AARRRGGGHHHH Mental health staff

[SenseofEntitlement]

OMG I am getting SO fed up.
(More of an admin rant, but people in here are more likely to get what I am talking about)

Right, so for ages, I have been told I will eventually be transferred from team A to team B. Fine. Nothing was finalised and I was told I would be fully informed, there would be a lot of work with team A to get me ready for (less intensive and specialised) team B. I was nervous, but generally OK with that.

Then, about six weeks ago, out of nowhere, I got a letter saying I have an appointment with Dr J (a new psych doctor I have never met) at my local surgery. I rang my team A, who knew nothing about it and said they would get back to me. They didn't.

Then, a couple of days later, a nurse who I have never met turned up at my door, with no appointment. I was in bed ill with a virus, but got up to speak to her. I can't really remember what was said (I was shaking and full of fever - would have cancelled an appointment if there was one) but she didn't know anything at all about my history or situation - not even that I had been in hospital recently.

So, the next day, when I was feeling a bit better, I rang my normal nurse at team A, and asked what was going on. She didn't know - she said she had had a meeting and talked about me to another nurse, but the plan was that they would do joint visits with plenty of warning (they know full well that these things make me anxious, and the thought of being left out of the loop REALLY makes me annoyed and anxious) so she would try to get in touch with the new nurse.

My normal nurse A came out to see me the next week (although she said she shouldn't) for a normal appointment (basically her and DH ridiculing me wanting to get a job and saying I should be happy just pottering about at home, and they would love to be able to be as lazy as me), and at the end she said she was still chasing up nurse B, who was on holiday, but that there would definitely be a full explanation and joint visits etc before I met the new doctor. Nurse A is usually really nice, but recently she has been distinctly cold, I'm pretty sure she is backing off so I can go to the new team.

In the meantime I have rung team A (I don't have a number for team B) several times, they have always said they will ring back or pass a message to the nurse A (who incidentally usually sees me once a week, but I have seen her once in the last eight weeks). They never get back to me.

I have lost the doctors letter, and hadn't put it in my diary as I was under the impression that it was going to be discussed with me first and was perhaps a mistake anyway (team A doctors come out to my house, so I have never seen this setup before, although obviously I know it exists on less intensive teams) I did have a vague memory it was at the beginning of December though.

So, after another full day of waiting for a call back, I rang team A and insisted the person look on my records and tell me if it said anything about this appointment. It didn't, but she found the name of nurse B and her phone number.

So I rang nurse B. She wasn't there, but there was someone on the same team, who did have a record of the doctors appointment (next wednesday). She couldn't however tell me exactly what the appointment is for, whether I should take my husband, etc. She said she will ask nurse B to ring me.

But nurse B hasn't been in touch all this time, why should I trust she will this time?

ARGH!!!!!!!!!!!!!!

If I get handed one more care plan, badly written in the first person, that I have had no input into, I will go beserk. They tell you to be proactive in your own treatment, then don't tell you anything about it. They promise they will look into various options, and never get back to you then send out a new member of staff who has never heard of it.

I have had it up to HERE/\ with bloody twatting patronising inefficient bollocking mental health bastarding twunt teams. How the hell do I engage with services if they won't engage with me? I was meant to be doing an advance directive. It hasn't happened. Relapse prevention plan hasn't happened. Counselling hasn't happened. Therapy hasn't happened. Medication reviews consist of me saying x drug isn't working on y symptom and them saying it must be and not telling me why, then telling me to not just rely on meds, but giving me absolutely zero idea of what else I can do (and I do everything the websites and books say)

So, I am essentially meant to sit here and wait for my next relapse, when they can railroad me into unsuitable treatment and then refuse to listen to my concerns?

Sorry for the rant, but has anyone had any experience of this?

I don't actually mind most MH staff (in fact I owe some my life), I'm just really really frustrated. Just having a severe mental illness does not mean I am stupid, but it does mean I need to know what is going on.

hi - rant away. Sounds like the systems are not set up for transfer between teams. You could contact your local advocacy service, which is independent and meet them and tell them what you have put here and get them to help arrange a meeting or a successful transfer and insist on things happening. That is the route I had to take.

For me, I can't say it was totally successful - had a care plan ignored for most of a year, now have a care co-ordrinator but no care to organise etc etc. But some things have been done and it made me feel more in control. There should be an advocacy service for each mental health area which is totally independend. Just a thought to help you with admin and frustration.

My god this sounds like a nightmare. Presumably you are talking about post discharge from a psychiatric ward? This team A and team B thing must be peculiar to your locality as this isn't the system in my area. I get the point though that transfer to team B should be undertaken with care and with joint input from you, team A nurse and team B nurse. You are clearly an articulate person and i really think it's time you wrote a letter of complaint, giving the details as in your post, to whoever is the Managerof the Mental Health Service who has responsibility for your care. I know that these services are stretched but just continually not returning calls and demonstrating that the right hand doesn't know what the left hand is doing, is simply not on and is obviously going to exacerbate your condition. PALS is a good idea too.

I think the nurse was very insensitive to say you should be content to potter and wished that she had as much time to be as lazy as you - shocking. I know your DH joined in but he is not a professional responsible for your care. Presumably you will turn up at the appt on Wed and try to find out what is happening.

After my discharge from a psych ward last year I had a CPN who always visited when she should and I am now seeing an NHS psychologist, and was followed up by the Conslt Psych every 3 months - just been discharged though not fully recovered, so I can't really complain. I guess though it depends on what type and the severity of someone's particular mental illness. Mine was/is depression and anxiety.

Do hope you can get things sorted, but I honestly think you should make a complaint in writing, which has to be read and acknowledged, rather than phone calls which can easily be forgotten.

Team A is an early intervention in psychosis team, team B is the normal community team. When I have been briefly put with crisis or a ward, things have been pretty smooth, but I think that is because EIP are so proactive (they really are usually very very good, and I really do get on with nurse A - I don't get out much so she can be the only person I speak to outside of my family for weeks at a time if I am unwell.) In fact, I am wondering I am maybe a bit spoiled because I am used to doctors coming out to my house to see me with only a few days notice, accompanied by someone I know and trust, not all this rigmarole.

So I am a bit baffled now.

Tomorrow I will ring the community team again, do my "assertive" thing (I will just pretend I am back at work - I can actually be very assertive when it isn't about me as I used to be a very good salesperson) and try and get some actual concrete information. I'll do the whole "so, what you are saying is...." and "maybe you can answer a question for me..." with the implication (and intention) that the question WILL be answered. I just keep asking for more contact numbers and names until I find the right person, but I can only do that if I am slightly manic, because it is so utterly soul destroying.

And if one more person gives me a patronising leaflet with no real information in it I will scream. I have just registered to do a course on biological psychology as it would seem to be the only way I can get any real information, which is a sad state of affairs.

The doctor in hospital earlier this year actually physically talked over my head, about me! I don't think he thought I understood the long words he was using tbh.

I would love to help make some form of training course for MH staff. I swear most of them see service users as a complete different species.

'If I get handed one more care plan, badly written in the first person, that I have had no input into, I will go beserk.'

Mine was full of spelling mistakes and barely made any sense. I really know where you're coming from on that.

No advice to offer really, just to say I hear you. My good friend has had much worse MH problems than me and the treatment she's had is appalling. She's so fragile at times, and the way they've handled her case has actually made things much worse. She has such terrible trust issues, and all the messages and calls that go unanswered do NOT help. And like you, she's sick of being patronised--she's got a degree in microbiology and is very clued up, yet she gets fobbed off or ignored during consultations.

I do despair, but my only comfort is knowing that if I were back in the US I'd only get what insurance would cover ('you must be fixed in 8 sessions or less') or if uninsured, nothing.

I think some HCPs think having MH issues = unintelligent. I can sort of understand someone who doesn't suffer with depression (as I do) thinking 'why doesn't she just logically think about it and realise stuff isn't that bad? she must be a bit stupid' and there is no way for them to ever truly understand if they don't have this illness.

Can endorse what you say YankNcock - I was hospitalised in 1995 (severe episode of depression) and again in 2010 (3 months each time) I was amazed that nothing had changed in terms of MH staff nurses and nursing assts in 15 years. I too had a care plan given to me by my key nurse. I did say "shouldn't I have been involved in making the plan" and she blushed a bit and said "well if there's anything you disagree with, we can change it. I got the feeling that it was just a task to be done and a box ticked and the whole thing was meaningless, as none of the plan was carried out!

Also the staff used to "talk around us" to each other and the only time they were interested in patients was when we were well enough to chit chat to them about their lives......no-one ever asked us what may have been the cause of our illnesses. A fundamental thing like introducing themselves on the ward was still not done, 15 years on. There were a few exceptions but mostly if you were having a really bad day you were left alone to get on with it. One day I just felt like I was in a very alien place and had no emotion at all and was very very scared (it was a warm summers day and the staff were talking about BBQs etc) Eventually a male staff nurse asked me if I was "ok" I answered "NO" and he said "what's your forward plan" and I said "do you really want to know" - "yes" he said - "to get rid of myself" and he just walked off...............great eh.

Another day I was in a bad state and was outside all morning with my head on a table (again warm day) and my friend arrived at visiting time and asked if anyone had tried to comfort me and I said NO, anyway she comforted me and I had a good cry. I said I felt paranoid that no one was wanting to offer me a crumb of comfort. I found out later that onher way out of the ward she accosted the first staff nurse she saw, and asked why I could be left for 3 hours without anyone helping me and she said I had felt paranoid that no one wanted to help me and the nurse said "now where has she heard a word like that"......................my friend (who is very direct) told her that I was an intelligent and insightful woman who had 30 years as a social worker and team manager in social services. "Oh yes" she said "I'd heard we had a social worker on the ward" and walked off.

Oh and I was also told by a nursing asst to "pull myself together" and another one told me to "cheer up" - I reported this to the ward manager and she was very annoyed about staff making these remarks to me and assured me they would be dealt with accordingly and they both apologised later.

Senseof Entitlement - I had posted about my after care being good but certainly not the practice on the ward. Yes I wish they made training in mental health an absolute priority but I fear little would change. The thing is I think is that they see the same sorts of mental illnesses all the time and the abnormal becomes normal and so they totally underestimate the torment that people are going through. Yes I too think they see service users as a different species.

Well done with your aim to be assertive - you are certainly very articulate/eloquent on paper, so go for it......loved the Qs you have in mind to ask and I'm sure withyour present determination you won't allow anyone to fob you off.

Can you come back and tell us how you got on.

Your treatment has been very poor. It seems to me that you have a better handle on what should be happening than the so called experts! Not good. I'm a CPN and I cringed when I read this post. I despair sometimes of systems and people. There should be more customer focused working.

I do have to say inhibernation that once discharged I had a really really lovely CPN who helped me enormously. She worked for a Conslt Psych who didn't like admitting people, as he thought it made them institutionalised (I was 66 at the second admission, so was on older people's ward) and I was severely depressed and suicidal, so he did admit me, which I have to say was a relief at the time. Consequently my CPN had little to do with the ward as most of her patients were being treated at home. She was very concerned to note that patients were just left to their own devices. The reviews that she attended also concerned her, justifiably, as the Conslt Psych was a very controlling figure, and all the staff were afraid of him (this was very obvious) and as far as patients were concerned, he was totally detached, not even giving eye contact! When he was away and the review was chaired by another psychiatrist, the tenor of the meeting was totally different, with others feeling free to make comments, and a much more relaxed attitude.

I had my CPN for 12 months and only discharged me because she was leaving the area, and she did in fact transfer me to a colleague, as my CPN referred me to an NHS pscyhologist and to access that service, there had to be a care co-ordinator, ie. a CPN. I was really upset to lose my CPN but the other nice was also lovely, but I only saw her a few times, as the psychologist decided that she could see me without a care co-ordinator.

It's good to have the input of a CPN on the thread and FWIW my experience of CPNs has been excellent.

nina - I'm glad you have had some positive experiences with care from a CMHT. Having worked in different areas of London I was pretty shocked to see how different care can be in some clinical settings compared with others. Acute care has it's place though often not where collaborative working occurs. It really should take place in community mental health teams though. This takes many forms - not just working together on care plans, relapse prevention work etc. but also supporting people to take ownership of their health and to help them make informed choices. I find that many of my colleagues are risk averse which can often really get in the way of collaborative working. For example, some CPNs might want a relapsing patient to go into hospital as a precaution even though the patient might be vehemently opposed to it. But working closely with the patient during this time, continually monitoring mental state , pooling support mechanisms and adjusting medication (if necessary) can often avert a relapse ergo no hospital admission (which saves money!), patient's wishes are respected, helps foster therapeutic alliance with care coordinator and the individual's confidence in their ability to cope is enhanced. Of course, there are times that the risk is too high and action needs to be taken - but there are so many situations where other ways of working are successful.

Sorry NanaNina

sense sadly is is indictive of the standard of MH care received. I'm sure there are good teams but they are few and far between. My experience was a catalogue of errors from start to finish. Hospitalized into a psychiatric unit (private) which was horrendous. A patient attacked me on the first night and I was told that "We're all in this together" and "Have you taken your meds?" not ONE scrap of professionalism between them. I spent that first night absolutely petrified. The same patient attatcked a membe of their own staff and STILL she was allowed to roam around the ward where, the night before, some poor bloke was sedated and straight jacketed purely for repeatedly asking for someone to talk to (and very nicely, patiently he asked as well) Utterly unbelievable but true.

After two weeks of hell and next to no support (I had similar experience in that someone asked me if I was ok, I answered no and they walked off!) I put on a show of being well enough to be discharged. I wasn't well enough but had to get the hell out of there.

Had a follow up appointment with a psychiatrist who spent forever taking notes on what led to my hospitalization, that was fine. Next appointment was with the same man, also fine, some continuity. Next appointment, different psychiatrist, went through my notes, no continuity. Same with the next two appointments, different people each time, starting at the beginning each time. Last appointment, different person YET again who didn't even have my notes! I said my piece, stood up and walked out, never returned.

It's a pile of crap.

Shakey that is terrible I think it's very difficult to get a "good" ward because so often agency staff are used and the issue with continuity is such a problem - as you highlight well. I'm not surprised you fought to get out of there.

By the way, what was David Cameron doing on your ward?

Do you mean the bloke asking for help?

He was so sweet you know, I'd heard him asking all day, not in an annoying way, but they just kept dismissing him and, understandably, he was getting distressed. Still didn't warrant them drop kicking him to sedate and straight jacket him yet this....this...woman was allowed to carry on. I nominated myself as spokesperson to voice the rest of the wards concern but was completely dismissed myself. Can't tell you how frustrating that was. The phrase "You're just a number" was totally apt.

And the last psychiatrist, after hearing me give a rant about how disgusted I was that she didn't even have my notes (and I'd just had the infuriating question "Tell me about yourself...") had the front to say "Well you're lucky I'm here at all, my son is ILL today" I replied "Well, I'm sorry to hear that and I wish him a speedy recovery but how THOROUGHLY unprofessional of you to mention it"

Cue Shakey's flounce.

No I meant the nurse who told you that you're all in it together

Good response to the cons psych

I found the camaraderie on the ward quite touching at times (and very powerful). It could also be quite difficult for nursing staff because patients wanted to advocate for eachother and of course we couldn't pass comment so it made it seem that we were being unnecessarily harsh or unreasonable.

Are straight jackets really still used. I thought that those and padded cells etc were a thing of the past.

Chemical restraint is used a fair bit when 'necesary' there are nice guidelines around it I think

In the UK straightjackets are not used. Rapid tranquilisation is used (injectable tranquilisation along with injectable anti-psychotics) especially in areas like psychiatric intensive care, forensic units etc.

as for padded cells - there are seclusion rooms which might have soft furniture (e.g think soft play areas)

Well, I saw the new doctor and was pleasantly surprised. He spoke to me like a human being, took my knowledge into account (just simple things like saying 'you seem to have bipolar one' and when I said that I know, he left it at that rather than giving me the slow idiots explanation) and spoke to me rather than the cpn.

What particulary impressed me was when he asked how I am in general, hand I said I was relatively ok, but not completely, he actually wanted to know and increased my medication, rather than just wanting to know if I was actually a risk. I felt, for the first time in years, that there is actually a possibility of getting better to the point where normal people are, rather than just learning to live with being mental.

Oh SofE - sooo glad you got such good treatment which you deserve. Hope the increased meds help - have you got a "follow-up appt" - I'm sure that the fact that he treated you like an intelligent, rational adult helped enormously.

I found that on they psych ward we were treated like children a lot of the time. One day I didn't want any lunch and I was standing by another patient and I was just a bit tearful. A nursing asst called out "NN come and get your lunch" I said I didn't want any thank you and she said in a loud voice with arrogant tone "well leave x alone and let her eat hers." I reacted like a child and began to cry loudly and went off to my room. She came in and said "what's all the noise about" and I said "you spoke to me like I was a child" and she said "don't talk such rubbish" and walked off. She was the worst on the ward though - she had the social skills of a slug!

Oh and inhibernation very relieved to hear that strait jackets are no longer used, nor padded cells! I was surprised to learn however that ECT was still used and I know it's very different now, from those first horror things we saw of people violently shaking. Some of the women on the ward were having ECT treatment and I talked to one nice Dr on the ward and he said it could be very effective as a last resort.

Great to have a CPN on here - don't go away!

And hoping you will post again SofE and that your faith in the medical model has been restored, though of course it is all so dependent on the actual HP you are seeing.

Right, joint appointment at my house with both nurses was meant to start at half past one. Nervous.

Gah. Rang both teams, who had never even heard of the appointment, then, just now - half an hour after the appointment - nurse b rang to rearrange. She hadn't even got in touch with nurse a. So that's a full day of sitting in, getting nervous for nothing. I am actually shaking now.
What is the bloody point?
Nurse b is ringing back in a minute to confirm the rearrangement. Should I say something?

Argh. Seriously. I just spoke to her and asked why I couldn't have been told earlier that the appointment wasn't going ahead, and she started spluttering and saying that she has been busy all day. So I asked why she couldn't have told me that she hadn't got in touch with nurse A and she said that she had been on annual leave. I asked why she couldn't have got a message to me and she said, and I quote: 'well I have a life you know, I can't be doing work all the time'

I am seriously giving up. Since when has getting a message to someone been a huge undertaking? If she doesn't work in her time off (fair enough) couldn't she have known that, by the end of her last day before annual leave, she hadn't got in touch with nurse a, and either given me a text message or asked someone else to?
And since fucking when does someone not doing their job and causing me distess and making me stay in all day give them the fucking right to tell me that they have a life? I have a bollocking life, and I don't get fucking paid to do simple tasks like sending a text message.

Don't you fucking dare try and make out that I am overdemanding for expecting you to take five minutes out of your working day to do your twatting job and save me from sitting here like some kind of lemon. Because us mentals don't have lives. Clearly. You utter twunt.

Is there anything that I can do, or am I stuck with this shit?

Sorry, had a bit of a cry and rant and calmed down. Still, it is really frustrating.

That is very frustrating/annoying for you, SoE - I agree the anticipation doesn't help , particularly with change that you want to go smoothly.

I think you can talk to PALS if you feel the situation's not been well handled.