How can I help my mother? (Sorry it's quite long)

[PistachioLemon]

My mother is bipolar and has had many hospitalisations since I was born (I am 33). For the past ten or so years she has had a very understanding doctor and when she has been ill we have been able to manage her at home but she recently became very ill and I reluctantly admitted her to hospital at the beginning of last week as I couldn't cope with her at home on my own (amongst other things, she thought I was going to kill her, set her bed on fire and hardly slept at all for at least three nights).

My siblings and I live a long way from her and she lives alone so we have decided to take turns staying at her house. At the moment I am here as I am the only one who can drive but but I have to go home soon, so my sister will be coming to stay for a week, and then another.

The problem is that she is extremely good at making people, including the health professionals, believe that she is well when in fact she is not. They are talking about discharging her already to a sort of half-way-house tomorrow and then discharging her properly at the beginning of next week. Even though I have tried to keep the staff at the hospital up-to-date with information neither I, nor any of my siblings, have been involved in making the decision about when she can come home.

What concerns me is that when I took her out for lunch today she was clearly quite high still. For example, it took a lot of negotiations and discussions to prevent her from spending a lot of money on things that she doesn't need (or probably truly want). The staff also don't seem to have addressed any of the concerns that I have about her behaviour including the fact that she deliberately stopped taking her medication at least two or three weeks before she was admitted (and she is usually very very reliable in this respect) and that she's become quite concerned that she's putting on weight (she isn't) to the point where some of her friends have said to me that they've noticed that she's not eating properly.

I just don't know what to do for best. I want to support my Mum and I do love her very much but I'm worried that if she comes home too soon she will just not be able to cope properly or that once no-one is staying with her she'll stop taking her medication again. Does anyone have any suggestions as to what I can or should do to try to get to the bottom of why she stopped taking her medication without making her feel bad for having done this? Please help, I'm really worried.

Sorry you're in this difficult situation.

When you say 'the staff', who have you spoken to? Have you spoken to the consultant?

Could you phone up and ask for a meeting with the consultant to express your concerns and to discuss what they plan to do to support your mum when discharged?

Does she think the medication is making her put on weight, or are there some other side effects?

The psychiatrist really should have discussed this with her, but they may not be able to discuss everything with you because of confidentiality.

Is there anyone else involved like a CPN who you could get advice from?

Thanks so much for replying Mildred. By staff I mean the nurses on the ward. I haven't met the consultant as my Mum wanted to see him on her own, as is her right, of course.

I think perhaps you are right and I should ask for a meeting with the psychiatrist and discuss what care plan they have in place to support her (and possibly us). I know she's had CPNs in the past but they've never lasted long as I think she feels that they 'baby' her and she persuades them that she's coping fine. Her own GP is wonderful but he sees her every few months at the most.

I think the thing that is bothering me the most is that even I, my brother and sisters, her friends and her sister all missed the signs this time and by the time we realised it was too late.

It's such a delicate balance between upholding her rights and trying to protect her, especially when she is an independent person. You sound a lovely, caring daughter btw so I'm sure you get that balance right.

It seems strange that she stopped taking her meds when she is usually reliable with them. Is it possible they had for some reason become less effective, so she became unwell, lost insight and thought she didn't need them? If you speak to the psychiatrist I would stress the point that she is usually good with the meds.

Don't feel bad about missing signs. It's easy to see with hindsight but not necessarily at the time.

I hope you do phone the psychiatrist. You have to remember that you have some rights here too as her carer. Good luck with it. Let me know how you get on if you want to.

I've been going through similar with friend who tends to push family away when unwell and rely more on us. She lives alone with young children. Although it's much much harder when it's your family.

Hey Mildred, thanks so much again for your kind message.

I tried to get hold of the psychiatrist this morning but the ward won't make an appointment for me, and say that he doesn't have a full-time secretary and that they can't give me his telephone number. They say that the mental health services are nurse-practitier based these days, that the nurse-practitioners are able to make decisions theirselves and that in any case, the psychiatrist will just take their recommendations.

I'm really frustrated by it all to be honest. Is it right that she doesn't need to be seen by a consultant any more? She's only been in hospital for just over a week and apart from the doctor she saw on admission, she only saw the consultant on Tuesday for about ten minutes. The nurse admitted that they would have discharged her fully today if I had not been away at the weekend - without consulting me, the person who would have to look after her, at all.

In my local hospital the psychiatrist would still have the final decision about things, although obviously they would use the ward staff's assessments to help make decisions. It sounds as if you are being fobbed off.

Surely it doesn't really matter what sort of model they work under, you are your mother's main carer and should have been consulted. Somebody needs to go through your concerns with you.

You could try phoning the hospital switchboard and just asking for the psychiatrist? Or you could put your concerns/questions in writing and hand them in to the ward? (Keep a copy).

Have they dishcarged her to the halfway house place yet?