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Mental health

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Original poster

Quick help please- FIL on way to hosptial (Mental Health)

31 replies

Armadale · 11/12/2013 15:57

I started a thread here somewhere yesterday asking for advice about FIL's anxiety..today he has lost it a bit- details sketchy but hitting walls, smashing furniture etc. Ambulance and DH on way round there.

Can anyone advice me what is likely to happen and what questions DH needs to ask at the hospital? Will they automatically keep him in? Is this an opportunity to get him on some proper meds? What do we do if they let him out tonight?

OP posts:

HoopHopes · 11/12/2013 16:03

Hi, much depends on how he presents at hospital. He will not automatically be kept in. There are few beds and much depends on whether he is a risk to himself or others. He could be sent home under care of a crisis team to observe him ( they can admit to hospital at any time). If he is over 65 he may be admitted to a ward for elderly care mental health if any in your area for assessment.

If he is sent home you could ask for assessment by adult social care to assess his needs etc.

HoopHopes · 11/12/2013 16:05

Sorry should say he will be assessed in hospital - you can request he be seen by the on call mental health worker ( may have to wait a bit). They may prescribe short term medication but I doubt would sort out long term medication as a dr ( like gp or psychiatrist) would oversee that sort of medication and not a hospital a and e.

You may be at hospital a while waiting tonight so remember to take book/drink/food/money/phone etc to help if you can. All the best.

Original poster

Armadale · 11/12/2013 16:08

Thanks for the reply.

He is over 65, don't know if there are such wards at that hospital.

I think the worry would be if they do send him home, how would MIL cope.

Would DH be able to be in contact with the crisis team, do you know (eg ring them if he is worried things are bad?)

re the social services, I think he had some sort of assessment in the summer, but they felt he was OK,(one of the big problems is he tends to put on a front for medical people)

OP posts:

Original poster

Armadale · 11/12/2013 16:10

thanks dh has gone straight from work, would take much longer to divert to pick me up, so he is on his own, no chance to give him supplies. If it looks like it is going to be a long one I could always get there to help later. He will hopefully ring when he can to update.

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HoopHopes · 11/12/2013 16:22

Just depends how long a wait in a and e and for someone from mental health to assess really.

Where I live they do not have any specific wards for over 65 in the hospital but they do in the smaller community hospitals etc.

In mental health they have 3 main services:
CAMHS for under 18's
Adult Mental Health -18 -65
Elderly Care Mental Health - for over 65's.
(Names can vary!!)

So at the very least I would ask your dh to ask for:
A mental health assessment by an approved mental health worker today
A referral to elderly care mental health team ( they have nurses, dr's, Occupational Therapists and Social Workers as part of their team). They are experienced at dealing with the very specific issues that affect elderly people ( retirement, change in physical health, memory issues etc etc). There may be a wait of a few weeks for this assessment but they can offer support to his carer and wider family too. Your MIL can request a carer's assessment ( done by adult social care usually) if he is taken on by this team, for support for her). If the hospital cannot do this, then get a gp appointment tomorrow to do this.
If sent home, some short term medication if they think it would help
If sent home tonight a plan of action to help. There will be no quick fixes and as with all NHS care there will be waiting times ( even cancer has a 2 week wait is how I always think of it), but knowing there is a longer term plan can help.
If your MIl cannot take him home then nursing home type care may be looked into? ( My area is under 18's so am not too familiar with elderly care I am afraid).

Original poster

Armadale · 11/12/2013 16:38

That list is incredibly helpful, thank you so much.
I am texting it to DH in small portions.

OP posts:

HoopHopes · 11/12/2013 19:21

Sorry it was so long!!

How is it going?

Original poster

Armadale · 11/12/2013 19:50

No it was brilliant, thanks.

I have not heard anything yet.

The ambulance came about 3.30, and they are very near the hospital, so not sure what is going on, he must have been seen by now, I would have thought. Possibly DH just can't slip away to call.

OP posts:

SnowyMouse · 11/12/2013 19:56

It can take quite some time for the mental health team to come and see people in A&E.

Original poster

Armadale · 11/12/2013 20:05

Ah, OK, thanks.

I feel so helpless here but don't want to ring him as I know he will call when he has the chance.

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SnowyMouse · 11/12/2013 20:05

It must be very difficult for you

HoopHopes · 11/12/2013 20:17

Yes it can take ages for a mental health worker to come, as they will not be sent for until they have done the usual a and e wait often. They may have to come from wards or be busy seeing another patient. It is encouraging he is still there though, indicates being treated seriously.

Jollyb · 11/12/2013 20:32

He will probably be assessed by the general medical team too. This will be to ensure that there isn 't any underlying medical cause of the deterioration - such as an infection.

Original poster

Armadale · 11/12/2013 20:44

Ok DH just got back 5 mins ago.

All a complete fuck up.

FIL refused to get in the ambulance, said he was very embarrassed now, he had calmed down. By the time DH got there they had agreed he didn't have to go to hospital if the GP would come out to see him instead so DH phoned GP.

Ambulance left. GP called back and said couldn't come out but bring him in.

10 minute flipping appointment the result of which was a prescription for AD's and told to come back if feeling worse

Dh then spent 4 hours at their house trying to get things right.

OP posts:

HoopHopes · 11/12/2013 20:45

Oh that is a really good point. And sometimes there are physical reasons that are underlying or exacerbates the situation.

Your dh should be able to leave him as he can be cared for by medical staff if you would appreciate a phonecall - if he has reception that is!

SnowyMouse · 11/12/2013 21:00

Oh dear, Armadale Did he say he would go back to the GP if he feels worse?

clio51 · 11/12/2013 21:27

I was wondering how your FIL was doing, looked at the post to see if you updated but like you said you couldn't find it.

The title made me look tonight.

Oh dear that's a shame he didn't go in the ambulance, but he would of probably only been kept there for literally hours until an on call mental health consultant was available if one at all! He may have seen a junior mh worker who couldn't make the discision to keep him in. Also if he changes his attitude/appearance when he's in front of doctors etc he would just be asked lots of questions and would he of really told them the truth?
I think they would of sent him home with diazepam to calm him down and told to see his gp.

Did the doctor not give him any diazepam? He could do with some for a few days to calm his anxiety back down help him relax.
So as the doctor upped his was it citalopram? Or something as well? If so what are they as he will get start up side effects which for some is heightened anxiety(don't won't to scare you) so will be worse before better.

HoopHopes · 11/12/2013 21:46

Hi, a gp can do everything ( and often more) that an a and e department can, so do not lose heart.

You can ask for an adult social care referral to be made if you feel that he is a risk to self or others.

It is rare for people to be detained in hospital as mental health beds have been seriously cut and unless he was a danger to himself then unlikely he would.

What sounds useful, if he would request it or accept it is a gp referral to elderly mental health care team. Who can assess and offer other treatments. Do you think he would ask the gp for that? Then a psychiatrist in the team can review medication as well as other mental health workers assess him and ensure there in nothing else going on or other needs not met. It would need to be a gp that did the referral ( a and e would not do that, just refer to a crisis team - which incidentally a gp can do as well).

If he deteriorates again it may be best to go to gp or a walk in centre or an out of hours gp ( unless it is a physical emergency) as the stress of going to hospital may not help and all gp and out of hour gp's can refer to crisis team if think he is in crisis.

Sorry for all your stress.

HoopHopes · 11/12/2013 21:48

And the gp is right - do go back to gp if feel worse, rather than hit a crisis point like today.

Original poster

Armadale · 11/12/2013 22:27

Hi thanks for the replies, sorry only just updating, Dh literally walked out of a job he was on this afternoon so he wanted to go back and get a bit straighter for tomorrow, so I went to keep him company.

Reading you posts it is perhaps not the fuck up I thought it was if indeed going to hospital could have made him worse and the gp can do all they can in terms of drugs- my worry is he is on his best behaviour in front of medical people and so it seems to be back to pretending everything is OK.

I'll talk to DH about the ideas you have suggested as clearly things can not go on in the way they have been.

for all the advice and help.

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Original poster

Armadale · 11/12/2013 22:30

Forgot to say, turns out he has been off citralopram for months, as it upset his stomach, so he hasn't been having anything. GP tonight prescribed Fluoxetine 20mg 1 a day for him.

OP posts:

HoopHopes · 11/12/2013 22:34

Oh that sounds a useful gp appointment.

Yes, he has to be willing to engage with services in order to be helped, so sounds like seeing a gp and building up trust is a good starting place.

Yes, some people think a hospital is a quick fix, but really unless someone is needing physical treatment a gp or out of hours dr can do exactly the same referrals ( including getting someone into hospital) as an a and e dept, and usually without the long wait!! Gp's can refer for people to be assessed etc and crisis teams come to houses. As most mental health assessment and treatment is done in the community, there are community mental health teams ( such as elderly mental health team) if a gp feels someone needs more treatment than a gp can offer.

clio51 · 11/12/2013 23:11

You have just possible hit the nail on the head, the way he as been behaving WITHDRAWAL from citalopram. Don't take it light hearted he must of been going through he'll, it's the same side effects as starting up an AD. So hence me saying if he's got new Ad's he will have start up effects for a good few weeks(not everybody the same degree) so don't expect any great changes for at the min 2 weeks But as I said your gp can give him diazepam(valium) only say 2mg or 5mg which will help greatly but not all will give these out as there addictive not 2 weeks through. So ask for them from his gp.

I got given them as the ad's I was on gave me suicidal thoughts(which is common) headaches,insomnia,no appetite,cold /hot sweats. Just to tell you what you MIGHT expect from him.

Original poster

Armadale · 11/12/2013 23:21

Really appreciate the heads up on the possible side effects, thanks. Will mention the Diezepan.

I think what Hoops said about the elderly mental health care team which has a psychiatrist to assess his meds is the way to go.

We have been thinking and he is also worried about drug interactions for some medicine he takes for a physical thing, so we could perhaps use that as a 'reason' to talk him into accessing that team to get advice.

OP posts:

clio51 · 11/12/2013 23:49

Hi.
Really don't won't to dishearten you about geriatric mental health help.

Don't know what part of country you live but it's very hard to get help quickly it takes months ie waiting lists.

When I was really bad mine was via gp referal to my crisis team, first I was given diazepam by gp 5 days worth whilst waiting. It took 2 days for mh team to visit me and boy was I desperate! They just spoke to me about what I thought brought it on, was I suicidal what was going through my mind etc. They came again couple days later again more questions, they know there isn't going to be much change because ads take a while to get into your system,I was given the phone no of crisis team,mh ward no of my hospital. I then got a visit of phychologist 2 weeks later to assess me to she if I what help I needed if any!!!
From then on I was accepted in the crisis team and got weekly visit and I could ring them anytime.it took 6mths!!!! To get to see psychiatrist and to be honest at the beginning I got the impression she just wanted to throw drugs at me no way! I didn't want to be a zombie!

Just want you to realize nhs is very slow even in times of crisis, they would rather you stay in familiar surroundings and not to mention no beds.

He is probably scared to death what's happening to him(I was at 54)
But yes that's an opening opportunity to get him talking and the more he talks about it the less embarrassed he will feel with everyone.

I don't know how much intervention your dh has or his dw with regarding his treatment as I can only speak for myself but certainly something to ask gp.

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