

Fair point. Some people would probably feel a lot happier and more secure in residential care than having to cope alone.

Whilst i agree with you the asylums brought about their own problems ,i started training as a mentsl health nurse in 1993 ,and the local psychiatric hospital was in the process of closing down many of the long stay wards its still there but only houses specialised regional units now
Lots of the long stay patients were institutionalised many had fairly mild learning disabillities most with support could probably have managed to live fairly indepedently if they hadent been locked away for years
Now the pendulam has swung to far in the oppisite direction ,and too many people are not getting the teatement they desperatley need
Mental health services have never been funded properly.

Yes I was working in MH when all this came in (ancillary nurse, not qualified) and it was a disaster from the off. It could have been very successful

However our understanding of what constitutes 'MH' conditions has changed since then but equally also our understanding of what hospitalisation can or cant do

We currently work on the basis that hospitalisation for people with ND is generally a negative experience and not therapeutic or helpful. What this means is that teams work hard to avoid and prevent hospital/sectioning for those people, sometimes that is right and sometimes it isnt. However there isnt anything else. Comorbid depression/anxiety/ND are huge factors in what the OP sets out, layers of trauma and maladaptive strategies cant really be undone by a couple of visits from the crisis team, which then stop, long waiting for any sort of therapy but the therapy not even being tailored for those people and hospital stays are possibly making things worse but are only designed to get someone off the streets for a while in any case.

Those actions are often taken as a form of control though, sometimes purposely.

Just to say that some of those attacks by people suffering with schizophrenia or other similar conditions, are by people who are in care.

There's a few bridges by us that are local "hot spots" for those wanting to end their lives. On Saturday, three roads ended up being closed into the local city for nearly 4 hours while Police tried to talk a jumper down and there were fire brigade/river rescue teams and an ambulance crew there as well. Thousands of motorists inconvenienced let alone the cost of the emergency services. It caused absolute gridlock and local businesses were badly affected.

Why should one person's mental health take priority over what everyone else was trying to do that day? People who try to do this repeatedly need to be sectioned and secured as they're an ongoing risk to public safety as well as their own. I completely agree about bringing back asylums.

We do still have a range of inpatient care options for people whose illness make it appropriate. It's just that they are underfunded and places are scarce. There is no need to return to an earlier model of inpatient mental health care. We just need to fund units properly and resolve the appalling fracture and chaos in the service.

(And even with an adequate number of places, inpatient care might not always be the most therapeutic option for an individual.)

I think that the abolition of 'asylums' was actually much more damaging for people with learning disabilities and developmental disorders. There was an awful lot wrong with the asylums that existed for people in these categories, but at their best they also provided opportunities to live and work with dignity in purpose-built commmunities. When these were taken away, the alternative of care in the community could only have filled the gap left if there had been a genuine and lasting commitment to spend larger amounts of money to fund smaller supporting residential units plus adequate support for people who were cared for in their family homes.

Its a bit more complex than that the acute wards where these people invariably end up cant reallty offer them any therapeutic treatment as they are too busy
Yes they would probably benefit from some long term inpatient treatment that could find the root cause of their behaviour but places like that will be few and far between
Asylums were far from perfect and many patients were institutionalised after being kept in hospital for far to long

I think it's a difficult one- nobody wants to punish the mentally ill, but what can be done if someone is repeatedly climbing on to train tracks to commit suicide for e.g., massively disrupting the trains for everyone else (who may also have mental health issues)?

Similarly, I used to know a guy who was an alcoholic with poor mental health. He was a very ill man and needed help (which he wouldn't engage with). But when drunk he would repeatedly ring 999 for an ambulance to attend because he was in a crisis state. Unsurprisingly, the paramedics were unimpressed.

So I'd imagine this kind of intervention is needed on occasion, harsh as it may seem.

@x2boysi agree there are conditions where there is a detachment from reality and all control is lost, however….ive experienced that there CAN be a process of poor choices that can lead to these states of psychosis and loss of lucidity. Many of these episodes are chicken/egg scenarios where if the person engaged in a wellness action plan where they recognise early signs of crisis they can choose a different path other than the ones that send them off the skids, like self medicating with street drugs, the trajectory can be different and better. Some responsibility can often be taken to manage symptoms and ultimately behaviours. I think your professional empathy is admirable and needed, but the reality of living with this irl has drained mine and after years of supporting someone who prioritizes their own short term comfort over their families safety with the choices they make in managing the situation. With devastating consequences for their children and no responsibility taken whatsoever.

There’s something about that here: https://www.bbc.co.uk/news/uk-66304472

I remember a thread a while ago titled something like “When everyone needs care, who will be available to give it?”. Quite a few people said the OP was being horrible but others saw what she meant. I think there’s a sense of compassion fatigue now - for individuals but also within society as a whole. Too much is asked too often by too many.

It is all very well to wish for better mental health services, but for some people no amount of help and support will ever be enough.

This is a description from @jacks11 earlier in the thread:
This person had a personality disorder diagnosis, ... somewhat distressed but not actually suicidal, often furious a request has been declined etc- if they did not a significant enough “reaction” from CMHT, would call GP, then escalate from there. On many occasions having two, three or even four of these services out in a single 24 hour period. On multiple occasions an ambulance out more than once a day. This individual would keep ambulances with them for long periods and in a quite rural area. There were multiple multi-disciplinary meetings including all services- taking up even more time and money. I can’t tell you the processes that were put in place- and money spent- on this individual for very little long-term progress.
... (threatening suicide if they left, refusing to be taken for mental health assessment as they wanted to go to hospital when there was no reason for an acute admission),
... threats of prosecution and then actually being charged did significantly lesson the abuse of services

Some people are so badly damaged that want they want or need is someone with them 24 hours, to soak up all their emotions, listen to their disordered thoughts, physically restrain them at times, basically someone to be a human sponge, mattress, and swaddle. For life.
Often such people have no capacity to put any energy into helping themselves get 'better'. They have no 'energy' of their own, they feed off the energy of others. And they don't even want to get better, they want to be mentally and emotionally wrapped in the care and attention of another human, all the time.

I don't think society can help. This level of need is too great. Even in hospital they won't get that level of attention, so will likely be drugged into docility instead.

Any care plan that tries to impose self-restraint or restrict their access to the attention of other humans will fail. They don't want that access to be restricted - that attention is their primary need.

However I note that in the example above, threat of prosecution did ease the abuse of public services. Presumably the person then sourced the human attention elsewhere.

Of course and there are many different complexties some people can
have drug induced psychosis
Some people self medicat with illicit substsances which exacerbates their existing symptons
Some people lack the insight into the need for medication and have frquent relapses.

You are obviously very involved with this teen @Serencwtch so would your time not be better off supporting them in getting a diagnosis which would at least open the door ajar for medication and professional support?

This is exactly right, many of my service users fall into this category and Ive learned over the years that when criticising CAMHS or adult MH services (who do sometimes drop the ball), actually a lot of this behaviour is behavioural, learned behaviour with no real solution and not a MH condition unless like you say we agree as a society that we just drug people up and sedate them.

I totally agree. I think another poster got the wrong end of the stick with my comment. Very sensible post x

This just sounds like SIM under another name.
I was under SIM. It was awful, and I was made to feel like a crisis was a crime.