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

My DM was on anti psychotic drugs for her last two weeks as she was hallucinating and became a safeguarding issue. However it was very short term as she was terminally ill anyway. We ended up having to sleep in her room for a few nights to stop her getting up in the middle of the night- we found her about to get into a cold bath at 4am one night. My sympathies OP.

I have never heard of the family of a patient suffering from psychosis being billed for the damage they have caused.

I sincerely hope you dont end up paying this, I cant see how you are liable for it at all, surely the home should be insured?

@Nimbostratus100 The GP has said the same thank you.

Thank you all again. Mum is on the same ward as there are no beds on the Dementia ward. She tried to leave (as expected) today but there is a DoLS on her so she was stopped. She became very aggressive with the staff. They have calmed her down (no mention of medication but they will 'tranquiliser' her after we agreed) and she is now ok. If the normal pattern is followed then she will be a handful tonight.

thank you

Yes, many people take antipsychotics permanently. Someone with, say, schizophrenia may be on an antipsychotic for the rest of their life to prevent relapse.
Which antipsychotic is right for your mum depends on her exact symptoms and the rest of her health conditions. The side effects can vary a lot; tbh a low dose taken at night of any of the modern ones (risperidone, quetiapine etc) may just calm her down and help her sleep, without any other real side effects, other than her maybe being a bit more sleepy during the day. I’m surprised it hasn’t been suggested already tbh, but NHS MH is very snowed under right now (not an excuse, I know…).

@FlatOutAgain lots of older people are on long term anti-psychotics. It needs to be carefully monitored to ensure that it sits them and isn't being used as done kind of chemical restraint. But it's a common course of action when the situation demands it.

Can you request she has a mental health act assessment, you are entitled to ask for this as her next of kin.

I have had a 12 year long experience of this due to my son. Very similar behaviour. Firstly the care home should not have discharged her to anywhere without a proper care plan being in place. Put in a formal written complaint and also let the CQC know. They had a duty of care to your mum and failed there.

They should have been the ones calling for help and escorting her to hospital and staying until a solution is found, that's what they are being paid to do.

Email your mums consultant with as much evidence as you can in support of her receiving the correct help and stating that you cannot be held responsible for her actions if she doesn't have her mental ill health treated.

You need to find out if she has a:
Named nurse
Psychiatrist/psychologist
Social worker
Care co-ordinator

Does she need to be held under a Section for a 72 hour assessment. As she sounds like she lacks capacity press for her to be sectioned. This then entitled her to certain care and means if and when she is discharged she comes under section 117.

Good luck. It is heartbreaking.

@FlatOutAgain also If you are a designated carer for your mum you may be entitled to a carers assessment.

Hi,

Another mental health nurse here. Agree with the PP MH nurse poster that this is very unlikely to be psychosis though sounds as though a low dose antipsychotic medication may be of benefit.

In your position I would be pushing for this above anything else.

Have the hospital ruled out a UTI?

My Mum had severe mental health issues and physical health issues in her last few months - she died of bowel cancer but also had Crohn’s and copd and a diagnosis of schizophrenia which was at its worst when I was 4-10 and then she was effectively medication free from when I was 10-37 (when she died) with no relapses that required sectioning (she did still have “moments”). When she became very physically unwell towards the end it did exacerbate her mental health issue and we ended up having her assessed through the continuing health care scheme and she was admitted to a secure nursing home for people with severe dementia (although she was only 70, a “young” 70
too, and didn’t have dementia) - they were the only place that could cope with her. I am wondering what other options you might have as it really doesn’t sound like the nursing home is suitable?

I am also wondering if it’s some sort of medication issue - ie taking medications at the same / wrong time (?) or an unresolved UTI as it does seem odd that she’s only like this at night…?

My DM has Alzheimer’s and suffered badly with paranoid delusions at the start, Risperidome really has helped, the only problem is due to the dementia she forgets to take it and I can tell when because she starts accusing me of nicking notepads and socks etc. I don’t understand why they aren’t trying them with your DM, even with potential side effects, which she might not get, this has hit crisis point and needs to be addressed so she and all around her are safe. She must be in a very scary place and it’s cruel of the doctors not to try and help. Best of luck OP, been here with both parents relatively young and it’s horrendous.

I struggle to understand how a care home can't cope with her behaviour despite being trained, yet a hospital will? I've been a senior nurse in both, atm a hospital ward and unfortunately it's so difficult with all these social admissions. There just isn't the staff for all the 1 to 1's needed which is when falls happen.

Sorry its been a very busy day and I have a few mins for an update. Thank you all from the bottom of my heart for replying. Although I haven't answered individually I have read through and I have put further actions into place.

Last night mum saw a psychiatrist from the OPMH. We were unaware of this until this morning when she called. She was utterly utterly lovely and explained that they are trying to get mum into the dementia ward but there are currently no beds. They may move her to an interim geriatrics ward as the noise in the current acute ward is disturbing her and making her restless.

The psychiatrist explained once they get her onto the dementia ward they will assess her over several days to work out what the best medication and care is. She went onto say that they will do what is the best for her and even asked how I was and it threw me as she is the first person to ask, apart from Dh who is living through this with me.

The care home had not packed anything for her at all so she had nothing. I went to the care home today and discussed things with them and asked if they had insurance and was surprised when they said they 'will look'. I saw mums room and it was not as bad as they made out. The wardrobe doors were pulled off but it was not smashed up as they said. Anyhow that is a battle for another day but I was not thinking and did not take photos.

I then went to dads, sorted out his shopping and a bit of cleaning and took him to the hospital. It was awful. I was there for around 4 hours with dad. Mum was in a heightend state and was shouting that everyone was trying to kill her. She ran at dad and tried to drag him from the ward saying they would kill him as well. The nurses asked if I would try to calm her down. She refused to believe she was in hospital and kept pointing out people and saying things like 'that man has walked past 3 times and he is going to kill me'. It took a long long time to calm her and trying to leave was difficult as she would not let us go. I promised to pop back later and pick her up so that placated her.

They have put her onto memantine. She has been refusing this since it was first prescribed by the OPMH which is why they discharged her from their care. I think honestly it is far too late for this drug.

Have asked for a care needs assessment for dad and the waiting list is 16 weeks. Have sorted out a home help but need to organise it with dad. Have filled out a form so he does not have to put his bins out, someone else will. Chased up the social worker but no go as yet.

Just to point out when I say 'I' this means dh and me a lot of the time.

So ups and downs with the psychiatrist being the high point. She said that when she chatted to mum that she had no recollection of the care home at all.

I have explained to the nurses that mum will keep saying she has breathing and chest pains. They did not know this and said they have to keep giving her and ECG. After speaking to me they have put a stop to it.

She still has DoLS but my worry is she will escape. She knows where all the doors are and which ones are locked etc. She is on high alert to escape as she has done it before.

Thank you all again for your lovely kind words and advice. It truly truly makes a difference

She needs medical assessment and intervention, she won't get that in the home.
And you say the home is trained for this, but it's unlikely that they are trained to manage the extreme behaviour that the OPs mum was displaying before she was admitted.

It does sound like she needs to be on a locked ward (a ward where you need keys to get through any doors and only the staff have keys). It’s almost impossible to escape from a locked ward; in the building I work in (a MH hospital) you need keys to get absolutely anywhere, especially outside. Locked wards can make visiting more tricky though.

Actually, we've found that being able to visit MIL on her locked ward isn't very much trickier than when she was on a trauma ward in a general hospital last year, in that we weren't able to gain access to that ward without being let in by staff either. Getting out was easier than on the locked ward, for obvious reasons. However MIL is apt to become agitated if she tries to go through a locked door, having no capacity to recall where she can't go, or why. This would be difficult for OP to manage, but not nearly as worrying as knowing the possibility of escape is very real.

OP, the MHU that I have experience of and one of DM's care homes had a 'race track' layout. It was so clever. 'Wandering' patients/residents literally walked in circles but never came up against locked doors they needed to fight their way out of, they just kept doing circuits. It just tired them out and then they needed to rest. Hopefully the dementia ward has this ' race track loop' as it makes for much less stress.

My DGM had episodes like this - not as chronic as your DM but there have been times she's behaved similarly.
Sounds like she needs anti-psychotics. I know DGM is on one and it hasn't happened since.

Thank you again for your replies. Sorry I have not responded sooner but it has been a very busy time.
Mum was going to move to the Dementia ward yesterday but it got cancelled due to the ambulance strike as the ward is on the other side of the road. Instead they moved her to a geriatrics ward and today whilst I was there with Dad, they moved her to the Dementia ward. That is good news.

I have a care worker allocated by Social Services for when mum is discharged from hospital. I thought they were called Social Workers but maybe there is a distinction or the name has now changed?

Care Home Select are also involved and will help look for a suitable home if/when mum is discharged although the psychiatrist said they will do that after they have assessed mums needs whilst in the dementia ward.

I can cope with mums situation now it has calmed down. Dad is another story and I have had to visit everyday to sort him out. Have a pre-assessment meeting tomorrow with the 'home help' as he is self-funding. They will clean, do washing, pop to the shops etc. Have also sorted out meals on wheels although not spoken to him about that yet. Care needs assessment in progress but will take between 4 and 6 months. Careline in place which is an emergency button should he fall. I do his shopping and will continue with that as I can do it when I do mine. Its just the time to do all of his washing, bed making, cleaning etc. I just lose whole days at a time and it really is not sustainable. I cannot think about the future just getting through the 'now'.

I start back at work next week so need to do as much as I can to help make him independent although that will be a massive stretch as he really is all at sea.

Thank you very much

That sounds extraordinarily stressful. I’ve had a similar situation and it’s so tiring being on high alert all the time.

My thoughts are with you. We were never anywhere near the stressful situations you are having to go through but it still took chunks out of us as a couple. It's really made us think about how to prepare better for old age than our parents did so that our children won't have to deal with a similar situation. My advice would be to outsource as much as you possibly can in terms of your dad's care as soon as possible or you will get burnout and exhaustion which can take years to heal from. His needs will only increase from now. Does he have a cleaner? Sorry if I missed this info. DMIL's cleaner was a godsend, she had just been through the dementia journey with her own DM and really went above and beyond (we used to live almost 2h from DMIL's house and the whole situation caused DH to have a suspected heart attack, which transpired to be a panic attack but still). Do look after yourselves! 💐

Another day.....

Thought mum would be ok in the dementia ward. I never seem to learn.

Last night mum tried to escape, she broke a door and repeatedly tried to smash a window. She was out of control and the staff had trouble managing her. The dementia ward is across the road from the hospital and so they have now had to transfer her back to the geriatrics ward. Even though this is absolutely not appropriate for her care it is closer to the security team.

Been phoning all day to try to get an update from the Psych team but as yet I have not managed it despite lots of promises.

I did find out they were holding off on the anti-psychotic drugs until they understood her better; her behaviour, triggers etc. They were going to observe her for 72 hours on an hourly basis in the dementia ward. That has now gone up in smoke so no idea what the next plan is until the psych team let me know.

Dreading the weekend.

Saw dad again and had a meeting with the home help team. Second meeting with them on Monday and hopefully something in place by the end of next week. Dad just sits and wallows in self-pity with the occassional crying fit. If he had bothered about mum throughout their marriage we may not not be paying the price. Sorry for moaning but sleep has been difficult.

Oh that all sounds so hard. I'm glad for you that you didn't bring your mum home from the care home and hopefully with time she'll be on a medication that works for her and she can settle. There's no point in me saying that sorting out her medication is out of your control so try not to think about it too much. I know that won't make you feel better.

But I would say anyway that you should concentrate your energy on what you can do and that's try to get your dad sorted out.

And maybe go for a long walk at the weekend or read a book in a cafe, whatever makes you feel better.

Hang on in there, there's not much else you can do.

You’re being very strong; as the PP said, try and do something for yourself to set your ‘reset’ button at the weekend as you need the energy and your mum is in a place where even though she did try to escape, she was not successful, so you can conclude that she can safely be contained for the moment. Which is good thing No 1. I have to say I find it strange that she got taken back to the geriatrics ward from the Dementia ward as you would have thought that the Dementia ward were more used to that kind of behaviour. But she is safe there and that’s your piece of mind.

Obviously we are all only outsiders looking in on the situation you have described, but I am impressed and maybe slightly surprised that no one has signed-off on a small dose of a second generation anti-psychotic at night. I think in other places she would be drugged up heavily already and I do think that this indicates you have a thoughtful and measured Psychiatrist in charge. Which is good thing Number 2. The horror stories of first generation drugs really aren’t applicable to the newer medications so try not to listen to anyone telling tales of those; pharmaceuticals evolve for a reason and that is mainly more benefit for less side effect.

I wish you all the best OP; you’re in the sea and you have to keep swimming, but you will inevitably get to the other side. Xx

@Dogsarebetterthanhumans that's a lovely considered post which makes huge sense

Thank you again for all of your help and answering my questions.

When mum was discharged from the Dementia ward it turns out she was trying to smash the window with someone's oxygen cylinder.

Mum had a good night on Friday and a bad night last night. Even though she is placed in DoLS and has a safeguarding policy in place (supposed to be 1 to 1 attention) she went missing last night and they found her on another ward.

Anyhow we keep trying to move on otherwise it would be too much. I found out today that she has been put onto Risperidone. Not sure as yet what the doseage is. I understand from google that it can take days or months to work.

I took today off from mum and dad and tomorrow I will be going to see dad as we have the second care meeting. I will then be going to the hospital. Are there any questions I need to ask about Risperidone, and from people's experience how long have you found it takes to work?

thank you and also thank you for your kind thoughts they are very much appreciated