Why is it so hard to get someone a bed on a psych ward/hospital?

[marne2]

DSS has been in out of psych hospitals for the past 2.5 years, a few months ago he was sectioned for the first time ( should have happened a long time a go but getting someone sectioned is near impossible ) after he tried to take his life, he was released after his section 2 ended ( I think it was 30 days ) and was allowed to return to his flat on his own. He is now struggling to look after himself and a few days ago was beaten up (again) and had to be taken to hospital. He's not safe to be on his own, he can't handle his money ( spends it on crazy things as soon as it goes into his bank and then can't pay bills or buy food ), he is at risk of being beaten up again as he lets anyone into his flat and trusts every one. We are waiting for mental health services to find him a place in a unit but this could take months even though they agree he is not safe to live alone. They won't section him again unless he attempts suicide or he hurts someone.

Why is it so hard to get a young lad the help he needs? .

DSS has no diagnosis as such but suffers with psychosis and has a lot of ASD traits ( both my dd's are on the spectrum and he is very similar ), he is mentally like a 10 year old.

I think it's a question of lack of resources marne2 - not sure where you are but the funding for mental health has been seriously reduced, more than any other part of the NHS which is a disgrace really, especially as these Tories keep talking about how MH should have parity with physical health, but it's not the case.

I think when backs are against walls, guarding the scant resources available is the order of the day. My CPN was telling me recently that the criterion for admission in the hospital trust that I'm in has been raised because of lack of beds. I think in the inner cities it is much worse.

Does your DSS have a CPN or someone from the CMHT to make sure he takes his meds, and help with budgeting - doesn't sound like he does. Assume you and his dad and maybe his mother support him. It's ridiculous to wait until he attempts suicide or hurts someone else but that's the way things are these days because of the massive cuts that the Tories have made in the NHS and all other public services. They care not for the likes of your DSS just themselves and their rich friends.

I think there is a growing crisis in A & E too and the govt are busy selling off chunks of the NHS to multi-national American companies who will make bug profits for themselves and their shareholders. I think in the next 5 years or so (and if they get in again) we will be like the USA - health care for those that can afford to pay and for the rest - well just get on with it. Sad but true I fear.

You could try writing to your local MP - sorry can't think of anything else.

I think Nana is right, op, in patient beds are so few and far between and the criteria is so very high, and people can feel left alone and desperate.

When I was very unwell, I had the crisis team or home treatment as they are sometimes called, visit every day and the Doctors came to my house to assess me, too. I found it quite useful as I have a young dd and I could keep things going until I was well enough for her to return. My CpN says home treatment is an alternative to inpatient treatment, which I didn't know until recently. They do things like administer medication and check on self-care. They also provide a crisis line 24/7. You don't need to be under a section to get this. I had it from an assesment at my local mental health clinic during a time of crisis (psychotic episode), but getting that assesment did take a while.

Have you thought about asking the GP to refer him for an urgent assesment at his local mh clinic and asing for the crisis team or home treatment?
Could you get in touch with the follow up care team (there must be some in place for hospital discharge), find out where he has been reffered to and tell them he needs an immediate chat with a Doctor, before his standard outpatient one?

As above , the mental health services are severely underfunded and are being constantly cutback.
Yes the criteria for admission has been raised and generally only those who are sectionable are admitted, even then it is not necessarily into a local bed.
The trusts say that money from bed closures has been put back into the community services but this is not true and community teams have been cut yet are being expected to look after iller people.
Could your DSS access a support worker from a service such as Mind ?

Would he be classed as LD? Could you access supported living through a LD service rather than MH?

Because he has no diagnoses of LD's they are just treating it as a mental health problem, they don't seem to understand that he has always had ASD traits, they think it's something that has come on suddenly due to drug use ( this isn't true ), his mental health has got a lot worse but he has always not been right. He does have someone from the mental health team that visits to make sure he takes his meds but sometimes he goes out and they can't find him, he is closely money eared by the gp as he is taking Vallium ( so has regular appointments ). His social skills are not great so he can be over friendly which gets him in trouble and attracts the wrong people ( as he will give away money and things to make friends ). His mum has phoned the unit he was staying in a while ago to push for a bed but was told there will probably be no space this side of Christmas. When he was sectioned he was taken 5 hours drive away as there were no beds here ( we are in the SW ).

Could you get an evaluation from an ed psych?

I think he's too old to be seen by ed psych? ( he's 21 )

He's been seen by so many people, none will give him a diagnosis, they just say 'he might be on the spectrum' or 'he might have schizophrenia' or it might be something else or a number of things, the only diagnosis we have had is psychosis but this was due to him self medicating. the fact he is a adult means we don't really have much say in what goes on, what medication he has or what care he receives. When he is in a unit he discharges himself after a few weeks, because he is not sectioned there is nothing anyone can do.

Oh, I feel for you . It took me a long time to get a regular care team in place, too. And on the best medication for me. If it's early on, they stay away from diagnosis (and I feel your frustration, I'm the same, 4 months into treatment). I think you could phone his oupatient clinic and express your concern? Try not to worry too much about diagnosis and everything else, it's a long process and it all comes later. The focus for you all now might need to be getting him safe and stable. I know this is very very hard because I've experienced it myself. Are there any relatives he can stay with, possibly?

I am aware that a lot of people with mental health problems self-medicate with drugs and/or alcohol and whilst I can see why they do this, it does of course cause more problems, by an addiction to illicit drugs/alcohol, and/or masking the symptoms of the mental health issue.

If he has a CPN and is monitored closely by the GP I don't think there is much more that can be done to be honest. Also people who self medicate tend to get less sympathy from the medics, who believe that the essence of the problem is with the self meds. Whilst there might be some truth in this, they fail to see that sometimes people are driven to this in an attempt to lessen the distressing symptoms of mental health issues. The fact that he discharges himself when he does get placed in some kind of unit, does of course make the whole thing extraordinary difficult. I think young people like this sadly fall through the "net" (though the net is very thin in any event and getting thinner!)

You're right he isn't entitled to an ed pysch assessment because of his age.

I agree with you, Nana. Problem is, all that self medicating must be so confusing for him and mask any underlying problems he has, possibly confusing the medics and not getting him proper care. You are right about that that thin net, too.

Do you think he might be able to get an advocate of some sort? My heart goes out to everyone in this situation, it must be so difficult.

Sadly the answer to your question is because there are so very few beds left available and it's so very expensive. Many low and medium secure beds are provided by the private sector.

It's possible to get a diagnosis for ASD as an adult, but the route isn't through MH services initially, but through the GP. I know personally two people who have been down hat route, and it opened doors to support for them.

As with all things it can take time to get an appointment after a referral, biter it's worth investigating.

As far as I know he has been clean since he was sectioned ( beginning of July ) but it's hard work keeping him clean as he is around others that do it and is easily led ( will do anything he is told to do ). It's heart breaking as he is such a nice lad and wouldn't hurt a fly. He has a key worker from the mental health team who tries his best to help him get to appointments and arranges activities for him but again there are times where DSS can't be contacted and key worker can't find him. We tried to get a diagnosis for him when he was 12 but DSS just sat there and refused to move or speak so they said they could not access him ( things would be different now if he was accessed ). We have thought about getting a private diagnosis but sadly it doesn't really make any difference as the diagnosis needs to be from NHS.

He has been accessed by several people, one said they had never met a case that's so complicated and they havn't got a clue what's wrong with him . We have also considered the fact he may be putting a lot of it on ( I know it sounds mean but he has always gone out of his way to be centre of attention and has done some pretty crazy things in the past ). I can see ADHD in him as well as ASD on top of psychosis, I can see why it would be hard to diagnose anything.

This has been going on for a couple years now so not sure if it's still 'early days' he has tried a number of medication and treatments, nothing seems to be working.

Oh I see, I missed the bit about it being on going. I wouldn't worry too much about what he's putting on and what he isn't, my cpn says psychosis is different for every person and is very real to them. What's most important is self management, and if he's distressed by it, then that's enough to warrant attention. I doubt very much he is putting it on, he's probbably very confused by his experience, but that's speaking from a personal view point and might not be relevant here. It could be that he makes himself centre of attention to mark out how distressed and confused it is, and if he's not getting enough professionally, then turning to the people around him. You mentioned he was your dss, are his Mum and Dad around, and what are they doing? Could they take care of him a little?

He may not be entitled to an assessment but he could have one privately I'd you could afford it and thought it would help him.

I work for a mental health trust and I would say that if he's been in and out a few times he will have a diagnosis. This will be on his discharge summaries that should be with his GP within 3 weeks of each discharge from hospital.

ADHD in adults is a service that our Trust do not provide, purely because the Commissioners will not pay us to provide it. Check with your Trust... there may be a Consultant there who has a special interest in Adult ADHD. If your local mental health Trust is not commissioned to provide this service, the your GP can buy that service in from another source (either out of area or private).

Thank you thenightsky, it's very hard for us to find out anything other than what he tells us, last time he was in a unit he said they had diagnosed psychosis and he had heard them mention schizophrenia, as far as I know the only diagnosis mentioned on paper is psychosis and schizophrenia tendencies ( but no real dx of schizophrenia ), but as I say 'it's hard for us to find out anything'.

His mum is giving him lots of support but we think she could be making matters worse as she keeps giving him money when he has blown his ( she keeps bailing him out ), he only really contacts dh when he has run out of money even though he knows we will not give him any ( we refuse to give him money as we don't know what it will be spent on ), we want to help him but he won't accept anything other than money, we have told him we are happy to help him out if he needs food and we are happy to take him to appointments etc..etc..

We are in contact with his mother but dh finds it hard to talk to her and we never know if she's telling the truth, she often hides things from us or twists things.

DSS has always been hard work, things got worse when dh and his ex split, DSS did not take it well ( he was 10 when dh left ) but even before that he showed signs of ADHD and ASD, he self harmed, had issues with anger and would go out of his way to be centre of attention, he is one of 3 of dh's children ( with his ex ) but has always wanted to be the only child, showed aggression towards his siblings ( to the point one will no longer talk to him ), he can be very withdrawn and his so each has never been very clear. He managed to get through life ok until he had a breakdown 2 years ago ( we think after using drugs ), he shut off completely and that's when the psychosis started as well as paranoia , since then there has been little improvement despite trying various medication, the psychosis comes and goes but he is still very withdrawn, can not handle his money and seems disorientated, he has very little life skills and his social skills are not great. He should not be living on his own , he has attempted suicide several times .