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 think his bowels were fairly regular but he's apparently not been for three days because he's not eating properly.

I'm going to ring his doctor tomorrow and find out what she actually did when she visited him on Friday. I don't even know if she took bloods or not.

He won't take his meds as they're poisoning him and the doctors are in cahoots with the police. He's not eating, he can't cope with cooking and I'm worried he's going to starve. The doctor said her hands are now tied, she can't do any more. She can only prescribe medication, which he won't take. She said to try the home treatment team because that's what they're there for. She said they're a bit useless though and the hours she spends chasing them is very frustrating so any weight we can throw behind things would be a great help.

Do we get him hospitalised so someone can feed him and make sure he's taking the medication? I fel awful to be honest at the thought of it. I feel like we should be doing it but I don't know what to do. DBil and DSil think perhaps he ought to go in for a little while. I just don't want him to think we're packing him off.

He is mentally ill, is currently unable to make rational judgements about his own well-being, is not taking his medication, sounds actively psychotic and is putting himself at risk by not eating. I would say hospital is needed.

Really? Why does it feel like we're giving up on him?

Dh is now in agreement with his brother and thinks his dad ought to go to hospital. I've just spoken to the home treatment team and they said they can see him tomorrow, either at home or we can take him to their hospital. That'll be fun, trying to get him there. Dh will have to come with me, I'm not going on my own. The chap on the phone did say it would be easier for them to see him there.

Is it likely that he'll have to stay or is it just an assessment? Should we pack an overnight bag for him?

It's not a case of giving up on him; it's a case of making sure he is safe and getting the right care and treatment.

Take an over night case just in case. I don't know whether the home treatment team is seeing him as an outpatient at the hospital, but it may be that admission is needed for effective assessment and treatment.

If you feel that he is not safe at home and that the family can't meet his needs re safety and care you MUST say this to the home treatment team.

OP my experience of this concerning my pensioner mother is that is GP's or Community mental health teams think there are capable family members able and willing to care for the person suffering with mental health episodes - then you are a low priority for their team to deal with.

My mother has schizophrenia and is paronoid too - when she was in a full blown episode at home freaking out because she thought people where trying to break in to the house and kill her, wearing the Crisis team, it was at the weekend, and the guy who answered the phone to us said "we are only here to deal with people who want to fling themselves of a bridge" can you imagine? This resulted in me driving my mother to the hospital and demanding medical attention - they couldn't turn us away, but it was an awful ordeal trying to coax her to go with us.

My advice is to be very assertive with the system and demand the care for your Dfil that he needs and you deserve to access for him. This is a massive maze of frustration for families and I really sympathise with what you are going through. I hope the situation resolves itself quickly so he gets the right treatment.

See this is why I feel guilty, because if I had to I could go up every day and at least make sure he had clean clothes on and had washed and had something to eat. But then dh often has periods where he works overnight and my parents are both dead so I have no-one else to sit with the dds. DBil and DSil have a similar set up except she has a baby too. It is logistically very difficult. And do we spend every evening with him so he's not lonely? What about during the day when we have to come home and get on with family stuff?

At least if he's in long enough to get a regular dose of medication down his neck to bring him down to a more lucid sensible frame of mind, that would be something. Just so he could be trusted to actually want to take his medication because he understands that it will help. So he could trusted to be able to look after himself at home.

Dh says he's given up. He's lost his wife, albeit three years ago, he's lost his much loved job and he's given up. Never mind that his children and grandchildren are still here. I think that's what hurts Dh and DBil. Some things never change.

Don't feel guilty. He's ill. You can't will him or nurture him better.

A hospital admission could be a very positive thing, it will just be hard for a while until he is properly medicated and reality kicks in a bit.

That's what we need. A dose of reality.

Thank you all so much for your help. I'm sorry if you've ever gone through this yourselves, it's no fun at all.

We'll see what tomorrow brings.

Even if you spent all day and all night with him you can't give him the specialised mental health care and treatment that he needs. He needs urgent specialist help.
Don't beat yourself up...you're doing what you can, which is a lot.

Thanks you. That means a lot.

Well the assessor is out on other cases and I have no idea when they can see him. I've just spoken to him and he was tearful. He's eaten a packet of crisps all day because he can't do anything for himself. I'm going to go over and sit with him for a bit but I've got to be back in a couple of hours to pick the dds up from school. I'll see if Dh can go over after work and get him something to eat. He usually comes here to eat on a Tuesday but he doesn't want to leave the house. I think I'd better forewarn Dh that if we still haven't heard anything to just call for an ambulance. The HT team are aware of how bad he is today but I guess I need to speak to this assessor before anything happens.

Gosh, I'm so cross at the runaround you are getting!!! Any further forward op?

You don't necessarily need to wait for the home treatment team, you could just take him to A&E. If you took him there and said he is psychotic, not eating, not taking his medication and unable to care for himself he would have to be seen...might be a bit of a wait in A&E, but he would be seen. This might be the best route to getting him seen urgently.

The assessor rang me back this afternoon and said they would come out and see him. He said he'd tried to pass it to some elderly care team but as the doctor hadn't officially diagnosed him with dementia or any other elderly-typical illness they wouldn't take it. So basically he tried to palm it off as something else to someone else.

When he arrived he asked all the usual questions like do you feel suicidal, will you take some medication, do you want to go to hospital, etc. DFil was clearly embarrassed and upset at being asked all these questions and basically said no he didn't want medication but no he didn't want to go to hospital. The upshot is they want to keep him at home and visit him themselves for the next few days to watch him take some medication. If this isn't successful they would have to consider hospitalisation. The trouble is there's apparently no spare hospital beds for mental health in this part of the country and he could end up being taken hundreds of miles away. He would definitely be on his own, there's no way we'd be able to visit him.

Dh was also there, he managed to knock off work early. He isn't happy. He thinks his dad should be in hospital, in company, being fed and looked after by professionals. He had to come away, he couldn't cope with the stuff his dad was running on about. He thought the guy was really the police, etc. He did say as much when the guy was there but the guy just put it down to DFil's paranoid delusions.

So we're no further forward. He's still sat at home on his own frightened and not eating. When I asked the chap to let me know what time he'd come and visit tomorrow he said he'd give me a call, as he practically shot out of the door. I got the feeling he didn't want me to be there.

That doesn't sound terribly helpful at all....most of it will be due to the utter lack of resources in mental health services (such as the lack of beds) but that doesn't help you much.
If FIL said he does not want to go to hospital then that would mean they have to look at compulsory admission. They may not be able to consider that at this stage without trying some more intensive home treatment first. Let us know how things go on.
Even when this mental health crisis is resolved, you may need to start thinking about your FIL's living and care needs long term...could he remain living at home if mentally well?

I don't know. If he doesn't get back to normal, I don't know. He's so isolated where he is. He can't even put a microwave on and his one set of neighbours are very antisocial and are often away.

Dh says if we can get him to a bit of a happier state, perhaps he should move into a sheltered housing complex. At least he'd have company and someone to look out for him. I find it hard to believe. He's only in his late 60's, he should have years left in him.

Try not to feel overwhelmed. One step at a time. No reason not to think that once he's stabilised he cant go back to normal. It could take a long time to get him stable, assuming it's his mental health, and nothing else going on. But again- one step at a time. Keep us posted

Thanks.

Apparently the doc did blood tests last week and they were all fine. I think it definitely is his mental health.

I think we are a bit overwhelmed. Will see how he is tomorrow when the chap comes again. I think he said he'll prescribe a different medication. God knows whether he'll ring me to tell me. He ascertained that Dh is the eldest child so he might want to talk to him as the nearest relative, although he's got my mobile number as well as our house number. Dh will be at work. I suppose at least DFil has met him now so he might be happy to let him in, he might not need me there.

One day at a time.

It sounds like this is an 'all age' rather than older people's crisis team.

Some areas have a whole separate service for people over 65 including separate inpatient beds. Some areas just have an 'age inclusive' service and to get into the 'older people's' service you have to have dementia or be 'frail' rather than just old. Sounds like this was the cause of the dispute.

IMHO (biased because I am an older people's psychiatrist). Older people get a rough deal from an 'age inclusive' service because their needs are not understood eg older people get physically sick quickly from not eating and drinking and may have health conditions or be on physical meds that interact with psych meds. Also it's not great if they have to share a ward with much younger people who they have nothing in common with and might be at risk from.

Now that he is on the books of the CRHTT at least they should be visiting him often and trying to get him to take meds. They are not always great at involving carers and may be more used to liaising direct with FIL. It may succeed and he may take meds and get better, he may agree to go into hospital and they find a bed or he might end up needing to be detained. They always say that there are no beds to persuade you that home treatment is best. Often one can be found when it comes down to it.

If he continues not to eat and especially if not drinking and if not taking essential physical health meds eg diabetes or thyroid meds then just going to A&E is an option at any time.

Your DH as nearest relative under the MHA has the right to request an MHA assessment. This is rarely done but the option exists if you feel he should be in hospital and that no-one is listening.

I would give the crisis team a chance for at least a few days to a week but if he's not letting them in or not taking meds then chase them up for further action or just go to A&E.

On a hopeful note most mental illness is treatable. Unless he has dementia (which it sounded too sudden a deterioration for) then once he gets on the right treatment he has an excellent chance of recovering and the team should look at his social care needs too eg care package, day centres. Don't lose hope.

OP I forgot to add my mum was not taking medication either, because it's voluntary, she would just refuse to take them because she thought the medics where trying to kill her.
What we did get in the end was a monthly injection administered by a community MH nurse in mums own home. Which she eventually agreed with and so far for the last year has complied with. We feel relieved knowing she has had her mess and the trigger is in place for the MH Nurse to contact my sister the minute mum refuses the injection. So we feel mum is being looked after we we are in the loop as a family with mums treatment.
Would an injection be an option for your Dfil?
Also agree with PP getting into the care of the older people's mental health team was certainly much better for mum, and when she was in hospital she was with older people like herself and the staff are trained to care for this group specifically .

They're now coming twice a day to check on him and make him take his meds. They took him for an ECG - we never got a phone call for some technical reason so had no idea he'd been taken away - and apparently he had a hearty lunch while he was there. Of course his version was that he'd been bundled into a van and taken away. He actually got voluntarily into a car, which is good progress.

DBil managed to get him back to his for tea tonight so he's had a busy day.

He's had his meds changed, he's on diazepam and mitazapine and another one beginning with R that I can't remember, or spell. As long as they keep coming over and making him take them we should start to see a change.

One thing I am quite cross about is that they had a report from a firearms officer to say that his shotguns had been taken away due to poor storage. Apparently they'd been stored outside in a Landrover. I said he hasn't got a Landrover, that can't be right. He had guns as part of his job, for decades, he was hardly likely to risk that. The chap insisted it was right. Our firearms officer rang us last night to see how DFil was getting on before he filed his report. So god knows whose report they've got. It definitely isn't DFil's, it hasn't been submitted yet! He lost his guns because there was concern for his and his neighbours safety, something I think is relevant.

That's a good point mamadoc about his long term care. If he never gets back to full health we need to look at home carers or possibly sheltered housing, although I can't see him leaving his home permanently.

Risperidone I should think (an antipsychotic). This all sounds much more promising. I hope you see some improvement soon.

That sounds like progress, and the mental health team are clearly taking it more seriously now. If they are supervising him taking his meds then you will most likely see improvement fairly soon. Longer term treatment options can be considered once he is improving in mental health.