Section 2 elderly brother what to expect from in patient experience

[limetrees32]

I suppose this is a silly question.
But wondering if anyone has any experience.
I'm worried he'll just be sedated and that his anxiety and depression won't be treated.

Section 2 is a month-long assessment period. It's unlikely he'll be sedated, because they'll not get a good assessment zonked out.

The ideal situation is 28 days in hospital, and a new care plan in the community that will properly treat his depression and anxiety.

Thank you @Weyoun14 .
He was on ADs for about 5 years but his GP reduced and then stopped then altogether apart from mirtazapine at night .
He's been in a general hospital, waiting for a bed for a week but he's had no ADs in that period .
I'm no sure how aware the medics are about his
previous use of ADs.

Will they try and encourage him to take part in any activities?

I'm no sure how aware the medics are about hisprevious use of ADs.

He should have had a handover from the community team when the Section papers were signed and the bed search began. If that's just the GP, then the GP should have provided a couple of years of history.

Will they try and encourage him to take part in any activities?

This will depend entirely on the hospital, but they'll have a weekly ward round and this will be shared with the family.

I’m an inpatient mental health nurse. What led to his admission in the first place? This will impact what medications he’s prescribed, what activities he takes part in and, ultimately, the length of stay. In terms of his past medication, in many places inpatient units can access GP notes (we use a system called CHIE to do this) or GP history will be requested. If he has had past community mental health team involvement they will use the same system as the impatient units.
Honestly, I would give the unit the ring and ask how he is is and about visiting. As long as he’s given consent to share, they will be happy to talk. Are you his nearest relative?

Thank you for your replies.
He's 78 and was waiting for assessment by CMHT.
He's become increasingly depressed, withdrawn since a SCA 6 years ago.
Excessively agitated complaining of itching and compulsion to access water to drink.
Partner took to A & E and he was sectioned .
V withdrawn , monosyllabic.
8 days in general hospital where he's been having lorazepam, but no ADs .
I realise this is ridiculous asking how he will be assessed and treated but I have zero experience of idea and I'm so worried about him.

He and his 81 year old partner don't live together and are not married.

His wanting to access water was accompanied by him pleading to be stopped " help me ,help me .Stop me it's a compulsion"
Security and restraint teams were called .

Sorry for the dumb question but what is an SCA?

Sorry sorry, not a dumb question.
Sudden cardiac arrest.
He was in induced coma afterwards.
Tests show no brain damage but I find that difficult to believe.
Have always suspected PTSD.

Ah see this may be a little more complicated. At 78, I would imagine that he’s been admitted to an older adults mental health ward. Treating the initial agitation with lorazepam was the standard thing to do. The next steps are to rule out mental health or neurological/physical disorders that are not anxiety and depression. As this has been going on for a while he will likely have brain scans to rule out brain damage and dementia and blood tests-itching and thirstiness may indicate difficulties with liver or kidneys, or diabetes. He may also be prescribed medications that are not anti depressants, including anti psychotics, depending on the strength of his compulsions. It can take a little while to work out exactly what is wrong and what will help before people start to get better.
Does he have any children? If not, you’re his nearest relative, legally. I would again suggest ringing the unit and, as long as he’s given consent to share, the nurses there will be happy to talk you through the plan. I hope this helps a little x

@JennieTheZebra yes , it's complicated.
I suppose I worry that all the factors won't be considered.
I suppose everyone is complicated !
Would there be an older person's mental health ward in the psychiatric hospital that he's been referred to ?
He's had a CT scan showing nothing of concern, he had an MRI yesterday.

He's in the right place, for now. Polydipsia (compulsion to drink water) is linked to mental health issues, but they will need to make sure he doesn't have, for example, diabetes insipidus. Polydipsia is serious because if you drink too much water it dilutes your electrolytes and can cause the brain to swell.

It's really worrying when your loved one is in hospital. It took us almost a week to find out anything about my DM and I had to make an official complaint before we were given any information. But tbh, the hospital she was in was dire and once the head of the organisation knew what was going on, he was phenomenal. One day, they wouldn't let us see DM because she couldn't dress and walk to see us off the ward (she had lost all self-care ability). We had driven 20 miles to see her. She was sitting at a table, arms outstretched, calling for us. We weren't allowed on the ward, and she couldn't walk to the visitors room. They said she clearly didn't want to see us because she'd get dressed if she did. The head of the service was walking down a corridor and heard me getting cross, so came to investigate. When I told him what was happening, he marched onto the ward, a door shut, I heard very raised voices, then he marched back up the ward and said "Lougle, this way. Come and dress your Mum." From that day on, we were allowed into the ward to visit until she was well enough to come out to the visitors room.

@Lougle thank you.
I expect my brother has a whole load of stuff going on ,i think mostly neurological and mental health.
Your experience is a worry. Psychiatric hospitals are such an unknown quantity to me and as such I find them terrifying. I know that's silly but you are so at the mercy of staff and local norms.

Try not to worry. Once we got over that hump they were quite cooperative. They'll work out what's going on and then come up with a plan.

But your experience was horrifying and it's correction dependent on a senior person happening to be in the vicinity.
I'm. 4 hours away .

@limetrees32 I know that psychiatric hospitals seem terrifying but that’s because we’re unknown to you. The best way of dispelling that is to build a relationship with the ward. Wards are staffed 24 hours a day by nurses and there will pretty much always be a nurse available to talk you by phone. You can arrange regular phone calls for updates, as often as is necessary for you to feel safe. I know you’re a little way away, but most mental health hospitals don’t really have visiting hours either-we’re happy to accept family up to about 10 pm and family leave is usually given early and freely. Please come when you can. If you want to attend ward rounds you can usually do so by video call or in person and doctors/consultants are usually able to give regular updates by phone. I work very closely with the doctors in my unit and am always happy to pass on the need for a phone call from the medical team.
Speaking as a nurse, we do really care for our patients and their families too, many of whom I have got to know really well. Please don’t be put off by other people’s negative experiences. Our aim is to help people to build the best life they can.

It can vary a bit from place to place. Most places do have an older people's mental health ward but sometimes they are mixed (general mental health and dementia) and some places have separate wards for each.

The wards are in many ways nicer than a general hospital, you usually have your own bedroom, many places ensuite, there will be a day room, dining room and often an activity room. Some places have secure garden spaces too so people can safely get a bit or fresh air.

There are usually activities, some will have a specific staff member to arrange these, access to an OT as well as the nurses and support workers. There should be a meeting "ward round" at least once a week which you can probably join remotely (on teams etc.).

The nurses will observe and record any behaviour changes and report this back to his named psychiatrist, they will make sure he has any medication he needs, they try to avoid over sedating people (but sometimes starting a new medication can make someone more tired). They should be able to update you if you're worried.

If you search for the hospital some websites have a bit of a guided tour of their wards so you know what to expect.

@VerityUnreasonble thank you that's very kind to go into that detail..
I should hear from his partner tonight and I'm visiting on Friday .
It's helpful to have some sort of idea in place before I go .

Hi OP. I'm so sorry to hear about this difficult situation.

Have the staff talked to you about a MH Advocate? There should be posters up on how to contact them and usually they introduce themselves as well.

Are they being seen specifically by an old age psychiatrist? Your relatives situation sounds especially complex.

As a PP said, check out if you are his nearest relative. This is not the same term as next of kin, it's a legal term and important.

Finally, bear in mind that hospitals differ. I've been in multiple MH units where no activities or OT input had been offered or available. And I include private hospitals in that. Care simply consisted of bed, board, medication and a weekly ward round. That is across at least 6 hospitals in the last 9 years.

Best wishes.

Oh @Youmustwakeup how kind of you to post.
The nearest relative is another sibling, but I believe that they have accepted his partner in this role.
I'm not sure.
I visited for a couple of days , found the environment v pleasant. Newly built , light and bright . Spacious.
There are no posters about MH advocates.
A support worker got my brother from his room .
A senior nurse greeted me on the second day and she arranged for a nurse to join self and brother to provide an update.
She wasn't familiar with my brothers situation , called him by the full version of his name and not the version he is known by .
She thought he was on a section 3 , etc.
Because I asked about access to fresh air and exercise ( my brother had always been v physically active with a great interest in the living world, since admission he is using a zimmer) I learnt that there were twice daily walks in the gardens .
It was explained that the reason my brother wasn't aware of these was because he spends all day in his room.
That's all he does, he says he'd is woken up for meals ,meds , blood pressure etc.
He has been wearing the same clothes for 4 days and sleeps in them.
I don't know who is " in charge' of his care or anything about the type of psychiatrist.

Could it be that my brother is being assessed on how he is without intervention ?
So they are observing his lack of self care and motivation ,maybe waiting to see if meds bring about change in his behaviour

Possibly, but I think very unlikely. I would be very concerned about the clothing and lack of communication. And the name used. And the section he is on.

He should have a full nursing assessment done which would include this. And be oriented to the ward.

None of these things sound like they were done and he should have a named nurse whom you KNOW to be the named nurse. Not just a senior one.

You may wish to consider requesting a meeting and highlighting all of these points because there are some red flags there in terms of care.

You may also wish to consider specifically requesting a MH Advocate and the goal of the section.

If you have any more questions just ask, I will do my best to answer them.

@Youmustwakeup thank you so much , that's really helpful.
I'm anxious not to undermine his partner by seeming to know better IYSWIM..
She is very sensitive to this , understandably.
She visits every day and feeling helpless wants to be in control. (. Don't we all ? ).
So I need to be tactful and strategic.

@Youmustwakeup I wonder if you have any thoughts on the following
Now on a section 3 , though he was happy to remain as an informal patient.
His partner attended a meeting on 30 March ( 28 days after admission)
Its thought that he's not responding enough to current meds and lithium is now being prescribed.
ECT is being discussed.
Having been visiting I can see that his mood has lifted , he's no longer monosyllabic and is engaged and iniating conversation.
Speaking to staff today I am concerned to hear them say that his consent is not necessarily required for ECT.
Apparently it may be felt that he is too ill to make a considered decision and that he may not release that he needs this procedure.
As an interpretation of capacity, this worries me greatly.
It is felt that if the meds he was started on 4 weeks ago were going to work it would be evident by now.
The staff are concerned because he stays in his room and needs prompting to change his clothes and to socialise with other patients.

Yes, that is correct. ECT can be given without consent under section 62 of the Mental Health Act to alleviate ‘great suffering’ or prevent acute deterioration (this is known as “emergency use”) or under section 58a as long as another doctor agrees it’s necessary. Why are you worried? ECT sounds scary but is the gold standard for depression and can do absolute wonders, especially if medication isn’t really working.