Sectioning (help/experience)

[FlatOutAgain]

Asking on here in case someone has experience or any answers. Those who have followed my threads know the issues with mum.

I am typing whilst waiting for a call back but as I have no knowledge of this someone else might.

Mum smashed up her room last night (again), has bitten and punched staff and has poured water into electrical appliances. She is a danger to herself and other residents as she has been going into other rooms and hiding etc. She has caused so many issues in only 9 days.

The care home have said they cannot cope with her and we have to pick her up. I can't just pick her up and put her with my 85 year old dad. I called 111 and they called the care home to assess. We are now waiting for a nurse/paramedic to call the care home to assess. All of the mental health services are not available on a sunday.

Anything anyone else can think of? I will pop back now and then to see if there is any advice. Sorry to ask on here but I am just trying every option I have

thank you

Should also say that my sister (lives over 2 hrs away) says do not pick mum up whatever else happens. Is this good advice?

Is there a Duty MH officer with your Council who will be on an emergency weekend rota?
my DM got sectioned on a Friday. It involved our GP in our town, the local council MH officer for our town and the SW from DM’s town as DM was staying in our house.
My first call would be to your social work department emergency help number.
sorry you are in this position

Oh gosh this sounds hard. I agree don't pick her up. She needs to be assessed by a clinician who can then help decide what the next atria would be. She's in a home as she was no longer able to live at home safely so taking her back home should not be an option. She may end up being taken to hospital on ground of deterioration of mental health or a "social admission" which of course it isn't.
How was she until 9 days ago? Could she have an infection that has caused delirium?
You / the home need to leave it to the professionals to deal with. Tell them you do not have a safe place to take her so they must wait for the nurse / paramedics.
So sorry OP

The home should also be able to access a rapid response team of some kind (they have different titles in different areas) rather than waiting for 111.

Phone local social services, the will have an emergency duty team who can help.

no, dont pick her up, if a team in the home cant cope with her, how could you by yourself? She is safer there, until sectioned

Don't collect her. Unfortunately we ended up with the police in a similar situation but they were fantastic and got him to hospital.
After a fairly long stay for assesment we ended up with a secure elderly psych placement who were utterly marvellous and he stayed there until he died. But we had to go through a fair few bumps to get there.
We got continuing health care funding, when this immediate crisis is over I'd have a look at the funding requirements and start collecting your examples/evidence for when you end up at panel.

Do not collect her. Do not go to the home.

Thank you. 111 are dealing with it but have a backlog. 111 and me have updated the care home. I have looked at a Section 136 and can refuse to have her taken home.

Thank you again and based on everyone's advice I will not pick her up.

Spoke to a clinical psychologist who seems to think that the situation is salvageable if mum can get access to the Mental Health team and then be assessed for the correct medication.

I have called as many services as possible, crisis team, mental health support, opmh, local hospitals etc. All say to stick with 111 so that is where we are at present.

Thank you again

@Mum5net going to try to find out if we have a LA MH person.

thank you

Just realised that I had already called the acute team at the LA who said 111

Thank you

This is such a horrible situation for you. YOu are in my thoughts

Sorry I don’t know your back story. Apologies if this has already been done.

has the home sort medical assessment in case this behaviour is caused by a UTI ?

Agree with what’s been said already, Don’t collect your mum.

I’m surprised the Care home have not already alerted the MH team! My stepfather is in a home - he went for 2 week’s respite following a hospital stay last year and is now there permanently. As soon as he was admitted the care home manager phoned me and said he was much worse than they thought he would be and she would be contacting the MH team. They visited hi within a couple of days, he saw a MN nurse and doctor. They adjusted his meds and he was referred to the DOLS team. All this was triggered by the call from the care home manager to the mental health services.
When you next speak to the care home, ask them what risk assessment is in place and that they complete ABC charts from now on. You also want a comprehensive record of what’s happened so far. You will need this info if you’re considering applying for continuing healthcare funding.
As others have said, do NOT take her home. You could start looking at other homes that would cater for her needs better - if they have vacancies they will go out and assess her.

She cannot be picked up on a S136 unless she is in a public place. I don't think a residential care setting counts, but that's a grey area.

Have you considered A&E? They will have a psych liason service. Alternatively check if your local mental health service has a Crisis Line, which are 24 hour services dealing with emergencies.

Sorry I see you have contacted Crisis services. Mental health services are so stretched that those in care homes are likely to be less of a priority.

I've followed your story and was hoping things would settle down for your mum.

This sounds truly hideous and I'm really sorry. How awful for your whole family, including your mum. No-one wants to see this kind of thing for their loved ones. I hated when people saw my gran's irrational behaviour. That wasn't who she was at all.

I have no advice, I'm sorry.

I work on an Emergency Duty Team and this isn't uncommon unfortunately...echo everyone who said don't pick her up, ring EDT and ask for advice and help. Sometimes just the liaison from someone with Social Worker title can be enough to make the home chill out. Hope it got sorted for your poor Mum.

Yes they will only take action if no alternative which there isn’t. My mum was in last year and it was the right thing. Home team will prob go in first and decide she needs more. Good luck

In the last 9 days has your mum’s medication changed at all? Just wondering what changed for her to behave as she is currently. Might give you some clues if you can find out. Side effects in the elderly can be different to those seen in younger people. I really hope it works out xxx

Sorry I can't answer all of the questions individually as I am up against it time wise.

When you think you have hit rock bottom there is always further down to go.

Yesterday was truly awful and fortunately my Dh took charge of it all. The care home needed to 'get rid' of mum and I fully understand their position. She had done so much damage and with the violence and trying to start a fire it was too much for them.

As someone correctly pointed out we could not use Section 136 as she was not in a public place. We spent at least 30 mins on the phone to the paramedics to try to find a solution other than take mum to A&E. Mum has a safeguarding plan in place at the hospital and we stressed again and again that the paramedics had to make sure the hospital picked this up. My Dh then went to the hospital only to find mum in a bay on her own. He got the nurse to look on mums record and print out the safeguarding plan which is a 1 to 1 care.

The local MH hospital had not beds and would not take a patient directly only via A&E.

OPMH had an answer phone as it was a Sunday

111 wait was 45 mins despite the advert on the radio saying 90 seconds.

I fully understand that the hospital are stretched for staff so my Dh sat with her through the evening. The Dr. assessed mum and said that without the background from my Dh they would have discharged her (unbeliveable).

Dh then spoke with the consultant and they admitted mum to the acute ward under DoLS.

Called everyone I could think of this morning. The hospital are transferring mum to another ward and are awaiting a psych review. The issue here is that during the day she is lucid and no-one seems to look at the history before declaring she is fine. She is far from fine and needs real help and a secure place.

The OPMH was utterly utterly useless and said give her diazepam. I kept telling them this was not a solution and she had had diazepam all week and every night had had psychotic episodes. For heavens sake

GP said she had also contacted the OPMH and been told the same.

Adult Social Services are trying to allocate a social worker but this has to be reviewed by the internal connect team.

The rest home said they will not take her back until it can be shown that she is recieving the correct medication and is no longer a danger. They have said we have to pay for the damage which is extensive.

I could go on but I know we are not yet at the bottom. Mum has decended into a psychotic hell and the system to keep her safe is broken. I have no other words.

thank you all again

I’m a MH nurse, although working age adult. This might be a silly question (and I’m not sure of your DM’s history in terms of dementia etc) but, if she’s lucid during the day, have you asked her why she’s behaving the way she is at night? Are you absolutely sure it’s psychosis or could it be extreme anxiety or nighttime confusion caused by dementia? Has anyone mentioned a small antipsychotic dose at night (eg risperidone) which would help her sleep and keep her calm? If it’s nighttime only then sectioning might not be necessary, especially if the cause of the behaviour is known.

@JennieTheZebra thank you

Yes she is having psychotic episodes. She believes that young boys with sticks are trying to get into her room. She put water on the floor and hand cream all over the window so if they got in (first floor) they would slip and this would give her time to escape. She also said they were on the roof and smashing up roof tiles. We spoke to a MH professional who said mum was in a permanent flight or fight mode and as flight was not an option she was fighting as she was terrified. This was a clinical psychologist who gave us time and explained what was happening in mums head.

We have spoken at length with the GP about anti psychotics and she said that mum may need to go on them but given mums health and age then be prepared that with the side effects, especially chest issues, it could/would like bring her demise.

Thank you

Have you spoken to a psychiatrist? The clinical psychologist sounds helpful but they’re not clinicians (medically trained) and so not familiar with the different drugs available, while GPs have had very limited psychiatric medication training. Not all antipsychotics are created equal and it is possible to prescribe them in such a way that the side effects are relatively limited. I presume your mum has heart problems? Cardiology can be involved in prescribing as necessary.
In terms of the fight/flight, this is a stress response. Is it the stress causing psychosis or the psychosis causing stress? Either way, keeping her as calm as possible is key. You mentioned diazepam? Has this has no positive effect at all? If not, other benzodiazepines (temazepam, lorazepam etc) are available that might work better.
It does sound very difficult. I suspect that a short admission to an acute OPMH ward is probably a good idea, even if it’s just to get medication straight.

@JennieTheZebra There will be a lot of stress associated with mums condition based on the different environments. In hospital she believed that the woman in the bed opposite was conspiring with the nurse to steal her money. She absconded from hospital and was picked up by 2 men in a car and by a sheer stroke of luck they were good people and got her home. She left hospital because she believed that a man had stolen their house and she even described the man despite being in hospital. She ended up in hospital because she called an ambulace as she believed she was dying from heart failure and would not make the morning. So paranoia, psychosis, halucination etc. but she is living in a different world and truly believes these things are happening.

Yes you are correct it needs the proper intervention from a trained professional who can hopefully find the right meds for her. This have never been done and we have everything crossed she will get that help. The OPMH saying give her diazepam is not good enough. In fact it was me who first went to the GP to ask for diazepam so my dad could medicate mum when she got too much. Dad found that the tablets did not work and the care home found the same but OPMH would not listen.

thank you

@JennieTheZebra sorry to ask but do you know if psychotic drugs can be taken over a long period? I read that 6 to 12 weeks would be the maximum and the side effects are dreadful. Are there milder ones that the person can be on permanently?

thank you