Crisis team coming to assess DFil, what can we expect?

[MsAdorabelleDearheartVonLipwig]

He won't take his ad's, his paranoia is rocketing, he's becoming argumentative and a bit aggressive and we're a bit worried about him living on his own. DSil - his other dil - is afraid to visit him on her own. I don't fancy it much either. The crisis team should visit either today or tomorrow. The Dr said if they deem him an emergency they might be able to help. They won't leave him on his own at home surely? If we can't convince him to take his meds he'll never get better. I don't know what to do.

I would think that to take him into hospital he will need to be sectioned under the Mental Health Act (unless he's prepared to go willingly). Whether they're prepared to section him depends on what they find when they get there, but if he's aggressive and unable to care for himself or keep himself safe then yes, I'm guessing that's what will happen. Only a doctor can assess this though. Someone from the family should probably be there (next of kin would be ideal as they may need to give permission).

But yes, if they don't deem him a threat to himself or others they will probably try to get him to take his meds and then leave again.

Thanks for your answer. I have absolutely no experience of this at all. He won't take his meds. He thinks people are trying to poison him, there's no way he'll take any pills.

The main aim of crisis teams is to keep people out of hospital if they think they can keep them safe at home and there's a workable shortish term treatment plan. They could suggest a hospital admission if they think your fil is ill enough and not safe to be left at home. Crisis team here would suggest a treatment plan if they're not taking someone on after an assessment. It could be anything from a referral onto out patients psychiatry, a CMHT, voluntary services or therapy services. If they recommend something they should also complete the referral but this sometimes gets missed so it's worth checking this has been done. If either you or someone could be there when the team visit it'll give them helpful information but clearly that might not be possible. Hope they can do something helpful.

Well someone from the crisis team, or home treatment as they're now called, rang DFil today to chat to him. He then apparently phoned DBil in a complete panic saying that someone was going to come and take him away. I expect the chap explained that hospitalisation would be an option if he was a danger to himself, and DFil has latched on to that and that is his new fear. Now all we'll hear about is that they're coming to take him away. There'll be no reasoning with him.

We had him over at ours for a few hours yesterday and it was all I could do not to scream. He talked utter gibberish the whole time he was here. We tried to explain his fears away and reassure him but he just lurched into a new tangent of equally confusing topic. His delusions are usually focussed on him being in trouble and the police being out to get him. They've bugged his house, his phone, his car, the house next door, etc. Everything is blown out of proportion and misconstrued. It's exhausting.

We have an appointment to see the home treatment team in a couple of weeks. Oh and apparently according to them the dosage of ad's he was on was little more than a sedative anyway. So all the crazy behaviour is him, not a reaction to the meds.

Any history of psychosis? Or it could be a psychotic depression? Sound like you should get home treatment team out to him. A phone call is not enough imo. I work in a mental health team, and home treatment are renowned for doing as little as possible. Demand a home visit before he gets any worse. He could be in danger if he keeps going

Oh god really, are they no good? We have zero experience of this and none of us know what to do or expect.

We think it's psychotic depression. Based on what we've googled ourselves to be honest. Had no information from the doctor whatsoever. He fits the symptoms. Do we basically have to look after him ourselves then? It's not logistically easy but I guess we could try and work something out, get a rota going for visits etc. Oh lord.

He sounds like he may need inpatient care, to be honest.
I would try to be there when the crisis team comes.
The other alternative if mental health services do not step up fast enough is to involve his GP.

It's his GP that we've been seeing. She's the one that got him on these AD's that apparently are next to useless.

As his nearest relatives you can ask for him to be assessed under the mental health act. This means two doctors and a social worker will go out and assess whether he needs to be admitted to hospital.

There's more information here www.rethink.org/resources/n/nearest-relative-factsheet but it's common for relatives to take this step when things go too far.

If it is psychotic depression, then he really does need inpatient care IMO. I've been in hospital with older folks who have psych depression and they really need that extra care. It's incredibly hard for relatives to take care of them.

Sometimes crisis can be more about acting as gatekeepers, and I'm not impressed that they only did a telephone consult considering how he's presenting at the moment.

Requesting an assessment really is the way to go in this case I think. I hope you can get this in place.

Does it sound like psychotic depression? He utterly believes that the police are watching him and that his house has hidden cameras watching his every move. He fusses over every letter and piece of paperwork. He goes from one thing to the next, worrying over it and keeping it close to him in case the cameras can see it. He believes we are in serious trouble with the police because we helped him with stuff at home. He won't go outside because the police will pounce. It's all just total madness but he is completely convinced and won't listen to anyone.

He's never done this before. He did say that his mother suffered from a bit of a breakdown when she was younger, but she's been dead for years so I can't check. He's a different person.

I started this thread last month. It explains a bit more about him, in case anyone has any further insight into anything.

Oh, sorry, thank you for the link, very interesting. Have forwarded it to DSil.

Well, one can't diagnose from the other side of a screen, but his thoughts sound delusional from what you describe, and delusions can be a symptom of psychosis.
Other possible causes such as infection would need ruling out also.
However his current mental state sounds as if he may be ill enough for use of the mental health act to be considered..is he taking his medication? Do you feel his illness means he could (even unwittingly) be a risk to himself or anyone else?

No he's not taking his medication. He was on the lowest dose of Mirtazapine which according to the man from the home treatment team was pretty much just a sedative anyway. DSil made him show her the packet and he'd only had a couple of them in a week. Knowing what he's like he probably thinks we're trying to poison him

So the crisis team / home treatment team are not due to see him for two weeks?
Do you feel that you all, and he, can manage until then?

God knows. I guess we're just going to have to try and get on with it. His friend who pops in to see him when we can't is going on holiday for a few days so he's going to be on his own a bit more. Might see if I can rearrange a couple of things so I can pop over.

I just dread being in his company. Isn't that a dreadful thing to say? He's never been overly close but now he drives me bonkers. He's always been hard to communicate with. Doesn't understand anyone's point of view. Doesn't recognise anyone else's opinion. No empathy for anything he's not directly interested in.

A family member was telling me that when Dh and DBil were small, they had to go along and watch him participate in his hobby or they never saw him. Aunts and uncles used to take them and DMil out for the day because he had no interest in family life. They never had a holiday because he didn't want to go anywhere. He's always been selfish and self centred. The world has always revolved around him. Now he's lost in this self obsessed pit of feeling sorry for himself that he's had forty years of perfecting. I don't know if he knows how else to be.

That sounds tough. Hard as it is though you need to focus on the fact that he is currently mentally ill and teetering on the edge of a crisis.
The things to watch out for are mainly is he a risk to himself or others? Are his delusions causing him to behave (unwittingly) dangerously in any way e.g harm himself in any way albeit accidentally.
Does he seem lucid and aware of what he is doing / his surroundings? If not then he cannot really be left alone. Is he likely to wander and lose sense of his surroundings or get lost? Is he disorientated?
Is he appearing to hear voices (auditory hallucinations) or have visual hallucinations? Does he seem to be responding to things that aren't there or to internal stimuli?
Any of the above could mean that he needs urgent assessment via mental health services...if any of the above are happening then ask his GP to arrange this urgently i.e. the same day.

I'm a mental health practitioner in child mental health by the way.

Don't think he's really at any serious risk, except perhaps a bit of self neglect. Not sure if his delusions may cause any accidents. His short term memory has definitely been affected, he can't remember doing things that he obviously has, eg moved things when nobody else has been there and blaming it on someone in his house. He does say sometimes that he can hear people talking and he can hear cameras clicking on and off. My Dh says there is a vent somewhere that flaps, it could be that he hears. Don't think he's getting any internal stimuli.

I feel a bit more positive actually in that he isn't doing most of the things you've suggested and probably isn't as bad as we think.

He is definitely very depressed though. And paranoid. And having delusions.

Just to add if the situation deteriorates that you can take him to A&E where he will be assessed by a mental health practitioner (doctor or nurse). Obv this is a last resort and relies on you being able to get him there but he shouldn't leave the hospital without being seen. Don't feel you have to let him suffer. Help us out there.

If the crisis team were not helpful I would take him to A&E.
Firstly because he will get seen by either a psychiatrist or at least an experienced MH nurse and secondly because in older people a first episode of psychosis can commonly have a physical cause. You need that ruled out.
From what you have described he is certainly psychotic but that can have a lot of causes; depression, mania, dementia, delirium even at a very outside chance epilepsy or a brain tumour.
How old is he? Is he in good health otherwise? If he's over 65 you should get to see the older people's MH team. You can ask his GP to make an urgent referral. I am very surprised at the CRHT just offering an appointment in a few weeks. That is definitely not a crisis response. If you are not happy then either 1. Contact the team and complain to them (they would usually leave contact details on a card with him) 2. Ask GP for an urgent re-referral if it seems CRHT are not acting 3. Take to A&E if all else fails.

Some really good advice here. I'm mental health practitioner in adult services. This does sound like a psychotic episode to me. Demand face to face assessment, and even tell them you think he could be a risk to himself, if that's what it takes. And lodge a complaint about that HTCR team- they are usually fully resourced, more so than the rest of MH services. No excuse for not properly assessing! How is he today?

Don't know, Dh and DBil went over at about eleven this morning and aren't back yet. Good point about insisting he might come to harm but they phoned him themselves and asked him that and told me they didn't think he was in need of emergency help. Can't go on like this though

Just cut out the middle man and take him to A&E (if they can persuade him to go of course)

Or at the very least take to GP and ask them to ring the MH team whilst you are there.

This really sounds like it needs an emergency response. Older people can get physically ill quite quickly from self neglect eg get dehydrated from not eating and drinking even if not suicidal it is still a risky situation and needs a proper emergency response.

Yes I agree re A&E

Strange question- are his bowels moving? Sometimes severe backlog can cause a build up of toxins, leading to bizarre behaviours. Might be worth checking?